Alcohol in ScotlandAlcohol in Scotlanda public health perspectivea public health perspective

Dr Lesley GrahamDr Lesley Graham Public Health Lead, Information Services Division, Public Health Lead, Information Services Division,

National Services ScotlandNational Services Scotland

Alcohol Policy Team, Scottish GovernmentAlcohol Policy Team, Scottish Government

The role of public health

evidence of the problem ‘framing’ the problems and solutions evidence for effective policies advocacy for policy into practice monitoring and evaluation of

implementation

Ecological Model

THE INDIVIDUAL

FAMILY

COMMUNITY

SOCIETY

UK Alcohol ConsumptionUK Alcohol ConsumptionLitres of pure alcohol consumption per capita in the UK Litres of pure alcohol consumption per capita in the UK 1900-20061900-2006

Alcohol Consumption in ScotlandAlcohol Consumption in Scotland

1 in 4 (27%) men and nearly 1 in 5 (18%) women exceed 1 in 4 (27%) men and nearly 1 in 5 (18%) women exceed double daily benchmarks (‘binge’ drinking) double daily benchmarks (‘binge’ drinking) [SHeS 2008][SHeS 2008]

younger age groups (16-24) drink most and are most likely younger age groups (16-24) drink most and are most likely to exceed weekly and double daily limits to exceed weekly and double daily limits [SHeS 2008][SHeS 2008]

little difference in exceeding limits by deprivation little difference in exceeding limits by deprivation category for men although men in most deprived category category for men although men in most deprived category drink more drink more [SHeS 2008][SHeS 2008]

women in the least deprived areas most likely to exceed women in the least deprived areas most likely to exceed limits and drink more limits and drink more [SHeS 2008][SHeS 2008]

apparent little difference in excess consumption between apparent little difference in excess consumption between Scotland and England Scotland and England [GHS 2007][GHS 2007]

butbut

known under-reporting in surveys (up to 50%)known under-reporting in surveys (up to 50%) surveys ‘health cohort’ and can miss heavy surveys ‘health cohort’ and can miss heavy

drinking groups e.g. homeless/prisonersdrinking groups e.g. homeless/prisonersindustry sales data show:industry sales data show: in 2007, 12.2 litres of pure alcohol per capita (>18 in 2007, 12.2 litres of pure alcohol per capita (>18

yrs) was sold in Scotland compared to 10.3 litres yrs) was sold in Scotland compared to 10.3 litres in England, enough for every man and woman in England, enough for every man and woman over 16 to exceed the adult male guidelines every over 16 to exceed the adult male guidelines every single weeksingle week [Nielsen 2007][Nielsen 2007]

the wider environmentthe wider environment

liberalisation of licensing laws in Scotland liberalisation of licensing laws in Scotland in 1976 (‘permission to drink’)in 1976 (‘permission to drink’)

alcohol more available (more licensed alcohol more available (more licensed premises and for longer hours)premises and for longer hours)

alcohol more affordable (69% more alcohol more affordable (69% more affordable since 1980)affordable since 1980)

Alcohol Related Harm

The average consumption of alcohol in a population is directly linked to the amount of harm [ECAS study Alcohol in Postwar Europe Nostrom et al]

Harm can be from the individual to societal level

Alcohol Related Deaths

15 of the 20 local areas in the UK with highest male alcohol-related death rate 1998-2004 are in Scotland:1. Glasgow City2. Inverclyde3. West

Dunbartonshire4. Renfrewshire5. Dundee City[ONS]

Chronic Liver Disease mortality rates per 100,000 population 1950-2006updated from Leon and McCambridge, Lancet 367 (2006)

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Age

sta

ndar

dise

d m

orta

lity

rate

per

100

,000

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Scotland

England and Wales

Scotland

England and Wales

Other Europeancountries

Other Europeancountries

Men aged 45-64 years Women aged 45-64 years

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Chronic Liver Disease Mortality by Deprivation, Scotland (Men) data from Leyland et al Inequalities in Scotland 1981-2001 MRC 2007

Male mortality rate for chronic liver disease per 100 000 population,

1980-2002

0

10

20

30

4050

60

70

80

90

1 2 3 4 5 6 7

Deprivation category

dea

ths

per

100

000

po

pu

lati

on

1980-82

1991-92

2000-02

Alcohol-related hospital discharges, 1996/7 - 2007/8

0

200

400

600

800

1000

1200

1400

160019

96/9

7

1997

/98

1998

/99

1999

/00

2000

/01

2001

/02

2002

/03

2003

/04

2004

/05

2005

/06

2006

/07

2007

/08

Eu

rop

ean

Rat

e S

tan

dar

dis

ed R

ate Under 15 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40-44 years

45-49 years

50-54 years

55-59 years

60 years and over

Alcohol and Social HarmAlcohol and Social Harm

Alcohol misuse a contributory factor in 1 in Alcohol misuse a contributory factor in 1 in 3 divorces 3 divorces

65,000 children under 16 estimated to be 65,000 children under 16 estimated to be living with parents with alcohol problemsliving with parents with alcohol problems

95% of people felt alcohol abuse in 95% of people felt alcohol abuse in Scotland as a problemScotland as a problem

Alcohol and CrimeAlcohol and Crime

49% of prisoners were drunk at the time of 49% of prisoners were drunk at the time of their offence (76% of young offenders) their offence (76% of young offenders) [Scottish Prison Survey 2008][Scottish Prison Survey 2008]

70% of assaults presenting to A&E likely to 70% of assaults presenting to A&E likely to be alcohol related be alcohol related [QIS audit 2008][QIS audit 2008]

Alcohol a contributory factor in two thirds Alcohol a contributory factor in two thirds of domestic violence of domestic violence [Home Office 2003][Home Office 2003]

Alcohol Policy: what works?

‘A considerable body of evidence shows not only that alcohol policies and interventions targeted at vulnerable populations can prevent alcohol-related harm but that policies targeted at the population at large can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. Thus, both population-based strategies and interventions, and those targeting particular groups.. are indicated’ [WHO Evidence based strategies and interventions to reduce alcohol related harm 2007]

The number of heavy drinkers in a population is directly linked to the average population consumption. So a fall in overall consumption will reduce the number of heavy drinkers[Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker BMJ 1997;314:1164 Colhoun et al]

Tackling alcohol related harm will also tackle health inequalities

Protective effects on vulnerable groups

What measures work best?

Price Availability Drink driving counter measures Brief interventions

[Alcohol policy in the European region; current status and the way forward WHO EURO/10/05;

Babor et al Alcohol: No Ordinary Commodity 2003;

Anderson and Baumberg Alcohol in Europe 2007]

Changing the Culture

‘Epidemics appear, and often disappear without traces, when a new culture period has started; thus with leprosy, and the English sweat. The history of epidemics is therefore the history of disturbances of human culture’. [Virchow cited in Rose, The Strategy of Preventive Medicine Oxford Medical Publications 1992]