The Prevention Green Paper: alcohol is absent because too many of us do not see alcohol harm as a problem

July 2019 | 9 minutes

The Prevention Green Paper, published 22 July 2019, looks to prevent ill-health before it happens - but alcohol, a leading cause of health harm, is nearly absent.

The Prevention Green Paper looks to stop ill-health happening in the first place, rather than prioritising treatment after the fact. It’s an exciting step forward: it promises that the Government, “both local and national, working with the health and care system, [will] put prevention at the centre of all our decision-making.” It aims to reduce the incidence of illnesses such as cancer, diabetes and heart disease. Measures are outlined which will help to achieve this – a tobacco levy, an extension of the sugar tax, advice on sleep hygiene.

Yet one key, preventable cause of health harm is noticeably almost entirely absent: alcohol.

Alcohol is a cause of cancer, a grade 1 carcinogen in the same category as tobacco, estimated to cause around 12,000 cases of cancer in the UK each year. Alcoholic liver disease is one of the only preventable conditions for which deaths are increasing in the UK, while they fall across most of Europe. Alcohol is a risk factor for many of the conditions mentioned in the green paper, including diabetes and heart disease, and intersects with many of the other issues addressed: obesity, mental health problems, smoking.

So why is this preventable cause of harm near-absent from the Prevention Green Paper?

Alcohol is a risk factor for many of the conditions mentioned in the green paper, including diabetes and heart disease. Why is this preventable cause of harm near-absent from the prevention green paper?

In the green paper, the short section on alcohol opens by saying, “Most people who drink, do so responsibly.” While it goes on to acknowledge that the harm caused by alcohol is rising, just that opening sentence is telling. At its heart, there is a denial about the scale of the problem.

Two weeks ago a new study was released which found that 1 in 10 hospital inpatients is alcohol dependent, while a huge 1 in 5 is drinking harmfully. The scale of the media coverage of this report showed the level of shock this caused. Most of us assume that alcohol problems are experienced by a tiny minority of people – who can be tidied away into a box marked ‘alcoholics’ – while the rest of us drink, as the green paper says, “responsibly”. The report showed that this picture simply isn’t accurate.

While the majority of people in the UK do drink within the low-risk drinking guidelines of 14 units a week, the group of people experiencing serious alcohol harm is huge and growing. The ‘alcoholics’ box does not exist. Alcohol harm happens on a spectrum, and millions of us – in England alone 1.9 million at higher risk and 8.5 million at increasing risk – are in the part of the spectrum at which there is real risk of cancer, alcohol-related brain damage, liver disease, heart disease and more. Even looking just at the most extreme end of this spectrum, there are around 590,000 dependent drinkers in England alone.

While the majority of people in the UK do drink within the low-risk drinking guidelines of 14 units a week, the group of people experiencing serious alcohol harm is huge and growing.

The harm caused by alcohol is immense. If we want to reduce the prevalence of the diseases which the green paper seeks to tackle – diabetes, cancers, heart disease – we must address alcohol.

This takes us on to what the green paper does say on alcohol. There are two new commitments outlined:

  • The promise to “work with industry to deliver a significant increase in the availability of alcohol-free and low-alcohol products by 2025”
  • And to “review the evidence to consider increasing the alcohol-free descriptor threshold from 0.05% abv up to 0.5% abv in line with some other countries in Europe” in order to “support further innovation in the sector and encourage people to move towards alcohol-free products”.

Alcohol-free and low alcohol products have a role to play for many individuals looking to cut down on their drinking, providing a stepping stone towards new habits. They aren’t for everyone, but for some their improved availability means that a lifestyle with less alcohol becomes more achievable – and more fun.

But they are simply not a solution to alcohol harm.

Alcohol-free and low alcohol products have a role to play for many individuals looking to cut down on their drinking. But this is simply not a solution to alcohol harm.

It isn't that we don’t know how to reduce alcohol harm. There are many effective, workable policies which would help to achieve the green paper’s prevention aims, many of which are laid out in the Alcohol Charter, endorsed by over 30 organisations across the drugs and alcohol sector, as well as MPs and peers from across political parties. These measures include:

  • Properly funding alcohol treatment, including ensuring provision for older drinkers and those with complex needs;
  • Minimum Unit Pricing, which works to increase the price of the very cheapest, strongest alcohol favoured by the heaviest drinkers;
  • Improving alcohol labelling, a common sense measure which would see consumers provided with the information they need to make informed choices around their drinking;
  • And improved alcohol marketing regulation.

It isn’t that we don’t know how to reduce alcohol harm. There are many effective, workable policies which would help to achieve the green paper’s prevention aims.

The green paper notes some great work already being done by Government to tackle alcohol harm, including the £6 million investment to support the 200,000 children in England with alcohol dependent parents and the commitment to rolling out alcohol care teams to the hospitals with the highest numbers of alcohol-related admissions over the next five years.

But there is so much more to do. What we need is a sustainable long-term plan which addresses alcohol in all its complexity, including its intersections with other causes of harm like poverty, social isolation and homelessness, which the existing small pockets of money and piloting do not provide.

What we need is a sustainable long-term plan which addresses alcohol in all its complexity, which the existing small pockets of money and piloting do not provide.

Alcohol is nearly absent from the green paper because too many of us in the UK, including many in our government, do not see alcohol harm as a problem. We see ‘alcoholics’ as a problem, but we cannot see that alcohol itself, as a substance with the potential to cause serious harm, needs attention and action. It has been in our lives since we were babies, in our bodies from our teens, part of our existence at almost every social, work and special occasion since then. Seeing alcohol as a problem is the challenge.

That doesn’t mean we have to stop drinking it. But it does mean that we have to get our heads around the scale of the harm it causes and take steps to reduce that harm. The Government has an opportunity, both in responding to the consultation on the Prevention Green Paper and going forward, to address the harm alcohol causes. It has the opportunity to prioritise saving and improving lives across the UK over the profits of the alcohol industry. We are ready to help them take that opportunity.