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Toasting to success for the Alcohol Bill?

The Public Health (Alcohol) Bill 2015 was approved amid much fanfare by the Government in December 2015. The official Department of Health press release at the time described it as “ground-breaking legislation”.

However, since then, to the anger of many in the medical community, it has not moved very far, with political support among some Government back-benchers waning and optimism among public health advocates severely tested.

Supported by public health advocates and opposed by the alcohol industry, there have been frequent reports of “unprecedented” lobbying of politicians in relation to this legislation.

At the end of last month, Minister for Health Simon Harris signalled that the delay may be nearing an end, despite some lingering concerns with aspects of the Bill among some members of his own party, Fine Gael.

With the Oireachtas just recently returned (20 September), the Bill is expected to be at the centre of the public health debate again over the coming weeks.

Speaking to reporters recently at the launch of the Rutland Centre’s second Annual Recovery Month, Minister Harris confirmed the Bill would be a significant focus for the Oireachtas this session.

Minister Harris indicated that he would like to see the stalled Bill now make rapid progress, and wants to see it pass through all stages by the end of autumn.

 “I suggest we listen to medics and to clinical experts perhaps an awful lot more than we listen to some vested interests in this regard,” Minister Harris told reporters.

“I believe you can make every ‘Trojan horse’ argument that you wish to dilute this legislation, but at the end of the day, if we are serious about showing political leadership on alcohol, rather than political platitudes, we need to get on with delivering this legislation.”

Minister Harris mentioned concerns raised by some Senators over the impact the Bill may have on small businesses, but he said this was not the intention of the legislation.

“Those comments [by Minister Harris] are quite encouraging,” Prof Joe Barry, Chair of Population Health Medicine at Trinity College Dublin, told the Medical Independent (MI).

“I think it does highlight the challenge though, because basically, his [Minister Harris] own backbenchers and Senators are defying him.

“The situation is this: It’s a Government Bill and the main opposition is coming from the Government party [Fine Gael].”

A strong supporter of the Bill, Prof Barry maintains that the coming weeks are important. However, he believes the public health arguments have essentially all been made. Now it’s up to the politicians to make the legislation happen. 

“I think it is purely about politics now,” said Prof Barry.

“We’ve [public health doctors] made our case. The industry does not want it. The Government says it’s a big problem. So therefore the logical thing is to act. We’ll see.”

According to the Department of Health, the stated aim of the Bill is to reduce alcohol consumption in Ireland and to reduce the harms associated with alcohol.

Supporters of the Bill insist its provisions — such as minimum unit pricing (MUP), health labelling of alcohol products, the regulation of advertising and sponsorship of alcohol products, and structural separation of alcohol products in mixed-trading outlets — will lead to a decrease in alcohol consumption and thus improve public health.

“The Public Health (Alcohol) Bill 2015 is currently at committee stage in the Seanad,” a Department spokesperson told MI last week.

“The Bill was withdrawn from committee stage in late 2016 in order for the Minister to consider the concerns raised in relation to a possible financial burden on small shops arising from the requirement in relation to the separation of alcohol products in mixed-retail outlets.

“The Minister has stated his intention to bring the Bill back to the Houses in the next session.”

Despite concerns raised by some Fine Gael party members, the party leader and Taoiseach holds a unique position within this debate, for it was he who originally published the Bill back in December 2015.

“This is legislation that I support strongly. I published it myself as Minister for Health and introduced it into the Seanad just over a year ago,” Taoiseach Leo Varadkar told the Dáil in its final week before the summer recess.

“I met with the Minister, Deputy Simon Harris, about it and other matters just last week. The Government is very keen to have this legislation enacted. It is not going to be possible to have it done before the recess, but it is intended to have it enacted through both the Dáil and Seanad in the next session.”

The Taoiseach was responding to a question from the former Chair of the Oireachtas Committee on the Future of Healthcare, Deputy Róisín Shortall (Social Democrats), who raised concerns about the delay of the passage of the Bill — concerns that have been echoed across the medical sector.

