Scotland has highest britain's alcohol-related deaths. In this presentation, it is showed a project conducted in the city of Edinburgh which is focused on the study of alcohol outlet density, health inequalities and policy translations.

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Alcohol outlet density, health
inequalities and policy translation:
findings from the UK
Professor Jamie Pearce
Chair in Health Geography
Centre for Research on Environment, Society and Health
University of Edinburgh
@jamie0pearce
jamie.pearce@ed.ac.uk

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Structure
• Geographies of alcohol
• Alcohol retail environment
• Alcohol environment and
health in Scotland
• Research translation
• What is missing?
Geographical Contribution
Pbase.com

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Place and Alcohol
• Individual behavioural perspectives
• BUT partial account for social & cultural
factors integral to understanding drinking.
• policy response – ‘lifestyle drift’ rather than
considered in wider context
• Drinking enabled & constrained by socio-
geographical factors
• reality of drinking in everyday life
• how public health messages received,
negotiated & mediated
• Individual factors and environments interact to
produce spaces that are more or less
favourable to drinking
• neighbourhoods, schools, workplaces, etc.
Geographical factors &
alcohol

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Inequalities as central
RESEARCH AIMS
• Scottish study examining:
• social & spatial distribution of alcohol
retailing
• associations between the geographies of
alcohol retailing and
(i) alcohol consumption
Assess whether these patterns vary by individual level
socio-economic status
(ii) related health outcomes

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Methods
Controlled for sex, age, religion, marital & socio-economic status, urbanity, neighbourhood deprivation
ALCOHOL OUTLET DATA
• Premises selling alcohol
licensed under the Licensing
(Scotland) Act 2005
• Postcodes of all licensed
premises (16,159) from
Liquor Licensing Boards
(4,800 off-sales and 11,359
on-sales)
• Created a density measure
at the data zone level for the
whole of Scotland for total
outlets, off-sales outlets and
on-sales outlets

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ALCOHOL OUTLET DISTRIBUTION
Alcohol outlet density and
area level deprivation

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Alcohol outlet density and
drinking behaviours
• Linked outlet data to individual level responses to the Scottish
Health Survey (2008-2011 n = 28,765)
• Four measures of drinking:
• Exceeding recommended weekly and/or daily limits (43.5%)
• Harmful drinking (4.5%)
• Binge drinking (21.2%)
• Problem drinking (8.6%)
• Need to cut down
• Feeling ashamed
• Annoyed by criticism
• Shaky hands
• Drinking in morning
• Unable to stop drinking
0.9
0.95
1
1.05
1.1
1.15
1.2
1.25
1.3
1.35
1.4
0.7
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
0.8
0.9
1
1.1
1.2
1.3
1.4
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
Exceeding Recommendations Harmful Drinking
Binge Drinking Problem Drinking
Controlled for sex, age, religion, marital & socio-economic status, urbanity, neighbourhood deprivation

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Income inequalities
0
10
20
30
40
50
60
Exceeding Harmful Binge Problem
%ofrespondents
<£16,339
£16340-£31707
>£31708
Exceeding recommendations
0.37
0.34
0.38
0.43
0.42 0.42
0.45 0.45
0.51
0.52
0.51
0.53
0.30
0.35
0.40
0.45
0.50
0.55
0.60
1 2 3 4
Probabilityofexceedingrecommendations
Lowest Income Middle Income Highest Income

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Harmful drinking
0.04
0.04
0.06
0.07
0.03 0.03
0.05
0.050.05
0.05
0.04 0.04
0.00
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.10
1 2 3 4
ProbabilityofHarmfulDrinking
Lowest Income Middle Income Highest Income
Binge drinking
0.17
0.16
0.19
0.24
0.19
0.20
0.23
0.22
0.24
0.25 0.25
0.25
0.10
0.12
0.14
0.16
0.18
0.20
0.22
0.24
0.26
0.28
0.30
1 2 3 4
Probabilityofbingedrinking
Lowest Income Middle Income Highest Income

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Problem drinking
0.10
0.11
0.12
0.15
0.08
0.09
0.11
0.10
0.09
0.09 0.09 0.08
0.05
0.07
0.09
0.11
0.13
0.15
0.17
0.19
1 2 3 4
Predictedprobabilityofproblemdrinking
Lowest Income Middle Income Highest Income
Alcohol outlet density:
mortality and morbidity
• Alcohol-related deaths
between 2002 and 2011
from General Register
Office for Scotland
(GROS) n=12,835
• Alcohol-related
hospitalisation indicator
from the Health domain of
the Scottish Index of
Multiple Deprivation 2012
(SIMD)

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Alcohol-related death rates for off-sales outlet
availability groups
Increasing Density
Alcohol-related hospitalisations for off-sales
availability groups
Increasing Density

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Summary
• The lowest income groups are disproportionately affected
by outlet density compared to both mid and higher income
groups.
• For all outcomes there is an increase in probability for the
lowest income tertile between the lowest and highest outlet
density.
• No significant increase for the highest or middle income
tertiles for any outcome, regardless of type of outlet.
• Alcohol-related death rates in neighbourhoods with the most
alcohol outlets were more than double the rates in those with
the fewest outlets.
• Across the whole of Scotland, alcohol-related hospitalisation
rates were significantly higher in neighbourhoods with the
most alcohol outlets.
Broader research translation
• Making data publically
available
• Twitter, presentations etc
• Blogs
• Infographics
• Commendation in the Scottish
Parliament supported by 27
MSPs
• Amendment proposed to a bill
to create retailers register

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Policy message
• Interventions that focus on changing individual behaviour
alone, ignoring broader context, will not work.
• Interventions must be designed to reduce inequalities,
otherwise they may increase the very inequalities they aim to
tackle.
• Tackling alcohol-related harm requires a multi-pronged
approach.
• Data should be freely available.
• Need to address the retail environment; in a Scottish context
this means defining overprovision and more clearly supporting
the public health licensing objective. How does this translate
in an Irish context?
• Failure to do so may exacerbate health inequalities.

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Biggest challenges
• Public opinion and how it is shaped – Stigma
(including place based stigma)
• Understanding the causal pathway between
environment and health behaviours
• Evidence into policy - conversations
What is lacking?
• Critical global health
• Longitudinal/lifecourse approaches
• Activity spaces
• A focus on co-behaviours (smoking, diet etc)
• A greater focus on inequalities

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What is lacking?
• Critical global health
• Longitudinal/lifecourse approaches
• Activity spaces
• A focus on co-behaviours (smoking, diet etc)
• A greater focus on inequalities
Availability of Alcohol AND
Tobacco by deprivation

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Funders
• Niamh Shortt, Richard Mitchell,
Catherine Tisch, Elizabeth
Richardson, Tom Clemens &
Esther Rind.
• This work was supported by
the European Research
Council [ERC-2010-StG Grant
263501]. The work developing
the tobacco outlet measures
was supported by the Scottish
Collaboration for Public Health
Research and Policy
(SCPHRP).
• All data available at
www.cresh.org.uk/webmap
• Twitter @jamie0pearce