EHJ February 2004, pages 40-42
Alcohol misuse in the UK is growing at an alarming rate with serious repercussions for crime and disorder, health and workplace productivity. The new licensing regime provides new opportunities for local authorities to address health issues around nightlife and incorporate safer practices into licensing policies. Nick Warburton reports

Heavy drinking kills. Stark warnings like this could appear on spirits, beers and wines if proposals to put health warnings on alcoholic drinks, announced by the Irish government last month, prove successful. Irish plans to introduce public health labelling over the next year highlight growing fears over the rise in alcohol consumption and its impact on people's health. The decision is being mooted as the latest in a series of measures to curb the nation's excessive drink culture and comes hot on the heels of the delayed workplace smoking ban, which should finally be enforced in the republic this month.

Similarly, problems associated with rising alcohol consumption levels have prompted action on this side of the Irish Sea. The Department of Health published a consultation on the government's national alcohol harm reduction strategy back in October 2002. It laid out proposals for reducing the negative effects of heavy drinking as well as providing help for victims of alcohol misuse. It also looked at tackling antisocial behaviour in public places.

Since then, the prime minister's strategy unit has published an interim analysis on alcohol harm reduction, a sobering read describing the impact of alcohol on the nation's social fabric (see below).

As a population, it is estimated that over 90 per cent of adults, nearly 40 million people, consume alcoholic drinks. Most of us, the report notes, drink sensibly most of the time. There is also evidence to suggest that drinking in moderation can confer some health benefits. But there is also a worrying trend that reveals that people are consuming more alcohol and drinking more often.

Almost one-in-three adult men and one-in-five women now exceed the weekly recommended guidelines of 21 and 14 units per week. Men consume more alcohol than women but women are catching up. Consumption levels are rising and, if present trends continue, the UK could be topping the consumption league in western Europe within the next 10 years.

High levels of binge drinking among 16- to 24-year-olds has become a new and alarming trend. A binge is defined as the heavy or risky consumption of alcohol in a single session. Anyone who drinks double their daily limit or six units for women and eight for men is considered to be on a binge. The report estimates that this form of heavy boozing now accounts for 40 per cent of all drinking sessions by men and 22 per cent by women.

A Mori survey, published in November, revealed that many British people are concerned about the country's binge drinking culture. However, the "How much is too much?" survey also found that only 7 per cent of men and 22 per cent of women are aware of the safe drinking limits.

Binge drinking is a common feature of nightlife, where drinks promotions and other special offers, such as happy hours, encourage revellers to consume large quantities of alcohol, often in short periods of time.

As binge drinking can have serious implications for the public's health and safety and on antisocial behaviour, environmental health departments may now be in a position to help influence safe drinking habits, particularly through the upcoming licensing regime. The Licensing Act 2003 requires local authorities to develop a licensing policy for their district, with the overall aim of reducing crime and disorder and public nuisance, and upholding public safety.

Under the act, licensees must obtain a personal licence, while each pub or club will be required to obtain an individual premises licence. Personal licences will be issued for a period of 10 years to applicants aged 18 or over as long as they do not possess a relevant criminal record and do pass a "knowledge test" of licensing law and social responsibilities. The act also provides for endorsement or withdrawal of licences within this period (EHJ, February 2003, pages 36-39).

Individual premises licences are granted indefinitely. They will carry conditions appropriate to that venue, like opening hours and operating requirements. They must also take into consideration the views of residents, the local community, and police and fire authority assessments. In effect, the new licensing regime gives local authorities the power to attach conditions to individual premises and, in the process, encourage safer nightlife practices.

Despite concerns about whether the licensing fee will cover council running costs, David Britt, who sits on the Lacors licensing committee and is environmental health manager at Basildon DC, welcomes the new regime. He says: "It provides an opportunity for EHOs to influence through their health and safety and noise control powers the safety of members of the public in pubs and the environment around pubs and clubs."

Officers with health and safety and noise responsibilities will be asked to comment on the terms and conditions of the licence, he adds. This means they will be able to give advice on anything that may impact on crime and disorder, public safety or nuisance.

Local authorities are currently awaiting the final version of the guidance before they can start formal consultations. According to Abigail Orme, policy officer at Lacors: "Officially, local authorities cannot produce and consult on their licensing policies until the final version of the guidance has been approved by parliament, since this gives guidance on writing policies." The guidance has yet to be tabled in parliament but Ms Orme says that the Department for Culture, Media and Sports hopes it will be approved by early February.

