Healthier Scotland - April 2012

The April edition of the SHA Scotland E-Bulletin - Healthier Scotland is now out!

The Alcohol (Public Health & Criminal Justice) (Scotland) Bill

New consultation from Scottish Labour MSP's Richard Simpson and Graham Pearson on their proposed Alcohol (Public Health & Criminal Justice) (Scotland) Bill.

While SHA Scotland supports minimum alcohol pricing we also recognise that this is only one measure of many that needs to be taken to tackle alcohol abuse in Scotland. 

 The Bill contains a total of 14 measures, spanning public health and criminal justice policy including:

• Stop retailers flaunting the new ban on bulk-buy promotions by closing down a loophole in the law
• Require government to report on progress on public health and child protection licensing objectives
• Clamp down on alcohol marketing in public places, especially where children may be exposed
• Introduce a legal limit of 150 mg per litre of caffeine of pre-mixed alcoholic drinks
• Evaluate and improve alcohol education and public information campaigns
• Tighten the law to prevent unfair discrimination against 18-21 year olds in off-sales
• Give local communities a greater say in licensing decisions
• Establish a National Licensing Forum to drive forward improvements in licensing laws and devise solutions to emerging problems
• Give local authorities powers to roll out ‘bottle-tagging’ to help the authorities crack-down on retailers selling to those under age and proxy purchasing
• More targeted disposals for those convicted of alcohol-related offences
• Fast track treatment for individuals taken into custody who are perceived to have an alcohol problem
• Give courts powers to ban individuals from drinking in specified places to help curb alcohol-related criminal or disorderly behaviour and to protect others from such behaviour
• Extend the successful Drug Treatment and Testing Orders (DTTO) to cover offences where alcohol has been a factor
• Require GPs to be notified of any new conviction by patients where alcohol was a factor to ensure patient receives appropriate treatment and support

This is a comprehensive paper that sets out a cogent case for the measures described. The consultation paper can be downloaded here. The SHA Scotland will be considering this at our May meeting and we would encourage members to read the paper and let us have your views.

Why We Support the Alcohol Minimum Pricing Bill

The Socialist Health Association Scotland supports the Alcohol Minimum Pricing (Scotland) Bill being debated at Holyrood today.

The price of alcohol misuse paid by Scottish society is well over 2 billion pounds, with the cost to the NHS estimated at over 400 million.

But, the true price of alcohol is borne by our communities and families.

Alcohol has an important place in our cultural and social lives and in our economy. But our relationship with alcohol has gone in wrong direction down the wrong road. In fact we have driven off the road and into a lamp post – drunk and disgraced.

The harmful effects of alcohol misuse are also widely known in terms of its impact on health and wellbeing and on health inequalities – where alcohol contributes much to the shameful inequality in life expectancy that blights the people of Scotland.  

Sadly, alcohol misuse hits the poorest hardest. But, as Ed Miliband said “the gap between rich and poor doesn’t just harm the poor. It harms us all”. And So problem drinking is not confined to certain groups, it affects us all. Recent data from the Scottish Health Survey show that we are all drinking too much.

Our efforts to tackle Scotland’s increasing alcohol culture have thus far been pretty hopeless. You may not be surprised that health education and awareness campaigns are the main alternative proposal from the drinks lobby. Such campaigns don’t work – are usually expensive and largely ineffective.

Many of the arguments against alcohol minimum pricing echo those we heard when the Labour-Liberal administration were legislating to ban smoking in public places. Landmark public health legislation which we can be proud in Scotland to have led the way on and which thre rest of the UK followed. Legislation, which in a short time has delivered dramatic reductions in heart disease and deaths with none of the adverse effects muted at the time.

The thrust of this Bill is to increase the cost of alcohol. Simple. Alcohol is too cheap – fact! It is over half as affordable now than it was in the ‘80s. And it’s not surprising then that consumption has doubled in the same period.

There is now a large body of evidence from around the world that links the price of alcohol to the level of consumption and in turn to the level of alcohol-related harm.

And, yes we recognise that taxation could achieve the same benefits, with the added advantage that revenue would go to the state rather than the retailers. However, excise duty is a reserved power and there is no way George Osborne and David Cameron will act. A compensatory levy, similar to the recent 'Tesco Tax', could cover this point. But it needn’t be an absolute condition for support.

The only other major argument against this legislation is that it will disproportionately affect low income groups.  Alcohol, at present, already disproportionately effects low income groups. The way supermarkets target and sell alcohol as a loss leader, row upon row of cheap cider and booze is a disgrace and no different to and arguably more harmful than a drug dealer up a close.

A robust evaluation of the policy, as it is introduced, should be undertaken which explores any adverse impacts – particularly, in relation to ensuring the most vulnerable communities are not harmed and inequalities widened. And the promised sunset clause to fully mitigate.

There is wide support for this, and the NHS, the police, the media, children’s charities, wide sections of civil society including religious groups, and public opinion. Up against who? The alcohol lobby and some licensing boards.

Like the smoking ban, this legislation is not perfect, nor is it going to be a panacea to all our alcohol problems. And of course it needs to be part of a wide range of initiatives, which need to be brought forward. But, there is no doubt it is part of the solution. 

Abstaining in parliament on such an important issue does not feel right and will not look right.

The right thing to do is to support the Bill.

Scottish Labour Fringe Meeting

SHA Scotland was on the fringe at last weekend's Scottish Labour Party conference in Dundee. 'Health policy - where next?' was sponsored by UNISON Scotland.

