WHY HAVE CONSUMPTION AND HARM INCREASED? - WHAT DOES THE EVIDENCE TELL US?
22. A number of major changes have occurred in Scotland over the last 20-30 years which are likely to have contributed to the increase in alcohol consumption and resultant alcohol-related harms.
Decline in the relative price of alcohol
23. There is strong evidence from over 50 studies conducted in 15 European countries, America, Canada, New Zealand and elsewhere, that levels of alcohol consumption are closely linked to the retail price of alcoholic beverages. As alcohol becomes more affordable, consumption increases. As the relative price increases, consumption goes down. In Switzerland in 1999, a 30 to 50% reduction in taxation on foreign spirits, led to a 28.6% increase in consumption of spirits. There was no significant change in the consumption of wine or beer. 27 In March 2004, Finland cut tax on alcohol (by one third) in an effort to reduce the level of cross-border shopping undertaken by Finns in other EU countries, particularly neighbouring Estonia, where the price of alcohol was much cheaper. Following the change, liver cirrhosis deaths were found to have risen by 30 per cent in just one year, as alcohol consumption increased by 10 per cent. 28
24. In real terms (taking into account disposable income) alcohol is 62% more affordable today than it was in 1980. 2 The graph below shows the relationship between alcohol consumption and affordability (price relative to income) between 1960 and 2002. The increase in consumption is almost an exact mirror image of the reduction in price relative to income, strongly indicating that price has influenced consumption patterns over the last 50 years. 29
Figure 1: Relationship between price and alcohol consumption, 1960-2002
25. But the increasing affordability of alcohol is not uniform across sectors. While on-sales ( e.g. pubs) prices have generally increased above the Retail Price Index ( RPI) over the last 20 years, off-sales ( e.g. shops and supermarkets) prices have remained more static and below RPI. This is largely due to supermarkets and larger grocers being able to heavily discount prices. The relatively low price of off-sales alcohol is likely to be driving the shift to home drinking and, in turn, the rise in overall consumption. Addressing low prices may therefore help to discourage excessive alcohol consumption.
Figure 2: the price of on and off sales alcohol, 1988-200730
Increase in availability and accessibility of alcohol
26. Alcohol is now more readily available in Scotland than ever before. The number of liquor licences is around 17,000, the equivalent of a licence for every 240 adults in Scotland. Off-sale licences have more than tripled to 6,000 and now make up around a third of all licences. A large majority of licensed premises (in excess of 10,000) also now hold one or more regular extensions to permitted hours. 31 There is evidence from a number of countries that removing restrictions on the days and times when alcohol is sold and increasing access results in a rise in consumption. 32 The increasing density of venues in city and town centres selling alcohol has resulted in large concentrations of drinkers in relatively small areas.
Changing our culture
27. We know that cultural and social norms are significant influences on drinking behaviours. 33 We want to create a Scotland where alcohol is uniformly viewed and used as a positive part of people's social enjoyment and interaction. Instead there has been an increase in 'drinking to get drunk', particularly among young people, and greater acceptance of public drunkenness. The frequent, and often positive, portrayal of alcohol misuse in some sections of the media has not helped. Alcohol is also widely and intensively advertised and promoted through an expanding range of media. And alcohol sponsorship of sport, music and cultural events is increasingly common. This helps portray alcohol as just another ordinary product, de-sensitising consumers to the potential for harm. By taking steps to 'denormalise' alcohol we can encourage and support people to make more positive choices about alcohol.
More choice but a lack of knowledge
28. As well as an increase in the range and choice of alcohol products available, new products specifically designed to appeal to certain segments of the market have been introduced in recent years ( e.g. 'alcopops' and strong cider). Many alcoholic drinks have become stronger and are now sold in larger servings. High strength, low cost products are increasingly associated with youth drinking and linked with anti-social behaviour and disorder.
29. But a lack of awareness may also be driving the problems. Only a minority of us know the recommended daily alcohol guidelines, while just 15% can correctly estimate the number of units in a bottle of wine and only around half of us know the number of units in a pint of beer. 34 Providing people with better knowledge and advice about alcohol and its effects can enable them to make more informed decisions about their alcohol use.