Category Archives: Alcohol facts and figures

Alcohol Pricing

An excellent blog post from Alcohol Policy UK discussing the Institute of Alcohol Studies updated fact sheet on alcohol pricing published in March.

Over to James:

The Institute of Alcohol Studies (IAS) have updated its factsheet on alcohol pricing as health groups seek to continue highlighting the importance of price in addressing alcohol harms.

Download ‘The price of alcohol’ [pdf] here or see a collection of pricing documents and research here.

Chapters covered in the report include:

Pricing, policy and the future of MUP?

Of central important to pricing debates is the relationship between price and consumption. Price, or more precisely affordability, influences the level of population consumption as has been shown by a wide literature. In the UK, attention has been on rising affordability and consumption during the second half of the 20th century, followed by the more recent decline since 2004. Rises in consumption over the last two years have indicated a possible return to an upward trend, whilst the price and sales gap between off-trade and on-trade prices has continued to widen. As such, attempts to see Minimum Unit Pricing (MUP) have been central to public health policy calls in England, while Scotland’s passing of MUP legislation in 2012 has yet to overcome industry-led challenges. A final verdict is expected this year.

Undoubtedly there are many complexities, with debates particularly focused on how pricing changes affect drinkers of different incomes and consumption levels. Whilst the well cited Sheffield Alcohol Research Group’s (SARG) various modelling has undoubtedly applied advanced and detailed methodologies, predicting the exact impacts is never possible. Indeed the factsheet acknowledges that ‘lower alcohol consumption generally reduces health risks’ and so there is ‘strong reason to expect that higher alcohol prices should improve health outcomes.’ Indeed the recent PHE evidence review found strong favour for pricing as a key desired policy, albeit complicated by issues such as the alcohol harm paradox and complexities in identifying longer term health impacts of harmful drinking.

Secondary to MUP, public health opportunities for taxation policy arise with each budget, though of course also facing strong opposing calls from some industry groups. Over the last decade duty changes have arguably gone both ways, with positive public health impacts reportedly seen as a result of the 2008-2014 duty escalator, but opponents subsequently seeing its end and cuts on certain drinks. This year’s budget ‘froze’ duty which would rise with inflation, although a tax consultation aimed mainly at ‘white ciders’ – typically one of the cheapest drinks per unit – is currently underway.

Affordability

Pricing debates as such are going nowhere, but the policy decisions are hard to call. The former coalition Government infamously u-turned on its 2012 MUP pledge, largely thwarted by the current Prime Minister as then Home Secretary. It was insisted MUP though was not being ‘ruled out’, rather than waiting for more conclusive evidence. Waiting to see what happens in Scotland arguably makes for sensible politics, albeit health groups argue that dealying MUP comes at the expense of lives. Wales and Ireland are also pursuing MUP, and with Brexit in the mix, the future of alcohol pricing policy is likely to remain uncertain.

Valuable research indeed.

A retrospective on 2016 (Friday sober jukebox: some riot)

So as I have pared down my blog activity and news sources the one I repeatedly return to is Alcohol Policy UK.  They wrote an excellent retrospective piece about 2016 which you can read here:

 

Alcohol policy in 2016 & what’s in store for 2017?

But what really struck me about this blog were the images featured at the end entitled: Selected alcohol slides from the ‘most interesting things about drugs and alcohol in 2016’ from Andrew Brown:

The top image was the first which highlighted how over half (54%) of strong ciders sold in the off-trade in England and Wales in 2015 were sold at below 20p a unit  <pauses to let that sink in for a minute>  so for less than the cost of a pint of milk! 🙁

Below I share the other three because visual images can be so much more impactful than words.  They all tell a compelling story which as yet is not being addressed by our govt sufficiently to change the trajectory of the graphs.

Association between the experience of physical and sexual abuse in the lives of women and dependence to drugs and alcohol …..

 

 

The number of offences committed pre and post treatment for alcohol use disorders ……

 

 

 

Graphic confirmation that those with the most problems with alcohol are more likely to use the NHS …..