“It is now almost a year-and-a-half since the Public Health (Alcohol) Bill started its passage through the Oireachtas,” Deputy Shortall told the Taoiseach on 5 July in the Dáil.

“It has been moving at a snail’s pace. In that period, there have been 1,600 alcohol-related deaths. Approximately 800,000 bed-nights have been taken up in hospitals as a result of alcohol-related illnesses and there have been 420,000 absenteeism days as a result of alcohol abuse.”

Advocacy bodies such as Alcohol Action Ireland have also bemoaned the Bill’s lack of progress. In June, it warned in a statement, “for over 500 days the Bill — a progressive piece of legislation designed to significantly and positively alter Ireland’s harmful relationship with alcohol — has languished in the Oireachtas and faced inordinate delay.”

Politics

Prof Barry believes the problem is “not the Taoiseach or the Minister [for Health]; they are fully behind it I think, which is very important”.

“But some of these Senators are dead against it. It really is a test for the Government.

“The Minister’s comments are quite encouraging, but there is still a challenge. That is the way I would see it.”

Prof Barry believes the debate over the Bill has moved from the world of medical advice into the hard reality of lobbying and politicking within the corridors of the Dáil and Seanad.

 “Look, the way I would see it now, is that it is purely down to politics. It is not about evidence now; it is about politics.

“I think politicians will be continually lobbied [in the coming weeks], even if it [the Bill] becomes enacted.

“But I think it is a question of the Government leaders, particularly the two most important people, the Taoiseach and the Minister for Health Simon Harris, and they have now both publicly on a few occasions said this should happen [the passage of the Bill].

“I think that’s great, so I think that hopefully means that they will not give in to pressure from the lobbyists and from their backbenchers.”

Although concerned about the political battle that may take place over the next few weeks, Prof Barry is convinced that the successful passage of the Bill would have both a symbolic and real impact on public health.

Important

“It is an important Bill, for a few reasons,” said Prof Barry.

“First of all, it is the very first Public Health Alcohol Bill; we have had very good public health tobacco legislation, for instance. But this is the first alcohol one and it [alcohol abuse] is a huge problem.

“Sure, a lot of the arguments [of the alcohol industry] are spurious. You know, I’m not sure when convenience stores started selling drink in the beginning, but when I was growing up they didn’t sell drink.

“It is a psychoactive substance. You should need to have a slightly stronger licence [to sell it]. It is about availability; the more available, the cheaper it gets. I think the Bill will make a difference, it will make alcohol less available. It will help people who are heavy drinkers, people who are alcohol-dependent, they will be helped because of the MUP and the restrictions on marketing. All this is needed.”

Hoping for change

In December 2015, the Public Health (Alcohol) Bill was published.

Then Minister for Health Leo Varadkar was very optimistic and positive about the significant difference the Bill would make when speaking at its launch.

“The evidence about Ireland’s drinking habits is shocking. Four out of 10 drinkers typically engage in binge-drinking,” said then Minister Varadkar.

“This Bill addresses alcohol as a public health issue for the first time by tackling price, availability, marketing, advertising and labelling.

“By taking this approach and confronting the problem in a wide range of ways, I am confident that we can make a huge difference to public health. We have talked about these measures for long enough. Now is the time to make it happen.”

However, since then the Bill has languished amid controversy over some of its proposals.

In the meantime, significant levels of alcohol-related morbidity and mortality continue in Ireland. Earlier this year, a study in The Lancet found that, of the 50 countries for which data was available, Ireland was in the top five countries for drinking alcohol during pregnancy. And just this month (September), Ireland was again the focus of attention when JAMA Paediatrics estimated that 47.5 children are born with foetal alcohol spectrum disorders (FASD) per 1,000 births in Ireland.  Only South Africa and Croatia are identified as having a higher occurrence.  This compares with a global average of 7.7 per 1,000, according to the JAMA Paediatrics study.

