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    The document to which these amendments relate  is on the Your Britain website.  At present these are merely proposals the Association is considering.  They are not yet agreed.

    Page 10

    Line 15 insert “We will make healthy choices easier by ensuring that the financial incentives and taxation system supports affordable healthy products such as fresh fruit and vegetables while making unhealthy products high in fat, salt and sugar better regulated and relatively more expensive.  We will tax alcohol progressively by unit of alcohol, introduce minimum unit pricing and encourage low alcohol products.  We will reduce the hours during which supermarkets are permitted to sell alcohol and make it more difficult to buy dangerous quantities of alcohol following the successful example of reducing damage caused by paracetamol poisoning.”

    Line 33 insert “We will progressively raise the age below which it is unlawful to supply tobacco to young people.  We will bring forward proposals to reform the law on misuse of drugs to balance the penalties against the harm done by different drugs including alcohol and tobacco.”

    “We will take forward the programme of fluoridation of the water supply to reduce the damage to children’s teeth”


    See also proposals relating to the documents on Stability and Prosperity, Work and Business, Living Standards and Sustainability, Stronger Safer Communities, Education and Children and Better Politics.



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    If you smoke, you’re going to be well aware of the health benefits of quitting, but are you fully aware of the difference that giving up smoking can make to your finances?

    Don’t underestimate the financial benefit of giving up cigarettes; quitting smoking will save you money, and lots of it!

    If you’re struggling to find the motivation to stop, then looking at the amount of money you could save should really help. If you needed any more convincing just look at the science – recent research has shown that your chance of successfully changing a health-related behaviour increases by 50% if there’s a financial reward at the end of it. Apply this logic to smoking and simply putting a price on quitting should help you quit for good.

    The good news is that you don’t have to go through it alone; there are plenty of places you can go for free support, and the products that make it easier to stop smoking aren’t expensive either.

    How much will you save on cigarettes

    The average cost of a 20 pack of cigarettes is currently £7.98, according to the charity Action on Smoking and Health. This means smoking 20 cigarettes a day costs you around £2,900 a year! If you think that’s expensive it’s only set to rise further with increased duty on tobacco. The British Heart Foundation website has a useful tool that lets you calculate how much money you could save if you quit smoking. Just enter the number of cigarettes you smoke to see how much better off you would be each week, month and year. Put a price on your habit then think about what else you could spend this extra money on. Then when you’re tempted to reach for a cigarette, just focus on this instead and hopefully it’ll help you resist.

    Other ways you’ll save by quitting

    Aside from the actual savings you’ll make by not buying cigarettes, stopping smoking will save you money in other ways too.

    Cheaper insurance

    When you don’t smoke life insurance is cheaper; your premiums could drop by as much as 50% once you have been smoke free for 12 months, for exactly the same amount of cover. Once you’re officially a non-smoke everything from your private healthcare insurance to income protection cover and even your home and car insurance could be much cheaper – all because you’ll be treated as a lower risk. When you successfully quit, let your insurance providers know this to start enjoying the benefits of reduced premiums. When you’ll be classed as a non-smoker will differ from insurer to insurer (it could be right away, it could be 3 years smoke-free) but the sooner you tell them, the sooner you’ll have the added incentive to stick with it.

    Better health = less time off work

    Once you quit smoking you should feel healthier and be less likely to take time off work. This will have a positive impact on your income, particularly if you are self-employed. Quitting smoking before it causes you serious health problems that impact your earnings is another financial motivator to kick your habit.

    What about the cost of quitting smoking?

    If you’re reluctant to try quitting over concerns that the products you’ll need to help you quit smoking are pricey – especially if you aren’t successful – this needn’t be a worry. Some quit smoking aids are available free of charge and for those that you pay for, it still works out a lot cheaper than paying for cigarettes each week. We take a look at just how cheaply you can stop smoking.

    Support for quitting smoking: Cost = Free

    Help with quitting is available free from NHS Stop Smoking advisers. Your GP can refer you for a one-to-one appointment or you can self-refer by phoning your local service directly. Besides helpful tips and support to help you with your quit attempt, these advisers can also help you get stop smoking medications and nicotine replacement therapy for a cheaper price. If you’re unable to get to a clinic near you, the NHS Stop Smoking App is available free via iTunes, which sends you daily motivational messages, as well as providing tips and access to a wealth of useful information. Additional free advice is also available online from sites such as NHS Smokefree, Quit and ASH and you can pick up a free NHS Quit Kit from your local pharmacy or order one online from the NHS website – these have tools to further increase your chances of successfully quitting.

