The presentation this morning is by officials of the Department of Health and Children on underage drinking. I welcome Dr. Anne Hope, Mr. Shane McGovern, Ms Kathleen Lombard and Mr. Kieran Cashman of the Department of Health and Children. They will make a presentation on alcohol misuse among young people. Later members will have an opportunity to ask any questions they wish.
Alcohol Misuse Among Young People: Presentation.
Mr. Shane McGovern
The health promotion unit welcomes the opportunity to make a presentation on this important subject to the joint committee. I would like to set out the context in which the health promotion unit approaches the issue of alcohol and young people, recent consumption trends and patterns, the research available, an outline of harm indicators, some of the initiatives undertaken by the HPU and an indication of future action in this area. For the purposes of this submission the health promotion unit has adopted the World Health Organisation definition of young people as those aged 25 and younger and young adults as those aged 18-25.
The health promotion unit of the Department of Health and Children was established in 1988, when it replaced the health education bureau. The HPU has a dual remit: a policy formulation function concerned with strategic planning, priority setting, research and evaluation and the development of a multi-sectoral approach to health promotion issues at national and local level; and an executive function concerned with raising awareness of lifestyle issues through multi-media awareness campaigns and the development of materials for the public.
The national alcohol policy was published in 1996 with the overall aim of reducing the level of alcohol-related problems and promoting moderation for those who wish to drink. In addition, Ireland, as a member of the WHO European region, has endorsed the European Charter on Alcohol, the European Alcohol Action Plan, and the Declaration on Young People and Alcohol. These documents have provided ethical principles and goals for advancing alcohol policy and a template of strategies for alcohol action. Ireland has also adopted the EU Council recommendation on the drinking of alcohol by young people, in particular children and adolescents. The approach taken by the HPU concerning alcohol related matters is guided by the principles outlined in these publications.
In the last decade, Ireland has had the highest increase in alcohol consumption among EU countries. Between 1989 and 2001, alcohol consumption per capita in Ireland increased by 49% while ten of the European Union member states showed a decrease and three other countries showed a modest increase during the same period. In 2001 Ireland ranked second highest after Luxembourg for alcohol consumption with a rate of 11.4 litres of pure alcohol per capita. The EU average is approximately 9.1 litres per capita.
It is against this backdrop of rising consumption that underage drinking must be viewed. International research has demonstrated that young people's beliefs about the effects of alcohol and the desirability of those affects are acquired through observation, vicarious learning, and assimilation of cultural stereotypes and are present in children before personal experience with alcohol begins. It is to be expected therefore that the increase in alcohol consumption in society in general would be mirrored by an increase in underage drinking and surveys confirm this pattern.
Drinking patterns have been influenced by changing lifestyles and expectations, more disposable income and a strong focus on consumerism which has ensured a dynamic relationship between market place and consumer. Young adults, namely, 18 to 25 year olds, are more likely to engage in binge drinking - five or more drinks in a row for females, seven or more in a row for males when they drink - but drink less frequently than older age groups. The pattern of drinking is also significant in that acute problems such as trips and falls, alcohol poisoning, incidents of unintentional sex, public order offences etc. tend to occur when individuals drink to excess on a single occasion.
It is internationally recognised that the key strategy areas that help to prevent and minimise alcohol related harm are concerned with regulating availability and providing deterrents. If alcohol becomes more accessible and available, it is reasonable to assume that those underage will have easier access to alcohol.
Many children and adolescents experiment with alcohol——
I hate intervening but we have a problem today in that there is another committee meeting in this venue at 12 o'clock. It is a long presentation which we have in written form. The committee would like a synopsis of the presentation. I am sorry about this. If you outline the main features we will then ask questions in regard to it. I am sorry about the time constraints but that is the situation.
Mr. McGovern
I will go through the various headings and make the main points in regard to each paragraph. I was just about to expand on the area of research on young people and alcohol. The health behaviour in school-aged children, HBSC, survey showed that over half of Ireland's young people begin experimenting with alcohol before the age of 12. In the younger age groups about one in five of boys aged 12-14 years are current drinkers.
Research has been carried out in the area of harm indicators which includes falls, accidents, drink-driving and suicide. It also encompasses attendance at accident and emergency departments from alcohol-related injuries and public order offences as well as personal and social problems that young people experience from the misuse of alcohol. This covers school performance, accidents, relationship issues, unintentional sex and unprotected sex. Excessive drinking also increases the risk of drunkenness, assaults, fights and other violent outbursts.
