Public Health (Alcohol) Bill 2015 [Seanad]: Second Stage (Resumed)

Question again proposed: "That the Bill be now read a Second Time."

As Fianna Fáil spokesman on mental health, I am strongly in support of this Bill because of the significance that it will have for mental health issues in Ireland. Alcohol is known as a depressant and has been proven to be a contributing factor in half of all suicides in Ireland. With national consumption levels of alcohol continuing to rise it has become increasingly imperative that we confront and combat this public health problem in our country. By introducing a minimum price for alcohol and restricting marketing, especially those advertisements aimed at youth, we can finally take steps to curb alcohol abuse and excessive consumption. The price of alcohol is directly linked to consumption levels and alcohol-related harms, so as these prices increase we can hope to see improvements in the cases of poor mental health of some people.

These mental health issues most noticeably affect our youth. Alcohol changes serotonin levels and neurotransmitters in the human brain and these changes are intensified in young people whose brains are still developing. Because of this effect, young people suffer more negative mental health consequences than adults do when consuming alcohol. A recent national study of youth mental health detailed an evident correlation between excessive drinking and poor mental health, low self-esteem and suicidal behaviour. This phenomenon is exacerbated by the binge drinking culture that is both perpetuated and enabled through alcohol advertising, low alcohol prices and easy accessibility.

Stemming also from the links between drinking and mental health problems is a lack of an organised infrastructure to deal with cases of dual diagnosis. Research has uncovered that many people suffer jointly from both substance abuse and mental health issues. In these cases, alcohol is often used as a form of self-medication for those suffering from severe mental illness. The World Health Organization has estimated that the risk of suicide increases eightfold when a person is under the influence of alcohol. Just recently, a University College Cork study of 121 suicides reported that 80% of the people had been under the influence of alcohol at the time of death.

Currently, there are no hybrid substance rehabilitation or mental health facilities in Ireland equipped to treat substance abuse and mental health diagnoses simultaneously, which ultimately leads to an ineffective treatment plan, repeated relapse and, in some cases, death. With this in mind, there are reports of hospitals turning away patients under the influence of drugs or alcohol who are presenting with symptoms of mental illness and suicidal behaviour. Last year, for example, it was reported that a young girl was denied admittance to a hospital after an attempted suicide due to the fact that she was intoxicated. This case points to the shortcomings in the health care system in dealing with mental health issues in the context of substance abuse. Another reported case of failed dual diagnosis treatment is a mother of four who suffered from both post-natal depression and alcoholism. After being treated for years for her alcohol issues with no success she was finally psychiatrically assessed following a suicide attempt. She was eventually diagnosed with post-natal depression, which led her to the help she needed through antidepressant medication.

This effectively halted her drinking problem, and she no longer turned to alcohol as a form of self-medication.

This specific case, which is one of many, illustrates how alcohol can magnify suicidal behaviour and worsen mental illness by increasing impulsivity, changing moods, and deepening depression. A multidisciplinary approach to solving these two intertwined problems is a necessity. People who suffer with both a mental health issue and substance problems struggle to access services. For many, substance abuse is a symptom of a deeper underlying mental health issue. These people have multiple and complex needs. For many it is not a lifestyle choice but a health condition, deserving of compassion, care and treatment.

While I welcome this Bill, it does not absolve the Government of its failure to put in place appropriate supports for those suffering from dual diagnosis of substance addiction and mental health issues. If this is a health initiative, it must include mental health. If it includes mental health it must include dual diagnosis, and if it includes dual diagnosis it must include the supports people need to recover. To recover, both the mental illness and the substance abuse must be treated. If both are not treated neither is treated.

I have focused more on mental health than the actual details of the Bill, but it is important to emphasise the importance of mental health as it relates to substance issues.

I thank Members for their contributions to the debate and I look forward to their support for the Bill and their further consideration on Committee Stage. I also thank the staff in the Department of Health and the ladies beside me for the work they have put into the Bill.

