The interim report is looking at improving outcomes for six major conditions but the proposals around alcohol need to be much bolder, introducing evidence-based policies that are known to work in reducing alcohol harm.
The report identifies alcohol use as one of the modifiable risk factors for improving outcomes for many of these major conditions, including cancer, heart disease and mental ill-health. Evidence shows that alcohol is the biggest risk factor for death, ill-health and disability among 15-49 year-olds in the UK, and the fifth biggest risk factor across all ages. It is not a problem that can be ignored.
Alcohol is also a causal factor in more than 60 medical conditions and therefore any strategy looking at prevention and better outcomes of major conditions needs to prioritise it as a risk factor.
While the DHSC’s interim report recognises wider determinants of health, stating that “our physical environments can have enormous impacts on our health and our behaviours,” disappointingly, there is no mention of policies to control and restrict the affordability, availability and promotion of alcohol. We know for example from the Scottish evaluation of Minimum Unit Pricing (MUP) that deaths have reduced by 13.4% as a result of this policy and a recommendation in the strategy to introduce it in England will save lives. The Scottish evaluation also showed that this policy was most effective in the most deprived areas, tying in with the goal of the strategy to reduce health inequalities.
The report talks about progress in reducing stigma for people with mental health conditions, and we would like to see this happen for people with alcohol dependence as well. Stigma towards people with alcohol problems can make them less likely to accept they have a problem in the first place and can be a big barrier to them seeking help. The exclusion of people with alcohol dependence in the Equality Act needs to be removed as an important step in reducing stigma and helping people with alcohol dependence be better protected in the workplace.
We also know that many people with alcohol dependence are refused treatment for mental health conditions before their dependency is tackled. The strategy must deliver person-centred and joined-up treatment for mental ill-health that gets those who need it the treatment and care they deserve. According to estimates from the Office for Health Improvement and Disparities, every £1 invested in alcohol treatment brings a social return of £3. However, there have been significant cuts both in alcohol treatment services and cuts to the wider public health budget which funds other support services , such as mental ill-health and social care.
Significant changes to the alcohol treatment system are required, not just through increased funding but also in areas such as assertive outreach, workforce development, commissioning cycles, and multi-agency working. The final strategy needs to come with more funding for alcohol treatment services to help reach the 80% of dependent drinkers in the UK who could benefit from alcohol treatment but are not receiving it.
Finally, while the interim report recognised alcohol as a risk factor, it doesn’t make the reduction of alcohol harm a priority. While the investment into research into alcohol use is welcome, the fact is evidence from the UK and elsewhere shows there are policies that work in reducing alcohol harm. Therefore, the lack of mention of these policies, such as the proper regulation of alcohol labelling and marketing, setting a minimum price for a unit of alcohol in England to reduce the availability of very strong, cheap alcohol and making improvements to the alcohol duty system, is disappointing. In order for the strategy to be successful, we urge the Department for Health and Social Care to work with other government departments to tackle alcohol harm holistically through an alcohol strategy and implement these well-evidenced policies that we know work.