A paper commissioned as part of the European comparative alcohol study, ECAS, estimated that alcohol related problems cost Irish society approximately €2.4 billion, £1.9 billion, per year. These include costs such as health care, road accidents, transfer payments, alcohol related crime and lost productivity.
In response to these problems posed by alcohol use and abuse the HPU has initiated a wide range of multi-sectoral actions. Our approach to alcohol is outlined in the health promotion strategy, which is our policy document for approaching topics, settings and population groups. In the settings approach we have developed a framework that helps colleges and third-level institutions adopt a campus alcohol policy. It is concerned with limiting harm in the drinking environment, raising awareness and providing support services. In the youth sector we have worked with the National Youth Council of Ireland by supporting a project called "It's Your Choice", which works with children in the informal sector, not in the school sector.
In the school setting the social, personal and health education programme, SPHE, is well established. The concept of the programme is to empower young people to make positive decisions about their lifestyle issues. Some 570 schools out of 750 are now engaged in the support services for the SPHE. By September all schools must make provision to include it on the school curriculum.
We have worked with the drinks industry in establishing a responsible serving of alcohol programme, to which there are three components. It is a training programme aimed at those in the bar and hospitality trades so they will recognise underage drinking and serving to intoxicated people and offer alternatives to drink driving.
In 2001 the unit launched an alcohol awareness campaign entitled "Think before you Drink - Less is More". Its initial aim was to raise awareness of alcohol related issues and problems as a public health issue, highlight recent research trends, particularly in respect of ESPAD and HBSC, and have alcohol related problems raised in public debate. The first phase of the campaign was aimed at individuals and drew attention to the fact that one could have a good time without over-indulging in drink. Another phase concerned radio advertisements and posters, encouraging those who buy or sell drink for under-age drinkers not to do so.
The latest phase of the campaign specifically targets binge drinkers in the 18 to 29 year old age group. We are taking a settings approach, focusing on colleges, communities and the workplace. We had a national advertising campaign late last year, which we are extending this year. We are trying to spread key messages through other public awareness material.
The Commission on Liquor Licensing, established by the Minister for Justice, Equality and Law Reform, recommended in its interim report that the Minister for Health and Children should establish a strategic task force on alcohol. The Minister accepted that recommendation and established it in January 2002. It published a report in May 2002. The interim report made recommendations on various areas regarding alcohol policy. A memorandum relating to the task force report was considered by Government this week and it has approved the establishment of an interdepartmental group that will co-ordinate the response of Departments to the recommendations of the task force.
The HPU has also commissioned a number of research projects on alcohol related matters, which we value highly. The research was commissioned in terms of guiding and focusing on particular initiatives we want to implement. They concern advertisements, accident and emergency attendances and the attitudes of the public towards alcohol policy changes. We supported the Irish College of General Practitioners in a project it wants to carry out with GPs aimed at patients who are attending their surgeries. Some national lifestyle surveys have been undertaken by the unit. SLÁN and HBSC are major national surveys. We have also undertaken a CLAN survey, a survey of colleges concerning lifestyle issues therein, particularly with regard to alcohol.
We have provided some copies of the report and documents to which I referred, which I hope members will find informative and helpful. They touch on much of the alcohol related work we have focused on in the past two to three years in the unit.
One report stated that by the time children reach 15 or 16 years, half of girls and two thirds of boys are current drinkers. We have also heard, in terms of binge drinking, that young people go out at night to get absolutely stocious. What is their mindset? What is the mindset of parents to drink and the astonishing revelation that young people are drinking by the age of 12? Based on your research, what do you regard to be the role of parents? What exactly is making people as young as 12 tamper with drink?
Mr. McGovern
I mentioned in the presentation that young people are influenced by behaviour in society, their parents and peers. Given the excessive rate of consumption of alcohol it is fair to assume that people are drinking much more than they used to. They are binge drinking, which has been outlined as having seven or more drinks in a row for men and five for women. Young people observe drinking to excess as the norm, and hence they adopt similar patterns.
The norm is set. That is the bottom line.
My point is related to that raised by the Chairman. It seems that the kind of drinking young people engage in is quite different from that of the adult population. I accept that they absorb their ideas about what is glamorous and desirable by observing adult behaviour. In my experience people get drunk as a consequence of drinking too much; however, with the younger generation the purpose is to get drunk before going out for the night. Maybe our generation gets drunk at the end of the night as a consequence of drinking too much, but the young drink cans really quickly before they leave the house or out in the fields before they go out. That is not something they are picking up from the rest of society. It is now a peer thing; they are all doing it. Where did it come from? I have not seen it anywhere else.
