Table Of ContentALCOHOL AND THE PUBLIC HEALTH
~ MEMBERSHIP OF WORKING PARTY
J. R. Kemm Chairman
Consultant in Public Health Medicine
Central Birmingham Health Authority
P. Anderson
Director of Health Education Authority Primary
Health Care Unit, Churchill Hospital, Oxford
A. Bull
Consultant in Public Health Medicine
Yorkshire Health
D. Cameron
Consultant Psychiatrist
Leicester
H. Norris
Director of Aquarius
Birmingham
v. Parker
Director of Public Health Medicine
Scunthorpe Health Authority
ALCOHOL
AND THE
PUBLIC HEALTH
A study by a working party of the Faculty of Public Health
Medicine of the Royal Colleges of Physicians on the
prevention of harm related to the use of alcohol and other
drugs
M
in association with the
Macmillan Education
MACMILLAN
~ © Faculty of Public Health Medicine,
Royal Colleges of Physicians 1991
Softcover reprint of the hardcover 1s t edition 1991
All rights reserved. No reproduction, copy or transmission
of this publication may be made without written permission.
No paragraph of this publication may be reproduced, copied
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Any person who does any unauthorised act in relation to
this publication may be liable to criminal prosecution and
civil claims for damages.
First published 1991
Published by
MACMILLAN EDUCATION LTD
Houndmills, Basingstoke, Hampshire RG21 2XS
and London
Companies and representatives
throughout the world
Edited and typeset by Povey/Edmondson
Okehampton and Rochdale, England
British Library Cataloguing in Publication Data
Faculty of Public Health Medicine
Alcohol and the public health
1. Alcoholism & drug abuse. Medical aspects
I. Title
616.86
ISBN 978-0-333-54779-3 ISBN 978-1-349-21280-4 (eBook)
DOI 10.1007/978-1-349-21280-4
CONTENTS
~ Introduction 1
What is public health?; Why alcohol?; Definitions;
Synopsis; Summary
~ 1 How much do we drink? 11
A short history of consumption; Alcohol-related
problems in the past; Alcohol in different countries;
Consumption in Britain
~ 2 Medical and psychiatric problems related to
alcohol use 23
The benefits of alcohol; Alcohol-related harm; Alco
hol-related disease; Alcohol and cancer; Alcohol and
stroke; Alcohol-related mortality; Hospital workload;
General practice workload; Alcohol in pregnancy;
Unwanted pregnancy; Alcohol and AIDS; Psycholo-
gical effects of alcohol; Hangover; Withdrawal pheno-
mena; Intoxication; Alcohol amnesia; Delayed effects
of alcohol; Chronic organic consequences of alcohol
use; Functional disorders related to alcohol use;
Accidents, fire and drowning
~ 3 Alcohol and harm to the community 43
Alcohol and crime; Drunkenness offences; Family
disputes and social problems; Alcohol and employ
ment; The economic cost of alcohol-related problems;
Strategies for prevention; Alcohol consumption as a
risk factor; High risk versus population strategies; The
relative importance of alcohol and other drugs
v
~ Contents
~ 4 A better-informed public 59
How much can I drink without damaging my health;
Individual variation; Informed choice; Personal re
sponsibility versus society's responsibility; Attitudes to
drinking; Evaluation of alcohol education and health
promotion; Drinkwise Day - a single-focus event;
Tyne Tees alcohol education campaign; Alcohol
education as part of personal and social education
(PSE); Alcohol issues in the Look After Your Heart!
(LA YH!) campaign; Media alcohol campaigns; Infor
mal discussion as part of routine medical contact;
Alcohol in the media; The need for proper funding
for alcohol education.