    Nicotine replacement therapy: Cost: Up to £8.05/week

    Some people find nicotine replacement therapy helps them deal with the physical symptoms of stopping smoking. It’s available to buy directly from pharmacies, but you can save money by obtaining a prescription for these from your GP or smoking cessation adviser. If you get free prescriptions you won’t need to pay a penny for these products and even if you do pay for your prescriptions, with the current charge for prescriptions set at £8.05, paying this for a week’s supply still works out around a third cheaper than buying direct from your local chemist.

    Prescription medication: Cost: On a case by case basis

    Zyban and Champix are prescription medications that can boost your chances of successfully kicking your smoking habit. They’re not suitable for everyone though and your doctor will decide whether you should try them as they do carry side-effects. In a similar way to nicotine replacement therapy, both are available at no cost if you don’t pay for your prescriptions, though you may otherwise need to pay for a course of this therapy. Zyban is typically taken for 7 to 9 weeks and Champix for 12 weeks, though this is a small price to pay if you successfully quit.

    E-cigarettes: Cost = £10-£18 per pack

    Although they are not officially recommended as a stop smoking aid, many smokers do find E-cigarettes a helpful way to quit, and the good news is that they can be cost-effective. Although you will pay anything from £10 to £90 for a starter pack, and then £10 to £18 for a pack of four refill cartridges, with each cartridge equal to 25 cigarettes, it’s easy to see how the savings soon mount up compared to the real thing.

    Complementary therapies: Cost = Free (depending on location)

    Hypnosis, acupressure and hypnosis may sometimes be available free of charge through NHS Smoking Services, though depending on where you live you may need to pay for these alternative therapies.

    Kick the habit!

    Now that you can see how much money you can save by giving up cigarettes and how little it costs to access smoking cessation support, what are you waiting for?

    Speak to your GP to find out more about the stop smoking aids that are most suitable for you and start you quit attempt ASAP.

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    When the UK Government abandoned its proposal to introduce minimum unit pricing for alcohol in July 2013, it argued there was a lack of concrete evidence that the policy would reduce the harm caused by alcohol without penalising responsible drinkers. In research published in the Lancet, the Sheffield Alcohol Research Group show minimum unit pricing avoids penalising moderate drinkers on low incomes and would contribute to the reduction of health inequalities.

    Minimum unit pricing (MUP) sets a threshold below which a unit of alcohol cannot be sold to consumers. Under a 45p MUP a pint of beer containing two units would need to cost at least 90p and a bottle of wine containing 9 units at least £4.05. Since heavier drinkers typically pay less per unit for their alcohol than moderate drinkers, and of course buy more units in the first place, this means that heavier drinkers would be affected the most by MUP.

    The impact of MUP on the poor

    In our new research, we explore the impact of MUP on those with low incomes who may be more likely to buy cheap alcohol. In particular we were interested in claims the policy could be particularly regressive by targeting drinks bought by the poor. To investigate this, we constructed a model of the relationship between MUP, people’s alcohol spending and consumption and the health risks associated with that consumption.

    We separated the population into moderate, hazardous and harmful drinkers and found moderate drinkers in the lowest income group bought very little alcohol for less than 45p per unit – less than one unit per week on average. When we estimated how much their consumption would reduce under a 45p MUP, we found it would drop by just 4 units per year – approximately 2 pints of beer. As this income group was the least likely to drink and most likely drink at moderate levels if they did so, this suggests the overwhelming majority of those on low incomes would not be substantially affected by MUP.
    Among heavier drinkers the picture was different. For harmful drinkers, a 45p MUP was estimated to have a large effect which varied substantially by income. For the lowest income group consumption would fall by 300 units per year among the 5% who are harmful drinkers, compared to 34 units in the highest income group of whom 8% are harmful drinkers.

    Reducing health inequalities

    Even though harmful drinkers with lower incomes are the group likely to be affected most by MUP, this does not necessarily mean the policy is regressive. To understand its full implications we need to look at its success in achieving MUP’s primary aim – reducing alcohol-related harm.

    For reasons which are unclear, those with lower incomes appear to suffer greater risks of harm from their drinking than those with higher incomes. The combined effect of the bigger risks and bigger consumption reductions means low income groups would be by far the biggest beneficiaries of the policy in terms of health improvements. A 45p MUP is estimated to lead to 860 fewer deaths and 29,900 fewer hospital admissions due to alcohol per year and routine or manual worker households would account for over 80% of these. On this measure, the policy can be argued to be strongly progressive.