Dr. Anne Hope
We believe they have taken on the pattern of drug use. They use drugs to get a buzz or get high. We believe that young people in Ireland and other European countries, indulging in binge drinking, are mirroring the pattern of drug use. We are concerned that young people want to drink large amounts of alcohol in a short space of time to get a buzz. They use even the same language that has been used in drug use for the past ten years. It is a very complex issue and there is no single explanation for it. There are wider societal issues; it is not alcohol per se, it is young people's attitudes to life in general and the way they deal with it.
The presentation has, yet again, made clear the frightening level of drinking among young people. The type of drinking they are engaging in is very serious. The national alcohol policy clearly did not work if consumption has increased by almost 50% in a decade. Something has gone seriously wrong.
Regarding the age frame of 18 to 25 years, should it not have gone as far as 30? Young people now seem to be young for longer; they do not tend to marry as young and seem to be able to store a lot of income. That should be looked at afresh. There is a huge cost involved. Accidents, violence, suicide, chronic illness and risky sexual activity have cost the State €2.4 billion. I presume obesity is another possibility; it certainly is not helped by heavy consumption of alcohol.
We cannot avoid the fact that money is central to all this. Today's young people have money unlike any other generation and the drinks industry and publicans are making large profits. They do not sponsor everything in sight, whether it is the local festival or the student rag, for no reason. Major investment is being made to extract major profits. The State and individuals are paying the price. This is surely the central issue when it comes to putting things right. Trying to create awareness among young people is all well and good - ultimately is it a matter of individual responsibility - but if we ignore the context of a hard-nosed commercial strategy that encourages young people to drink more and more alcohol, we will not get to grips with this.
This committee has a role to play in assisting the work that is being done. Generally speaking, we support any measures that have been taken. The kind of commercial activity that leads to binge drinking is not being countered in any effective way.
Mr. McGovern
We adopted the WHO definition of young people as those aged 25 and under. Much of our research categorises young people as those up to age 29. We have been concerned at the rising levels of consumption for some time and the rising level of harm associated with it.
The strategic task force on alcohol made recommendations in a number of areas, some of which relate to the issues raised by the Deputy such as cost, commercial activity and the behaviour of young people and their attitudes towards drinking. Many of the issues the Deputy raised will be addressed through the inter-departmental group established to oversee the response of Departments to those recommendations. Members will be aware the Minister for Finance increased taxes on alcohol in the budget. That was a recommendation of the strategic task force on alcohol. Cost and availability of alcohol are internationally recognised as strategies to be used to combat alcohol related harm.
I tabled a parliamentary question on the issue of warnings on alcoholic beverages. The reply said such warnings were not found to be effective. Will the delegation comment on this? We seem to take for granted warnings on tobacco products: why should we not have them on alcoholic beverages? Has the Department conducted any studies to determine how this impacts on other health services? We have seen the television programmes on the already overburdened accident and emergency services. I am seeking figures that show to what extent this impacts on A&E units.
Should taxes on alcohol be taken out of the CPI? That we cannot tax alcohol and tobacco products because it affects the CPI is an argument that has often been made. What is the delegation's view on this?
Does the delegation agree the difference between the present generation and the older generation relates to lifestyle? The older generation had a different attitude. There seems to be a difference in attitudes to drink driving. The older generation has a more lax attitude to drink driving whereas the younger generation has a stricter one. This seems to be inexplicable in the context of binge drinking. The younger generation is busier and have more planning in their lives. Therefore, binge drinking is a planned exercise. They go out to get drunk on a Saturday night but will be ready for work on Monday morning. Does the delegation agree they are under intense pressure in terms of their lifestyles and this is how they react? This is my analysis.
Mr. McGovern
In the presentation I mentioned that we assisted in some research at the accident and emergency unit in the Mater Hospital. It showed that one in four attendances at accident and emergency departments were alcohol related. That was a small study in one hospital. We were not sure if it was truly representative, so we have extended the study to four major hospitals - the Mater, St. Vincent's Hospital, Dublin, Galway Regional Hospital and Waterford Regional Hospital. We have done so to ensure the results are representative of attendances at accident and emergency departments and to give us a better picture of the alcohol-related incidents at A&E departments. It has just been commissioned so the study will not be complete for about a year.
I mentioned earlier that price and availability are two internationally recognised measures to control alcohol-related harm. The strategic task force on alcohol raised the issue of taxation on drinks which will be addressed through the inter-departmental group which is representative of the relevant Departments upon which the recommendations impinge.
