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Alcohol & Health Harm: the Scale of the Problem
North-South Alcohol ConferenceArmagh
26th January 2012
Ian Gilmore, University of Liverpool,Chair, UK Alcohol Health Alliance
WHO Global Status Report 2011
Why is per capita consumption apparently falling?
• number of abstainers in UK is increasing
• average consumption per non-teetotal adult = 25 units/wk
• increase this by 15% for unrecorded / consumed abroad
Abstainers in last 12 months
(% of adult population
)
China –the new global market for alcohol
Recorded adult per capita consumption age 15+– (unrecorded 1+l/person)
Illicit and ‘informally produced’ alcohol• 27% alcohol consumption
worldwide unrecorded (WHO)
• varies across the world:o slovenian wine mainly unrecordedo one-third consumption in Russia unrecordedo two-thirds consumption in India ,,
o 90% consumption in East Africa ,,
• average Ukranian consumes 8 litres unrecorded alcohol per annum
Drinking with meals in the EU 15
Source Eurobarometer 2003
WHO Global Status Report 2011
ESPAD data on amount drunk by 15-16 yr-olds on last drinking occasion
ESPAD 2007
ESPAD data on % 15-16 yr-olds who had been drunk in last year
ESPAD 2007
Consumption and young people
Good news and bad news…….
•Fewer 11-15 year olds admit to having drunk alcohol in the UK
•However those that do are drinking more
Of women that drink hazardously - 81% do so to relieve stress
Know Your Limits/YouGov; Netmums, 2008
Drinking to unwind after stressful day…..
Women and alcohol
• Advertising and marketing – more sophisticated and more aimed at women
Pre-loading
DALYs lost attributable to 10 leading risk factors forthe age group 15–59 years in the world, 2004
WHO Global Status Report on alcohol and health 2011
Global distribution of alcohol-attributable deaths and DALYs by broad disease and injury categories, 2004
WHO Global Status Report 2011
Alcohol Related Admissions for Liverpool PCT (residents) 2002/03 to 2008/09 by Condition Group.
0
500
1000
1500
2000
2500
3000
3500
2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009
Rat
e pe
r 10
0,00
0
Chronic Conditions Rate
Wholly Attributable Rate
Acute Consequences Rate
CHRONIC CONDITIONS
DEPENDENCE
Male alcohol-related deaths by age group, England
Jones et al, NW Public Health Observatory Report 2008
Binge drinking
•The consequences of getting drunk:
• Violence, accidents
• STD’s, sexual mishaps
patterns of drinking and harm
Regular drinking
•the consequences of repeated heavy exposure
• Cirrhosis• Other physical
damage• Psychosocial
harms
But note that these patterns are not mutually exclusive
Pattern of drinking
(adjusted for total
consumption) and mortality
riskKauhanen et al, BMJ, 1997
Patterns of drinking and harm
Liver cirrhosis mortality rates in Europe
• up to 20-fold differences between countries (range 4/100,000 for Icelandic males, 75/100,000 for Hungarian males)
• rates tend to be much higher in East than West Europe, particularly in under 45 years
• male female ratio across countries very constant, men being 2-3x higher
• liver mortality correlates with other alcohol-related deaths, especially in <45 yr age group
Men Women
Scotland 227 170
England & Wales 224 185
Ireland 135 160
France 91 66
Spain 69 57
Italy 76 57
Differences in standardised mortality rates over the last decade – ages 15-44 (%)
Leon and McCambridge, Lancet 2006
Sheron 2010,
Projections for UK liver deaths
Lancet 2011
Countries with markedly rising cirrhosis rates in last twenty years
• Bulgaria• Denmark• Estonia• Finland• Baltic countries • Poland• Russia• UK + Ireland
Tend to be:• Northern and
Eastern European
• Beer/spirit drinking
• Binge pattern• Starting from
lower levels
Countries with markedly falling cirrhosis rates in last twenty years
• Austria• France• Germany• Greece• Italy• Portugal• Spain
Tend to be:• Southern
European• Wine drinking• With meals• Starting from
high levels
Passive drinking
• consumption stands at 10.9 litres per capita, despite 19% abstainers
• 25% of Irish men report bingeing at least once per week
• half of Irish drinkers do so in a harmful pattern
• there has been a shift from pub to home drinking
• alcohol remains a huge risk factor for ill-health, relationship breakdown, hospital admission, suicide and and death from other causes.
The situation in Republic of Ireland
Age-standardised alcohol-related death rates by deprivation* twentieth and sex, England and Wales 1999-
2003
* Carstairs deprivation index
Mostdeprived
Least deprived
Source: ONS 2007
Why is alcohol such a large health inequalities issue?
• Mean consumption across the social scale similar
• Is it under-reporting?
• Is it another factor eg obesity?
• Is it the distribution of drinking patterns?
Drinking type by annual household income quintile, 2008
Three decades of evidence
• Alcohol control policies in public health perspectives –Bruun et al , 1975
• Alcohol policy and the public good – Edwards et al 1994
• Alcohol: no ordinary commodity – Babor et al 2003 and 2010
•Alcohol is normal
• Problems arise when a minority of people misuse it ( “spoil it for the rest of us)
• Therefore the solution is to change the behaviour of the minority (“target other people“) through education and “culture change”
(Industry paradigm)
Competing frameworks for alcohol policy
•Alcohol is not an ordinary product
• The problem is not with the individual but the product
• Therefore the solution is to make the environment less pro-alcohol and reduce the population consumption
• The maximum health gain is through shifting the consumption curve left (“everyone’s problem”)(Public health paradigm)
(from Evelyn Gillan, Alcohol Focus Scotland)
International evidence to ‘shift the curve’ and maximise health gain:
• availability
• promotion by the alcohol producers and retailers
• price of alcohol
Impact of a 50p minimum unit price
• Research into the effect of a 50p minimum price per unit shows for every year (England):
• 3,393 fewer deaths • 97,900 fewer hospital
admissions • 45,800 fewer crimes • 296,900 fewer sick
days • And a total saving of
£15 billion over ten years (health, crime, social care.)
• Source: Chief Medical Officers Report 2008, Meier 2009
•Alcohol use is legal and firmly embedded in our society and will remain so.
• The cardiovascular benefits, if real, are seen at very low consumption levels, affect only the middle aged + and are not a reason for non-drinkers to drink
• Health and other harms are a major societal issue and are not confined to those who obviously misuse alcohol.
• We need to better understand the links to low socio-economic status
Final thoughts…..
• While the relationship between population consumption and harm are not perfect, the maximum health improvements will be seen through shifting the whole consumption curve downwards
• Individuals may choose to live with different levels of risk associated with their pattern and volume of consumption, but must be provided with good information on those risks. This is not currently possible
• Within those who ‘choose’ to drink at higher levels there will will be many with a degree of dependence on alcohol who are not exercising ‘free will’, and we need to get better at identifying and helping them.
Final thoughts… (2)