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Alcohol in Ireland.    Major health burden.   Major economic burden.     Major opportunity.            Prof Frank Murray  ...
Policies that reduce the availability         of alcohol though:  Price increases                   or  Reducing outlets a...
• Europe is the heaviest drinking region in  the world• Alcohol is the main cause of liver disease  in Europe• The prevale...
Problems addressing the alcohol        problem in Ireland!!!!• Drinking alcohol can be harmless, in  contrast to cigarette...
Alcohol in Europe• Europe is the highest drinking region in  the world• 200,000 deaths per year• Cost €125 billion per yea...
DALY (Disability adjusted life             year)• The sum of the life years lost due to  premature death or years lived in...
Alcohol cause huge health problems• WHO:  – 4% of global mortality  – 5% of global DALY• Europe worse  – 7% mortality  – 1...
Alcohol cause huge health problems• Worse in males: 17% of DALYs( vs 4%)• Worst in young males• Alcohol cause 35% of death...
Alcohol responsibility for many           youth deaths• 25% of male• 10% of female
Major disease burdens attributable            to alcohol
Main cause of alcohol DALY• Liver disease• 75% men• 85% women
• There is a direct correlation between  amount of alcohol consumed and  cirrhosis mortality
CIRRHOSIS AND PORTAL HYPERTENSION            Cirrhosis               and       Portal Hypertension
SURVIVAL TIMES IN CIRRHOSIS     Decompensation in cirrhosis         Shortens Survival               100                 80...
Mortality due to cirrhosis in Ireland
There is a big human cost here•   Ill and dying patients•   Often young•   Often little opportunity to change•   Families
Does not end there•   Absenteeism•   Loss of professional performance•   Domestic violence•   Unhappiness
3 main types of alcohol misuse• Hazardous• Harmful• Dependent drinking.
Hazardous drinking• Drinks over the recommended weekly limit  of alcohol• 21/17 units for men and• 14/11 units for women.•...
Harmful drinking• Drinks more than the recommended weekly  maximum amount of alcohol and experiences  health problems that...
Dependent drinking• Both physically and psychologically addictive• Become dependent on it• Feels unable to function withou...
Binge drinking• 4 (female)• 5 (male)• units in 2h        – or• 8 (male)• 6 (female)• units in 24 hours• Rapidly increasing...
So most alcohol consumption is   mostly drunk safely?…..• 75% of alcohol consumed in UK is by  hazardous and harmful drink...
Absolute risk of death from alcohol-          related disease
Adult alcohol consumption
Heavy episodic drinking of at least 60gof pure alcohol in last 7 days (women)
Irish consumption• 11.9 litres of alcohol per adult (>15y) in  2010• Over half Irish drinkers have a harmful  drinking pat...
Irish costs of alcohol• €3.7 billion• Healthcare €1.2 billion (8% of total)• Approx 2,000 hospital beds per night• 7% of G...
Fundamental problem in Ireland•   Too much alcohol•   Binge drinking•   Availability•   Number of outlets•   Opening hours
Availability
Supermarkets•   Promotions•   Special offers•   Packaging in larger units•   Not quarantined, all over the shop
Concerts
Sports sponsorship
Under-age drinking
Marketing towards young people
Options• Do nothing• Do “something”• Take thought-through series of steps.  Leads to immediate health social and  politica...
Systematic reviews and meta-analyses.          Proven policies.• Policies regulating the environment in  which alcohol is ...
Key messagesA substantive evidence base of systematicreviews and meta-analyses inform alcoholpolicy
Making alcohol moreexpensive and lessavailable are highly cost-effective strategies to reduceharm
• Banning of alcohol advertising• Drink-driving countermeasures• Individually-directed  interventions to drinkers already ...
School-based education doesnot reduce harm, but publicinformation and educationprogrammes can increaseattention to alcohol...
If more stringent alcohol policiesare not put into place, globalalcohol-related harm is likely tocontinue to increase
Actions• Reduce number of outlets dramatically• Increase cost-minimum unit pricing• Expand and enforce legislation re alco...
Successful legislated constructive     social changes in Ireland• Smoking ban• Reduction in alcohol driving  limit• Cyclin...
RCPI alcohol group• RCPI established a national policy group to  address the health and social burden of  alcohol in Irela...
Policies that reduce the availability          of alcohol though:  Price increases                   and  Reducing outlets...
Alcohol-related harm in Ireland - a health perspective
Alcohol-related harm in Ireland - a health perspective
Alcohol-related harm in Ireland - a health perspective
Alcohol-related harm in Ireland - a health perspective
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Alcohol-related harm in Ireland - a health perspective

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Professor Frank Murray, Consultant Gastroenterologist and chair of national alcohol policy group, RCPI, speaks about alcohol-related harm in Ireland at Alcohol Action Ireland's conference "Time Please... For Change".

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Alcohol-related harm in Ireland - a health perspective