~ 5 Control of availability: licensing laws 79
The efficacy of licensing laws; Enforcement; Restric
tion on number of retail outlets; Other restrictions on
alcohol sales; Control of opening hours - the Scottish
experience; The age limit; Changing sales patterns;
Licensing Justices; Licensing policies; Police and the
Licensing Justices; The concept of need for a new
licence; Control at the point of sale; Drinking in public
places
~ 6 Does taxation affect consumption? 95
Relative price and consumption; Effect of price versus
income; Effect of tax on price; Taxes on alcohol;
Objectives and constraints of alcohol taxation policy;
Tax revenue and alcohol; Trade, industry and employ
ment; Inflation; Payment of indirect social costs;
Alcohol tax as a prevention policy; The European
Community; Alcohol in the Retail Price Index
~ 7 Separating drinking and driving 109
Scale of the problem; Age distribution of accident
victims; Alcohol and road traffic accidents; Cost of
road traffic accidents; Evidential testing; The risk of an
accident and alcohol levels; Factors influencing blood
VI
Contents ~
alcohol levels; Drinking pedestrian or drinking driver;
The history of breath testing in the United Kingdom;
Deterring the drinking driver; Breath testing; Indiscri
minate systematic breath testing; Lowering the legal
limit; Zero legal limit; Organisations campaigning on
alcohol and road safety; Driving licence withdrawal;
Host liability; Hip flask defence; Insurance schemes;
Characteristics of drink drivers; Problem drinker/high
risk offenders; Courses for drink-drive offenders;
Prevention; Driving instruction
~ 8 Provision ofa dequate and early help 135
The need for services for problem drinkers; A range of
services; Self help and family support; Alcohol and
voluntary organisations; Alcoholics Anonymous; Spe
cialist alcohol voluntary agencies; Relevant non
alcohol-specialist agencies; Alcohol problems and
primary care; Alcohol and occupational health; Alco
hol and general hospitals; Care of problem drinkers by
psychiatric services; A planned and integrated service
~ 9 Local action to limit harm 154
Levels of prevention; Primary prevention is not
enough; Local policy and strategy statements; Exam
ples of local action; Collection of local data; Alcohol
education in schools; Local work with young people;
Providing alternatives; Workplace policies; Local
licensing forums; Drinkwise campaigns; Local work
with ethnic minorities; Local working with offenders;
Prison and after-care; Alcohol and the homeless;
Drying-out facilities; Meetings to elicit and co
ordinate local action
~ 10 The responsibility of the alcohol industry 171
Social responsibility; Financial support for alcohol
agencies; Customer education; Packaging and label-
ling; Health warnings on containers; Non-alcoholic
drinks; Advertising; Sports sponsorship; The drinking
environment
Vll
~ Contents
~ 11 Educating doctors 184
Recognising and helping patients with alcohol-related
problems; Doctors' attitudes to alcohol and alcohol
problems; Educational needs of doctors; Undergradu
ate medical education; Higher professional training;
Continuing education; Changing public attitudes; The
exemplar role of the doctor; Other occupations
~ 12 Recommendations for action 196
Who should do what?; The Government; The
Department of Health; The Treasury; The Home
Office; The Department of Transport; The Ministry
of Agriculture, Fisheries and Food; The Health
Education Authority; The BBC and IBA; The District
health authorities and Family Health Service Author
ities; Local authorities; Local education authorities and
schools; Magistrates; The Licensing Bench; The police;
The Probation Service; Health education departments;
Specialist alcohol agencies; The alcohol trade; Employ
ers; Medical schools and organisers of postgraduate
medical education; Everyone
~ Useful addresses 204
~ Index 207
viii
INTRODUCTION
~ What is public health?
Public health medicine is concerned with maintammg and
improving the health of the population by identifying and
tackling the factors in our lifestyle and environment which
threaten health. When the speciality was founded the greatest
scourges of the population were infectious diseases whose spread
was fostered by bad and unsanitary housing, polluted water
supplies and food which was· inadequate in quantity and quality.
These dangers have now been contained (though not abolished)
and the major threats to public health are posed by a different set
of diseases which are fostered by another set of environmental
hazards.
~ Why alcohol?
There have been many previous reports on the effects of alcohol
on health but these have largely concentrated on the health of
individuals. Alcohol problems are very much public health
problems since the health and well-being of individuals are
affected not only by their own drinking but also by the drinking
of their family, friends, workmates and other members of the
community in which they live.
The reduction of alcohol-related problems will not be
achieved entirely by the actions of individuals, though each
individual has considerable influence over their own suscept
ibility to the hazards of the environment in which they live.
Public health measures are needed to minimise the harms related
to the use of alcohol in our society.
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