Good morning Chairman and members of the committee. I am pleased to be here today to bring these public hearings on the general scheme of a new public health (alcohol) Bill 2015 to a close. Before I start, I would like to remind the committee that at the start of the year the Minister of State, Deputy Lynch and I set out our 25 actions for the year and grouped them around five themes. First among those themes was Healthy Ireland, followed by patient outcomes and safety, the first steps towards universal health care, investment in infrastructure and facilities, and reform.
The reason we put Healthy Ireland at the top is that we strongly believe we need to improve our health as individuals and as a nation. If we do not do that we will never get on top of chronic disease problems and illnesses that we have and will certainly never get the health budget under control in the long term. This will involve a number of different actions. The Healthy Ireland survey is now under way and we will have the first figures in the summer. This is the first study of Ireland's health since Slán in 2007. We will repeat that study every year to see if our policies are working. There will also be specific actions on obesity and an event next Monday at Farmleigh to which I hope committee members are invited. The committee members will be familiar with the actions taken on tobacco already. There will also be a new sexual health strategy before the end of the year along with the national physical activity plan. Alcohol fits into all that as part of a general drive towards better public and individual health.
I commend the Chairman, Deputy Jerry Buttimer, the members of the committee, other members of the Oireachtas who participated in these hearings, and all the invited guests on the sensible and constructive approach that we have witnessed over the past few weeks. My officials and I have found the presentations and insights presented by the witnesses very useful. I am confident that these submissions and the report the committee will produce will greatly assist me and my officials in the drafting of the final legislation.
I am sure the committee members will agree that Ireland has a serious problem – we drink too much alcohol. The consumption of alcohol in Ireland increased by 192% between 1960 and 2001, from an average of 4.9 litres of pure alcohol per adult to 14.3 litres at peak. Even though this is a problem going back decades and centuries, it is much worse than it was before the 1960s. Since this peak in 2001, alcohol consumption has reduced and in 2013 alcohol consumption per adult was 10.64 litres. Ireland’s alcohol consumption remains in the top five among the EU 28 member states. The European region has the highest consumption in the world. Early statistics indicate that alcohol consumption increased in 2014 from 10.6 litres to 11 litres per person, which is worrying as it suggests that a feature of the recovering economy is going to be an increase in alcohol consumption as more people get back to work and have more money in their pockets. It is a certainty that alcohol consumption will continue to grow as the economy grows in the absence of any policy change and that is part of why these measures are so important.
As a country, when we drink, we tend to binge drink. I doubt many of us in this room are entirely innocent of that. It is very much part of our culture. Patterns of drinking, especially drinking to intoxication, play an important role in causing alcohol-related harm. The evidence suggests that a majority of Irish drinkers engage in excessive or problematic drinking behaviours and that Irish drinkers underestimate their alcohol intake. Ireland was second in the WHO European region in binge drinking with 39% of the population misusing alcohol in this manner at least monthly.
Our most recent national alcohol consumption survey was published by the Health Research Board last year. It found that 54% of drinkers were classified as harmful drinkers; 75% of all alcohol consumed was done as part of a binge drinking session; and Irish drinkers underestimate how much they drink by about 61%. The study also shows that more than half of adult drinkers in the population are classified as harmful drinkers, and this figure does not include 20.6% of the population who abstain. When the proportion of survey respondents who are classified as harmful drinkers is applied to the population, this equates with between 1.3 and 1.4 million harmful drinkers in the country.
Harmful drinking is more common among men than women, and most common among 18 to 24 year olds. In this category a staggering 75% drink in a harmful way. In addition, a considerable proportion of self-defined light, moderate or social drinkers drink six or more standard drinks on a typical drinking occasion. This is the equivalent of binge drinking. Even these light or social drinkers do not realise that they consume alcohol in an unhealthy manner.
The findings of this study lead to the conclusion that, among the drinking population, harmful drinking is the norm in Ireland, in particular for men and women under 35. I am aware that over the past weeks the committee has listened to numerous speakers who have presented on the kinds of damage that alcohol misuse of this magnitude does to the drinker, families, communities and society and the economy.
The general scheme of the Bill was published last February and my Department is now drafting the Bill. It is my intention to have the Bill ready before the summer recess and introduced in the Houses of the Oireachtas in autumn. This legislation is the most far-reaching proposed by any Irish Government, with alcohol being addressed for the first time as a public health measure. The significance of that might not have been fully understood by many people. This is health legislation, rather than justice or enterprise legislation, so the regulations will be signed by the Minister for Health and will come from a health point of view. The enterprise Minister would be coming from more of a consumer and competition point of view and the justice Minister from a criminal justice point of view.
