The purpose of this study is for the writer to explore the government strategies in combating the rising rates of underage binge drinking in the UK. The writer will approach this topic by briefly examining the prevalence, determinants, and effects of underage binge drinking. The writer will also critically analyse gaps in government strategies in tackling underage drinking and subsequently formulate a policy intervention that would address the gaps highlighted. Ethical consideration of the policy intervention will also be explored, and subsequently reflection and conclusion will close the study.
There is no universal definition of binge drinking, but it is often described as a pattern of excessive intake of alcohol over a short period of time (Home Office Findings (HOFs), 2005). Parliamentary Office of Science and Technology (POST) (2005) expands this definition further as such behaviour that leads to a rapid increase in blood alcohol concentration and consequently to drunkenness. However, the writer believes that binge drinking occurs when people have no limit of their alcohol intake within a short period resulting in exposing themselves or/and other people to risk.
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Underage binge drinking continues to increase in the UK, although the number of young people aged 11 to 15 who drink alcohol has fallen since 2001 (National Institute for Health and Clinical Excellence (NICE), 2007). However, those that drink alcohol continue to drink more and more often (HM Government, 2007 In NICE, 2007). According to HOFs (2006), the nature of offences among aged 10 to 17 during or after drinking was associated with frequency of drinking. Those that drink once a week or more reported getting involved in arguments (48%), fights (19%) and criminal damage offences (12%) during or after drinking compared to those that drink between one and three times a month (16%, 6% and 4% respectively). Another study undertaken by The European School Survey Project on Alcohol and other Drugs (ESPAD) has examined drinking among representative samples of aged 15 and 16 in the UK. In 2003 study, UK was ranked as the third most teenage binge drinkers out of 35 European countries (Hibell et al., 2004).
There are some effects of teenage binge drinking, and one of this is medical effect. Binge drinking causes brain damage that destroys the brain cells and evidence suggests that adolescent binge drinkers are likely to experience impaired memory and reasoning skills (Institute of Alcohol Studies (IAS), 2007). Alcohol poisoning is another common medical condition among young binge drinkers. The risk of cardiovascular, hypertension, strokes, heart diseases, psychological problems, breast and oral cancers are later effects of teenage drinking on adulthood (IAS, 2007).
One of the economic implications of binge drinking is the cost to the NHS, it is estimated that the cost of alcohol harm to the NHS in England is £2.7 billion (2006/07) as compared to £1.7 billion in 2001/02 prices (The Health and Social Care Information Centre (THSCIC), 2009).
Other effects of underage binge drinking result in alcohol related accidents. For example, in 2007, 6,541 deaths in England were directly related to alcohol consumption and this has increased by 19% between 2001 and 2007 (THSCIC, 2009). Also, binge drinking results in unsafe behaviour such as sexual activities and other illicit drug use, which is more prominent with young binge drinkers (IAS, 2007).
DETERMINANTS OF UNDERAGE BINGE DRINKING
Dahlgren and Whitehead (1991) (see appendix) formulated a useful framework to intensively explore the determinants of health. It is argued that public health is not mainly the absence of diseases (World Health Organisation (WHO), 1948) but to promote ways of prolonging people's lives (Acheson, 1988) through the complex interactions between social and economic factors, the physical environment and individual behaviour as well as fixed factors such as age, sex and hereditary.
The peak of teenage binge drinking age seems to occur around aged 15 and above. HOFs (2006) reported that children aged 16 to 17 reported having had alcoholic drink in the previous 12 months. This report shows the highest alcohol consumption (88%) between the age bracket as compared to children aged 10 to 13 that have the lowest (29%). Conversely, children aged 15 to 16 were used in ESPAD's study, which shows high rate of underage binge drinking in the UK among these age bracket (Hibell et al., 2004).
HOFs (2005) reported that young males are likely to binge drink (49%) than young females (39%). However, Hibell et al. (2004) argued that UK drinking culture seems to be shifting from young males consuming alcohol far more than young females because figures show that in the UK, Ireland and Isle of Man, teenage girls are more likely than teenage boys to have consumed alcohol in binges (Velleman, 2009).
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Griffith (2000) suggested that drinking has been reported as being part of British drinking culture for generations. Plant and plant (2006) argued that most people in the UK drink alcoholic beverages and the negative effects of this drinking are clearly a big problem. The drinking patterns are highly influenced by national culture (Velleman, 2009). For example, in Mediterranean culture, young people are most likely to drink and drink more often and never caused public drunkenness (Velleman, 2009) whereas in northern European, drinking is characterised by excessive drinking but less frequent and heavier when it does occur (IAS, 2007).
