Transcript Alcohol in Ireland

Alcohol in Ireland.
Major health burden.
Major economic burden.
Major opportunity.
Prof Frank Murray
Registrar RCPI
Consultant Gastroenterologist/Hepatologist,
Beaumont Hospital/RCSI,
Dublin 9
Policies that reduce the availability
of alcohol though:
Price increases
or
Reducing outlets and hours of
sale
Have been shown to be effective
• 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
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
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
DALY (Disability adjusted life year)
• The sum of the life years lost due to
premature death or years lived in disability
Alcohol cause huge health problems
• WHO:
– 4% of global mortality
– 5% of global DALY
• Europe worse
– 7% mortality
– 12% of DALY
Alcohol cause huge health problems
• Worse in males: 17% of DALYs( vs 4%)
• Worst in young males
• Alcohol cause 35% of deaths aged 3550
Alcohol responsibility for many
youth deaths
• 25% of male
• 10% of female
Major disease burdens attributable
to alcohol
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Cirrhosis
Cancer
Diabetes Mellitus
Neuropsychiatric
Injuries
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BP
CVA/stroke
Cardiomyopathy
Cancer
– ENT.
– Most of GI tract,
breast, liver.
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
Median survival
~ 9 years
All patients
with cirrhosis
60
Probability of
survival
40
20
Decompensated
cirrhosis
Median survival
~ 1.6 years
0
0
20
40
60
80
100
Months
Gines et. al., Hepatology 1987;7:122
120
140
160
180
Mortality due to cirrhosis in Ireland
There is a big human cost here
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Ill and dying patients
Often young
Often little opportunity to change
Families
Does not end there
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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.
• It is also possible to drink hazardously by
binge drinking, even if within weekly limit.
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
Dependent drinking
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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.
Binge drinking
• 4 (female)
• 5 (male)
• units in 2h
– or
• 8 (male)
• 6 (female)
• units in 24 hours
• Rapidly increasing in prevalance
So most alcohol consumption is
mostly drunk safely?…..
• 75% of alcohol consumed in UK is by
hazardous and harmful drinkers in the UK
Absolute risk of death from alcoholrelated disease
Adult alcohol consumption
Heavy episodic drinking of at least 60g
of 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 pattern
• Much more affordable
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
Fundamental problem in Ireland
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Too much alcohol
Binge drinking
Availability
Number of outlets
Opening hours
Availability
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Off-licences
Convenience store
Supermarkets
Petrol stations
• Pubs
• Hotels
• Restaurants
Supermarkets
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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
political gains
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.
Key messages
A substantive evidence base of systematic
reviews and meta-analyses inform alcohol
policy
Making alcohol more
expensive and less
available are highly costeffective strategies to reduce
harm
• Banning of alcohol advertising
• Drink-driving countermeasures
• Individually-directed
interventions to drinkers already
at risk
are also cost-effective approaches
School-based education does
not reduce harm, but public
information and education
programmes can increase
attention to alcohol on public
and political agendas
If more stringent alcohol policies
are not put into place, global
alcohol-related harm is likely to
continue to increase
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
Successful legislated constructive
social changes in Ireland
• Smoking ban
• Reduction in alcohol driving
limit
• Cycling helmets
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.
Policies that reduce the availability
of alcohol though:
Price increases
and
Reducing outlets and hours of
sale
Have been shown to be effective