The UK Responsibility Deal and its implications for effective alcohol policy in the UK and internationally


In 2010, the UK Government's Responsibility Deal Alcohol Network (RDAN) was set up with representatives of the alcohol industry and health organisations. Acknowledging that RDAN does not advance public health objectives, the health groups withdrew from RDAN in 2011. This editorial argues that social responsibility deals as in RDAN and the European Alcohol Health Forum will be significantly undermined unless Corporate Social Responsibility is consistent in all activities across the whole sector.

The close relationship between the global alcohol industry and sovereign states mitigates against the proper regulation of the sales, distribution and marketing activities of the industry. The need for such regulation in the UK, and the evidence that it can be effective, are laid out in Alcohol: No Ordinary Commodity[1]. The annual cost of alcohol misuse in England and Wales has been estimated to be £25bn and £2.25bn in Scotland. Whilst there has been a small reduction in consumption in recent years, the number of people dying from alcohol related liver disease is increasing [2]. Heavy drinking is common in all socioeconomic groups, but there is a disproportionate level of harm in the most vulnerable and in the lower socioeconomic groups; this contributes to transgenerational social deprivation in which underachievement in education and subsequent occupational status are related to familial drinking patterns [3].

The previous Labour government's approach to a UK national alcohol strategy relied heavily on a ‘Social Responsibility Charter’ with the alcohol industry, in the context of the European Social Charter [4]. This approach included promoting product labelling. This issue is one of the approaches to reducing alcohol related harm as agreed within the current Coalition Government's Responsibility Deal (RD) [5]. The UK Department of Health (DH) is working with all sectors of the relevant industries to address the health harms related to alcohol, food, physical activity and the workplace. The RD Alcohol Network (RDAN) was set up with representatives of the alcohol industry and health organisations that included Alcohol Concern, British Association for the Study of the Liver, British Liver Trust, British Medical Association, Cancer Research UK, Institute of Alcohol Studies, National Heart Forum and the Royal College of Physicians. Before it could be publicly launched, on 7th March 2011, the majority of the health groups decided to resign, with the exception of Cancer Research UK and National Heart Forum. These two organisations remained in the process in the hope that significant health benefits for the UK population would emerge from, for example, agreements on reduced salt in foods. The key concerns of the health organisations related to: the lack of a robust evidence base; the absence of firm outcomes carefully monitored; and apparent prioritisation of ‘pledges’ from the alcohol industry over those aimed at public health. There was also concern that a comprehensive cross-departmental evidence-based strategy to reduce alcohol harm was being marginalised.

RDAN discussions resulted in a set of ‘pledges’ from the drinks producers, and retailers including supermarkets. These relate to activities that are likely to have only limited effectiveness [1] such as information on labels (80% of bottles and cans should have health information by 2013), no alcohol advertising posters within 100m of schools, and (alcohol) unit information on beer mats in pubs. Discussion on more significant issues such as irresponsible marketing and promotion, and licensing hours appear not to have been encouraged. The proposal that monitoring of RDAN ‘pledges’ should be undertaken by the Portman Group, a trade body exclusively funded by alcohol producers, was vehemently opposed by the health groups.

So where has the RDAN got to since many public health-facing organisations left the table? In fact there has been significant progress, in that there has been agreement to have a public health expert co-chair of the network, Professor Mark Bellis, who also has oversight of monitoring arrangements of three priority areas. Organisations in RDAN are encouraged to maintain their pledges to explore best practice in retailing, develope and market lower alcohol products and smaller server sizes, and target education aimed at delaying the onset of drinking under 18 years.

There have been signs that the Government is getting tougher in its pressure on the alcohol industry. However it remains to be seen whether or not these voluntary ‘pledges’ will be translated into reductions of alcohol related harm in the UK.

The RDAN concept reflected the European Alcohol Health Forum (EAHF), working within DG SANCO of the EU Commission. Membership of EAHF was dependent on the industrial organisations and NGOs making commitments to address alcohol related harm, via its EAHF representatives. EAHF has been well managed and has significant representation from NGOs and youth organisations. An effective balance of interests and a robust defence of public health interests is maintained by DG SANCO and the Council of Member states (CANNAPA), which has reinforced the directive that industry commitments should be related to core issues which are likely to reduce alcohol related harm. However the whole structure is up for review and its future uncertain.

