Alcohol & Health Harm: the Scale of the
Problem
North-South Alcohol Conference
Armagh
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 unrecorded
o one-third consumption in Russia
unrecorded
o 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
Drinking to unwind after
stressful day…..
Of women that drink hazardously - 81% do so to relieve
stress
Know Your Limits/YouGov; Netmums, 2008
Women and alcohol
• Advertising and marketing – more
sophisticated and more aimed at women
Pre-loading
DALYs lost attributable to 10 leading risk factors for
the 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.
3500
Rate per 100,000
3000
2500
CHRONIC
CONDITIONS
2000
Chronic Conditions Rate
Wholly Attributable Rate
1500
Acute Consequences Rate
1000
DEPENDENCE
500
0
2002/2003
2003/2004
2004/2005
2005/2006
2006/2007
2007/2008
2008/2009
Male alcohol-related deaths by age group, England
Jones et al, NW Public Health Observatory Report 2008
patterns of drinking and harm
Binge drinking
•The consequences of
getting drunk:
• Violence,
accidents
• STD’s, sexual
mishaps
Regular drinking
•the consequences of
repeated heavy
exposure
• Cirrhosis
• Other physical
damage
• Psychosocial harms
But note that these patterns are not mutually exclusive
Patterns
of drinking
and harm
Pattern of
drinking (adjusted
for total
consumption) and
mortality risk
Kauhanen et al, BMJ, 1997
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
Differences in standardised mortality rates
over the last decade – ages 15-44 (%)
Men
Women
Scotland
227
170
England & Wales
224
185
Ireland
135
160
France
91
66
Spain
69
57
Italy
76
57
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
The situation in Republic of Ireland
• 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.
Age-standardised alcohol-related death rates by deprivation*
twentieth and sex, England and Wales 1999-2003
Least
deprived
* Carstairs deprivation index
Most
deprived
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
Competing frameworks for alcohol policy
•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)
•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
Final thoughts…..
•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 socioeconomic status
Final thoughts… (2)
• 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.