I thank the committee for the invitation to come before it. I greatly appreciate the opportunity to speak on the subject of alcohol. I commend the Chairman and his committee on the excellent report recently produced on alcohol which I have no doubt will resonate very closely over the course of this discussion with many of recommendations made by the expert group that I had the privilege of chairing. I would particularly like to talk to about the steering group I chaired, about alcohol and its effects and about the recommendations we have made. My presentation is grounded in the evidence base that underpins the report, particularly the effects of alcohol and what will work.
In 2009, the Government, on publication of the national drugs strategy, decided that policy on alcohol and other substances should be integrated. Therefore, an expert group was established to bring alcohol policy into line with policy on drugs as a single overall integrated policy. This group, initially under my co-chairmanship and that of the former Department of Community, Rural and Gaeltacht Affairs, was established in December that year. When establishing the group, a cross-departmental and cross-sectoral representation was required to reflect a whole-population approach effectively. The steering group comprised representatives from relevant Departments and agencies, medical professional bodies, the community and voluntary sectors and the alcohol industry. It included the Department of Justice and Equality, the Department of Education and Skills, the HSE, the College of Psychiatry of Ireland, the Royal College of Physicians in Ireland, the Irish College of General Practitioners and Alcohol Action Ireland.
The steering group met a total of 20 times in the period December 2009 to October 2011. A public consultation was undertaken as part of our work in December 2009, whereby an advertisement was placed in national newspapers inviting individuals and groups to submit their proposals in regard to alcohol. A total of 65 submissions were received and, along with a range of reports and policy documents and materials we pulled together, these were considered by the steering group in reaching conclusions and recommendations. The report of our steering group - I understand the members have this - sets out 45 recommendations organised in the five so-called pillars used by the national drugs strategy. These are supply, prevention, treatment, rehabilitation and research. This is to facilitate alignment between both strategies. The report also sets out in summary the evidence upon which these recommendations are based, both in terms of harm and in terms of likely effectiveness. The report was launched on 7 February.
The World Health Organization has stated that alcohol is the third most significant lifestyle risk factor for disease. Through research and study, we know much about it and its varied health and wider social consequences. Alcohol is no ordinary commodity. That is why we regulate its sale, availability and access to it by minors. It has major public health implications and it is responsible for a considerable burden of health and social harm at individual and societal levels. It is a psychoactive substance that impairs motor skills and judgment. It is a drug of dependence and acts as a gateway to the use of other substances for some people. The practice of polydrug use is now widespread among problem drug users as a consequence, and we also know binge drinking is also a common phenomenon in this country. The Chairman alluded to that in his introduction.
It is true that there are some positives relating to alcohol, including some level of social lubrication and some health benefits. These benefits are derived only from low levels of alcohol consumption and that is not the way we drink alcohol in this country. Somehow we have let ourselves believe that alcohol is not really a problem in Ireland and we are complacent about our consumption and its impact on lives. Individually and sometimes collectively, we choose to ignore evidence of the significant and avoidable extent of the problem that alcohol wreaks on our society.
A particular issue of concern for the committee I chaired is that in recent years a significant shift has occurred in the share of alcohol sales from pubs, which provide a controlled environment for the consumption of alcohol, to the off-trade, including dedicated off-licences and mixed traders. We were especially concerned about supermarkets and other mixed traders whose core business is not the sale of alcohol, given the increased availability of alcohol it provides and the fact this leads to the normalisation of alcohol among a range of other products, such as bread. A further concern which our recommendations address is that many of these outlets use discounting of alcohol products and alcohol-based promotions to encourage people - often younger people - into their premises.
Per capita consumption is considered a good indicator of alcohol related harm in a country, with the specific measure used being per capita consumption of litres of pure alcohol per year for every person in the population over 15. International evidence indicates that the higher the average consumption of alcohol at the individual level and in a population, the higher the incidence of alcohol related problems for both. There is a clear and proportional causal relationship, which justifies a population-based approach. This goes to the core of the issue. There are many people who would seek to define our problems with alcohol as being with an implied minority who misuse alcohol. They may not wish to support population-based measures as they may not wish, necessarily, for Ireland to consume less alcohol. They will say that they share the concern about alcohol misuse but they will argue against population-based approaches.
In 2010, the per capita consumption in Ireland equated to 11.9 litres of pure alcohol per adult, corresponding to 482 pints of lager, 125 bottles of ordinary strength wine or 45 bottles of vodka. That is almost a bottle of vodka per week, which is a stark statistic. Given that 19% of the adult population are abstainers, according to best estimates, the actual amount of alcohol consumed per drinker is considerably more than the figures suggest. It is important, therefore, to reduce the overall level of consumption across the population, and that is why the steering group recommendations set this target for alcohol consumption of 9.2 litres of pure alcohol per person over 15 per year by 2016. That is the single measure of success of this strategy.