Parental influence was critically explored by Velleman et al. (2005) of which family structure was one of the areas where families can influence their minors' substance use behaviour. Hellandsjo Bu et al. (2002) stated that children drinking at a younger age from single-parent families have limited family support. Steinberg et al. (1994) argued that non-separated parents who expect a lot from their children and provide a sense of self-efficacy tend to have children who are less likely to be misusing alcohol.
Environmental factor such as advertisement (direct and indirect) is another factor influencing underage binge drinking. Anderson & Baumberg (2006) and Hastings (2007) have suggested in their review that alcohol advertising and marketing are significant factors in the rise in alcohol consumption by young people. In contrast, alcohol and advertising industries argued that as the alcoholic drink is a legal product it should be legally possible for it to be advertised (IAS, 2008).
Other determinants are the influence of peer pressure (Velleman, 2009) and socio-economic factors (Measham, 1996) as well as individual factors (Ryan, 2005 In IAS, 2007) such as impulsive personality traits, living away from home and to greater affluence, and increase in binge drinking for those who have weak health beliefs.
CURRENT GOVERNMENT STRATEGIES AND BINGE DRINKING
The four countries that constitute UK responded to ways in which rising rate of binge drinking could be controlled. In England, government published a policy document in 2004 on Alcohol Harm Reduction Strategy for England (Cabinet Office Prime Minister's Strategy Unit, 2004). This strategy sets out to address better education and communication to achieve a long term change in attitudes to irresponsible drinking. It also focuses on better health and treatment systems to improve early identification and treatment of alcohol problems as well as to combat alcohol related crime and working with the alcohol industry to build on the good practice of existing initiatives and develop new ones. Finally, the new licensing law that allows 24 hour access to alcohol was introduced by the government in November 2005 (Department for Culture, Media & Sport, 2005).
The government measure to tackle binge drinking focuses on harm minimisation but failed to address the availability of alcohol through its 24 hour licensing law and affordability (POST, 2005). The current licensing law according to the government tends to reduce the practice of hoarding alcohol just before the closing hours and also reducing the numbers of people rushing into the street to purchase alcohol. The Royal College of Physician (RCP) strongly disagreed with government policy on its 24 hour licensing law. It was suggested that this will increase the overall consumption of alcohol and will have public health implications (POST, 2005). Government argued that its alcohol licensing law will reduce crime and anti-social behaviour and encourage a change in UK drinking culture (POST, 2005). Following the evidence presented above about the consequence of binge drinking in the UK, it is clear that more reliable and evidence based solutions need to be put in place because the government is hoping to curb alcohol related crime rather than putting strategy that would curb the overall consumption of alcohol in order to safeguard the health of the people in general. The government policy on alcohol seems to contradict the Ottawa Charter for Health Promotion (OCHP) which suggests that all public policies should be examined for its impact on health (WHO, 1986) which seems to have been overlooked by the government.
Furthermore, the numbers of people experiencing alcohol related harm continue to increase in the UK. For example, the numbers of people dieing from alcoholic liver diseases are increasing in England and Wales (HM Government, 2007 In NICE, 2007). The writer feels that if the strategy to curb the overall consumption of alcohol could be put in place, it will surely promote what the government is hoping to achieve. People should be entitled to good health and what binge drinking is causing in the UK is contradicting what a good health should be. WHO (1948) defines health as a state of complete physical, mental and social well-being but not necessarily absence of disease. Alma-Ata declaration argued that people should have access to healthcare at a cost that is affordable and people becoming the ownership of their care (WHO, 1978). It also argued that health should be a fundamental human right and not a privilege. The government's strategy on binge drinking seems to lack public health benefits as it contradicts Alma-Ata declaration of what a good health should be for the people.
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According to Stevenson et al. (2002, p.533) policy is 'a course of action adopted or proposed by an organization or person'. However, the writer argued that a policy is a set of rule or guideline that is specifically drafted for a particular purpose for an individual, organisation or country to follow.
The writer will therefore focus on strengthening the current government strategy as this strategy appears not to be combating teenage binge drinking in the UK.
The writer aims to propose a policy to reduce 24 hours access to alcohol (licensing law) to a restricted time scale and to increase alcohol taxes as ways of managing the availability of alcohol and to reduce early alcohol drinking. These ideas are well supported by RCP, British Medical Association, and Academy of Medical Sciences (POST, 2005).