 

 

 

I’ll finish with a haunting performance from Elbow and the BBC Concert Orchestra of Guy Garvey’s ode to a friend lost to alcohol addiction  – some riot.

The impact of alcohol is all too plain to see and hear to those who have eyes and ears.  Shame our govt is looking the other way with its collective fingers in its ears (except perhaps Liam Byrne) …..

PS Yesterday was day 1250!

Alcohol misuse most often treated in middle age

This report featured in the Institute of Alcohol Studies report in November 2016.  This report struck me because I stopped drinking just before my 45th birthday.

Average age of alcohol only clients seeking treatment is 45 years (04 November)

Drinkers in their forties make up the most number of alcohol only treatment users for substance misuse in England, according to new figures published by Public Health England (PHE).

The National Drug Treatment Monitoring System (NDTMS) report ‘Adult substance treatment activity in England 2015-16’ shows that in the 12 months to 31st March 2016, clients exhibiting problematic or dependent drinking represented a total of 144,908 individuals, the second largest group in treatment (see pie chart, illustrated right). Of these, 85,035 were treated for alcohol treatment only and 59,873 for alcohol problems alongside other substances.

The overall number of individuals in treatment for alcohol fell by 4% compared to 2014-15, with the numbers for alcohol only decreasing by 5% since then, to reach its lowest total since 2009-10 (illustrated below). However, this figure still represents more than double the annual number of alcohol only clients recorded since records began in 2005-06 (35,221 clients).

The report noted that those in treatment for alcohol only and opiates tend to be much older than individuals who have presented for problems with other substances. The median age of alcohol only clients was 45 years, with 68% aged 40 or over and 11% aged 60 years and over.

Roughly three-fifths of alcohol only clients were male (61%) although this was a lower proportion than those representing the entire treatment population in 2015-16 (70%). The report’s authors suggested that this finding is “likely (to) reflect the differences in the gender prevalence of problematic alcohol and drug use.” PHE will be releasing estimates of alcohol dependency late 2016.

Individuals starting treatment in 2015-16 were most likely to present with problematic alcohol use (62%, or 84,931 new clients) (illustrated, below). But alcohol only clients also had the highest rates of successful exits of all clients presenting for treatment, with just under two-thirds (62%) successfully completing treatment, up on 61% in the previous year.

However, there were also more deaths among those accessing treatment for alcohol only problems; there were 817 deaths in 2015-16, 3% more than the previous year.

The report also noted that since alcohol service providers started reporting to NDTMS in 2005-06, alcohol citations have remained relatively stable, although the gathering of information on alcohol treatment service providers since 2008-09 may have been one of the main drivers of an overall increase in clients seeking treatment for substance use in general over the last decade.

Responding to the latest figures, Rosanna O’Connor, Director, Alcohol, Drugs & Tobacco within the PHE Health and Wellbeing Directorate, said:

“It is clear from the data that there is an increasing need for services to meet the complex needs of older more vulnerable drug and alcohol users in treatment as well as finding ways of helping those accessing services for the first time to get the treatment they need and move on with their lives.

“Within the data there is much to be hopeful about… But we certainly can’t be complacent – PHE, national and local government and providers, all need to enhance our efforts to ensure that treatment is a safe platform from which to achieve recovery.”

Before you pick up a drink again maybe reflect on this data and if you are in this age range perhaps ask yourself the question whether you really want to go back to that cycle of drinking or whether a longer period of abstinence might be helpful to evaluate your relationship to drinking further?  Just a thought 🙂

Do I Drink Too Much?

So it’s the last day of January and to those of you taking part in Dry January congratulations if you made it this far.  Have you been reflecting on whether you drink too much as part of that month off?  Perhaps on your last night of sipping sparkling water you might want to watch this documentary which aired in December on BBC Wales.  Thanks to my friend Libby for bringing it to my attention!