Support

The successful passing of this Bill is not the only measure the Minister for Health has tried to make in the area of public health in recent months. As exclusively reported in MI in January, specific price increases on cigarettes and alcohol that were sought by Minister Harris did not make Budget 2017.

Minister Harris wrote a detailed letter to the then Minister for Finance Michael Noonan on the issue of duties on tobacco and alcohol two weeks before the announcement of Budget 2017. However, these increases were not introduced in the final Budget.

But the support for the Alcohol Bill goes beyond the Minister and high-profile public health leaders like Prof Barry and the RCPI Policy Group on Alcohol. Ireland’s leading medical representative bodies have also weighed-in behind the Bill, insisting that the legislation must be a priority.

The IMO has previously called for the “urgent enactment” of the Bill. The union also urged the Government to introduce a specific “levy on the alcohol industry for the treatment of alcohol-related harm”.

Earlier this summer, the NAGP also came out in strong support of the Bill. In a statement, the Association demanded that the “Government not… bow to pressure from private interests”.

“This is an important Bill, legislating for the first time on alcohol consumption as a public health measure. As healthcare professionals in the community, we recognise the importance of this Bill,” said NAGP President Dr Emmet Kerin in June.

“The Government must resist the pressures of private interests who would seek to put profit from alcohol sales ahead of the public interest. The visibility of alcohol must be reduced in retail outlets and health labelling should be included to help consumers make better decisions for their health and wellbeing, both mental and physical.

“Our health system is overwhelmed. Health promotion initiatives such as the Public Health (Alcohol) Bill are critical to reducing preventable diseases and keeping patients well.”

Lobbying

The mention of ‘private interests’ brings forth the debate about lobbying around the Public Health (Alcohol) Bill.

Earlier this year, RCPI President Prof Frank Murray, another strong supporter of the Bill, told MI that “an enormous amount of lobbying is taking place by the alcohol industry”. Prof Murray added that the “intensity of the lobbying is almost unprecedented in terms of its scale”.

“Alcohol has a huge impact on everyone who needs access to healthcare, because it drains the resources of the State and the healthcare system,” he told MI. “There are consequences every single day that we don’t implement [the Bill].”

Echoing his comments, Prof Barry told this newspaper: “This is completely David versus Goliath. They are big corporations with huge profits.”

A Department of Health spokesperson admitted to this newspaper earlier this year that the scale of recent lobbying against the Bill has been “significant”.

However, the alcohol industry defended its right to MI to seek what it sees as improvements in the proposed legislation. The Alcohol Beverage Federation of Ireland (ABFI) cited the World Health Organisation (WHO) as encouraging the inclusion of all “stakeholders” in the development of national health policies and strategies.

“As an industry, we’ve openly supported the introduction of legislation to tackle alcohol misuse and the consumption of alcohol by young people,” Ms Patricia Callan, Director of ABFI, told MI.

“However, we are concerned certain proposals are not supported by evidence with regard to decreasing misuse. As such, it’s perfectly legitimate to seek improvements to proposed legislation to ensure that it is workable and evidence-based, rather than rushed and ineffective.

“It is entirely appropriate as part of the democratic process for stakeholders to communicate their positions [on] the Bill to politicians who are charged with scrutinising its provisions before its enactment.

“The WHO says that national health policies, strategies and plans are more likely to get implemented effectively if their development and negotiation is inclusive of all stakeholders in and beyond the health sector. The includes the private sector and businesses.

“Our activities in this regard remain completely open and transparent and are publicly available to view on the Lobbying Register.”

Industry

Ms Callan claimed that the alcohol industry is not against any legislation in this area.

“As an industry, we’ve openly supported the introduction of legislation to tackle alcohol misuse and the consumption of alcohol by young people,” Ms Callan told MI.

