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1. 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

2. WHO Global Status Report 2011

5. 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

6. Abstainers
in last 12
months
(% of adult
population)

7. China –the new global market for alcohol
Recorded adult per capita consumption age 15+– (unrecorded 1+l/person)

8. 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

9. Drinking with meals in the EU
15
Source Eurobarometer 2003

10. WHO Global Status Report 2011

11. ESPAD data on amount drunk by 15-16 yr-olds on last
drinking occasion
ESPAD 2007

12. ESPAD data on % 15-16 yr-olds who had been drunk in last
year
ESPAD 2007

13. 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

14. Of women that drink hazardously - 81% do so to relieve
stress
Know Your Limits/YouGov; Netmums, 2008
Drinking to unwind after
stressful day…..

15. Women and alcohol
• Advertising and marketing – more
sophisticated and more aimed at women

16. Pre-loading

17. 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

18. Global distribution of alcohol-attributable deaths and DALYs by
broad disease and injury categories, 2004
WHO Global Status Report 2011

19. 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
Rate
per
100,000
Chronic Conditions Rate
Wholly Attributable Rate
Acute Consequences Rate
CHRONIC
CONDITIONS
DEPENDENCE

20. Male alcohol-related deaths by age group, England
Jones et al, NW Public Health Observatory Report 2008

22. 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

23. Pattern of
drinking (adjusted
for total
consumption) and
mortality risk
Kauhanen et al, BMJ, 1997
Patterns
of drinking
and harm

24. 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

25. 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

26. Sheron 2010,

27. Projections for UK liver deaths
Lancet 2011

28. 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

29. 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

30. Passive drinking

31. • 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

32. Age-standardised alcohol-related death rates by deprivation*
twentieth and sex, England and Wales 1999-2003
* Carstairs deprivation index
Most
deprived
Least
deprived

33. 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?

34. Drinking type by annual household income quintile, 2008

35. 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

36. •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)

37. International evidence to ‘shift the curve’
and maximise health gain:
• availability
• promotion by the alcohol producers and
retailers
• price of alcohol

38. 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

39. •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…..

40. • 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)