In terms of lifestyle, one of the factors relevant to the lifestyle behaviour of young people is that they have more disposable income, are influenced by marketing and consumerism and have an intention to get drunk when they drink - they binge drink. We are concerned about this and we are exploring it - we need to address it in a more extensive manner.
Dr. Hope
In the USA there were two warnings, one in relation to the effects of alcohol on drink driving or using mechanical machinery and the other in terms of pregnancy, but the health warnings had no effect on behaviour. However, they are useful for raising awareness or informing people. We have looked at this at EU-level because there is a great deal of importation of alcohol so we need conformity if there are going to be warnings. All alcohol advertising in France has a message on moderation. It has strict laws on advertising and sponsorship. Individual member states have taken their own initiatives but we are trying to see if we can agree an overall health warning so it could be part of the regulations. The information allowed on labels is quite strict in relation to alcohol, showing just the alcohol volume. We need to get compliance across the member states when it comes to labelling drinks.
We must also be aware that many people drink out of a pint or half pint glass so they do not necessarily read the label on the bottle because they are not consuming from it. The most important thing is that, because it is a complex issue, we must have a variety of strategies. No one strategy, such as limiting availability or price, will work on its own. We know from research that one must use a variety of measures in order to have any impact. While we are looking at warning labels and have been in discussions on an EU working group to see if we can agree on them, the problem is that we cannot agree what to put on the labels.
Dr. Hope mentioned that France has applied warning labels unilaterally, so there is nothing to stop us doing that here. On the question of people drinking from glasses, we can put warnings on beer mats - they are seen all over pubs. Perhaps these areas could be examined.
I thank the delegation for their useful presentation. The increase in the consumption of alcohol by young people is enormous but the figure for girls, specifically, is astonishing. The witnesses spoke about unprotected sex in this context. I am on the board of the Rotunda Hospital and take a great interest is the sexual assault unit there. I do not know if it is pointed out to girls how vulnerable they make themselves to sexual assault, even though that is no excuse for someone having sex with a girl because she is drunk. People come into the unit with blood alcohol levels of 300 to 400 milligrammes - I would have thought they would be dead at levels like that. There is a feeling that people who get into such a state have had their drinks spiked with something like Rohypnol, but we have done tests over the years and have not had a single positive one even though it stays in the blood for 72 hours - these have just been cases of high levels of alcohol. It alarms me that girls are targeted specifically in some pubs in promotions particularly of sweeter, more appealing drinks. A young woman told me she was in a pub not far from here recently where they had a special promotion for Bacardi rum. Is there anything we can do to stop these promotions, which are also run in colleges? It is important we do so.
I thank the delegation for taking the time to talk to us.
Alcohol drinking among young people is not a new problem - it has existed in other countries for some time although it is relatively new here. What evidence do we have from research in other countries as to how the problem can be solved? It seems we are being bogged down by a plethora of reports, some of which simply duplicate existing results. What are the witnesses comments on what can be done to stop the problem?
I agree with Deputy Gormley that alcohol should be removed from the CPI. What are the delegation's views on that? Many young people who are drinking are under the legal age. Do you have any views as to how the supply of alcohol to them can be stopped?
I too welcome the delegation.
I have watched this debate develop for years. I am a publican, in the fourth generation of the same pub and, as Deputy Mitchell said, there has been a change over the years, in terms of the young people coming into the pub, away from controlled, laid-back drinking. I have always believed that advertising is a huge factor in glamorising the effect of alcohol. This, combined with sponsorship and, as Senator Henry pointed out, promotions have a huge effect on young people. It makes young people feel they are part of a trend with an upmarket input. The trend in pubs is huge as any publican can tell you. They are in the business to make money but I do not condone any abuse. Changes are afoot and publicans recognise that having young people drinking in a pub for the last three hours of the day is better than having a middle-aged group for the previous 12 hours. That must be examined.
It is important to have alcohol warnings regardless of what the case is elsewhere. Young people are clever - they can read the signs. I was having a drink last night, not thinking about this meeting, and I was watching an advertisement for smoking placed when a packet of cigarettes was 2d. Four footballers were jumping in the air to catch a football. Things have moved on since, but I hope it does not take us such a long time to realise the ill effects of alcohol. The first step is to consider the issue of advertising. Sponsorship in pubs creates an image that this is the "in" thing. We often see well known personalities in sponsorship promotions. That must encourage the view that there is nothing wrong with it.
Awareness should also be raised of the effects of alcohol. The figures we heard a few minutes ago pertaining to accident and emergency wards show that rather than looking at reports from other countries we should consider our own. Can we research the effects of advertising? Has it a positive effect, at least among young people? I believe it has. Tackling sponsorship, advertising and the glamorisation of alcohol would be a positive start.