    Minimum Unit Pricing

    Model-based estimates of policy effects are, of course, subject to uncertainty and we take account of this by using different assumptions and inputting alternative data to see what the range of plausible effects might be. Although the size of the effects varied under these scenarios, the key findings remained the same and give us greater confidence in our conclusions.

    Effectiveness and fairness

    We consistently find, across a wide range of plausible scenarios, no support for the UK Government’s concerns that minimum unit pricing would penalise responsible drinkers. This is because the estimated effects on this group are negligible, even in the lowest income groups. Instead, the policy targets those at greatest risk of harm – heavier drinkers on low incomes. As such, the benefits of the policy are also concentrated on this group.

    The reduction of health inequalities, including those generated by alcohol consumption, is an explicit aim of the Government’s public health policy. Our research shows minimum unit pricing would make an effective contribution to reducing such inequalities by particularly reducing the harm caused by alcohol in lower socioeconomic groups. It also challenges perceptions about levels of drinking among the poorest in our society and raises important questions about how we judge the fairness of public health policies.

    This BMA info graphic is based on the lowest proposed unit price of 40p. The BMA believes the minimum price should be no less than 50p per unit.

    Dr John Holmes, Sheffield Alcohol Research Group

    This article first appeared in Healthier Scotland – The Journal Published by Socialist Health Association Scotland March 2014

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    Presentation on European Union Common Agricultural Policy by Christopher Birt at our seminar in Sheffield, 11th October 2013

    The origins of the Common Agricultural Policy were in  the famine and starvation in Europe in 1940s and  post-war rationing which was retained in UK to feed Germany. The first aim of European agricultural policy was to ensure that this never recurred.

    The Common Agricultural Policy  is designed to protect the rural economy, and  to ensure food self-sufficiency. It is based on support to the production of certain commodities.  In the first 20 years this led to “beef mountains”, “milk lakes”, “butter mountains”, etc., CAP responses included milk quotas, free butter for hospitals (!), etc. There was agreement in 2003 to “uncouple” production and subsidy (implemented from early 2005). Farm support is now linked to environmental protection, food safety, and animal welfare standards, etc., but there is no real incentive to alter production to meet changing needs.

    There are now three main components of CAP:

    • direct “whole farm payments”,
    • price guarantees to producers, and
    • use of subsidy to manipulate market, e.g.
      • free butter for hospitals,
      • subsidised school milk,
      • school fruit scheme,
      • purchase of wine for distillation, etc.

      Health impacts of  the Common Agricultural Policy

    The INTERHEART Study described how ”nine potentially modifiable risk factors account for over 90% of the risk of an initial acute myocardial infarction”. Diet explains more than half the deaths from heart disease.

    potentially modifiable risk factors associated with myocardial infarction

    Salim Yusuf et al . Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet  364  9437   11 Sept 2004

    Common Agricultural Policy and Sugar

    At world price no European production  of sugar would be economic. The creation of an artificial high price is in the interests of producers. There is a large export subsidy and import tax;  all this lowers world price and hits producers in the developing world.  There is a recent World Trade Organisation agreement to reduce export taxes (and therefore internal EU price) by a third – not it is not yet implemented.

    Common Agricultural Policy and Beef

    There is a massive subsidy (“over 90% of income” for some farmers), so  a massive market has developed for “cheap” beef. This diverts grain production to animal food, and results in massive grain and soya imports  from developing countries, large quantities of mass-produced home- produced and imported beef, cheap burgers full of saturated fat, and a high incidence and death rate from Coronary Heart Disease  throughout the EU.

    Common Agricultural Policy and milk

    Dairy fat is the principal cause of high levels of population mean serum cholesterol. There is massive subsidy to milk producers, •massive overproduction, of which Commission is required to dispose. The public are encouraged to buy low fat dairy products, but the residual (saturated) dairy fat is used in cakes, pies, pastries, etc.

    Common Agricultural Policy and Cereals

    Cereals should be a cheap plentiful supply of fibre and micronutrients, while also being low in fat content. There is a

    high subsidy and maintenance of high price. Cereal production is diverted to support meat factory farming, but it should provide a cheap basis for a healthy human diet.

