Doctors can’t fix the alcohol problem by themselves

A decade ago the jurisdiction of England and Wales was on the brink of introducing a policy that would have led to substantial reductions in the harms done by alcohol (doi:10.1136/bmj.f7646).1 Instead, politicians U turned, ignoring strong health advice in favour of protecting industry interests. Other, braver territories, including Ireland and Australian states, brought in minimum unit pricing, and today the policy saves lives and reduces consumption and hospital admissions (doi:10.1136/bmj-2023-077550).2 After Scotland introduced a minimum unit price, the biggest reduction in alcohol related deaths was seen among the most deprived groups.

As evidence mounts for the effect of minimum pricing on reducing alcohol consumption, those countries holding out are basing their reluctance on other factors, such as their cosy relationship with big alcohol. Over and over again we see how the industry is an active participant in policy development (doi:10.1136/bmj.q800).3 The sector still provides masterclasses in spin, most recently in a UK parliamentary inquiry, claiming credit for declines in youth drinking while downplaying historical highs in alcohol related deaths.

Public knowledge about the true extent of the harm done by alcohol lags behind the science. Where are the public health campaigns and mandatory product labelling to ensure that people know that alcohol causes cancer and that every additional drink increases the risk? And why would any country open its classroom doors or university campuses to the alcohol industry’s drama productions, “educational” shot glasses, and unit wheels? (doi:10.1136/bmj.q851).4 We have become so socialised to the “freshers’ week of oblivion” that we miss the misinformation being pumped out. These industry backed materials focus on what the individual drinker should do so they don’t get “too drunk” rather than on the need to restrict the sale and marketing of alcohol.

Public health advocates need to step up, as they did in Ireland to counter the industry’s influence on students. In her exit interview as royal college chair, paediatric leader Camilla Kingdon is a model of such medical advocacy (doi:10.1136/bmj.q877 doi:10.1136/bmj.q882).56 Children are often at greater risk of harm—witness the rising rates of whooping cough sweeping through Europe (doi:10.1136/bmj.q736) and the recent epidemic of scarlet fever (doi:10.1136/bmj-2023-077561).78 Kingdon is “ashamed” at the drift backwards in child health, chiefly the sustained rise in infant mortality in England over the past decade. One concern (among many) is vaccination rates falling below the World Health Organization’s target levels. Here doctors can play a direct role: 86% of parents say that healthcare professionals are their most trusted sources of vaccine information.

Kingdon’s deeply alarming impression of the shaming conditions facing too many children, including chronic hunger, shows that the problems are too big for doctors and other healthcare workers to be able to solve on their own. Helen Salisbury uses the analogy of not just fishing bodies out of the river but going upstream to find out who’s pushing people in (doi:10.1136/bmj.q918).9 With the honourable exception of colleagues in public health, she says, most doctors are downstream trying to “ease suffering when we can’t cure.”

Ultimately, it’s the government’s job to tackle the wider causes of ill health.