Finally, we should invite in representatives from the Vintners' Federation of Ireland. I have been a member of the VFI for many years. Many publicans resent the implication that they are in this to try to cash in on the needs of young people. A number of publicans run very responsible establishments and they want to be part of the solution. That might sound farcical, but I can assure members it is the case. I have been at many AGMs over the years. Publicans want to get back to the days of a controlled atmosphere. They want to see people coming into their pubs who have a respect for alcohol and they want to move away from binge drinking. We have a positive role to play in that.
Mr. McGovern
Dr. Hope mentioned earlier that there was no one strategy to address these issues. What we need is a multiplicity of approaches. The WHO has outlined ten areas of approach to alcohol policy which could address rising consumption, underage drinking and abuse of alcohol. The strategic task force on alcohol, when it was established in January of last year, was given three months to make recommendations to the Minister for Health and Children. Due to the very short timeframe in which it operated, it was decided to take the WHO approach in making recommendations to address the problem. In its interim report, however, it confined itself to six areas. When the task force is reconvened this year it will consider the other four and also return to the six areas it dealt with and explore them more fully.
One of the areas dealt with by the WHO and the task force is advertising, sponsorship and promotions of alcohol. The Minister for Health and Children is currently exploring ways in which these issues might be addressed. A group has been established in the Department to explore various actions the Minister could take and he is currently examining those options. It is reasonable to say that some action will be taken in terms of addressing advertising, sponsorship and sales promotions. As I mentioned already, it is accepted internationally that two areas of policy which have been proven to be successful in tackling alcohol abuse are those of availability and pricing. The task force on alcohol will be exploring those issues with the relevant Departments.
Dr. Hope
It is useful to look at page 17 of the document of the strategic task force. It clearly outlines what are effective strategies. Because the aim of the national alcohol policy is to reduce harm, we must look at the evidence. We must put effort, time and money into a strategy on the basis that it has been shown to work somewhere else or that we have done a pilot that shows it is effective. It is not just about changing people's drinking patterns: the main focus is on reducing harm. While health warnings and other measures can be useful in informing people, the evidence does not show that it has any impact on reducing harm.
What we have done is to look very carefully at all the research around the world to find the most effective documented strategies, which are summarised on page 17 and are worth examining. They are clearly to do with availability. If alcohol is easy to get for a ten, 12 or 15 year-old - young people tell us it is all the time - we can give them endless information and all the education programmes, but they will still have access to it. A disturbing aspect which happens in Ireland is that many adults - those over 18 - are buying alcohol for those who are under age. They tell us that they can go in and buy it themselves or adults buy it for them. This is an issue we must all consider. What is happening in our communities?
We do know that advertising is very important. All advertising now is very much about lifestyle and glamorisation. It is not about branding at all - it is a much broader issue. Much research has been done on this. I was at a WHO conference at which we looked globally at alcohol advertising. It appeals to the emotional side of people, particularly young people. The message being given out is that alcohol is fun, free and a must if you want to have a good time. We must explore ways of reducing the over-exposure of alcohol in advertising. We must focus on children in particular because they are greatly influenced by advertising.
We must go forward with what works, rather than what we think might work or sounds good. We have limited resources, as in all areas, and we must prioritise what we believe will reduce alcohol harm on the streets, in hospitals and to individuals. To return to Senator Henry's point, it is very important that we focus on young girls and women in particular, and we are intending to do it as part of our campaign this year. Two issues have come up: they are drinking pint for pint with men and it has a much greater effect because of their body size and so on; and what they are drinking does not taste of alcohol but tastes sweet, so that people do not realise the amount of alcohol they are putting into their systems. We need to address those issues with young people.
In Dr. Hope's initial contribution, she mentioned how young people wanted a "buzz" and were getting drunk quickly. They are doing this because of what is happening in their own lives and how they deal with it. That is a very important statement and something I have thought about for a long time. Young people are physically much improved over previous generations, but psychologically and emotionally, are they better? Has she any views on why young people seem to be less together than previous generations? What should be done? Have any studies been done on why young people seem to have less emotional and psychological stability than they apparently had previously? Indications of this include the abuse of alcohol, increases in suicide rates and so on. Are there any indications as to why that is happening or what can be done to deal with it? Has any research been done into why young people seem to be less emotionally and psychologically together, if that is the right word, than previous generations?