Lib featured it as part of her News and Update round-up for December on Alcohol Policy UK and if you wish to read all of it you can find it here:

News & updates December 2016: middle-age health, drink-driving, the rise of alcohol-free & the return of benchgirl

Public Health England publish review of evidence on alcohol

Public Health EnglandThis summary report was published by Alcohol Research UK in December.  It looked at Public Health England’s new published review of evidence on alcohol.

Public Health England has published a review of international evidence on alcohol policy and harm reduction.  The new report, based on almost two years of research and analysis, addresses a number of key policy areas.

These include:

  • The price of alcohol and its effect on consumption
  • The impact of both the number of alcohol outlets in a given area, and the times at which they operate, on a range of potential harms
  • The effectiveness of existing controls on marketing, sponsorship and promotion
  • The role of ‘brief interventions’ in preventing harmful drinking
  • The effectiveness of schools-based education programmes
  • The evidence on alcohol treatment in tackling harmful and dependent drinking

We welcome this important contribution to the literature on alcohol harm prevention. It provides both a resource for identifying key evidence and an evaluation of the relative effectiveness of policy interventions based on an extensive process of reflection and review.

Today’s report also provides a new analysis of drinking trends and their economic effects. It confirms that average consumption has been falling in the UK for over ten years, especially among young people. However, it also shows that trends vary between social groups, reminding us that average consumption provides only a rough guide to where harms are concentrated, and that harms can rise even when overall consumption falls.

Importantly, the report confirms previous studies showing that around one third of all the alcohol consumed is drunk by the heaviest drinking 5% of the population.  This demonstrates not only how heavy drinking is concentrated, but the very high proportion of alcohol that is sold to people with serious drinking problems.

The report draws particular attention to the impact of alcohol on economic productivity: suggesting that drinking causes more years of life lost to the workforce than are caused by the top ten most common cancers combined. While the precise social costs of alcohol remain hard to quantify, this report shows clearly that heavy drinking creates an enormous burden for the wider economy.

The PHE report echoes previous evidence reviews in demonstrating that price is a key policy lever in shaping consumption. Its findings suggest that a combination of minimum pricing and more targeted taxation could reduce both harmful drinking and health inequalities (especially the so-called ‘alcohol harm paradox’). Clearly, this is a significant finding as the Scottish Government continues to deal with a prolonged legal challenge to MUP from the Scotch Whisky Association.

The report also argues that while evidence on factors such as outlet density is less compelling than is the case for price, nonetheless limiting hours of sales can reduce antisocial behaviour and drink-driving. While, in the UK, evidence on the relaxation of licensing hours since 2005 has not shown a clear effect in terms of crime, disorder or hospital admissions the authors point to international studies and reviews that show a stronger correlation.

The report also follows previous reviews in pointing to evidence that exposure to marketing can lead to earlier and higher levels of consumption among young people. It finds no robust evidence that existing marketing controls are effective in preventing youth exposure to marketing, and so will strengthen calls for a reassessment of the current regulatory framework.

It also finds no clear evidence that voluntary industry-led partnerships (including the recent ‘Responsibility Deal’) reduce alcohol harms. This is partly because there are insufficient independent and robust evaluations of such schemes to provide clear evidence of an effect, and also because it has been argued that many of the changes introduced under the Responsibility Deal would have happened anyway.

While the report confirms that, from a public health perspective, price, availability and marketing are key issues, it also addresses questions around treatment and interventions. This is especially important as the impact of austerity continues to be felt in widespread cuts to budgets for treatment services across the country.

The review finds considerable evidence that screening and brief interventions in primary care can help prevent harmful drinking. On a policy level, a key question now is how to support GPs in actually carrying out screening and delivering interventions effectively where there is a need. Currently, delivery of interventions in primary care remains low so work to better incentivise and train GPs is needed. The review, however, also notes that the evidence for the effectiveness of brief interventions in other settings (such as the workplace or local pharmacies) is much less robust..