“We are concerned that certain proposals are not supported by evidence with regard to decreasing misuse. The facts tell us that they will not reduce misuse, but that they will have unintended negative consequences on jobs and business, affecting the 200,000 people employed in the drinks and hospitality sector across Ireland.

“For example, the Bill contains a series of punitive measures that would make Ireland among the most restricted countries in the world in terms of marketing freedoms for alcoholic products. It will not only make Ireland less attractive as a business location for global players, but it will also suffocate smaller players attempting to promote their products.”

According to Ms Callan, the ABFI believes the advertising restrictions in the Bill are “Draconian”.

“In reality, Ireland already has the strictest placement and advertising content codes of most global markets,” she said.

She added that “we have a shared responsibility to address misuse, and drinks companies understand this. We should evaluate policy on the basis of its evidence. Real change will only come if we work constructively together. However, the balance must be struck between achieving public health ambitions and supporting a thriving industry”.

Last week Ms Callan clashed with GP Dr Ciara Kelly on a televised debate on Irish alcohol policy, with further debates on the issue likely to take place in the coming weeks.

Public

However, the public appears to be strongly in favour of the measures outlined in the Bill.

A new opinion poll commissioned by Alcohol Health Alliance Ireland shows strong support for the Government’s intention to curb alcohol marketing that appeals to young people.

The poll, conducted by Ireland Thinks, between 12 and 16 June among a sample of 1,300 adults across the country, found that the public would support stronger regulation of alcohol marketing than is proposed in the Bill.

Notably, the support for action among the supporters of political parties — Fine Gael, Fianna Fáil and Independents — central to the Programme for Government, consistently reflected the national average.

Political party supporters who strongly agreed (excluding neither) with a total ban on alcohol marketing to young people were:

84 per cent, Fine Gael.

82 per cent, Fianna Fáil.

79 per cent, Sinn Féin,

85 per cent, Independents.

79 per cent, Labour Party.

Commenting on the findings, Prof Murray, who is also Chair of the Alcohol Health Alliance, said it is now time for the Government to respond to the strong public desire to protect young people from alcohol marketing.

“These findings very clearly show the need for the Government and other political parties to stand up to vested interests who are trying to water-down the Public Health (Alcohol) Bill and enact this long-delayed legislation. Their supporters want them to take a historic step to protect children from marketing tactics designed to recruit the next generation of drinkers.

“It is our strong belief that the measures within the Bill, when taken together, will provide a reasonable, pragmatic means to achieving the ambition of this progressive public health initiative — namely, to protect children, to ease the pressure on our health services and make for a healthier and more productive society for everyone. It’s time to take this historic step forward to create a more sustainable economy and better society for everyone,” he said.

Key recommendations of Public Health (Alcohol) Bill 2015

With all the debates around the Bill, and the fierce lobbying that has taken place, it is almost easy to forget the central measures that the Bill proposes to introduce.

These include:

A minimum unit price of 10c per gram of alcohol in alcohol products to eliminate very cheap alcohol from all stores and shops.

Structural separation of alcohol products from other products in outlets, either by containment in a unit or a separate area of the store, so that it’s not sold like a normal grocery product.

Prohibition of price-based promotions and tougher restrictions on targeted promotions such as ‘happy-hour’.

Health warnings and calorie labelling on alcohol products, with corresponding warning signs and information in pubs and off-licences.

Regulation of advertising, marketing of alcohol and sponsorship, with criminal sanctions applying for the first time.

An enforcement regime with inspections by authorised HSE officers and penalties for non-compliance, including fixed payment notices.

What will be the result of the introduction of these measures?

The Department of Health has made some public predictions and set goals for how the Bill will impact on alcohol consumption in Ireland.

“The Bill aims to reduce average annual alcohol consumption in Ireland from 11 to 9.1 litres per person by 2020,” said the Department of Health in late 2015, although this time frame may have to change somewhat, given the subsequent lengthy delay with the passage of the Bill through the Oireachtas.

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