Like other speakers, I thank the Department for its presentation. Young people start drinking now at a young age, some as young as 12. Are we seeing any teenagers being treated on rehab programmes, going into counselling or anything like that? I was told a very sad story a few weeks ago about a young girl who was already drying out by the time she reached the legal age to have her first drink. She had been hospitalised on four occasions for this type of treatment. She had started drinking at the age of nine. Her family comes from a very large town in the west.
To go back to something you said earlier, Chairman, how responsible are the parents and how can they be held responsible? The mother in this particular case told me that she had gone around to several off-licences, not pubs. Apparently this is where younger children are getting alcohol. Publicans are being somewhat responsible in refusing to give it to them but they seem to get it more easily from an off-licence. She said her hands were tied and that she was fighting against a brick wall, with nobody doing anything to help her. Her daughter, at 18, tells the very sad story of her life being ruined, not knowing where she is going to go, not having any friends, of being at the end of a road and not seeing any future. Is there a pattern in this regard? Are we seeing younger people being hospitalised to dry out, a terrible phrase?
I also want to discuss advertising on third level campuses and the programme the Department has put in place to make students more aware. Could we see that introduced at second level? I know there is a big difference between the two and that there is no advertising in second level schools, but the problem does not exist at third level alone; it also exists at second level and possibly even at the senior end of primary level. It is only in the last three or four years that we have had alcopops, about which Senator Henry spoke, being put into the category where they belong, namely, alcoholic drinks. I think it was Deputy Tom Kitt, in his former ministerial role, who took them out of the soft drinks category, where they were being advertised, and into the category where they rightly belong. There has to be greater restriction on that type of drink because it is with them that young girls in particular start their drinking.
I welcome the representatives of the Department and am delighted they came along. A few ironies are thrown up by their presentation. Price and availability were mentioned a lot, but in continental Europe, alcohol is as freely available and probably cheaper than here, but these countries do not appear to have this youth drinking culture. Is there something in the psyche of Irish youth that makes them more vulnerable to alcohol? The United States has health warnings on drink, yet they serve the largest measures of spirits that I have ever come across. There is no control at all on how they serve spirits.
The reason we are discussing this here is the anti-social activities of young people. Many main streets in towns, not just Dublin, are very dangerous at closing time. We may have to revisit opening times for pubs. Promotions are one of the most insidious things I have come across. They did not exist when I was going to college but my children tell me now that not a weekend goes by without a Heineken promotion, alcopop promotion or whatever——
They go off campus and into the nearest pub.
Yes, you get so many tickets to go drinking for the evening. We will have to look at advertising and sponsorship again. We have to hit those and rein them in somewhat. Dr. Henry talked about the huge levels of alcohol found in patients coming into the sexual assault unit in the Rotunda Hospital. Perhaps everybody who visits an A&E department or goes into hospital a result of an alcohol-related problem should be handed a print out of their alcohol levels when leaving the following morning. That might impact upon some of them. Dr. Henry was talking about huge levels - 300 milligrams - of alcohol. That would be enough to kill many of us, yet still these people walk out the following day.
Minus the 300 milligrams.
Is the Deputy saying they should be given the bill?
There is clearly wide availability of alcohol in France and such countries. On the other hand, alcohol in Scandinavia is very expensive and is not widely available, yet some of those countries seem to have invented binge drinking. Could the representatives of the Department please explain that to us?
It is the weather.
Dr. Hope
I will deal with the issue of binge drinking. A very important study, the European Comparative Alcohol Study, was done among 15 EU member states, which looked at patterns of drink consumption, policy and harm over the past 50 years. It shows clearly that in southern Europe, the attitude to alcohol is very different. This is partly because it is seen as part of food consumption, something that accompanies a meal, and they do not have the type of pub drinking that we have in northern Europe. The Irish are the biggest consumers of alcohol outside the home. We do most of our drinking in public places and that is why we have so much alcohol-related public disorder on the streets. Most of our drinking is done in pubs and clubs rather than in homes and so on.
In northern Europe, the US, Australia and so on, availability is a critical factor. While overall consumption is a very good indicator, patterns of consumption can add to the amount of harm done. That is exactly what we are seeing now because we are doing most of our harmful drinking in a public place. It will take a generation to change our attitudes to alcohol. Culture is very engrained and all of us have to be more conscious of it. We all have to make a greater effort. We tend to blame the problem on young people but the fundamental point is that young people are doing what they see their older brothers and sisters doing. This does not perhaps apply to those who are 50-plus, but it certainly does to the 18-30 age group. Teenagers see people of this age coming home and talking about drink. Celebrations of every kind revolve around drink and the idea of advertising is to make every social occasion a drinking occasion. That is what young people are buying into.
