Last week’s publication of the UK Chief Medical Officers’ proposed new alcohol guidelines has been widely reported. Key recommendations – that regular weekly consumption should not exceed 14 units of alcohol for men and women; that this should be spread across several days in a week that also includes some alcohol-free days; and that pregnant women should not drink at all – were splashed across the media. Most importantly the guidelines state that no level of alcohol consumption is risk-free.
Various commentators have heralded this as the latest manifestation of the nanny state, including Nigel Farage who called for “a mass protest against this”, apparently by having a drink or two at lunchtime. In response, the Chief Medical Officer of England, Dame Sally Davies has been robust in defending the guidelines, pointing out that they were based on a comprehensive review of the scientific evidence. Speaking on BBC Radio 4’s Today programme, she said: “We have to be very careful to ensure that the public know the risks of drink, so they can take their choice.”
Given this mixed reaction, we might wonder whether people will adopt the new guidelines. Much of this depends on how easy they are to understand and how easy they are to follow. At the same time as many of us chafe against the ‘nanny state’, we also look to government health advice for messages that are clear and unambiguous. This is why the anti-smoking message has proved successful. Over decades it has evolved from ‘smoking is bad for you’ to ‘smoking is bad for you AND we are going to make it expensive and difficult’. This has worked; smoking has declined among adults in recent years and a very small minority of children start the habit before the age of 16.
Reading the coverage and eavesdropping on people’s conversations makes me sceptical that the new advice on alcohol consumption will be any easier to follow than previous recommendations. In 2007, the Health Survey for England asked whether people knew what these were: around two in five adults said they didn’t. Importantly, too, a substantial minority of drinkers didn’t know the alcohol content of what they had drunk in the last week.
Even if recommendations are known and understood, they are not necessarily followed. The 5-a-day fruit and vegetable recommendation is an example. It’s a simple message, widely recognised, and not that difficult to follow, but 60% of adults fail to manage it. Recommendations that require a change from our comfortable habits face a challenge to succeed. Although overall alcohol consumption has been falling since 2006, currently 32% of men and 16% of women in England usually drink more than 14 units a week.
It’s worth having a look at the summary of evidence behind the recommendations, which makes explicit that they are about regular drinking patterns and are based on the risks associated with different levels of consumption. The risks of alcohol are ‘dose-dependent’, that is, they increase with the amount you drink. The recommendations assumed the same level of risk that you might incur as a car driver. Professor David Spieglhalter, guru of risk, suggested that drinking within the amounts specified was probably less dangerous than watching TV for an hour or more a day or eating a bacon sandwich twice a week. He said "It all seems to come down to what pleasure you get from moderate drinking."
Interestingly – and largely ignored by the commentariat – the recommendations also address ‘single drinking episodes’, the one-off occasions like Christmas, birthdays or holidays, when people drink more than they normally would. Recent research by John Moores University suggests that untypical drinking like this may account for around 25% extra consumption on top of the routine drinking captured by surveys such as the Health Survey for England.
The new guidance about drinking in these situations focuses on behaviour not quantity. It suggests drinking slowly, drinking with food, and taking in plenty of water. It stresses the importance of understanding your own limits. It advises “avoiding risky places and activities, making sure you have people you know around, and ensuring that you can get home safely”.
In other words, Nanny isn’t going to tell you to stop, it’s up to you.