Focus - Alcohol Consumption Guidelines Under Scrutiny

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The recommendation by a House of Commons committee that UK consumers take two days off from drinking a week has thrust the issue of safe alcohol consumption guidelines back into the media spotlight. Ben Cooper reports.

The publication in the UK this week of a report by the House of Commons Science and Technology Committee recommending adults abstain from drinking for two days a week means 2012 has begun as 2011 ended; with the issue of alcohol consumption guidelines being widely discussed.

In addition to two drink-free days, the report recommends “greater efforts” be focused on helping people understand the guidelines. It says that awareness of the guidelines is high, but a deeper understanding of alcohol units is “lacking”.

It makes two further recommendations: Advocating an interim review of the pledge by industry, under the government’s Responsibility Deal (RD), to ensure that over 80% of alcoholic products on-shelf will have labels featuring alcoholic unit content and the drinking guidelines by 2013, and establishing a working group to review whether the guidelines themselves should be revised.

The recommendations have been enthusiastically welcomed by UK medical groups. The British Liver Trust (BLT) applauded the report, and “strongly supports” the formation of a working group to review the guidelines. Sir Ian Gilmore, the Royal College of Physicians' (RCP) special adviser on alcohol, said the RCP also supports the review, taking the opportunity to call again for minimum pricing. The RCP advocates two to three drink-free days a week. 

Possibly drawing succour from the report’s suggestion that Government “should remain mindful that sensible drinking messages may conflict with the business objectives of drinks companies”, the BLT says that the working group should comprise “health and scientific experts and definitely not representatives of the alcohol retail industry”.

Speaking to just-drinks, Gavin Partington of the Wine and Spirit Association (WSTA) suggests that any revision of the guidelines should “be based on the best available medical evidence with that assessed by government”.

However, there is a danger of confusion between “the best medical evidence and the best medical campaigning”. He adds: “Some of the groups operating in this area convey messages on the basis of what they campaign for publicly as opposed to relying solely on the best medical evidence”.

This remark is likely to incense campaigning public health professionals, and speaks to the complete impasse that now exists between the industry and the public health community on alcohol policy issues.

Partington stresses that “the really important thing” is that guidance should be “communicated efficiently and effectively to consumers”, alluding to efforts by retailers and producers to communicate guidelines and information on units on packaging and at point of sale. 

The BLT describes industry efforts to inform the public of the dangers of alcohol as “half-hearted”, and says it “fully endorses” a pre-review of the RD pledge on unit labelling.

Partington is not sure that such a review is necessary. Industry, he says, is committed to delivering on the pledge and would be “rightly judged” if it fails to do so, adding that progress is being monitored by the Portman Group. “My clear understanding is that the industry is making very, very good progress towards delivering on this target and we’re confident that it will deliver on it,” he says.

Having been relaxed in the 1990s after research suggested alcohol may reduce the risk of coronary heart disease among certain population groups, current UK government guidelines recommend men should not regularly drink more than three to four units a day and women no more than two to three units. On the face of it, this seems fairly simple advice, but the issue of recommended consumption limits is nowhere near as straightforward as it first appears. 

A glance at a table of comparative safe consumption guidelines across different countries, published by the industry-sponsored think-tank, the International Center for Alcohol Policies (ICAP), shows considerable divergence, not only between what different countries consider to be a safe consumption threshold, but also in how such guidelines are expressed.

Some governments represent consumption in grams, some in number of drinks, others in units. How much alcohol a unit represents is not standardised across different nations. This confusing picture amply illustrates that calibrating and communicating alcohol consumption is no easy task. 

And, for the consumer, the language and points of reference are only the beginning. When purchasing a bottle of wine in a supermarket, the alcohol level and the volume provide a solid information base; unit values on labels may help further. But, once that bottle – along with a few others – is being consumed at a dinner party by six people and glasses are being topped up when half empty during the evening, maintaining a firm idea of how much one is consuming is no easy task.

Dr Marjana Martinic, senior vice president at ICAP, describes the lack of uniformity in measuring and communicating consumption as “a problem”, and agrees that consumer understanding of alcohol units is not high.

She adds that, while the use of the alcohol units needs to be “part of a broader effort to educate consumers about what they are drinking”, having the unit information on the label is “quite useful” and a “good idea”. 

With regard to the ‘days off’ proposal, Martinic points to evidence that the health benefits with regard to cardio-vascular disease are from “regular, moderate drinking”, and that there is a danger “people might interpret the two days off as being licence to drink more on the other days”.  

Meanwhile, Mariann Skar, secretary general of European alcohol public health pressure group Eurocare, welcomes the idea of advocating two days off from drinking. However, Skar is more sceptical about the use of alcohol units as a consumer communication tool. “People don’t really understand it. The message is difficult and people get very easily confused,” Skar told just-drinks. 

Skar concedes that, while simply referring to the number of drinks people might consume (which is much more prevalent in public health advice in continental Europe) brings its own disadvantages in terms of lack of precision, it is at least a concept that “people understand”. Consumers themselves are able to differentiate between a small and a large glass of wine, she says, and the key objective is to have an overall message that is “understood by people”.

Regarding efforts to establish widespread unit labelling in the UK, Skar says: “On paper it sounds great but, if people don’t understand it, it’s of no value.”

Given that the move towards widespread unit labelling has been endorsed by the Department of Health in the UK, Skar’s comments suggest some divergence in views within the public health community on this question.

Partington, meanwhile, remains convinced of the merits of unit labelling. “I don’t think it is too difficult to understand and I think there is growing awareness of what it comprises,” he says, alluding to efforts the industry is making in the on- and off-trade to “hammer home” what a unit is. “We’ve got the system that we have and we’re making great efforts to communicate it effectively in support of the government’s public health objectives.”

In reiterating that consumers need more help in keeping track of their consumption – whether measured in units or another way – the House of Commons report is echoing a view shared by most stakeholders. But, as in so many areas of alcohol policy, there is little common ground between industry and the medical community on how that can best be achieved.

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