I wish we had the answers, and some research has been done, but it is a very complex issue. Social and personal health education is trying to make young people in schools a bit more reflective, to look at their own value systems and beliefs and to see where they can develop self confidence and relationships with others. The whole idea of the value of community is also emphasised. It will take a long time, but the idea is for young people to see their lives in the broader context and not just as revolving around alcohol. That is why SPHE is very important. It is not about just giving young people information about alcohol, although of course we are doing that. They are getting information on drugs, sex, etc. The broader picture on the meaning of life for them is more important. What is their value system and what is it they want out of life? That will take many years to unfold. All of us in society have to look at how we can support that, otherwise we are in for a another turbulent ten years before we see this change.
Is it fair to say the problem has not been recognised, only at certain levels? Society has not recognised there is a problem.
Dr. Hope
But who makes up society?
Almost everybody one talks to does not know what one is talking about when one mentions these things. They relate them in a superficial way to difficulties young people are going through.
Dr. Hope
We are looking at several issues. We believe community is very important and we have done some pilots in communities where one is supporting parents. Parents cannot work on their own, they need supports. The communities in which people live are central to the value system. Because we have seen the consumption figures increase for the past six years in Ireland, one of the key aspects of the campaign was to try to raise public awareness. We believe we have been successful in that. People are now aware there is a problem. The problem has existed but we are now only hearing about it. People are debating it. We welcome the fact that the committee is discussing it. It is only through public debate that we can inform people and get them to say "we all have a contribution to make in solving this problem".
Should we change the licensing hours back to what they were? I voted in favour of them. I thought we would get like the continentals and loll about the place, having a couple of glasses of wine. I live on Burlington Road. Between Leeson Street and Baggot Street the level of vomit in the morning is shocking, a result of people being so drunk. I wondered if we should close the fast food outlets as it would make the place look cleaner. I have never seen another city like that.
We need to look at our Public Order Act as well which is so antiquated it goes back to the time of the miners' strike in the UK and we copied it. It is not strong enough. If the consequence of a night's drunkenness was more severe than it is, perhaps it would be a deterrent. If we are looking at licensing law we should look at that issue also.
On the point raised by Senator Henry and Dr. Hope's remarks about the different culture and drink in southern Europe, when we relaxed the licensing laws, not when the opening hours were changed but prior to that, in an attempt to give alcohol licensing to restaurants we were all to become continental, with the exception of the climate. To come at it from the other side, Dr. Hope says we are unique in having purely drinking establishments where one goes only to drink. Is there an argument for insisting on places that are licensed serving food? I notice that many pubs stop serving at 7 p.m. because it interferes with getting the drink out quickly enough. Should we try to associate drink more with food rather than have people go out specifically to get as much drink into them as possible?
It is fascinating to read in the Strategic Task Force on Alcohol Interim Report, page 17 of which outlines what works and what does not work. It is clear that curbing the drinks industry and restricting access are the kind of measures that have an impact. We should explore that further through the committee. It is clear that advertising, warning labels and alcohol education in schools appear to have no effect, which is news to me. In relation to community mobilisation which has some effect, at a practical level would it be worthwhile to encourage local authorities, councils, town councils, county councils and chambers of commerce to discuss and look at the conditions within their own area as to what is happening on the ground? There is a great deal of local knowledge - we have heard it here this morning - where people know what is going on. If a local authority had a strategy within the larger strategy it could create a certain amount of moral authority on practices in local areas as regards off-licences, public order and so on. This strategy should also include the Garda. Rather than simply using community groups should the statutory authorities within an area play their part?
I want to refer to the point made by Deputy McManus about proved effectiveness, limiting hours and days of sales. That all relates to availability. Will the delegation be recommending to this interdepartmental group that we change back the licensing laws? This is something that could be done because the Minister for Justice, Equality and Law Reform said the other day that the Dáil had voted for this and that is the way it is going to remain. Is this a recommendation that the delegation would make?
Mr. McGovern
Many of the points made by Deputies and Senators refer to availability in its wider sense in terms of opening hours and availability through restaurants and other means. From a public health perspective, we have recommended for the last number of years that it has been internationally recognised and accepted that greater availability equals greater harm. We continue to put forward that position from a public health perspective. There have been other arguments in terms of longer opening hours, the tourism trade, etc. The interdepartmental group which will be established will have representatives from all relevant Departments. The issue of availability, as recommended in the task force report, will be addressed through that forum.
