Following our successful piece on HIV in Sex Workers, the Lancet asked us to produce an infographic to summarise the findings of the UK Commission on Liver Disease. Producer: Aimée Stewart • Designers: Paulo Estriga & Caroline Leprovost for Graphic Digital Agency

1. The UK population changed their drinking habits
reflecting the affordability of stronger alcohol
at home…
…and the number of people admitted to hospital
for alcohol-related liver disease has almost doubled
in a decade.
UK LIVER
DISEASE CRISIS
Survival rates have improved for almost every disease of every organ in the last
few decades, with one notable exception: liver disease1
.
What’s driving this?
Annual deaths related to hepatitis C have
quadrupled since 1996. It is estimated that
around 75% of infected cases are unknown4
.
Introduce a minimum price of 50p to reduce alcohol consumption.
reduction
in obesity
rate for
women
reduction
in obesity
rate for
men
20%TAX
on soft drinks
3.8% 2.4%
Identify the15-20% of NAFLD*
cases likely to progress to
severe liver disease when
screening for other
obesity-related diseases.
Increase medical provision
with more specialists and
liver clinics distributed
across the UK.
Vaccinate at-risk populations
for Hepatitis B and target use
of antiretrovirals for people
with hepatitis B and C
PROJECTED MINIMUM PRICE PER UNIT OF ALCOHOL AND RESULTING PERCENTAGE DECREASE IN CONSUMPTION5
50p
5p
10p
20p
5p
20p20p
10p
20p
20p
20p
5p
20p
20p
10p
50p
20p
50p
0% -0.1% -0.4% -1.1%
-2.4%
-4.3%
-6.7%
-11.9%
-17.5%
What have the UK’s European neighbours done?
So what changes do we need to make in the UK?
A steady fall in cirrhosis deaths in France over
the last 30 years corresponds to a proportionate
fall in alcohol consumption over the period7
.
Conversely, a 33% reduction in Finnish
alcohol taxation in 2004 resulted in soaring
rates of liver disease8
.
Introduce a tax on soft drinks to reduce sugar intake9
.
POLICY MAKERS
MEDICAL CARE
Of the 25% of the UK population with
obesity, a vast majority has non-alcohol
related fatty liver disease1
.
2 3
1
France and Italy have seen a dramatic reduction in liver mortality whereas the UK and Finland
have seen liver deaths rise more than fivefold1
.
PERCENTAGE CHANGE IN STANDARDISED UK MORTALITY RATES (AGE 0–64) NORMALISED TO 100% IN 19701
0%
20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970
300%
600%
BLOOD DIABETES CANCERENDOCRINE /
METABOLIC
HEART
DISEASE
RESPIRATORY CIRCULATORY STROKE
ALL ITEMS
BEER OFF SALES*WINE & SPIRITS OFF SALES*
WINE & SPIRITS ON SALES*BEER ON SALES*
1987 1990 1995 2000 2005 2010 2013
350
100
150
200
250
300
PRICE OF BEER, WINE & SPIRITS VERSUS INFLATION2
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
50,000
Admissions
Admissions
Deaths per 100,000
Number of deaths
Hours worked
*NAFLD = non alcoholic fatty liver disease
Price re-based to 100
* On-sales means in pubs and restaurants, off-sales means liquor stores and supermarkets.
40,000
30,000
20,000
25,000
35,000
45,000
ALCOHOL-RELATED HOSPITAL ADMISSIONS3
HOSPITAL ADMISSIONS FOR NON-ALCOHOL
RELATED FATTY LIVER DISEASE1
DEATHS FROM LIVER FAILURE OR LIVER CANCER
IN THOSE WITH HEPATITIS C6
20,000
10,000
0
5,000
15,000
500
300
0
200
100
400
1998 2000 2005 2010 20122010200520001996
PERCENTANGE CHANGE IN STANDARDISED DEATH RATES1
40
35
30
25
20
15
10
5
0
UNITED KINGDOM ITALY NETHERLANDSSWEDEN NORWAYIRELANDFRANCE FINLAND
20101970 1975 1985 20051980 1990 1995 2000
Additionally, people in France diagnosed with
hepatitis C are 6–12 times more likely to receive
treatment than those diagnosed in the UK.4
HOURS AN INDUSTRY WORKER HAS TO WORK TO
AFFORD HALF A LITRE OF VODKA IN FINLAND8
TOTAL WINE CONSUMPTION IN FRANCE,
NORMALISED TO 100% IN 20007
2
1.5
1
0.5
0
1965 1970 1980 1990 2008
1990 1995 2000 2005 2009
250%
150%
0%
100%
50%
200%
2000
For further information on the recommendations of the Commission or to read the full report, visit
http://www.thelancet.com/commissions/crisis-of-liver-disease-in-the-UK
SOURCES
1
Williams R, Aspinall R, Bellis M, et al. Addressing liver disease in the UK: a
blueprint for attaining excellence in healthcare for liver disease and reducing
premature mortality from the major lifestyle issue of excess alcohol
consumption, obesity, and viral hepatitis. Lancet 2014; published online Nov 27,
2014. http://dx/doi.org/10.1016/S0140-6736(14)61838-9
2
ONS. Retail price index: all items versus beer, wine, and spirits, on and off
sales. 1987–2014. Newport; Office for National Statistics, 2014.
http://www.ons.gov.uk/ons/datasets-and-tables/data-selector.html?table-id=2.1
&dataset=mm23
3
HSCIC. Statistics on alcohol: England, 2014. Leeds; Health and Social Care
Information Centre, 2014.
4
The Hepatitis C Trust. The UK vs Europe: losing the fight against hepatitis C,
2005. London; The Hepatitis C Trust and the University of Southampton, 2005.
5
British Medical Association. Reducing the affordability of alcohol: a briefing
from the BMA Board of Science. London; British Medical Association, 2012.
6
Constella A, Goldberg D, Harris H, et al and Public Health England. Hepatitis C
in the UK: 2014 report. London; Public Health England, revised July 31, 2014.
7
Jewell J, Sheron N. 2010. Trends in European liver death rates: implications
for alcohol policy. Clin Med 2010; 10: 259–63.
8
Karlsson T, Mäkelä P, Österberg E, Tigerstedt C. A new alcohol environment.
Trends in alcohol consumption, harms and policy: Finland 1990–2010. Nord
Stud Alcohol Dr 2013; 27: 497–513.
9
Manyema M, Veerman LJ, Chola L. The potential impact of a 20% tax on
sugar-sweetened beverages on obesity in South African adults: a mathematical
model. PLoS One 2014; 9: e105287.
LIVER
20101970