Transcript Document
Alcohol in Scotland
a public health perspective
Dr Lesley Graham
Public Health Lead, Information Services Division,
National Services Scotland
Alcohol Policy Team, Scottish Government
The role of public health
evidence of the problem
‘framing’ the problems and solutions
evidence for effective policies
advocacy for policy into practice
monitoring and evaluation of
implementation
Ecological Model
SOCIETY
COMMUNITY
THE
INDIVIDUAL
FAMILY
UK Alcohol Consumption
Litres of pure alcohol consumption per capita in the UK
1900-2006
Alcohol Consumption in Scotland
1 in 4 (27%) men and nearly 1 in 5 (18%) women exceed
double daily benchmarks (‘binge’ drinking) [SHeS 2008]
younger age groups (16-24) drink most and are most likely
to exceed weekly and double daily limits [SHeS 2008]
little difference in exceeding limits by deprivation category
for men although men in most deprived category drink
more [SHeS 2008]
women in the least deprived areas most likely to exceed
limits and drink more [SHeS 2008]
apparent little difference in excess consumption between
Scotland and England [GHS 2007]
but
known under-reporting in surveys (up to 50%)
surveys ‘health cohort’ and can miss heavy
drinking groups e.g. homeless/prisoners
industry sales data show:
in 2007, 12.2 litres of pure alcohol per capita (>18
yrs) was sold in Scotland compared to 10.3 litres
in England, enough for every man and woman
over 16 to exceed the adult male guidelines every
single week [Nielsen 2007]
the wider environment
liberalisation of licensing laws in Scotland
in 1976 (‘permission to drink’)
alcohol more available (more licensed
premises and for longer hours)
alcohol more affordable (69% more
affordable since 1980)
Alcohol Related Harm
The average consumption of alcohol in a
population is directly linked to the amount
of harm [ECAS study Alcohol in Postwar Europe Nostrom et al]
Harm can be from the individual to societal
level
Alcohol Related Deaths
15 of the 20 local areas in
the UK with highest
male alcohol-related
death rate 1998-2004
are in Scotland:
1. Glasgow City
2. Inverclyde
3. West
Dunbartonshire
4. Renfrewshire
5. Dundee City
[ONS]
Chronic Liver Disease mortality rates per 100,000
population 1950-2006
updated from Leon and McCambridge, Lancet 367 (2006)
Men aged 45-64 years
80
Age standardised mortality rate per 100,000
80
70
60
Scotland
Other European
countries
Women aged 45-64 years
70
60
50
50
40
40
Scotland
30
30
20
20
England
and Wales
10
0
1950
1960
1970
1980
1990
2000
Other European
countries
10
0
1950
England
and Wales
1960
80
70
1970
1980
1990
2000
Chronic Liver Disease Mortality by Deprivation,
Scotland (Men)
data from Leyland et al Inequalities in Scotland 1981-2001 MRC 2007
Male m ortality rate for chronic liver disease per 100 000 population,
1980-2002
deaths per 100 000 population
1980-82
1991-92
90
80
70
60
50
40
30
20
10
0
2000-02
1
2
3
4
5
Deprivation category
6
7
1600
Under 15 years
1400
15-19 years
1200
20-24 years
25-29 years
1000
30-34 years
800
35-39 years
600
40-44 years
45-49 years
400
50-54 years
200
55-59 years
0
2007/08
2006/07
2005/06
2004/05
2003/04
2002/03
2001/02
2000/01
1999/00
1998/99
1997/98
60 years and over
1996/97
European Rate Standardised Rate
Alcohol-related hospital discharges, 1996/7 - 2007/8
Alcohol and Social Harm
Alcohol misuse a contributory factor in 1 in
3 divorces
65,000 children under 16 estimated to be
living with parents with alcohol problems
95% of people felt alcohol abuse in
Scotland as a problem
Alcohol and Crime
49% of prisoners were drunk at the time of
their offence (76% of young offenders)
[Scottish Prison Survey 2008]
70% of assaults presenting to A&E likely to
be alcohol related [QIS audit 2008]
Alcohol a contributory factor in two thirds
of domestic violence [Home Office 2003]
Alcohol Policy: what works?
‘A considerable body of evidence shows not only
that alcohol policies and interventions targeted at
vulnerable populations can prevent alcohol-related
harm but that policies targeted at the population at
large can have a protective effect on vulnerable
populations and reduce the overall level of alcohol
problems. Thus, both population-based strategies
and interventions, and those targeting particular
groups.. are indicated’
[WHO Evidence based strategies and interventions to reduce alcohol
related harm 2007]
Protective effects on vulnerable
groups
The number of heavy drinkers in a population is
directly linked to the average population
consumption. So a fall in overall consumption will
reduce the number of heavy drinkers
[Ecological analysis of collectivity of alcohol consumption in England:
importance of average drinker BMJ 1997;314:1164
Colhoun et al]
Tackling alcohol related harm will also tackle
health inequalities
What measures work best?
Price
Availability
Drink driving counter measures
Brief interventions
[Alcohol policy in the European region; current status and the way
forward WHO EURO/10/05;
Babor et al Alcohol: No Ordinary Commodity 2003;
Anderson and Baumberg Alcohol in Europe 2007]
Changing the Culture
‘Epidemics appear, and often disappear
without traces, when a new culture period
has started; thus with leprosy, and the
English sweat. The history of epidemics is
therefore the history of disturbances of
human culture’.
[Virchow cited in Rose, The Strategy of Preventive Medicine Oxford
Medical Publications 1992]