In line with most previous reviews, the report finds that while education can play an important role in raising awareness and knowledge, the evidence for its effectiveness in changing behaviour is weak. This is not necessarily because schools-based prevention and education is wholly ineffective, but because its impact is inevitably limited (behaviours are driven by far more than simple knowledge of harms) and because the delivery of programmes is often highly inconsistent.

Finally, on drink-driving, the review finds strong evidence that reducing the blood alcohol limit is effective in reducing accidents. England and Wales currently have a BAC limit of 0.8 g/l – the highest in Europe, alongside Malta.

Overall, this report represents a key summary of the available evidence on alcohol. It confirms that there are policy levers available to Government that can have a measurable impact on alcohol harm reduction. Clearly, alcohol policy needs to balance a range of interests, but if the Government is serious about seeking to reduce the health impacts of alcohol then this evidence review is of critical importance.

The PHE report is based on a very wide-ranging analysis of available research and an extensive process of peer review. We hope that it forms a key element in the development of alcohol policies in future.

So 5% of the population equates to approximately 2.6 million people here in the UK …… (source).  And Alcohol Policy UK pose the prompted question which I’d like to know the answer to as well:

PHE evidence review 2016: will Government policy respond?

 

 

Alcohol-related cancers projected to rise – can mass media campaigns help?

cruk-university-of-sheffield-logoThis was published by Alcohol Policy UK in December regarding alcohol-related cancers.

Increasing recognition of the risks of alcohol-related cancer has been a priority for a number of health organisations, with recent research identifying limited levels of awareness and projected rises in incidences.

report released last month commissioned by Cancer Research UK (CRUK) attracted significant media coverage of its findings that alcohol-related cancers could cause around 135,000 deaths over the next 20 years in England. The modelling was carried out by Sheffield University and analysed figures under a number of consumption forecasts, and also provided updated estimates of the potential benefits of Minimum Unit Pricing (MUP). A 50 pence MUP could reduce all alcohol-attributable deaths by 7,200, including 670 cancer deaths over the next two decades, reducing alcohol-related healthcare costs by £1.3 billion.

The report follows findings released earlier in the year by CRUK stating the understanding of the link between alcohol consumption and cancer was “worryingly low”; only 13% identified cancers as a possible risk when asked to identify alcohol-related health conditions associated with drinking too much. Recognition improved when prompted with possible cancer types, but those such as breast cancer had far lower recognition than less prevalent alcohol-related cancers. See here for a CRUK alcohol and cancer page.

Data used from the report though has just been published in BMC Public Health journal revealing significantly higher awareness of the links in the North East region, where Balance North East has been conducting media campaigns including TV advertswww.reducemyrisk.tv and #7cancers Twitter activity.

Media campaigns: a question of behaviour change?

Health groups though tend not to want to see health campaigns in isolation owing to the limited impact on behaviour. Indeed similar debates have taken place with regard to the awareness of the revised drinking guidelines and the limitations of their impact on consumption.

Ealier this year Chief Medical Officer Dame Sally Davies attracted controversy for suggesting drinkers should think ‘Do I want the glass of wine or do I want to raise my own risk of breast cancer?’ each time they drink. Whether any significant number of people have taken on the CMO’s advice – or indeed deliberately rejected it – will remain unknown, but based on the evidence of the complexity of behaviour change it would seem unlikely.

As such health groups, including CRUK, not only wish to see media campaigns and improved information through mandatory labelling, but also action on price, availability and marketing. Such levers have considerably stronger evidence to support an impact on drinking behaviours, but are of course opposed by those who may support informed individual decision making but not the Government in influencing it via regulation.