    Common Agricultural Policy and fruit and vegetables

    There was no subsidy until recently, but there has been regular destruction of cheap production to maintain high price. Fruit and vegetables can now be included within the  “whole farm payment” scheme. There is considerable under-production in relation to need. Thus there is insufficient EU production to support “5 a day” if there were 100% take-up in the  UK alone!
    Ffruit and vegetables protect against cardiovascular disease and some cancers, and the World Health Organisation recommends at least 400g fruit and vegetables (excluding potato) daily.

     Common Agricultural Policy and Tobacco

    Direct subsidies to farmers for tobacco production ended in 2010 but tobacco can still be grown within the “whole farm payments” scheme!

    Common Agricultural Policy influence on Health

    Within the European Union the Common Agricultural Policy has caused:
    •over-consumption of saturated fat-rich beef,
    •over-consumption of saturated fat-rich dairy products,
    •consumption of saturated fat-rich cakes, pies, pastries, etc.,
    •under-consumption of fruit, vegetables and cereals,
    •under-consumption of vegetable protein products containing “healthy” fats,
    •overproduction of high tar tobacco (exported to developing countries), and
    •high incidence and death rate from CVDs and cancers, both in EU and beyond.

    The EU per capita consumption of protein from animal food products is more than double the world’s average.

    Protein consumption in Europe
    •in EU-15 in 2001, there were an estimated 48,050 CHD and 17,800 stroke deaths per decade attributable to inadequate fruit and vegetable intake,
    •if everyone in EU-15 ate recommended levels of fruit and vegetables, it is estimated that 7% of CHD and 4% of stroke deaths prevented, and
    •without subsidies on saturated fat production, assumed that consumption would be 1% less, that unsaturated fat intake 0.5% higher, so mean serum total cholesterol level would be 0.06 mmol/l lower, with 7,000 CHD and 2,000 stroke deaths saved annually (across EU-15).

    Reform of the  Common Agricultural Policy

    Common Agricultural Policy Reform

    reforms introduced in 2005:
    •“uncoupling” of production from subsidy,
    •from 2005 – 2007 subsidy (“whole farm payments”) available to farmers who:
    •    use land to produce food (and some  other) products,
    •    protect the local rural environment,
    •    maintain standards of food safety, and
    •    maintain adequate standards of  animal welfare.

    Outcomes forecast for the 2005 CAP reforms:

    •reduction of the emphasis on subsidies for beef, dairy and sugar production, within “whole farm payments”,
    •removal of the incentive to maximise production of beef and milk,
    •unlikely to result in increased fruit and vegetable production, until 2007 policy change, after which could be included within “whole farm payments”,
    •observers considered it unlikely that these reforms would result in any radical changes to “traditional” patterns of production.

     EU Health Strategy 2007-2013


    • Shared health values
    • Health is wealth
    • Health Impact Assessment  in All Policies
    • Health inequalities
    • EU’s global health voice

    BUT No specific actions identified for the Common Agricultural Policy

    CAP reforms since 2007:

    • School milk regime:
      •   Introduction of a flat rate subsidy for all milk
      •   Extension of the range of products eligible
      •  Inclusion of secondary schools

    •Fruit & vegetable regime:

    • Integration of F&V into single payment scheme
    • Promoting consumption: additional funds, limited  free distribution
    • EU school fruit scheme proposal

    Further reforms are needed.  While subsidies remain, they should be used to promote health, both in Europe and in developing countries, by:

    •  removal of subsidy from beef, dairy,  and tobacco production (including in whole farm payment subsidies), etc.,
    • transfer of subsidy from saturated fat to unsaturated fat food products,
    • increased use of subsidy to promote fruit and  vegetable production, and
    • maintenance of subsidy for cereals for  human consumption, etc.,
    •     but what should we do about sugar?   Tax it?

    Principles for Healthy CAP reform:

    • must be responsive to health requirements,
    • must guarantee health protection requirement of Article 168,
    • CAP (and CFP) should support production and promotion of healthy foods (e.g. to increase consumption of “healthy” oils of fish and vegetable origin in place of saturated fats)
    • the CAP should support production of protein of vegetable origin.
    • CAP must promote health and welfare in rural areas, especially in the new member states,
    • CAP should encourage food industry to produce and promote healthy food, and
    • must not damage developing countries.

    Some of our immediate advocacy objectives:

    • gradual phase-out (over 10 years?) from “whole farm payment” scheme of beef (other than entirely grass-fed), dairy (other than low fat) and tobacco production,
    • gradual inclusion within “whole farm payments” scheme of some types of fish farming, and vegetable protein (e.g. pulses),
    • more support to olive, rapeseed, etc., oil production, and
    • •more social marketing of healthy foods throughout EU.