This population-based approach to the problem of alcohol benefits not only relates to those who are not in regular contact with the health services but those who have not been specifically advised to reduce their alcohol intake as it also aids the prevention of drinking harmful or hazardous quantities of alcohol. Therefore, a population-based approach will automatically help harm-reduction and prevention with cohorts of the population, such as children, who are not in regular contact with the services.
I will speak to some of the impacts. At the outset, the steering group reported that alcohol was responsible for at least 88 deaths every month in 2008, and we have no reason to believe the data are much different now. In men between 15 and 34, it is estimated to be responsible for one in every four deaths, which compares, in that age group, with one in 12 deaths due to cancer or one in 25 deaths due to cardiovascular disease. It is a contributory factor in half of all suicides and in deliberate self-harm, and it also increases the risk of more than 60 medical conditions such as cancers. I will return to that point. Alcohol is associated with approximately 2,000 beds being occupied every night in Irish acute hospitals and a quarter of injuries presenting to emergency departments and almost 8,000 admissions in 2010 to specialised addiction treatment centres throughout the country. We know it is associated with harm to the baby if consumed by pregnant women. It is also a factor in unplanned pregnancies. We have seen a significant increase in foetal alcohol related syndrome disorders in this country in recent years. It increases the risk of children needing special care with an estimation that adult alcohol problems are associated with about one in six of child abuse cases. We know from data in 2005 that it has been identified as a trigger in approximately one third of domestic abuse cases.
As the Minister of State has alluded to, alcohol, through these mechanisms, has substantial direct and indirect costs. Based on data from 2007 it is estimated, in direct terms, to account for €1.2 billion of health expenditure and a similar amount for alcohol related crime. At that time the cost of lost economic output was estimated to be roughly €500 million. Alcohol related road accidents cost a similar amount. The total figure was €3.7 billion in 2007. There is no substantial reason for us to believe that the costs would be different now.
I will go into a little more detail on some of the health effects. We know that alcohol, even in small amounts, increases the risk of cancer of the mouth, oesophagus, breast, colon, liver and pancreas. We also know that alcohol in very low quantities spread over time can have a protective effect against certain conditions, including cardiovascular disease. Higher levels consumed over shorter periods not only have no protective effect against heart disease but will increase the risk. In epidemiology we call that a J-shaped curve. Alcohol, even at moderate levels, can lead to injury and death in the short term from accidental and non-accidental injuries. It can cause a wide range of family problems from marital breakdown to child abuse and domestic violence, on which I have given members data. We know that children of alcoholic parents can suffer the effects of alcohol throughout their lives. We know it has a wider societal impact through the loss of productivity from absenteeism in the workplace and school, and it is associated with crime.
An argument can be made, and is advanced by some, that the consumption of alcohol is the choice of the individual. Please consider the following. Children born to mothers who drank heavily during pregnancy may develop a range of disorders, known as foetal alcohol syndrome disorders, that can have a devastating effect on their entire lives. As I have mentioned, we have seen an increase in that spectrum of disorders in recent years in this country. One in six cases of child abuse in Ireland is attributed to alcohol and approximately half of perpetrators and victims of sexual assault were drinking at the time of the assault. The upshot is that there are innocent victims of hazardous drinking that must be protected from this preventable harm by the direct and sustained intervention of Government on a population basis, by regulatory and-or other means. This is simply the State acting to protect the vulnerable by preventing the occurrence of harm in the first place, and nobody could contest the aims of such intervention.
Everyone can see that alcohol has an enormous burden of harm. It is this burden that largely informed the steering group's recommendations to tackle the widespread availability of alcohol, its marketing and advertising, along with strengthening our care and health promotion services and systems to tackle it. Of course, it cannot be denied that there are other agendas that do not prioritise the protection of public health and our social well-being. It is inevitable that such agendas will be critical of the process and will suggest bias, ask for more debate, research and evidence or use the latter, or certain forms of it, in a manner that is not conducive to achieving the aim of protecting public health. Often such agendas can be propagated to obfuscate and confuse the public debate.
There is no single intervention that can reduce the impact of alcohol on our society. If we take an àla carte approach to the report’s recommendations rather than seeing them as a whole, we will not succeed. The evidence about the amounts of alcohol we consume is clear. The evidence of how we consume alcohol is clear. The evidence about what will work to reduce alcohol consumption is also clear. It requires a sustained multisectoral approach to the alcohol epidemic backed by a strong political and cross-societal consensus.
I thank the Chairman for the opportunity to address the meeting this morning and I will be happy to answer any questions and go through the recommendations in more detail.