As for the near future, momentum may continue with a general trend in increasing awareness of alcohol health harms. Whether this will be supported in England by legislation to ensure mandatory labelling on containers, or indeed change environmental influences, is uncertain. In the meantime, alcohol-related cancers are likely to rise before they fall, even should consumption fall further.

estimated-trends-in-annual-alcohol-attritubutable-cancer-deaths-following-reduction-in-consumptionA picture paints a thousand words ……

And edited to add this small celebratory footnote: Voted  Top 100 Addiction Blogs Winner from thousands of top Addiction blogs in Feedspot’s index using search and social metrics.  Ranked 53rd based on Google reputation and search ranking, influence and popularity on Facebook, Twitter and other social media sites, quality and consistency of posts and Feedspot’s editorial team and expert review 🙂

Back to life, back to reality … Women closing the drinking gap on men

women-closing-the-drinking-gap-on-menIt’s the end of the Christmas and New Year break and most of us head back to work or school, hence the Soul II Soul lyrics in the blog post title.  And part of that reality is that women are closing the drinking gap on men as reported by the Institute of Alcohol Studies in October 2016.  Over to their analysis:

Trend most evident among young adults, international analysis shows (25 October)

Women are catching up with men in terms of their alcohol consumption and its impact on their health, finds an analysis of the available international evidence, spanning over a century and published in the online journal BMJ Open.

This trend is most evident among young adults, the findings show. Historically, men have been far more likely than women to drink alcohol and to drink it in quantities that damage their health, with some figures suggesting up to a 12-fold difference between the sexes. But now evidence is beginning to emerge that suggests this gap is narrowing.

In a bid to quantify this trend over time, a research team pooled the data from 68 relevant international studies published between 1980 and 2014. The studies calculated male-to-female ratios for 3 broad categories of alcohol use and harms (any alcohol use, problematic alcohol use and alcohol-related harms) stratified by 5-year birth cohorts ranging from 1891 to 2001, generating 1,568 sex ratios (see above data table).

Sixteen of the studies spanned 20 or more years; five spanned 30 or more. All the studies included explicit regional or national comparisons of men’s and women’s drinking patterns across at least two time periods.

Results:

The pooled data showed that the gap between the sexes consistently narrowed across all three categories of any use, problematic use, and associated harms over time.

Men born between 1891 and 1910 were twice (2.2) as likely as their female peers to drink alcohol; but this had almost reached parity among those born between 1991 and 2000 (1.1, illustrated). The same patterns were evident for problematic use, where the gender gap fell from 3 to 1.2, and for associated harms, where the gender gap fell from 3.6 to 1.3.

After taking account of potential mathematical bias in the calculations, the gender gap fell by 3.2% with each successive five-year period of births, but was steepest among those born from 1966 onwards.

Associated health harms fall disproportionately on female drinkers

The calculation used was not designed to address whether alcohol use is falling among men or rising among women, the researchers caution.

But among the 42 studies that reported some evidence for a convergence of drinking levels between the sexes, most (n = 31) indicated that this was driven by greater use of alcohol among women, and 5% of the sex ratios were under 1, suggesting that women born after 1981 may actually be drinking more than their male peers, the researchers claimed.

Conclusions

The researchers wrote: “Findings confirm the closing male–female gap in indicators of alcohol use and related harms. The closing male–female gap is most evident among young adults, highlighting the importance of prospectively tracking young male and female cohorts as they age into their 30s, 40s and beyond.”

While they did not set out to explain the reasons behind their observed findings, they emphasised that their results “have implications for the framing and targeting of alcohol use prevention and intervention programmes.”

They concluded: “Alcohol use and alcohol use disorders have historically been viewed as a male phenomenon. The present study calls this assumption into question and suggests that young women in particular should be the target of concerted efforts to reduce the impact of substance use and related harms.

“These findings (also) highlight the importance of further tracking young male and female cohorts as they age into their 30s, 40s and beyond”, they added.

Institute of Alcohol Studies director Katherine Brown said: “The findings from this study illustrate a trend that has been in the making for decades. Women are increasingly subjected to heavily targeted marketing practices by alcohol companies enticing them to drink more. This is a global phenomenon, with drinks manufacturers producing sweet, often pink, fizzy alcoholic beverages that appeal to young women, with glamorous advertising campaigns.

