Wasted
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Irish society, he believes, is still defining itself too closely with drink, simple as that.
‘Ireland has to learn that if you have a problem, alcohol isn’t the answer. We are still doing that; we did fifty years ago. If you had a problem, you avoided it and used drink to try [to] sort it out. We have a lot, too, of what I call the JR Ewing style of drinking. This is where people come in after a long drive or a journey and the first thing they do is reach for a glass of whiskey or a glass of wine. Those are bad habits. We need to bring the pot of tea back.’
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One of the main problems when looking at the issue of alcohol abuse in Ireland is that no one central agency or public health body is responsible for either research into the area or suggesting ways to deal with it. Several different sectors of society are conducting research into the causes and effects of alcohol abuse, but there are often disparate approaches, aims and objectives between the drinks lobby, public health and government.
At any one time several different reports are in the process of being published or about to be undertaken, whether it’s the drinks lobby looking at consumer trends, public health looking at alcohol-related harm, or individual institutions such as the Gehry Institute looking at wider sociological issues. There can’t be any joined-up thinking, because there is no coherent strategy to deal with the problem of alcohol abuse in Irish society. Government lacks the political will to seriously tackle the issue, preferring instead to speak in general terms about society’s responsibility. The voices of public health professionals are often muffled by the marketing juggernaut of the drinks industry. For instance, in one report by the Health Research Board (Mongan D, Reynolds S, Fanagan S and Long J (2007) ‘Health-related consequences of problem alcohol use’. Overview 6. Dublin: Health Research Board) looking at the health-related consequences of problem alcohol abuse, the recommendations highlight just how lacking the response to the problem has been thus far. The report called for a comprehensive strategy to reduce alcohol-related harm with a strong public health base. It went on to say that taxation, regulating the physical availability of alcohol and drink-driving countermeasures were only part of the solution.
One of the main recommendations was to ‘delay in the initiation to drinking among young people. It is important to decrease the easy access and availability of alcohol to young people and to increase the provision of alternative alcohol-free social activities.’
In terms of available data, the report acknowledged serious gaps and called for ‘accurate and complete data on the numbers receiving treatment for alcohol use’ as well as ‘greater integration of alcohol and drug treatment services’.
This call was made in recognition of the fact that one in five people receiving treatment for problem alcohol use also report problem use of at least one other drug.
As well as this, calls were made for strong health promotion campaigns to inform and educate women about the dangers of alcohol, especially during pregnancy; data on people with alcohol-related conditions who attend accident and emergency units but are not admitted to hospital; and accurate data on alcohol-related deaths, including those where alcohol was a contributory factor.
Much work needs to be done also in the area of alcohol-related suicide. At a recent conference in Cork, Dr Jane Marshall, consultant psychiatrist at the Maudsley Hospital, London, said alcohol was implicated in one in six suicides in Ireland but she believed the rate was much higher. She said, ‘Suicide rates are lower in women because of lower rates of alcohol and substance abuse, but as women drink more, we will probably see a corresponding increase in suicide among young women. It’s the chicken-and-egg syndrome. Usually, the alcohol problem comes first, but in some people, particularly women who have experienced traumatic life events such as sexual abuse, alcohol seems to be secondary to their depression problem.’
Also addressing the conference, Barnardos chief executive Fergus Finlay said the organisation was dealing with an increasing number of children whose lives had been ‘blighted by suicide’ where alcohol and drugs had been involved.
Finlay outlined the case of one 10-year-old boy whose father left him a letter telling him he was now the head of the household after taking his own life. ‘The number of people who commit suicide fortified by drink and drugs is staggering but a ten-year-old child cannot understand this link. Every single kid we work with carries guilt—sometimes for the rest of their lives or until they are lucky enough to get help—and believes they are responsible in some way for their mother or father’s suicide,’ said Mr Finlay.
Dr Declan Bedford, public health consultant with the HSE North East, whose study Minister Wallace referred to, pointed out that 16–17 year olds in Ireland spend a staggering €145 million per annum on alcohol.
He said: ‘The Irish suicide rate increased consistently from 1980 to 2006 with a slight drop in recent years. The alcohol consumption rate mirrors the suicide rate, i.e., the more a nation drinks, the more alcohol-related harm there will be.’
In a study of coroners’ reports on suicide deaths, Dr Bedford found that 90 per cent of those under 30 had alcohol in their blood, 58 per cent were drunk and nearly all were men. ‘I can tell you suicide was far from their minds when they went out that night,’ he said. Dr Bhamjee in Clare, too, had thoughts on the link between suicide and alcohol. ‘If you look at the time when many suicides occur among young people it is often Friday, Saturday and Sunday nights. I think it’s hard for young people to separate alcoholism from drugs these days as the two of them are nearly always linked. We see them together in at least sixty per cent of cases and both are major factors in suicides.’
Currently, research and targeted campaigns into the area of suicide, and all the other areas highlighted by the 2007 Health Research Board report, are lacking. It makes for a bleak if somewhat compelling insight into just how little concerted action has been taken to tackle the alcohol abuse epidemic in Ireland over the past two decades.
