And so the longest month of the year – at least it feels that way – is finally over. But as the days get ever so slightly longer, and as new year resolutions start to falter, what to make of that programme of month-long abstinence that so many Britons seemed to engage in?
Dry January is a public health campaign that was started in 2013 by Alcohol Change UK. As you may know, it involves avoiding all alcohol for the month; this has individual benefits such as saving money, avoiding hangovers, better sleep, fewer empty calories and better overall energy levels. It comes at a time that has seen a transition towards not drinking at all in younger generations, with an estimated 20% of the population now never consuming alcohol.
This may sound surprising but, on average, British people consume roughly the same amount of alcohol as their European counterparts, or even a slightly lower amount per capita. Given these statistics, why is Britain still seen as boozy? These averages hide that alcohol consumption is not a generalised problem across the population but one focused in a small group of people. The problem is binge drinking: the heaviest drinkers in England, who make up just 4% of the population, consume about 30% of the alcohol that is sold and make up almost a quarter of all industry revenue. The pandemic only exacerbated this: while overall consumption of alcohol went down, drinking at harmful levels increased in certain groups.
This heavy drinking has a clear impact on our health and healthcare. The NHS has been struggling to deal with the volume of care that it’s expected to deliver. Alcohol-related admissions add to this. In England, in 2018-19, they represented almost 6% of all hospital admissions (with 73% of patients being male). Admissions were linked to cardiovascular disease, mental and behavioural disorders due to alcohol, cancer, liver disease, diseases of the nervous system and the acute toxic effect of alcohol.
This is even higher in emergency departments, where an estimated 12-15% of admissions are due to acute alcohol intoxication, which rises to 70% on Friday and Saturday nights. Simon Stevens, former head of NHS England, once pointed this out, saying that the NHS is not the National Hangover Service, though it might feel like it in the hospital at weekends.
While it’s universally agreed that binge drinking is harmful, what about a beer at the pub, or being a social drinker? Could a glass of red wine even be beneficial for health? On this, the science is clear: just last month, the World Health Organization put out a strong statement saying that “no level of alcohol consumption is safe for our health”, noting that alcohol causes at least seven types of cancer, cardiovascular disease and type 2 diabetes. This is true even for light or moderate drinkers. The WHO pointed to research indicating that the more you drink, the more harmful it is, while the less you drink, the better it is.
But clearly, public health is a constant balance between regulating risk factors that harm our health, and letting individuals live meaningful lives in the way they want to. For many people, the pleasure or fun of having a glass of wine or a beer with friends is worth the harm. Life is about moderation.
Public policy, though, has to step in when this spills into harm to others, in the form of drink-driving or ending up in A&E, which can strain health services. A key priority to address this is supporting heavy drinkers, that 4%, to consume less alcohol and move towards safer intake. A look at Scotland gives us a sense of what can be achieved through policy.
Over the past 15 years, its devolved government has attempted to reduce alcohol-related harm through a ban on multi-buy price promotions on alcohol, minimum unit pricing, reducing the drink-driving limit and restricting alcohol marketing on TV. And partly due to these efforts, alcohol harm fell in Scotland between 2003 and 2012, before plateauing. The emphasis in Scotland continues to be on high-risk groups.
So, while there are many health benefits to Dry January, an even better resolution for England would be a No Binge 2023.
Prof Devi Sridhar is chair of global public health at the University of Edinburgh