    Common Agricultural Policy reform

    Questions on price support:

    •phase it out for fruit and vegetables?
    •what policy for beef and dairy?
    •what about sugar?
    Can we add Public Health objectives to “whole farm” payments? e.g. could we invent a score for unsaturated fat, fruit and vegetable production?

    Could the health and environmental lobbies combine in a strategic alliance?   Environmental lobby objectives include to:

    • •promote environmental protection and sustainability for positive impacts on health,
      •devise tools to support Europe`s high value natural farming systems,
      •link of trade with sustainability,
      •achieve a Soil Directive to prevent degradation,
      •prevent environmental contamination by Genetically Modified Organisms

    Beyond this,  the Global Warming Agenda. Farming contributes up to 25% of greenhouse gases. Cows (i.e. beef and dairy) contribute up to 19% (= to all transport!). Accordingly, reduction in both beef and dairy farming could have both health and environmental benefits.

     Health and Environment Impact Assessments:

    •as a part of post-2013, these should be inbuilt to agriculture policy development;
    •this proposal provides a further platform for joint working between health and environment lobbies;
    •improved nutrition should be written into CAP as an objective.
    European Commission statement, 18th November 2010: “The Reform of the CAP towards 2020”:

    “Creating the conditions for easy access to healthy, sustainable and nutritious diet has clear public health benefits as diet is one of the major modifiable risk factor for chronic non-communicable diseases (obesity, diabetes, cardiovascular disease, cancer).   The number of overweight children increases by 1.2 million per year and (with increase in child obesity 400,000 per year) in the EU.   From a public health perspective, access to nutritious-effective food remains insufficient for some groups of EU citizens (e.g. the most deprived), availability of local and directly marketed food stuffs is limited, and acceptability is largely influenced by mass media which is biased towards unhealthy food stuffs (soft drinks, highly processed foods).   Finally, there are concerns as regards other qualities of the food, which include the ethical factors related to production and the way animals are treated.”

    Three options for policy are outlined:

    1.“…further gradual changes to the current policy framework.”  (i.e. “steady as she goes”!);
    2.“…capture the opportunity for reform… targeted measures…more understandable to the EU citizen…to address…economic, environmental and social challenges…”;
    3.“…far reaching reform of the CAP with a strong focus on environmental and climate change objectives,…moving away…from income support and most market measures.”

    Commissioner Cioloş said:  “The Common Agriculture Policy has a clear contribution to health policies, providing safe and diverse food, at affordable prices for consumers and in sufficient quantity, promoting a balanced nutrition, based on quality products. But we can do more to create synergies between agriculture, education and health, to ensure that European policies address the challenges of diet related chronic diseases“

    EPHAC Policy Debate Public Health’s role in the CAP, European Parliament , June 16th 2011

    2011 Proposals

    Direct payments – fairer distribution

    •Capping is based on percentage cuts within certain income ranges i.e. no direct payments over 300.000 EUR
    •Exemption from social, environment and climate change requirements for organic farms, etc.
    •Phasing out of historic references – new criteria for distribution of direct aid between member states
    Direct payments – greening
    •Diversification of crop production, 3 crops (single crop> 5 %   main crop < 70%)
    •Maintenance of permanent pasture
    •Ecological priority areas must cover 7% of total cultivated area
    •Natura 2000 zones and organic farms automatically qualify for the last 30% of whole farm payments
    Rural Development
    •Simplification of payments to small farmers
    •Increased emphasis on developing local and regional food systems – i.e. better market access for small and medium size farms to local markets
    Some positive features:
    •Increased budget (from 90 – 150M EUR) for School Fruit Scheme and increased EC contribution from 50/75% to 75/90% to improve MS uptake
    •Inclusion of nutritional criteria for both School Fruit and School Milk schemes (i.e. low fat products, sugar content)
    Some possibly negative features:
    •Phasing out of sugar quotas – will lead to lower sugar prices
    •Strong lobby by sugar consuming food industries – phasing out already postponed from 2014 to 2015
    •More equitable distribution of direct payments between MS (phasing out historical references) and between farmers in MS (capping) linked to social criteria
    •Greening, 30 % of direct payments to target crop diversification, ecological focus areas and maintenance of permanent pasture
    •Increased focus in Rural Development on small and medium size farms market access local and regional systems
    •Increased funding to School Fruit Scheme + increased EC contribution
    •School Fruit and School Milk Schemes increased focus on nutrition
    One can conclude therefore that while public health nutrition is identified as a very important and desirable objective,

    •its provision is still not yet awarded high priority within CAP reform discussions!