There is indisputable evidence that alcohol and the abuse of alcohol significantly and negatively impacts on lives. It affects not only the individual but also their family and friends and it has serious implications for employers, the health services and other social services. We can no longer ignore the evidence of the harm and costs caused by harmful drinking. The passage of the Bill through this House is an opportunity for a frank debate about our attitude to alcohol and the role it currently plays in our society and in our lives. It is also an opportunity to make changes where they are needed in order that we can address and mitigate some of the harms of alcohol misuse.

During the debate, clarification on a number of issues was sought and I can provide that clarification now. Deputy Kelly asked about section 4 of the Bill, which provides that a person applying for a liquor licence, or applying to renew a licence, will be required to give one month's written notice of the application to the HSE. The section provides that the HSE may give evidence at a court hearing on such applications. The purpose of this provision is to ensure that issues regarding compliance with relevant public health law, such as this Bill when enacted, are brought to the attention of the court before making its decision.

On minimum unit pricing, Deputy Kelleher, among others, asked about the position with Northern Ireland and whether this measure would become operational simultaneously in both jurisdictions. The Government decision approving minimum unit pricing acknowledged the need for the two jurisdictions to act simultaneously to allay concerns about negative impacts on cross-Border trade. I recognise that it will be most effective if an equivalent measure is introduced in Northern Ireland at the same time. However, we are all aware of the difficulties facing Northern Ireland, not only in terms of restarting its administration but also the possible impacts of Brexit. Those issues were not envisaged at the time of the Government decision, therefore we will need to reflect further after the enactment of the Bill before deciding on the timing of the commencement of this provision.

Concerns were raised in our debate about the fact that minimum unit pricing will impact those on a lesser income more than those on a higher income. The Department of Health has commissioned studies which show that the real impact of minimum unit pricing is that it will reduce alcohol consumption among high-risk drinkers the most. The research shows that lower-priced alcohol is disproportionately purchased by the heaviest drinkers. This measure will increase the price of high-strength, low-cost alcohol. It is estimated that it will reduce the consumption levels of the highest-risk drinkers by more than 15%. It will also ensure that strong alcohol can no longer be sold at pocket money prices.

We are not alone in proposing to introduce a minimum price for alcohol. In 2012, Scotland introduced the Alcohol (Minimum Pricing) (Scotland) Act. The Scotch Whisky Association and others challenged the lawfulness of the Act and the matter was referred to the Court of Justice of the European Union. The court ruled that minimum unit pricing is not precluded by EU law if it is considered to be an appropriate and proportionate response for the protection of human life and health, and this cannot be achieved by other measures, such as increased taxation. The case was appealed to the UK Supreme Court and on 15 November last year, the UK Supreme Court unanimously rejected the appeal. It found that the Act did not breach EU law and that minimum unit pricing is a proportionate means of achieving a legitimate public health aim. Scotland will introduce minimum unit pricing from May this year.

A number of Deputies raised the issue of labelling measures in the Bill. Deputy Kelleher and others sought clarification on who has the responsibility for ensuring that the prescribed information on labels is present. The Bill does not list the responsible persons specifically but instead it provides that it is an offence to sell a product to a person in the State without the necessary information on that label.

In view of the numerous questions raised on this issue, the Department of Health sought legal advice from the Office of the Attorney General to ensure that I can provide a comprehensive response. The offence in the Bill is in relation to selling alcohol products within the State without the required warnings and information. Any person who sells an alcohol product in the State without the required warnings and information can be prosecuted under the section. The range of persons who may be prosecuted includes wholesalers, manufacturers and retailers. If a product is manufactured in the State without the required labelling information and the product is sold to a retailer or wholesaler in the State, then the manufacturer can be prosecuted. Wholesalers and retailers may also be prosecuted if they sell the product on without the required labelling.

It is not an offence to import for sale in the State an alcohol product that does not bear the required information and warnings. However, a person that imports an alcohol product which does not have the required labelling and sells the product within the State, without affixing the required information and warnings, may be prosecuted. On this point, the question was raised as to whether a person buying alcohol abroad for personal consumption would have to add the required information. If a person does not intend to sell the product in Ireland, then adding the information is not necessary. It is not an offence to export an alcohol product outside the State without the prescribed warnings and information. It is an offence only if the product is sold in the State.

