A ‘responsibility deal’ is not enough. The BMA believes we need tough legislation to tackle the damage caused by alcohol

The cost of alcohol to British society is currently estimated at over £25bn per annum. This is not just the health costs, but also costs relating to crime and disorder, including domestic violence and fights and accidents on the streets. Health workers see the personal costs; we see the fractured families, the individual tragedies of wholly preventable death and disability. And we want action, now, to start to address this complex problem.

The government is about to launch its alcohol responsibility deal but the BMA, along with other health organisations, has been unable to sign up. We are so dissatisfied with the deal, and given the government does not seem to accept our concerns, we believe we had no option but to publicly walk away. The World Health Organisation has recognised that alcohol is a major cause of ill-health worldwide and that action on alcohol must fall into three areas: affordability, availability and promotion. The healthcare professionals and charities with special expertise in alcohol share this concern and this understanding of the need for a joined-up approach. This means that, as the health secretary Andrew Lansley keeps saying, every minister must see him or herself as a public health minister and seek out actions they can take to promote health rather than booze.

The sad truth is that many drinkers have no idea how much they are drinking, or the harm it is doing. Still fewer have any idea that alcohol is a poison that kills, as well as causing chronic liver and other organ damage. Drinking at levels that will harm health or lead to premature death occurs in all social classes and all age groups, but the health harms are disproportionately felt by the poorest in our communities. The government must commission more research into attitudes towards alcohol in the UK, make sure school-based and general public education are clear, and consistent and are part of a wider strategy. All alcohol packs – cans and bottles – must by law be labelled with easy to read information about the number of units within them, the safe drinking levels and a warning message about not exceeding these levels.

Retailers and the industry also need to play a role: legislation should look at price, and the way in which alcohol is marketed and licensing legislation should be strictly enforced; including ensuring that there are the resources for that enforcement. Applications for more licences to sell alcohol should be reviewed against a background of considering public health and street crime; we must reduce the availability of alcohol by reducing the number of places selling it.

What we need is a joined-up and comprehensive alcohol strategy. This includes dealing with drink-driving laws and treatment for individuals with alcohol problems. We know that driving is affected by drink. The government must stop ignoring the advice from Peter North and lower the drink-driving limit, and legislate to allow the police to do random roadside testing.

In the healthcare sector we must make sure we have sufficient resources for those needing help to stop or limit their drinking, with no long waits for referrals where these are needed. This must mean training in and then funding for brief interventions a well as for the necessary specialist services.

The good news for government is that we have two alcohol strategies available from the last decade. Action must deal with the problem areas, including pricing, and it must have teeth – industry must be in no doubt about the willingness of government to regulate and legislate. Independent expert monitoring and evaluation should be built in to make sure we are meeting targets such as a year-on-year real reduction in the numbers who drink excessively. This is not impossible – it looks as if France has achieved this, and that its alcohol industry has maintained its bottom line while selling less.

If supermarkets can find large sums of money to fund alcohol education, fine. But that money should go to charities who know what they are doing and are wholly independent of industry, such as the Institute of Alcohol Studies and Alcohol Concern who should then commission, and evaluate, the education.

We know that regulation and legislation take time, especially where Europe is involved. But further delay now is not the answer. We should start to legislate today and use voluntary agreements to get action while the process of legislating is under way. Anything else and we condemn more people to unnecessary deaths, and our economy to a steadily increasing financial burden.

Vivienne Nathanson
guardian.co.uk,  Monday 14 March 2011
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