‘The two taskforce reports had about a hundred recommendations between them,’ says Prof. Barry. ‘If we’re waiting for unanimity then nothing will ever happen. Obviously the drinks companies will vigorously oppose in public and in private any attempts to reduce our overall consumption. So then any partnership between the industry and public health doesn’t make any sense. The ways you reduce consumption include tax and pricing. Taxes are relatively high here; prices are not, certainly in off-licences. Most of the cheap drink sold here is sold in multiples, such as supermarkets. There have been recommendations for a minimum pricing structure, which government haven’t to date implemented. That would be one way. Drink-driving [restrictions] will reduce consumption. [Reducing] availability of outlets could reduce consumption. Like anything, the more outlets you have the more alcohol will be sold.’
As previously mentioned, the drink-driving campaign in the past few years is an example of the positive role legislation can play in the alcohol debate. Public awareness campaigns, including stark television advertising, were having little effect in decreasing road deaths. The problem needed to be tackled, as behavioural changes were not occurring voluntarily among the public. Yet it took almost a decade before government took the advice of the public health lobby in this instance. Public health campaigns had been calling for mandatory breath testing since 1997, and it wasn’t introduced until 2007. A year after its introduction, 100 lives were saved, which makes you wonder how many could have been saved had the public health lobby been listened to much earlier.
‘The government is like everybody else—they respond to pressure,’ says Prof. Barry. ‘So they’re getting some pressure from the public health lobby. But the access the industry has to government is greater than public health. They’re very powerful companies, big corporations. It’s a globalised industry. They lobby at European level. They lobby locally. They give government ministers seats at Croke Park for international matches. You know. And the government have freely accepted and admitted that. You give somebody a ticket
for Croke Park, it’s that little bit less likely that they will do anything tough.’
In general terms, though, aside from public houses, where numbers are declining (most notably in rural areas), there hasn’t been any reduction in points of sale for alcohol in the last decade. In fact, in contrast to a decade ago, the majority of supermarkets and petrol stations now sell alcohol. Coupled with this, the marketing spend by the drinks industry has risen considerably, with some observers putting the annual ‘over the radar’ marketing spend at somewhere in the region of €70 million per annum.
The current programme for government has plans to initiate discussions with sporting bodies with a view to phasing out alcohol sponsorship in sport. But so far there’s little sign that the appetite exists or any concrete discussions are taking place in this regard. Advertising revenues continue to increase. ‘The industry will say advertising does not increase overall consumption,’ says Prof. Barry. ‘If not, then why spend that kind of money?’ It’s an important point and one that the government will have to tackle in the years ahead. The simple fact is that the industry spends so much on advertising because they believe it works and it gets people drinking their product. ‘There is a cultural dimension,’ says Prof. Barry. ‘There has been a few reports commissioned on the impact of advertising. Young people see and hear and experience the advertising. Alcohol adverts are brilliant ads, very clever. I heard a story of some Danish teachers who were visiting a national school in Ireland, and were talking to the twelve-year-old kids. One of their teachers asked, “Any questions now for the visitors?” And one of the kids asked, “Is it true the Danes don’t like Carlsberg to leave Denmark?” So those advertisements impact on young people.’
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Established in 2002, MEAS (Mature Enjoyment of Alcohol in Society) is a group whose origins lie in the Drinks Industry Group of Ireland, and was set up, as it says itself, ‘in order to better support the development and implementation of social responsibility initiatives’. The member companies of MEAS are Beamish and Crawford, C&C group, Diageo Ireland, Drinks Industry Group of Ireland, Edward Dillon & Co., Heineken Ireland, InBev Ireland, Irish Distillers Ltd, Licensed Vintners Association and Vintners Federation of Ireland. The society has a code of practice including guidelines on marketing and packaging of alcohol, and also holds an annual conference and issues a variety of publications. It also highlights individual bars and outlets who breach its code of ethics. One of the main offshoots of the organisation is the drinkaware.ie media campaign and website, which was launched in November 2006. The site is interesting and eyecatching, obviously aimed at a younger market, and includes features such as a ‘drinks diary’, facts on ‘alcohol, sport and you’, and various other bits of information and consumer polls. The largest aspect of the website, when I clicked on in mid-March 2009, was a box highlighting ‘The Morning After Cure’. This basically turned out to be a chatty guide to how to minimise hangovers, from drinking water to telling people to have ‘48 hours without alcohol if it was a heavy session’. The tagline says that, in respect of hangovers, ‘time is the only cure’. Moderation doesn’t get a look in.