  1. 1. Alcohol in Ireland. Major health burden. Major economic burden. Major opportunity. Prof Frank Murray Registrar RCPIConsultant Gastroenterologist/Hepatologist, Beaumont Hospital/RCSI, Dublin 9
  2. 2. Policies that reduce the availability of alcohol though: Price increases or Reducing outlets and hours of saleHave been shown to be effective
  3. 3. • Europe is the heaviest drinking region in the world• Alcohol is the main cause of liver disease in Europe• The prevalence of alcoholic liver disease is rising in Ireland
  4. 4. Problems addressing the alcohol problem in Ireland!!!!• Drinking alcohol can be harmless, in contrast to cigarettes• Alcohol is strongly rooted in our society• The alcohol industries receive the majority of their turnover in UK from harmful and hazardous drinkers
  5. 5. Alcohol in Europe• Europe is the highest drinking region in the world• 200,000 deaths per year• Cost €125 billion per year. 1.3% of GDP• Third commonest cause of premature death and disability• Main cause of liver disease and death
  6. 6. DALY (Disability adjusted life year)• The sum of the life years lost due to premature death or years lived in disability
  7. 7. Alcohol cause huge health problems• WHO: – 4% of global mortality – 5% of global DALY• Europe worse – 7% mortality – 12% of DALY
  8. 8. Alcohol cause huge health problems• Worse in males: 17% of DALYs( vs 4%)• Worst in young males• Alcohol cause 35% of deaths aged 35- 50
  9. 9. Alcohol responsibility for many youth deaths• 25% of male• 10% of female
  10. 10. Major disease burdens attributable to alcohol
  11. 11. Main cause of alcohol DALY• Liver disease• 75% men• 85% women
  12. 12. • There is a direct correlation between amount of alcohol consumed and cirrhosis mortality
  13. 13. CIRRHOSIS AND PORTAL HYPERTENSION Cirrhosis and Portal Hypertension
  14. 14. SURVIVAL TIMES IN CIRRHOSIS Decompensation in cirrhosis Shortens Survival 100 80 Median survival Median survival ~ 9 years ~ 9 years 60 All patients with cirrhosisProbability of survival 40 20 Decompensated Median survival Median survival cirrhosis ~ 1.6 years ~ 1.6 years 0 0 20 40 60 80 100 120 140 160 180 MonthsGines et. al., Hepatology 1987;7:122
  15. 15. Mortality due to cirrhosis in Ireland
  16. 16. There is a big human cost here• Ill and dying patients• Often young• Often little opportunity to change• Families
  17. 17. Does not end there• Absenteeism• Loss of professional performance• Domestic violence• Unhappiness
  18. 18. 3 main types of alcohol misuse• Hazardous• Harmful• Dependent drinking.
  19. 19. Hazardous drinking• Drinks over the recommended weekly limit of alcohol• 21/17 units for men and• 14/11 units for women.• It is also possible to drink hazardously by binge drinking, even if within weekly limit.
  20. 20. Harmful drinking• Drinks more than the recommended weekly maximum amount of alcohol and experiences health problems that are directly related to alcohol.• Cirrhosis• depression• an alcohol-related accident, such as a head injury• acute pancreatitis (inflammation of the pancreas)• high blood pressure• some types of cancer• heart disease
  21. 21. Dependent drinking• Both physically and psychologically addictive• Become dependent on it• Feels unable to function without alcohol• Consumption of alcohol becomes an important, or sometimes the most important, factor in their life• Can experience withdrawal symptoms (both physical and psychological) if they suddenly stop drinking alcohol.
  22. 22. Binge drinking• 4 (female)• 5 (male)• units in 2h – or• 8 (male)• 6 (female)• units in 24 hours• Rapidly increasing in prevalance
  23. 23. So most alcohol consumption is mostly drunk safely?…..• 75% of alcohol consumed in UK is by hazardous and harmful drinkers in the UK
  24. 24. Absolute risk of death from alcohol- related disease
  25. 25. Adult alcohol consumption
  26. 26. Heavy episodic drinking of at least 60gof pure alcohol in last 7 days (women)
  27. 27. Irish consumption• 11.9 litres of alcohol per adult (>15y) in 2010• Over half Irish drinkers have a harmful drinking pattern• Much more affordable
  28. 28. Irish costs of alcohol• €3.7 billion• Healthcare €1.2 billion (8% of total)• Approx 2,000 hospital beds per night• 7% of GP costs• 30% of Emergency Department costs
  29. 29. Fundamental problem in Ireland• Too much alcohol• Binge drinking• Availability• Number of outlets• Opening hours
  30. 30. Availability
  31. 31. Supermarkets• Promotions• Special offers• Packaging in larger units• Not quarantined, all over the shop
  32. 32. Concerts
  33. 33. Sports sponsorship
  34. 34. Under-age drinking
  35. 35. Marketing towards young people
  36. 36. Options• Do nothing• Do “something”• Take thought-through series of steps. Leads to immediate health social and political gains
  37. 37. Systematic reviews and meta-analyses. Proven policies.• Policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm.• Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
  38. 38. Key messagesA substantive evidence base of systematicreviews and meta-analyses inform alcoholpolicy
  39. 39. Making alcohol moreexpensive and lessavailable are highly cost-effective strategies to reduceharm
  40. 40. • Banning of alcohol advertising• Drink-driving countermeasures• Individually-directed interventions to drinkers already at risk are also cost-effective approaches
  41. 41. School-based education doesnot reduce harm, but publicinformation and educationprogrammes can increaseattention to alcohol on publicand political agendas
  42. 42. If more stringent alcohol policiesare not put into place, globalalcohol-related harm is likely tocontinue to increase
  43. 43. Actions• Reduce number of outlets dramatically• Increase cost-minimum unit pricing• Expand and enforce legislation re alcohol consumption in public and public order offences• All of proven international proven benefit
  44. 44. Successful legislated constructive social changes in Ireland• Smoking ban• Reduction in alcohol driving limit• Cycling helmets
  45. 45. RCPI alcohol group• RCPI established a national policy group to address the health and social burden of alcohol in Ireland.• The policy group brings together experts from a wide range of medical specialist bodies to speak with one voice on the issue of alcohol, to support• Propose practical solutions backed up by a robust, international evidence base• Focused on reducing the harm caused by alcohol to health and society.
  46. 46. Policies that reduce the availability of alcohol though: Price increases and Reducing outlets and hours of saleHave been shown to be effective

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