    Presentation on European Union Health Policy by Christopher Birt at our seminar in Sheffield, 11th October 2013

    Longer presentation on the health implications of the Common Agricultural Policy

    EU Health Programme 2008-13 “Together for Health” is coming to a close. Objectives:
    •to increase health security:  emergency planning; patient safety; blood, tissues, cells, etc.;
    •to promote health, by addressing health determinants and to tackle health inequalities;
    •To generate and disseminate health information;  health information systems.
    A new programme EU Health for Growth (2014-20) starts next year
    •themes for 2008-13 to be continued;
    •new emphases on innovation and sustainability of health services, public health, and cross-border health threats;
    •everything to be subsumed into the wider objective for all EU policies and programmes:  to make the EU economy more dynamic, profitable, and export-oriented (linked to Horizon 2020).

    Revision of the Tobacco Products Directive

    Linda McAvan

    Linda McAvan MEP

    Expected to be agreed by the end of 2013.  Proposes:

    •harmonised framework for tobacco sales, replacing 2001 rules;
    •regulates non-tobacco (e.g. electronic and herbal cigarettes) – as pharmaceuticals?;
    •labelling and packaging – 75% warnings;
    •flavours and “health benefits” (e.g. menthol, liquorice, caffeine, vitamins, taurine) all prohibited;
    •internet sales of tobacco products;
    •tracking & tracing of tobacco products
    Other aspects of tobacco policy
    •agriculture:  “whole farm subsidies”; – tobacco is still a subsidised crop
    •high tar tobacco and Trade – Tobacco grown in Europe is too high in tar to be sold in Europe.  It goes to developing countries.

    Alcohol Policy

    3 strands:
    •raise awareness of PH concerns at EU and Member State levels;
    •initiate actions at EU level, where competence allows;
    •support and coordinate national actions;  identify and disseminate good practice.
    European Commission  prioritised actions
    •projects to reduce alcohol-related harm, especially to children and young people;
    •support development of research methodologies to develop indicators;
    •monitor binge drinking, especially by girls;
    •curbing under-age drinking;
    •development of health education programmes;
    •supporting healthier and productive workplaces;
    •report on the progress on of all of these.

    Implementation of the  Patients` Rights Directive – October 25th

    National Contact Points:

    •who is best placed for this function?
    •who has been consulted:
    •what is happening?

    Prior Authorisation:

    •What are the policy objectives here?
    •How will this be used?

    Prices and tariffs:

    •What is reimbursement tariff, and when payable?
    •How to ensure non-discrimination?

    Information to patients:

    •Definition of entitlements – clear to patients?
    •What information should be available to patients?

    The government’s failure to implement the plain cigarette packaging legislations in the UK reveals a much larger issue to do with international trade and the restrictions it will put on democratically elected governments. When will the UK start putting the health of its citizens first again?

    Proposed Australian plain cigarette packs

    Proposed Australian cigarette packs

    The government’s failure to push ahead with promised plain cigarette packaging has been treated by the British press as a national issue, with the key point of contention being how far Tory election strategist Lynton Crosby influenced Cameron’s decision, while the much broader international trade context and the implications for future legislative deterrence have escaped public attention.

    On December 1, 2012, Australia introduced the world’s first legislation requiring tobacco products to be sold in olive-coloured plain packaging (Australia’s Tobacco Plain Packaging Act 2011).

    Before the legislation came into force, British American Tobacco and Japan Tobacco International, supported by Phillip Morris International, brought a case against the Australian government. The High Court there judged in favour of the Australian government.

    Immediately following that judgement, the Ukrainian government raised a dispute against Australia at the World Trade Organisation, on the basis of Australia’s failure to meet its commitments under the WTO TRIPS (Trade-Related Intellectual Property Rights Agreement).

    As WTO disputes have to be state-to-state and the Ukraine has had no tobacco trade with Australia since 2005, the issue arose as Phillip Morris subsidiary based there, employing a large number of people. According to Ukrainian officials, the decision to pursue the dispute by their government was made secretly within the Ministry of Economics and – in spite of their President’s attempts to deter the high level of smoking in the Ukraine – the letter was not shown the Ukrainian Ministry of Health. Australia has rejected the dispute once, but will be forced to respond when the Ukraine reapplies.