Once the final version of the guidance is available, local authorities will then have six months to put their licensing policies in place before the first applications are received. Ms Orme points out that most local authorities have already produced draft versions and, when parliament gives its approval, they will be able to make any adaptations before going through the formal consultation process.

One of the expected impacts of the Licensing Act is the introduction of flexible opening hours, with the potential for 24-hour opening, seven-days-a-week. At present, fixed closing times often lead to large numbers of drunks loitering on streets once pubs and clubs have closed, in some cases resulting in high levels of violence and disorder. The rationale behind flexible opening hours is that it will reduce the potential for aggression, as revellers avoid being thrown out of pubs and bars at closing time.

Research published by the north-west safer nightlife group at the Centre for Public Health at Liverpool John Moores University, shows that one-in-five incidents of violence in the UK takes place outside a pub or club. In 80 per cent of assaults linked to pubs and clubs, the offender is thought to be under the influence of alcohol.

The Portman Group, the alcohol industry-funded group that promotes sensible drinking, claims that many factors interact to produce criminal or violent behaviour. Alcohol consumption is just one possible factor in the mix. The group has launched its own sensible drinking campaign to raise awareness of the harm caused by excessive drinking. It is also calling for more research to measure the extent to which alcohol is a risk factor in crime and disorder.

Prof Mark Bellis, co-author of the report Safer nightlife in the north-west of England and director of the Centre for Public Health, points to a range of initiatives currently underway or being explored in the north-west, all aimed at addressing nightlife issues. These include:

• campaigns to promote sensible drinking behaviour
• engaging in dialogue with breweries and licensed premises in an attempt to reduce irresponsible drinks promotions
• setting a latest entry time for late night premises, and
• training for licensees and bar staff, involving issues such as legal responsibilities, preventing under-age sales through proof-of-age cards, and preventing drunkenness and alcohol-related violence.

Local authorities could also investigate working with venue owners so that they design premises that encourage people to drink more slowly. The report points out that venues have been removing seats from bars to encourage people to drink more. This is known as vertical drinking. By providing customers with a relaxed and comfortable environment, claims the report, licensees can reduce disorder and encourage people to stay on the premises longer.

The success of many of these schemes is dependent on the long-term cooperation of the licensing trade. As the government's response to a select committee report on the evening economy and the urban renaissance, published in October 2003, makes clear, the issue is not about stopping people from drinking. The whole rationale behind the Licensing Act is to strike a balance in the context of licensable activities. On the one hand, it seeks to allow sensible drinking while also ensuring that trouble hotspots are tackled by a combination of licensing decisions and police enforcement.

And as Prof Bellis points out: "Any approach to alcohol has to recognise the benefits." The growth of the evening economy and the expansion of pubs and clubs may pose challenges in terms of noise, nuisance, fear of crime and public safety, but it has to be balanced against the benefits it brings in terms of urban regeneration. Then there are the wider benefits that alcohol brings to the economy. The strategy report estimates that the alcoholic drinks market is worth in excess of £30bn and generates approximately 1 million jobs.

Initiatives at the local level are nonetheless important feeders into the national debate on rising alcohol consumption levels. Drinker ignorance over safe limits has galvanised health experts to campaign for the government to place health labels on cans and bottles, with explicit warnings that exceeding safe limits can seriously damage health.

Eric Appleby, chief executive at Alcohol Concern and an advisory member of the alcohol harm reduction strategy group, agrees with labelling but does not see it as a priority. He argues that the evidence shows that health warnings have had mixed success. He would rather see tighter regulation on drinks, with a crackdown on alcohol advertising and a ban on happy hours.

Having consulted with a wide range of stakeholders, including government departments, trade bodies and campaigning groups, the prime minister's strategy unit is still putting the final touches to its report, which will set out the government's policy recommendations on tackling issues such as binge drinking.

Expected next month, there is speculation that strengthening of the alcohol advertising code is on the cards. Once published, it will be up to the Home Office, the Department for Culture, Media and Sports and the Department of Health to implement its recommendations.

Drinkers will be hoping that the government will not be forced to use the sort of shock tactics proposed for cigarette smokers. Your favourite bottle of wine will not look so appealing with a picture of a diseased liver on the label.