As Department of Health and Children officials we will certainly put forward public health arguments in terms of availability but I do not want to pre-empt the outcome. We will be addressing advertising, promotion and sales through the Department of Health and Children group and the Minister will look at various options. We have a specific third level campus initiative. We have developed a framework whereby third level institutions can adopt a policy which reflects their campus ethos. I am not sure at this stage whether it could be extended to post-primary schools. Post-primary schools must have the SPHE programme in place by next September. The vast majority have it already. Some of the issues can be addressed through that forum.
Dr. Hope
The big difference between college and school campuses is that those in the college campus are legally entitled to drink alcohol so it is a totally different approach. On the issue of advertising - the committee has a copy of the Framework Document which we produced - it is for each college to decide what is acceptable advertising. We found that to sell a society event, the practice was to say "come to the debate and you will get free drink all night". It is fine to promote an activity but it should not be done through free alcohol. Some colleges decided to put forward guidelines. If there is to be free alcohol, there should be no more than two drinks per individual. If one is to get sponsorship from the drinks industry, make sure it is received in monetary terms and not in the form of free kegs - money is needed to run events, not free kegs. There were the various ideas put forward.
Each college has produced an alcohol policy and has decided its own ground rules. One university, for example, has ensured that facilities like cafés, etc. remain open in the evening so that people have an alternative to the pub where they can go and have a cup of coffee when they come out of the library. Those are practical, simple measures. Entertainment officers are looking at providing a whole range of activities that are not centred around alcohol and where people can have a good time without going to the pub and getting drunk every night. Those issues are important.
It would be very difficult to apply that to a school setting. Those under the age of 18 are not entitled to buy or consume alcohol but guidelines have now been published for schools to develop an alcohol and drugs policy in terms of how they deal with issues at school. That is in place but it is a very different approach to that of the colleges.
When I spoke about communities I meant the whole community in, say, a small town or part of a larger community, and the local authorities could be a very useful mechanism to support that. In regard to the community interventions, the first thing we requested was that they do an audit of what was going on in their local community, because many people said they did not realise what was going on, the number of outlets in the community, the sort of promotions that are run and the mixed messages young people are being given. Doing the audits raised a huge amount of awareness even before there were further interventions, and that is important.
Regarding restaurants, the thinking behind that was that we should drink with our meals. People drank with their meals but they just added to the amount of drinking. They go to the pub two or three nights a week but they are also having wine with their meals at home so it just increased the amount of alcohol we are taking in rather than changing habits. That is a problem.
Two of the biggest social changes that have occurred in my lifetime are the change in the drink driving culture and smoking. Are there any lessons to be learned from those campaigns? Smoking is now relatively unfashionable. The younger generation will not get into a car with drink on them. They will not drive if they have had a drink. These changes came about as a result of campaigns run over the years.
Is the report by the Swedish Professor Room based on world studies or on northern European studies?
Dr. Hope
World studies.
It makes very depressing reading in that educational procedures are virtually of no benefit and we should be raising the minimum age for drinking. That is coming from a totally different viewpoint. Would Dr. Hope be supportive of that?
Dr. Hope
For alcohol policy to be effective it is important that there is public support for it. There are many examples of that outside the alcohol area in that if there is not public support for particular rules and resolutions, they are ignored and are not worth the paper they are written on. We have to look at what is effective. There is no mood in Europe to increase the minimum drinking age. Some European countries do not have an age restriction, although most have. The age limit in most of these countries is between 16 and 18. This report is based on a global perspective. One of the most effective measures in Australia was the introduction of random breath testing because within a very short period fatalities and crashes were down about 30% or 40% and remained at that level for four years. Clear measures can be taken, therefore, and that is what we are saying in terms of the way forward.
I thank you for your presence here today. The presentation has been extremely informative and has raised many additional questions which this committee will have to seriously examine. Any of us who saw the "Prime Time" programme on the drink culture felt there was an onus on us as members of this committee to examine in great detail the issues raised in the programme and the mindset of young people. In addition to any initiatives the Minister or the interdepartmental group will take, this committee will have to decide whether to bring into the public forum people who have never been in the public forum before and ask them about their responsibilities in relation to young people and how they believe they should conduct themselves in terms of being responsible citizens.
Arising from "Prime Time", and particularly from what Senator Henry said this morning, I would like members' permission to invite a group of accident and emergency consultants to come before the committee as a first measure so that we could hear what is happening at the coalface in hospitals, particularly at weekends. At our next meeting dealing with this issue perhaps we could have a representative from Dublin, Cork, Galway or wherever to hear their views. At that stage we will have to make up our minds whether we should do an indepth report on the multifaceted issues involved. Is that agreed? Agreed.
The joint committee went into private session and adjourned at 11.10 a.m.