UK budget: Why is public health being left solely in the hands of our Chancellor?

A new and crucial budget is happening this week in the UK. The Alcohol Health Alliance UK has submitted evidence to the Treasury about the urgent need to increase alcohol duty in order to protect our nation’s health.

We are campaigning for this rise because the World Health Organization has long identified increasing alcohol duty as one of the most cost-effective measures in tackling alcohol harm. Cuts and freezes to alcohol duty in seven out of the last eight years have been a catastrophe for public health. Changes in duty policy since 2013 have led to significant increases in alcohol harm, including a rise in both hospital admissions and alcohol-related deaths. These policies have also cost the Treasury more than £1.3 billion annually in lost revenue—money that is urgently needed to support public services such as the NHS and the police, and that could help address the costs of the covid-19 response.

Public Health England estimates that alcohol costs the UK at least £27 billion a year. Yet over the past five years, alcohol duty has raised just £10.5-£12.1 billion annually. This is simply not enough to foot the colossal bill for alcohol harm: missed days of work due to hangovers, the trips to the emergency department from alcohol related injuries, the alcohol services that are so desperately underfunded. When broken down, the scale of alcohol harm is staggering and wide-ranging.

Yet our message that an insufficient level of alcohol duty is harming our health and costing our society risks being drowned out by voices from the multi-billion pound alcohol industry lobbying for alcohol duty cuts. With alcohol now 74% more affordable in real terms in England than it was in 1987, it is high time that we put people before profits.

The UK government has listened to public health experts before. The tobacco duty escalator—which sees the price of cigarettes increase 2% above inflation—has proved a successful intervention in reducing the number of new smokers, and is projected to avoid more than 75,000 new cases of smoking-related diseases between 2015 and 2035. Unfortunately, the alcohol duty escalator—which was also 2% above inflation—was scrapped in 2013 by George Osborne, the then chancellor, following intense lobbying from the alcohol industry. This decision has caused insurmountable damage. Research from the University of Sheffield estimates that abolishing the alcohol duty escalator has led to a rise in alcohol consumption and substantial increases in alcohol-related harms and associated costs. Most alarmingly of all, the researchers found that between 2012-2019, an estimated 2,225 additional alcohol-related deaths were recorded in England and Scotland compared to if the escalator had remained in place. This begs the question: should life-saving public health measures become a political football ahead of each annual Budget? Public health must always be prioritised above profits of alcohol companies and measures should be put in place to safeguard matters of public health when financial decisions are being made. 

But there is hope on the horizon for a change to the system. The government is reviewing alcohol duty, creating a unique opportunity to revamp the system and make sure alcohol duty reflects the true cost of harm. The current alcohol duty structure is complex and inconsistent, with different alcoholic products being taxed at different rates. Beer and spirits are taxed by volume of alcohol, whereas cider and wine are taxed by volume of liquid. This means that tax on a litre of 8% ABV wine is the same amount of tax as a litre of 15% ABV wine—despite containing very different amounts of alcohol.

We need a scaled alcohol duty structure that ensures the strongest products pay the most tax in order to encourage drinkers to move away from purchasing the most dangerous products on the market. We also need the new duty structure to be uprated, automatically increasing in line with inflation or earnings. An independent body similar to the Low Pay Commission could periodically review the rate and provide advice on the optimal level of alcohol duty. Without urgent action, alcohol harm will continue to place the health of our nation in jeopardy. We are already at crisis point, with the most recent Global Drugs Survey revealing that the UK rate of hospital admissions because of alcohol was higher than among users of any other drug cited in the report apart from heroin and with more than 5% of people under 25 in the UK reporting having sought hospital treatment after getting drunk.

There is no time for delay, with 80 people across the UK dying from an alcohol-related cause every day, we need urgent action to tackle this health crisis.

Ian Gilmore, Chair of the Alcohol Health Alliance UK.
Jennifer Keen, Head of Policy, Institute of Alcohol Studies.

Megan Griffiths, Alcohol Health Alliance UK.

Competing interests: The Institute of Alcohol Studies receives funding from the Alliance House Foundation.