Any impact of RDAN and the EAHF will not be felt until sometime in the future. Of course RDAN is just one component of an emerging alcohol strategy in England. The Licensing Act [6] is in the process of being reformed, guidelines for ‘safe limits’ are likely to be reviewed, and there is increasing interest, at least from the Prime Minister, in following the Scottish move towards Minimum Unit Pricing. The new UK Alcohol Strategy was announced on 23rd March. This indicated a commitment by the Coalition government to a MUP of 40 pence, which would be reviewed subject to a process of consultation.

Demonstrating the effectiveness of social policies is problematic [7]. In reviewing the decreasing levels of consumption of alcohol since 2004, Professor Meier has suggested that the combination of the changes in the 2003 Licensing Act in 2005 [6], and the ban on smoking in public places across the UK from 2006 to 2007, may have contributed to limited changes in the consumer profile using the ‘on-trade’. The increasing and rapid increase in alcohol-related admissions to hospitals may be explained by a time lag in the development of alcohol-related chronic harm, although in other countries a fall in consumption has been followed by a remarkably rapid fall in cirrhosis deaths. Another factor may be the rise in heavy episodic drinking and the selection, particularly in women, of drinks containing higher concentrations of alcohol. This complex set of interacting forces suggests the need for a comprehensive UK alcohol strategy supported across government departments, as attempted by the previous government in its attempts to tackle social exclusion [8].

However, the key issue of voluntary regulation (by the industry) versus statutory regulation remains to be addressed. The Health Select Committee ‘. . . is unconvinced that it [The RD] will be effective in resolving issues such as obesity and alcohol abuse . . . those with a financial interest must not be allowed to set the agenda for health improvement’[9].

In the context of the current political debates on ‘Responsible Capitalism’ and austerity economic planning, effective alcohol policies need to embrace wider issues than mortality and liver death statistics. The changing balance between ‘on sales’, which are declining and the increase in ‘off sales’ is reflected in increasing home drinking. This is concerning in view of the observations that increased expenditure on alcohol may lead to concomitant reductions in spending on good nutrition [10], and has the potential to exacerbate domestic violence. Alcohol is significantly involved in the 54 000 domestic violence incidents recorded in London in 2010 [11]. At a time of budgetary constraints from recessionary pressures, there are clearly economic advantages in gaining support from industry, as seen in the £5 million additional sponsorship of Drinkaware, a UK industry sponsored educational trust. However this is offset by actions like the withdrawal of government funding from the well-respected NGO, Alcohol Concern, which now has an uncertain future.

The RDAN aim to ‘. . . foster a culture of responsible dinking . . .’ , and the Coalition government places much emphasis on ‘nudging’ to bring about this cultural shift [12]. But the alcohol industry is surely nudging strongly in the opposite direction, for example, with a multi-million dollar contract agreed last autumn between Diageo and Facebook. An effective alcohol policy is needed to counterbalance the alcohol-fuelled culture promoted by user-generated activity in Smirnoff NightLife Exchange. This sophisticated digital marketing engagement with those linking in the extensive and expanding web-based community facilitated through this and other Facebook pages, will be ‘. . . more effective than the companies own websites . . .’[13].

The concept of (social) responsibility deals as in RDAN and the EAHF will be significantly undermined unless Corporate Social Responsibility is consistent in all activities across individual organisations and the whole sector.

Declaration of interest

Both authors have participated in the Responsibility Deal Alcohol Network (RDAN) and the European Alcohol Health Forum (EAHF). AB was Director of the Institute of Alcohol Studies and has now resumed his role as Reader in Medicine and Health in The Centre for Health Services Studies at the University of Kent. He is Health Adviser for the Salvation Army. IG is Chairman of the Alcohol Health Alliance and consultant liver physician. He is past president of the Royal College of Physicians and currently RCP special adviser on alcohol. IG is president-elect of the British Society of Gastroenterology.