The Bill is part of a comprehensive package of measures to reduce excessive patterns of alcohol consumption as set out in the steering group report on a national substance misuse strategy. It is also one of the measures being taken under the Healthy Ireland framework. The aim is to reduce alcohol consumption in Ireland to 9.1 litres per person per annum - the western world average - by 2020, to reduce binge drinking in particular and to reduce the harms associated with alcohol. I believe the legislative measures contained in the Bill are necessary if we are to achieve this aim and change our relationship with alcohol. The Bill includes provisions for minimum unit pricing to eliminate cheap alcohol from supermarkets; structural separation in shops to reduce availability and visibility; labelling on alcohol products; restrictions on the advertising and marketing of alcohol; regulation of sports sponsorship; and enforcement powers for environmental health officers.
Addressing the price of alcohol is an important component of any long-term approach to tackling alcohol misuse. The price of alcohol is linked to consumption levels and levels of alcohol-related harms. The World Health Organization states that there is “indisputable evidence that the price of alcohol matters. If the price of alcohol goes up, alcohol-related harm goes down.” Despite Ireland having relatively high excise duty, alcohol remains very affordable, particularly in supermarkets. A woman can reach her low-risk weekly drinking limit for just €6.30, while a man can reach this weekly limit for less than €10.
The public health (alcohol) Bill will make it illegal to sell or advertise for sale alcohol at a price below a set minimum price, essentially a floor price for alcohol. Minimum unit pricing, MUP, sets a minimum price per gram of alcohol. The minimum price of an alcohol product shall be based on the number of grams of alcohol in the product. I know that Dr. John Holmes and Dr. Colin Angus from the University of Sheffield delivered an excellent presentation on minimum unit pricing and the study they carried out in Ireland. Suffice to say that the study provided robust evidence that minimum unit pricing policies would be effective in reducing alcohol consumption, alcohol harms including alcohol-related deaths, hospitalisations, crimes and workplace absences and the costs associated with those harms.
The study also showed that minimum unit pricing would only have a small impact on alcohol consumption for low risk drinkers. Somewhat larger impacts would be experienced by increasing risk drinkers, with the most substantial effects being experienced by high risk drinkers. This is because minimum unit pricing is aimed at those who drink in a harmful and hazardous manner. Alcohol products which are strong and cheap are those favoured by the heaviest drinkers, who are most at risk of alcohol-related illness and death and young people who have the least disposable income. Minimum unit pricing is not expected to affect the price of alcohol in the on-trade in the main. However, it will prevent large multiple retailers from absorbing increases in excise rates and from using alcohol as a loss leader. Officials in my Department are also looking at possible mechanisms to ensure that some of the financial benefits of minimum unit pricing may flow back to the Exchequer, although if it succeeds in significantly reducing consumption, there may not be any financial benefit.
Some members have been calling for a ban on below-cost selling instead of minimum unit pricing. I would like to take the opportunity to clarify why minimum unit pricing is more effective than a ban on below-cost selling. First of all, there is no agreed definition of below-cost selling in Ireland or how it could be calculated. If it is interpreted as alcohol being sold below VAT and excise duty then very little alcohol is sold at this price in Ireland. The University of Sheffield study found that a ban on below-cost selling would have a negligible impact on alcohol consumption and related harms. Working out a cost price that incorporates other costs such as manufacturing, transportation and retailing is a complex, expensive and perhaps inaccurate exercise. Banning below-cost selling would be difficult to implement, monitor and enforce. MUP is easier to understand, measure and enforce than a ban on below cost selling
Others have been calling for a general increase in excise rates. However, further increases in excise rates would render premium and higher-priced alcohol more expensive, which is unnecessary for the purpose of targeting hazardous and harmful drinkers, who purchase larger quantities of cheap alcohol. It would be just another tax. A tax increase would not necessarily have the same effect as a compulsory minimum price, because of the risk that taxes would not be passed on in full. However, minimum unit pricing prevents large multiple retailers, or any retailers, from absorbing increases in excise rates and from using alcohol as a loss leader.