It has been suggested that Irish products will be stigmatised abroad because of this measure on the basis that they will be in competition with alcohol products from other jurisdictions with labels that do not contain health warnings. As I have just set out, there is no requirement for alcohol products that are being exported to have this information on their labels. There will be no direct competition with products from other countries of the kind suggested. On this issue, I am not convinced that consumers in other jurisdictions will think that the alcohol in one product has health risks associated with it but the same alcohol in another does not merely because of the presence or absence of a label.

Concerns were raised that smaller manufacturers, such as craft brewers, which wish to export products will suffer major costs as they will have to have labels for products for sale in Ireland and different labels for products to be exported. The Bill does not prevent the relevant warnings and information being added through the use of stickers to the container or similar means. This is already provided for in respect of the necessary health warnings on tobacco products and there is no reason it cannot be done for alcohol products also.

Deputy Kelleher asked if there is an exemption from the labelling requirements for products being bought in airport shops by passengers leaving the State. There is not. The customer in an airport shop will be provided with the same health and other information about the product that they are buying as those customers in a shop that is not in an airport.

The same issue was raised with regard to luxury brand whiskeys or other expensive alcohol products sold in airport shops. The purpose of this measure is to give information. It is no more than that. If the information is given, consumers will know what they are drinking and will be able to make an informed decision about that purchase. I do not see why customers in airport shops should be prevented from knowing how many calories are in the product they are buying, how much alcohol is in it or what health risks are associated with it. We are all consumers and we are entitled to know about it when we are consuming a product that has health impacts.

It was suggested that labelling would be best tackled at EU level. Commissioner Andriukaitis, who has responsibility for health and food safety in the European Commission, has expressed public support for the Bill and Ireland will continue to support EU initiatives to prevent the harmful misuse of alcohol throughout Europe. However, the current position at EU level is that the European Commission is awaiting the alcohol industry’s self-regulatory proposals on providing information on labels relating to ingredients and calorie content only. The measures in the Bill go beyond such proposals because we have a problem with alcohol in our country and we have an obligation as legislators to address it if we can and to put the health of our people first. In accordance with our EU obligations, the amendments made to the Bill in Seanad Éireann have been notified to the European Commission. We await the outcome of its assessment.

There was discussion of the link between alcohol and cancer and references were made to the suggestion that burnt toast was an equal risk. I welcome the responses of Deputies O’Reilly, Chambers and Calleary who rightly addressed this suggestion in the context of the real health risks of alcohol. Suggestions such as that about burnt toast may seem amusing but they are not. The 2013 publication, Cancer Incidence and Mortality due to Alcohol: An Analysis of 10-Year Data, from Dr. Marie Laffoy of the national cancer control programme and others found that 12.2% of breast cancers or 305 cases annually in Ireland were attributable to alcohol in that period. This is the kind of analysis from respected sources that underpins the measures in the Bill. We will not be deterred from bringing it forward by attempts to trivialise or distract from what we are trying to do here for the good of all of our people.

It has been suggested that there are other problems which we should be tackling or other products which have health risks that should be labelled and therefore we should not deal with this product at this time. I do not agree. This Bill is an opportunity for us to show leadership on an important health issue. Ireland was the first country in the world to ban smoking in the workplace and other countries followed our lead on that undertaking. I suspect that the same will occur on the enactment of the Bill and that we will see other countries following our lead with their own alcohol legislation.

If we accept that there is a problem with the harmful use of alcohol in our country, which I think all of us in this House do, we must be prepared to do what we can to address the problem. The provisions in the Bill on the advertising and marketing of alcohol are designed to protect our young people also. The Bill will restrict the amount of advertising that children are exposed to by creating alcohol advertising free zones in parks, on public transport and around schools, playgrounds and crèches. The measures on the content of advertising will make alcohol advertisements less appealing to children. The Bill also prohibits the sponsorship of events where the majority of participants are children or the event is aimed at children and also restricts the advertising of alcohol products at these events.

