This years Doolin lecture addressed the issue of alcohol consumption and its adverse effects on health in Ireland. The very title of the talk is indicative that we as a country are beginning to take the issue of alcohol excess more seriously. Its always dif?cult when a doctor has to stand up and present a thou shalt not lecture. Joe Barrys talk, however, was both timely and necessary. Alcohol intake needs to be controlled and monitored. Medicine does not have any antedote for addiction or its toxic medical effects. Moderation is our only protection against the adverse effects of alcohol. One of the central themes of the lecture was who should act as public guardians in the moderation of drink intake.
Alcohol consumption has increased in the Irish population. Consumption per capita has risen from 7.6 litres (1989) to 11.1 litres (2000). Factors implicated in this increase include a higher per cent of regular drinkers at 18 years and greater alcohol availability through longer opening hours.
- Irish alcohol consumption has increased 7.6 litres (1989) 11.1 litres (2000)
- Higher per cent drinkers at 18 years
- Greater access to alcohol
Alcohol is harmful in a wide variety of ways. In excess it causes personal medical and psychiatric harm, an adverse effect on relationships, frequently precipitates violent behaviour, leads to drink driving. While overall mortality has decreased by 15%, alcohol related mortality has risen. More liver related problems are now being encountered.
- Alcohol causes a wide spectrum of problems
- 25% 0f A/E admissions are due to alcohol
- 40% fatal RTAs have an alcohol factor
- One third of pedestrians killed in RTAs have high alcohol concentrations
- Unremembered sex- Drink is the real rape problem
Regulation measures work best in controlling alcohol consumption. Education on its own has little or no effect. One debate is whether the minimal age should be raised from 18 years to 21 years. Random blood testing of drivers is also proposed as an effective ploy. Taxation is known to in?uence alcohol consumption. In the last 10 years the tax on alcohol has decreased from 37% to 31%.
- Regulation is more effective than Education
- Some feel that the minimum age should be raised from 18 yrs to 21 yrs
- The role of random blood testing of drivers
- Lowering of blood alcohol level to 50mgs%
- Increased alcohol taxation is a consideration
Barrys central theme is that alcohol is embedded in Irish culture and society. Alcohol is part of all our social events. Alcohol has a high pro?le in Irish sporting events. Examples include All-Ireland hurling ?nals and Heinekin cup rugby. At one partical event the word Guinness appeared 6 times on each admission ticket. Guinness also have a major presence at music events and festivals.
- Strong alcohol advertising in all media
- Drinking together and thinking together
- Exposure and extensive sponsorship
- Promotions with highly visible sports
The Second Report of the Strategic Task Force on Alcohol was published in September 2004. It highlights the healthcare costs. In 2003 the total was 2653.8 million Euro. The top items were loss of output due to work absences 1053 million Euro, medical costs 433 million Euro, RTAs cost 322 million Euro. The Report recommends that availability should be regulated, alcohol promotion should be controlled, public and private environments should be protected, effective treatments must be put in place.
MEAS stands for Managing the Enjoyment of Alcohol in Society. Most of the major players in the drink industry are members. Their document has been critised because it does not state safe limits and binging is not discussed. Barry suggests that the alternative meaning of MEAS is Minimising Effective Action by the State. Public Health experts feel that alcohol control cannot be left to the industry and the free market. Central control is necessary. It wants alcohol taxes raised and adverts banned.
- Alcohol control cannot be left to the free market
- Taxes should be raised
- Ban alcohol related adverts
Gro Harlem Bruntland, Director General of WHO states although drinking is a personal act and an individual responsibility it is also a behaviour shaped by our societies for which society as a whole has a responsibility.. it is thus counterproductive to formulate health policy responses exclusively for the individual.
JFA Murphy Editor
Irish Medical Journal January 2005 Volume 98 Number 1 www.imj.ie/ |