The appropriate minimum unit pricing will be chosen taking into account estimates from the report of the University of Sheffield and in consultation with the relevant Departments. The price needs to be set at a level the evidence indicates will reduce the burden of harm from alcohol use. In short, it needs to be high enough to eliminate very cheap alcohol but not so high that it affects the price of a glass of wine in the pizzeria.
We must also take into account what Northern Ireland does, so that we do not create a new issue around cross-Border trade. I know that many members are concerned about the impact that MUP might have on cross-border trade. The Minister for Health in Northern Ireland, Jim Wells, MLA, has also announced plans to introduce minimum unit pricing for alcohol. My officials are in contact with their counterparts in the Department of Health, Social Services and Public Safety on the matter and we are cognisant of the requirement to work together with the North on the implementation of minimum unit pricing.
Finally, I will give the committee an update on the current European court case regarding minimum unit pricing. Last February, the Scottish Inner Court of Sessions, Scotland’s highest court, referred a number of questions on minimum unit pricing to the European Court of Justice. The court is due to hold a hearing on this case on 6 May and we expect a judgment by the end of the year. We intervened in this case and the relevant officials will be attending the hearing in Luxembourg. We are hopeful that minimum unit pricing will be found to be compatible with EU treaties and rules and it is therefore important that all the necessary steps have been put in place to commence the legislation, if enacted. However, it is a risk and the court will have to decide which is more important: public health or eliminating barriers to free trade. It is noteworthy that the EU was initially established as a common market, the European Economic Community, a trade-based organisation, rather than one based on public health. We will fight as hard as we can to ensure the court makes the right decision.
Moving on to the regulation of marketing and advertising, protecting children from exposure to alcohol marketing is an important public health goal. There is a compelling body of research which shows that exposure to alcohol marketing, whether it is on TV, in movies, in public places or through alcohol branded sponsorship, predicts future youth drinking. Numerous longitudinal studies have found that young people who are exposed to alcohol marketing are more likely to start drinking, or if already drinking, to drink more. Research also shows that self-regulation is not able to protect young people from exposure to large volumes of alcohol marketing and appealing alcohol advertising.
The public health (alcohol) Bill will make it illegal to market or advertise alcohol in a manner that is appealing to children. It provides for the making of regulations on the marketing and advertising of alcohol and includes provisions for restrictions on broadcast marketing and advertising, cinema advertising, outdoor advertising, print media and the regulation of sponsorship by alcohol companies. This will encompass major sporting events for the first time by putting the existing code of practice for sponsorship by drinks companies on a legal footing with enforcement powers and penalties. The legislation will contain a commitment that the provisions on marketing and advertising will be reviewed after three years.
On labelling, research shows that accurate information on the alcohol content of specific beverages is essential to promote awareness of alcohol intake. However, "standard drink" units are widely misunderstood by the general public. In order to address this, the Bill will provide that labels on alcohol products will contain health warnings, including for pregnancy; the amount of pure alcohol as measured in grams; and the calorie count. Under the Bill, pubs and restaurants will also be obliged to provide this information to customers for alcohol products sold on draught or in measures, e.g. pints, glasses of wine and measures of spirits. Finally, health warnings will also have to be included on all promotional material.
From a merchandising perspective, at the moment the Minister for Justice and Equality and I are examining the best way to implement the separation of alcohol products from other products in mixed trading premises. Our aim is to ensure that alcohol products cannot be displayed like ordinary grocery products, but will be subject to strict merchandising requirements. We want to do it in a manner that is not too onerous on retailers and that will not impose excessive cost on them in order to comply.
The public health (alcohol) Bill will be enforced by environmental health officers. Provisions to be enforced include minimum unit pricing; health labelling; the control of marketing and advertising; structural separation of alcohol from other products; and regulations relating to the sale, supply and consumption of alcohol products under section 16 of the Intoxicating Liquor Act 2008. These pertain to restrictions on advertising, promoting, selling or supplying alcohol at reduced prices or free of charge.
To conclude, I believe that the public health (alcohol) Bill will act as a powerful enabler for a healthier relationship with alcohol in Ireland. I know some people believe the measures do not go far enough, but I am confident that it is a bold and major step in the right direction. As I said earlier, I will seek Government approval to publish the Bill before the summer recess and plan to initiate it in the Houses of the Oireachtas in the autumn.
I thank the Chairman and all of those who have participated in these public hearings for the valuable contribution they have made to this issue and for the assistance they have provided to me and my officials in the work that lies ahead. I look forward to receiving the committee's report and reflecting it in the legislation as published.