Research shows that the advertising of alcohol products is effective and it encourages our children to start drinking or drink more if they already do. The Bill is our opportunity to heed that evidence and to give our children a chance to play, to socialise and to learn without the marketing influence of alcohol. Several Deputies mentioned situations where underage drinkers are getting access to alcohol through others. I share their concerns on this issue. One of the primary objectives of the Bill is to delay the initiation of alcohol consumption by children and young people.

Deputy Kelleher and Deputy Kelly asked about the broadcast watershed times in the Bill for television and radio advertising. The watershed times were agreed in consultation with the Department of Communications, Climate Action and Environment and the Broadcasting Authority of Ireland and relate to the times when children might be in the audience for television or radio. If the measures in the Bill are enacted, our young people may not be interested in drinking alcohol until they are adults and, if they do drink, they will be better informed about alcohol and the risks associated with harmful drinking. I agree with the points made that education is important but the evidence shows that it is not enough on its own.

The World Health Organization’s 2010 Global Strategy to Reduce the Harmful Use of Alcohol found:

... the evidence base indicates that the impact of alcohol-education programmes on harmful use of alcohol is small. To be effective, education about alcohol needs to go beyond providing information about the risks of... alcohol to promoting the availability of effective interventions and mobilizing public opinion and support for effective alcohol policies.

The measures in the Bill will raise awareness among all of us about the risks associated with the misuse of alcohol and will implement practical changes to protect our children and all of our citizens. None of the individual measures in the Bill will on their own change our culture overnight but it is my strong view that the Bill as a whole will do so.

A number of Deputies raised whether reference to drinkaware.ie will continue to be allowed on labels and in advertisements. Under the Bill, the details of an alcohol public health website to be established and maintained by the HSE will be included on labelling and in advertising. That website, askaboutalcohol.ie, is already established. It explains the health risks of alcohol and offers support and guidance to anyone who wants to cut back on his or her drinking. It is an independent source of information. The drinkaware.ie website is funded by the alcohol industry.

Several Deputies spoke about whiskey museums and visitor centres in distilleries and suggested that the advertising provisions in the Bill would have major consequences for these tourist attractions. The provisions on the location and content of advertisements are designed to apply to advertisements that promote an alcohol product rather than to those that are solely promoting or giving directions to a visitor centre or similar destination. I am confident that advertisers will find ways to apply their creativity within the new requirements and continue those success stories of which we are all rightly proud.

I wish to make clear that we have a problem with the level of consumption of alcohol in this country and, contrary to what has been stated, it is increasing. According to the figures from the Office of the Revenue Commissioners, 11.6 litres of pure alcohol per capita were consumed in 2010. In 2011, the figure was 11.7 litres; in 2012, it was 11.5 litres; in 2013, it was 10.6 litres; in 2014, it was 11 litres; in 2015, it was 10.9 litres; and in 2016, it was 11.5 litres. This is an average of 11 litres of pure alcohol per capita per year. This amount of pure alcohol is the same as that in 41 700 ml bottles of vodka, 116 750 ml bottles of wine or 445 pints of beer. This is too much. The objective of the Bill is to reduce this level to the OECD average of 9.1 litres.

For the first time, we are addressing alcohol on the basis of its impact on public health . We do so through a Bill which includes provisions which have been adopted elsewhere to tackle major public alcohol problems and which have saved lives and improved the health and well-being of citizens. On enactment, the legislation can do the same here. It is a first step towards a future in which alcohol is enjoyed in an age-appropriate and safe manner and in which the harm from alcohol misuse is significantly reduced.

I thank all Members who participated in the debate, as does the Minister, Deputy Harris. Above all, I thank Members for responding to the legislation as they have done. I thank Members for allowing the Bill to be introduced in the House. I look forward to further debate on Committee Stage and, ultimately, to the enactment of this important landmark Bill. I thank the Leas-Cheann Comhairle and the other Members who have chaired the debate and I thank the Ceann Comhairle for the time provided to those who wanted to speak to the Bill.

Question put and agreed to.