Currently in the UK, the legal drinking age is 18 years (Office of communications, 2004) and the writer is proposing that the age should be increased to 21 in order to reduce teenage drinking at early age and its associated harm. There has been a debate in the Australian media suggesting increasing the legal age of alcohol consumption from 18 to 21 years (Toumbourou, et al. 2008). Several studies conducted in the past suggested that raising the age would reduce adolescents' access to alcohol and subsequent associated harms (Grube, 1997; Ludbrook et al., 2002). Lowering the legal drinking age from 20 to 18 in New Zealand is reported to have resulted in a sharp increase in teenage and adults binge drinking (Everitt & Jones, 2002). The writer feels that if this approach is embraced, it will restrict access to alcohol among aged 18 to 21 which will partly reduce rate of drinking. However, this action on its own will not resolve the binge drinking and all its associated harm.
NICE (2007) produces public health guidelines on sensible alcohol consumption for use in primary and secondary schools in order to tackle the drinking problem among the young people. The policy also sets to provide support for alcohol drinking parents. It appears that government is trying their best to curb the rising rate of underage drinking in the UK. However, the writer feels that sophisticated alcohol awareness programmes should be made available to the parents through their General Practitioners (GPs). There is no routine on alcohol awareness programme for the parents through their GPs and what appears to be available through the GP is to offer support when alcohol is becoming or had become a problem. There is a need for routine based alcohol awareness for the drinking parents in all the GP surgeries. This idea is well supported by OCHP which focuses on helping people develop their skills in order to be in control of their lives and have more power in decisions that affect them (WHO, 1986). In doing this, parents will be able to give advise on alcohol drinking as they will lead by example by not drinking or stocking alcohol beverages in the house. Evidence shows that parents are likely to influence their children through their drinking behaviour (Bandura 1977, In Velleman, 2009).
The writer is also proposing that all alcohol related adverts (direct or indirect) should be ban in the UK because a recent review of seven international research studies revealed that there is a correlation between prior alcohol advertising and marketing exposure and subsequent alcohol drinking behaviour in young people (Smith & Foxcroft, 2007). Taking actions on alcohol advertisement in order to safeguard the future of minors are well supported by WHO's European Charter on alcohol. It addresses the European countries to take action on alcohol advertisement of which banning was part of the recommendations that were highlighted (IAS, 2008). However, the writer is aware that this approach might not be in favour of the UK economy because alcohol investors may leave or not invest in such country where promotion of their alcohol product can not be advertised. The writer believes that overall health of the people should outweigh such economic problem.
Lastly, the writer is proposing that a measure such as introducing a national identity card for its citizens with a view that this card will be used at the point of alcohol purchase in order to keep a record of government recommended (THSCIC, 2009) daily alcohol intake (3-4 and 2-3 units for men and women respectively) for an individual who uses his/her card. This proposal will be monitored in relation to daily alcohol intake should people start to hoard alcohol. This proposal will also limit alcohol access to the minors as evidence suggests they still have access to alcohol despite government policy (HOFs, 2006).
This study considers the four widely accepted ethical principles (Beauchamp & Childress, 1995) which are autonomy, beneficence, non-maleficence and justice. This study will encourage the underage people to make choices based on the information provided. The right information will be passed to them and will be allowed to make their informed decisions. The study is also constructed in a way that is beneficial to underage people, family and society at large. The confidentiality and respect of the people will be maintained. Lastly, the writer will ensure that people are treated fairly and the resources will be shared equally among those that need support.
My understanding of public health and application of theory into practice has developed to a considerable level during the course of this study. This study seems to be complex and requiring in-depth knowledge and understanding of public health practice. With adequate human and material resources obtained, I was able to uncover difficulties that were initially evident. This study has given credence to the gaps that sometimes occur in government strategy to combat a problem.
I am aware that for an issue such as underage binge drinking to be revisited on the public agenda, there may be a need to advocate and mediate between different interests for the pursuit of health of the people in the society. Such way is achieved through media, advertising to raise public awareness, personal appeals by public officials and celebrities and many other approaches (Pencheon et al., 2006). Although this is not a guarantee that such issues will gain public agenda but it is suggested that public opinion has its greatest impact on government decision-making when people feel strongly and clearly about a problem (Pencheon et al., 2006).
This study has attempted to explore the rising rate of underage binge drinking by critically appraising the government measures in tackling the problem, with raised and explored policy interventions in order to address gaps in government strategy. It is hoped that the policy interventions would address the overall alcohol consumption rather than targeting only the alcohol binge drinkers.
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