Europeans love to drink. From the “wine-dark sea” of Homer, to family gatherings at Christmas, to a glass of wine at lunch, alcohol is an integral part of European culture. But alcohol has a dark side and, despite frequent public health warnings, is not always “enjoyed in moderation”.

Booze can also be expensive (not just in terms of excise duty). One study, published in 2004 by the World Health Organisation (WHO), estimated that the total societal costs of alcohol abuse to national economies can run to several percentage points of Gross Domestic Product (GDP), ranging from 1.42% in France to 5-6% in Italy. This includes the cost of treatment, prevention, research, law enforcement and lost productivity (e.g. people pulling a sickie at work) plus some measure of the quality of life years lost.

That report is now over a decade old, but more recent reports, such as the British government’s 2012 alcohol strategy report, still put the economic impact at significant (though lower) levels. The UK report estimates the cost of alcohol abuse at roughly £21 billion per year – which is certainly a hefty chunk when you consider the total annual budget of the National Health Service (NHS) is £95.6 billion.

And this is only the economic cost. There is also an enormous human cost to alcohol abuse, which is difficult to estimate. In fact, we had a comment sent in by Marie-France arguing that alcohol is even worse than tobacco, and higher taxes on alcohol would be a very good thing.

To get a response, we put Marie-France’s comment to Paul Skehan, Director General at Spirits Europe, a European representative body for producers of alcoholic spirit drinks. How would he respond?

To get another perspective, we also spoke to Dr Nick Sheron, who is the Royal College of Physicians (RCP) representative to the EU Alcohol Forum. Did he think alcohol could be as bad, or even worse, than tobacco?

Well, in actual fact that is probably truer than most people realise. And the reason for that is this: alcohol tends to kill people at a young age, compared to other risk factors such as tobacco.

So, if you look at the harms that alcohol causes, they can basically be split into three categories. There are the harms associated with people being drunk and doing stupid things like falling in front of buses, driving cars into trees, getting into fights, killing other people or themselves. There are harms associated with the fact that alcohol is a drug of addiction and it induces addiction at a relatively early age – people often become addicted to alcohol in their 20s or 30s. And, finally, alcohol is directly toxic to a number of systems within the body, including the brain and the liver, and it causes about 10% of cancers in European men and 3% of cancers in European women.

And when you add all of those things together, one of the ways you can calculate this is something called “years of life lost” or “Disability-Adjusted Life Years” (DALY), which takes into account your age at death as well as disabilities, such as living with alcoholism. In the UK, the Office of National Statistics (ONS) publishes this data annually, and when you add up the years of life lost, then alcohol is responsible for more years of life lost than smoking, which is something that I think would probably shock a lot of people.

But wouldn’t raising alcohol tax just encourage a black market in untaxed alcohol to flourish? After all, US prohibition of alcohol in the 1920s did little but profit gangsters and bootleggers (though that’s on the extreme end of the spectrum). At some point, would extra taxation be counter-productive?

The Scottish government has recently proposed an alternative measure. It has suggested bringing in minimum alcohol pricing, which it hopes would affect mostly heavy drinkers who purchase cheap alcohol in bulk. The hope is that those who enjoy “the odd glass of wine” would be unaffected by the new measures.

However, we had a comment from Tarquin wondering if policies such as minimum alcohol pricing are even possible according to EU rules. Certainly, the Scottish government’s plans have recently been referred to the European Court of Justice. What would Paul Skehan say?

Finally, how would Dr Nick Sheron respond to the same comment from Tarquin?

Well, the Scottish government have already introduced minimum unit price. The bill was passed overwhelmingly by the Scottish Parliament, and incidentally it was a manifesto commitment. So, in the UK there’s a tradition that opposition parties will not vote against manifesto commitments, because to do so would be seen to be anti-democratic. So, the bill was passed in Scotland and signed off by the Queen, it’s gone into legislation – but the legislation was then challenged in Scotland by the Scottish drinks industry, most notably by the Wine and Spirits Trade Association.

There have been two court hearings in Scotland, and the Scottish courts have tried very hard to chuck out this bill to start with, but there’s an automatic right of appeal in Scotland so it went to appeal, and the appeal court now referred it to the European Court of Justice. So, the ECJ is currently making a decision on that, which is going to boil down to whether the profits of the drinks industry hold more sway with the ECJ than public health, which is the justification for minimum unit pricing.

The key thing about minimum unit pricing is that it is exquisitely targeted to very heavy drinkers. I’m a liver doctor, and my patients drink on average the equivalent of five bottles of vodka per week, and as a result of that they drink the cheapest alcohol that it’s possible to find. Because minimum unit pricing is only targeted at cheap alcohol, it doesn’t affect the price of alcohol in pubs or bars at all, and because patients with severe alcohol-related problems are drinking a lot of cheap alcohol, then the end result is that, for example, a minimum unit price set at 50 pence in the UK would have a 200 times greater impact on harmful, dependent drinkers with liver cirrhosis than on moderate or low-risk drinkers.

Should there be minimum alcohol pricing in Europe? Let us know your thoughts and comments in the form below, and we’ll take them to policymakers and experts for their reactions!

IMAGE CREDITS: CC / Flickr – Ryan McGuire