UNISON's Gordon McKay chaired the well attended meeting and opened by referring to the Progress journal's implied support for the English health reforms and marketisation of the NHS. Some 'comrades' clearly have lost the plot! He contrasted this with SHA Scotland's new policy journal Healthier Scotland.

Dr David Conway kicked off the debate with SHA Scotland's principles and his analysis of where we needed to take the debate.  He welcomed the level of political consensus in Scotland around health inequalities but recognised that we have huge health challenges to address and that requires new thinking on how to address them.

Shadow Health Secretary Jackie Baillie MSP debunked the myth that NHS Scotland was somehow protected from cuts - £319m was being cut. But her main message was that the agenda for Scottish Labour is wider than simply healthcare. We need to relentlessly focus on life chances for the youngest children. 

There were many excellent contributions from the floor. In particular a lot of debate around social care integration in Scotland.  Including concerns that the Change Fund is being used to privatise not integrate care services. The Highland pilot in particular is heading for disaster according to more than one contribution.

Good debate as ever from a knowledgeable audience. 

Healthier Scotland - The Journal

The first edition of our new policy journal - Healthier Scotland has been published.

The March 2012 edition was launched at our fringe meeting at the Scottish Labour Party Conference in Dundee.

This edition includes:

 

Future health policy	Jackie Baillie MSP
Minimum price for alcohol?	Dave Watson
Low pay is bad for your health	Eddie Follan
Health impact of climate change	Dr David Conway
NHS Scotland ‘leading edge’ of industrial relations	John Gallacher
Housing and health	Murdo Mathison
Local healthcare in Norway	Eberhard ‘Paddy’ Bort
Scotland in the midst of an obesity epidemic	Richard Simpson MSP
English health reforms	Stephen Adshead
NHS Scotland – the real challenges	Matt McLaughlin
Coronary heart disease	Janet McKay

Asset Based Approaches in Scotland

The latest edition of Scottish Anti Poverty Review has an excellent article by Lynne Friedli on the rise of asset based approaches to tackling poverty in Scotland.

This is critical study that while recognising some of the strengths of this approach, cautions against solely relying on it as this quote highlights:

"It also means keeping the focus on the root causes of poverty. Persistently asking: ‘what are the social structures that result in and maintain profound inequalities in the distribution of assets in Scotland?’ The failure to ask this question is the primary weakness of the assets movement. Like complexity theory and other ecological explanations for social problems, assets approaches are based on the view that achieving positive social change is essentially ‘an organic, collaborative and apolitical process in which different stakeholders contribute to an agenda that benefits everyone’ (Greenhalgh 2009). What are missing from these accounts are vested interests and the political struggle which is required to achieve both fairer distribution and ‘lines of accountability for the factories of social injustice’ (Birn 2009)."

Dr Lynne Friedli is the keynote speaker at a Social Health Association meeting on the subject 'Health Inequality - Mental and Physical'. It will be held on Saturday 9 June11am - 4pm at Edinburgh Quaker Meeting House  7 Victoria Terrace, EH1 2JL.

Scottish Labour conference motion

This is SHA Scotland's contemporary motion to the 2012 Scottish Labour Party conference.

Alcohol (Minimum Pricing) Bill

This conference notes that the Alcohol (Minimum Pricing) Bill is currently being considered by the Scottish Parliament. The Bill seeks to introduce a price at which a unit of alcohol cannot be sold below with the aim of reducing alcohol consumption and related harms.

Conference recognises that Scotland has one of the fastest growing rates of chronic liver disease and cirrhosis in the world. There are more than 42,000 hospital discharges due to alcohol related illness and injury and mortality as a direct result of alcohol has more than doubled since the early 1990s. Alcohol is a contributory factor in 1 in 20 deaths in Scotland.  49% of Scottish prisoners (including 76% of young offenders) and two-thirds of those accused of homicide said they were drunk at the time of their offence. Alcohol misuse costs Scotland an estimated £3.56bn per annum. Scottish consumption of alcohol is now 23% higher than in England.

Conference accepts that there are legitimate concerns about the legislation. The measure can be viewed as unfairly penalising the majority of moderate drinkers and disproportionately affecting low income groups who tend to pay less for a unit of alcohol. There is also a concern that if alcohol prices increase, problem drinkers with a low income may use spending from elsewhere in their budget to maintain their consumption levels to the detriment of families. The legislation may also be incompatible with EU law. However, we have to accept the evidence of the relationship between price and consumption.

Conference recognises that taxation could achieve the same benefits, with the added advantage that revenue would go to the state rather than the retailers. However, excise duty is a reserved power and there are no indications that the UK Government is prepared to act. A compensatory levy, similar to the recent 'Tesco Tax', could cover this point.

Conference believes that for Scottish Labour the impact on reducing health inequalities by reducing the harm caused by alcohol is a key issue. People living in our poorer communities carry a disproportionate share of alcohol-related health and social harm. Alcohol mortality rates are six times higher in the most deprived areas. Our primary concern should therefore be to introduce alcohol policies which are in the public health interest and will be effective in reducing the high levels of alcohol harm in Scotland.

Conference recognises that minimum unit pricing is widely supported by the medical and public health community and also by the police, children’s charities and a wide section of civil society. While we recognise concerns over the effectiveness of the measure there is an overwhelming need to take action.

Conference therefore believes that we should be prepared to consider supporting the Alcohol Minimum Pricing Bill as one measure in a more comprehensive plan to reduce alcohol harm, subject to a detailed evaluation process including fully assessing adverse effects particularly on poorer communities, families, and individuals; extension of the compensatory levy, and a corresponding sunset clause.