As with the general drinks industry response to Ireland’s issues with alcohol over the past two decades, there is a real sense of closing the stable door long after the horse has bolted. In another section entitled ‘Top Ten Booze Myths’, it looks at whether or not milk should be drunk to line the stomach before a night out. The site, and by association the drinks industry who fund it, offer the following advice: ‘. . . eating before you drink is way better than scoffing a bag of greasy chips after a skin full. You’ll avoid puking on the dance floor because you drank on an empty stomach and you won’t succumb to overpriced burgers, which you’d rightly avoid under normal circumstances. Milk on its own won’t do much for you though.’ Is this really the manner in which responsible drinking should be promoted? Does it not raise issues about the suitability of self-regulation within the drinks industry and its ability to carry the public health agenda?
I raised the subject of MEAS and drinkaware.ie with Professor Joe Barry. At the very least, the drinks industry were attempting to raise important points of public health through the media; surely that should be welcomed? ‘The coverage in the media has taken on the public health view, by and large. Which is unusual, given that historically journalists (like doctors) would have strong relationships with alcohol. You read the business pages, though, and you see a completely different agenda from drinks companies. If they’re on about corporate social responsibility, it’s a meaningless phrase. The difficulty with MEAS is that they are funded by the industry. MEAS are not going to do anything that will harm the industry. I don’t believe that they work independently. They have the same views as the industry on any topic. Okay, so MEAS will get tough with some poor publican down the country who goes against their codes, but in general, MEAS don’t criticise. They’re not independent. Full stop. They have slogans such as “drink responsibly.” We have asked the industry, “What does drink responsibly mean?” and we haven’t got an answer. It’s meaningless. The public need information, but I would prefer to see it coming from the health sector than the drinks industry.’
Fionnuala Sheehan, Chief Executive of MEAS, rejects criticisms of the organisation and says that the drinks industry has provided a €20 million funding commitment over the next five years towards the organisation. She points to the fact that MEAS is run by an independent board appointed by member organisations and that she and her team work separately from the drinks industry. She says the industry became concerned with establishing a code of ethics in 2001/2002 and that the work of MEAS is very much research led. Her comments, below, though would seem to underline the view held by some in the public health lobby—that the drinks industry has the ear of government, more so than those pushing the health agenda: ‘Our point of view in MEAS is that we recognise the sensitivities involved and are conscious of the funding we receive. We also believe we would be very much open to the HSE involving itself in a direct way into the area of drink responsibility as was done with the drink-driving campaign. I have to say, though, the response of government so far has been very positive. I’d refer you to the comments made by [the] Minister for Health Promotion a year ago, where he referred in warm and positive terms to the work of MEAS and expressed a desire to see greater collaboration between us and the HSE.’ She agrees with the view that drinking patterns are shifting, and when pressed on whether or not MEAS agrees that alcohol consumption levels are too high, Sheehan says the following: ‘MEAS is on record many times saying our alcohol consumption levels are at an internationally high level. We referred to a reaction occurring in recent times and we said that is a positive development.’
As already mentioned, the Irish industry does not differentiate between beers and spirits and its approach to the problem of alcohol abuse is one of a united front, unlike in Denmark, for instance, where the industry has fractured.
‘We are strongly of the view that alcohol is alcohol is alcohol. Our view is that it would not be useful in helping to promote responsible drinking if we differentiated between the products. We don’t believe one product is benign as opposed to another one.’
Of the current deficiencies in the overall approach to problem drinking in Ireland, MEAS, though, accepts there are shortcomings in the current societal approach: ‘I think there is recognition that this is a complex problem that needs a multifaceted approach. It’s something we don’t have at present. There is a lot of consensus that we need a national policy towards alcohol involving all the relevant departments. There are some individuals opposed to us all getting around a table, as they see it purely as a public health issue. That will have to change.’
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It’s clear from the current body of research that Ireland has high levels of problem drinking which is costing society. Our per capita consumption levels continue to rank among the highest in Europe. It’s worth bearing in mind also that the Total Abs
tinence Association (or Pioneers) still claim membership of close to 200,000 individuals in Ireland, committed to abstaining from alcohol. When that group is taken out of the adult population, then the statistics paint an even starker picture. The binge-drinking levels, particularly among young adults, are placing huge burdens on health services, and will continue to do so through the life of each drinker. More studies are needed on the links between alcohol, suicide and depression, and there is also a need for more accurate information with regard to coroners’ reports and the collection of alcohol-related harm statistics. The government, for their part, are in a difficult position, with a powerful drinks lobby employing close to 100,000 individuals at a time of economic stress. There are different viewpoints within government as to how best to tackle the problem and indeed the responsibility falls, sometimes, between different departments.
It remains to be seen whether or not self-regulation within the industry is the best way to approach the issue. During the 1990s and into 2001, when research was showing drinking levels to be reaching critical proportions, the industry took very little concrete action to tackle the issue, aside from internal discussions. It wasn’t until 2002, after damning statistics on binge-drinking had been released the previous year, that efforts were made to publicly address the problem. MEAS, despite its protestations, is a drinks industry body, and rarely if ever criticises the direction of Ireland’s drinking patterns in public. There is a cosy feel to its literature and stance, and it comes across as more of an ‘after the event’ body than one seriously committed to tackling the underlying issues of Ireland’s drinking patterns.