    In July, the UK government shelved legislation similar to that introduced by Australia on the grounds of ‘wait and see the health effects in Australia’. The discussion has been drawn out as anti-tobacco health groups have not let go on such an important issue. But, still conveniently for the British government, the discussion has been limited to national level. This is definitively, however, an international trade issue.

    The UK is always completely committed to ‘free trade’, mostly on behalf of global finance interests in the City of London, making it the main neoliberal proponent within the EU. The UK could not and would not make a move that is counter to ‘free trade’, especially at a point in time at which it would effectively be supporting Australia in this dispute.

    Rather than someone ‘influencing’ David Cameron’s decision, surely this was a case of someone reminding him to join the dots. Lynton Crosby’s lobbying firm for instance, has a contract with Phillip Morris International, though he is refusing to say how much it is for.

    As well as this monumental betrayal in regard to the nation’s health, this event is an indication of the likely trade agenda effects on all future UK legislation, on health and much more. Due to the direction of EU trade commitments, the UK will be far more vulnerable than Australia.

    The EU is now including Investor State Dispute Settlement in all its trade deals including the big US/EU Transatlantic Trade and Investment Partnership (TTIP). ISDS allows corporations to sue governments directly in international trade dispute jurisdictions of the corporation’s choosing, i.e. not at the level of the host country’s legal system, for any loss (or ‘expropriation’) of anticipated profits.

    Australian PM Julia Gillard refused to include ISDS in Australia’s trade deals (I hope her displacement doesn’t see any backtracking on this), hence only the national and WTO legal arenas could be used to attack the Australian legislation.

    With ISDS, the UK’s policy space to legislate will be far more restricted. What ISDS does is prevent any backtracking of trade commitments, which, in the EU, are made without our knowledge anyway.

    Although these dimensions were not recognised in the UK public sphere, the cigarette packaging issue is an indication of how the UK government will be positioned on any future health issue, because trade rules are now at the core of health legislation. For anyone concerned about our health system, this is necessary knowledge.

    World Health Organization: “Tobacco is the only legal consumer product that kills when used exactly as intended by the manufacturer.”

    This article was first published by Open Democracy and is reproduced with permission

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    Full text of the agreement

    This lists policies directly relating to health, NHS  and social care services only, not the various less directly relevent measures about the economy, housing, benefits, transport and so on. Continue reading »

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    • The harmful use of alcohol results in 2.5 million deaths each year.
    • 320 000 young people between the age of 15 and 29 die from alcohol-related causes, resulting in 9% of all deaths in that age group.
    • Alcohol is the world’s third largest risk factor for disease burden; it is the leading risk factor in the Western Pacific and the Americas and the second largest in Europe.
    • Alcohol is associated with many serious social and developmental issues, including violence, child neglect and abuse, and absenteeism in the workplace.

    (World Health Organisation)

    Harm attributed to different drugs

    Harm attributed to different drugs

    In the UK alcohol causes more harm than any other drug. (Independent Scientific Committee on Drugs)

    Eighty per cent of alcohol purchases in Britain are made by 30% of the population.  Surveys have shown that about 25% of the population are drinking at hazardous or harmful levels. (Royal College of  Physicians). Between 1980 and 2007  beer for home consumption became 139% more affordable (wine during the same period 124% more affordable). Supermarkets frequently sell alcohol at a loss – so heavy drinkers are subsidised by the rest of their customers.

    Alcohol consumption tends to fall in a recession, along with disposable income. The Office of National Statistics this week report the proportion of men drinking on five or more days a week fell from 23% in 1998 to 16% in 2011 and that of women from 13% to 9%. But the drop only began to be seen after 2007.  Heavy drinking is also falling.  But not fast enough.

    There is plenty of evidence that  alcohol consumption is reduced most effectively by increases in price and reduction in availability.  Education doesn’t have much effect. Increased prices lead to delay in the start of drinking among teenagers and reduce the amount drunk.  Increased prices reduce the harm caused by alcohol and and have a much greater effect on heavier than lighter drinkers.

    Increasing the minimum price of a unit of alcohol to 50p would probably cut overall consumption by 6.9%  and result in extra spending of £10 a year for moderate drinkers – perhaps less for those who don’t drink White Cider.  There should also be a reduction of around 2.8% in the cost of food and non-alcoholic drink is supermarkets.

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    Richard Simpson MSP argues that we need more than just minimum pricing to tackle alcohol misuse.

    Alcohol misuse and its consequence for health and community safety remains a significant challenge throughout the UK. The Sheffield model on which the debate around minimum unit price (MUP) has been based predicated a reduction in consumption of 3.8% from a ban on discounting. In practice there was a reduction of only 1%. It is worrying for MUP that the model has been found flawed at the first test.

    Increases in duty and VAT have led to an increase in price and will have contributed to the reduction in the UK consumption over recent years. Many other measurements are improving including deaths particularly in men down 15%, self reported hazardous drinking down by a quarter, and reductions in admissions and discharges from hospital. Scotland remains the nation with the greatest problem in the UK. It was clear at the time of the debate on MUP that whatever the merits of MUP many stakeholders were of the opinion that other measures were needed.

    With the support of Labour colleagues I have consulted on fourteen measures which may form part of a private members bill. The responses have been generally positive or very positive. There are two strands to the bill. One is concerned with those whose pattern of alcohol consumption is getting them into difficulty. Many of them build on pilot work already undertaken.

    Areas where there were diverse views many supportive but with some suggesting the need for further evidence and evaluation included:

    • Restrictions on pre-mixed caffeinated alcohol products;
    • Licensing Boards having the power to make bottle-tagging schemes a licensing condition;
    • Fine Diversion being made available on a statutory basis;
    • Arrest Referral Schemes for alcohol (as well as drugs) being a statutory requirement in each Community Justice Authority;
    • Drink Banning Orders;
    • Extending Drug Treatment and Testing Orders (DTTOs) to become Alcohol Drug Treatment and Testing Orders (ADTTOs).

    The evidence on the risks of premixed caffeine alcohol drinks has strengthened since this was last proposed. The USA has now banned premixed drinks completely.

    The use of Bottle Tagging to gather intelligence on the source of purchases involved in both underage drinking and proxy purchasing could help tackle underage drinking. There are some objections on the ground of cost to the licensee. However, this would not be a requirement on all licensees rather a power to make it part of the license if requested by the police.

    Fine diversion into educational programmes has proved worthwhile in a Fife pilot.

    Currently a very substantial proportion of offenders in short term custody have an alcohol element in their offence. Short term custody does not allow the Scottish Prison service to undertake work with prisoners so more diversion which does address their problem should be valuable. Arrest referral is only currently available in two sherrifdoms though some five do have such a referral mechanism for drug misuse. The bill would extend this to all eight sheriffdoms.

    Drink Banning Orders in England show some benefit both in the individual behaviour and in community safety. Some of the new Police Commissioners are committed to extending their use. ACPOS support for this measure is particularly welcomed.

    Increase diversion from custodial sentences into treatment, building on the Drug Testing and Treatment orders (DTTO) and Community Orders, is proposed with a specific order for Alcohol (ATTO).

    One reference was made in the consultation response to the application of breathalyser locks being required by some US states following an offence. Drivers have to demonstrate that they meet the drink driving limits before a vehicle will start. This is not in the bill at present but may be worth considering
    There are a number of general measures including clarification on the licensing conditions on the public health interest and protecting children; re-establishing the national licensing forum; strengthening the discount ban and restricting advertising. The full response to the consultation on the bill will be published as soon as we have the government’s view.

    Dr Richard Simpson MSP is Scottish Labour’s Public Health spokesman.

    From Healthier Scotland: the Journal

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    Liver disease in ScotlandThis shows the comparison of rates of liver disease in Scotland against other European countries, and against England and Wales.

    As alcohol becomes more affordable, consumption increases; as consumption increases, harm increases.

    The Scottish Government is proposing to introduce a Minimum Unit Price for alcohol so that the harm caused by cheap, strong alcohol is significantly reduced. The Minimum Unit Price is based on the number of UK units of alcohol (10 mls of pure alcohol) in a product multiplied by 50p (€0.601) per unit which is the Scottish Government’s preferred price.

    UK alcohol affordability index versus alcohol-related discharge rates (Scotland), 1982-20109

    UK alcohol affordability index versus alcohol-related discharge rates (Scotland), 1982-2010/9

    The Scottish Government’s case is that increased taxation would not – and cannot – deliver the targeted impact on hazardous and harmful drinkers that is so vital. The untargeted nature of taxation means that any attempt to design an excise regime capable of delivering a similar effect to a 50p Minimum Unit Price would, inevitably, mean a significant increase in the price of all products, regardless of their contribution to alcohol-related harm. Such increases – roughly £3.30 (€4) increase on the price of all 75cl bottles of wine, or an extra £5 (€6) on a bottle of spirits – would be both unnecessary and unjustifiable in health terms.

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