“Another major driver of alcohol consumption is price, with very cheap products commonly on sale for as little as 16 pence per unit in shops and supermarkets. We are no longer a nation of pub goers, with two-thirds of all UK alcohol drunk at home. Pre-loading on cheap shop bought alcohol before a night out is common practice and police have reported strong links to crime, disorder and vulnerable behaviour in towns and city centres.

“Alcohol places a huge strain on our NHS and emergency services, with the total costs to society at £21 billion each year. We need to take this issue seriously and introduce evidence-based measures such as minimum unit pricing and marketing restrictions in order to protect out future generations and improve the health and wellbeing of our most vulnerable communities.”

Coverage from Alcohol Policy UK:

‘Women have caught up with men’ in alcohol consumption levels, headlines reported across the media. According to international research the gap between men and women is closing rapidly when it comes to use and alcohol-related harms, though in the UK men still drink more. See NHS behind the headlines analysis or BBC, The Sun and Guardian reports.

To act as a counter-balance to this view here is a recent article from the Guardian citing another BMJ study:

Female binge drinkers unfairly stigmatised by media, says study

It’s worth a read and has an interesting conclusion that begs the question: who is funding this research?

Further evidential data:

(taken from HSE 2015)

Health Survey for England 2015: latest consumption figures

Eight in 10 middle-aged Britons ‘are overweight or exercise too little’ (oh and drink too much!)

Ladies it’s the beginning of January and it’s not too late to join us for Dry January.  You can start the clock today and not become part of these statistics of the future.

Understanding the relationship between poverty and alcohol

CPH poverty and alcohol misuse 2016This rapid review examined evidence of the association between poverty and alcohol use. The research primarily focused on work undertaken in the UK and was commissioned by the Joseph Rowntree Foundation as part of their programme to develop Anti-Poverty Strategies for the UK. The purpose of the rapid review was to provide an evidence base that the Joseph Rowntree Foundation could use in developing their strategies, and to inform how alcohol misuse was addressed.

What struck me about this review was the section on stigma and marginalisation:

How people respond to others’ alcohol use exacerbates harm (World Health Organization, 2007). Alcohol dependence is a highly stigmatized health condition and as Room (2005) argues, “the use of alcohol [and drugs] is strongly moralized, and those transgressing moral norms are subject to stigma and social marginalization”. The relationship between alcohol dependence and stigma particularly manifests itself through the perception that those affected have personal control over their illness (Livingston et al., 2011). The WHO Expert Committee on Problems Related to Alcohol Consumption noted that “there a clear tendency for many cultures to marginalize particularly those who are both poor and habitually intoxicated, and that there are many pathways by which poverty can enable or exacerbate the stigmatization of intoxication” (World Health Organization, 2007). People who are poor or living in poverty may be less able to avoid or  buffer the social consequences of their drinking unlike their more affluent counterparts. Police surveillance of ‘anti-social behaviour’ such as public drunkenness may also be heightened in poor communities. Thus in affluent societies, the WHO Expert Committee (World Health Organization, 2007) highlighted “that there is a very strong overlap between the most marginalized population and those defined as having serious alcohol problems”.

What is the extent of problem alcohol use among people living in poverty?
As there are no figures available to determine what proportion of the estimated 13 million adults who live in poverty overlap with the categories of problem drinkers the extent of the problem is unknown.
According to Public Health England (2014), around 9 million adults in England are hazardous drinkers with 2.2 million also harmful drinkers. An estimated 1.6 million adults in England may have some degree of alcohol dependence. Of these, around 250,000 may be moderately or severely dependent on alcohol.  According to the 2007 Psychiatric Morbidity Survey, 8.5% of men and 3.0% of women in the lowest income quintile had experienced any symptoms of alcohol dependence in the last 6 months; 2.5% and 0.1%, respectively, had experienced moderate or severe symptoms of dependence that would indicate a need for assisted alcohol withdrawal.
You can read the full report here:

The Alcohol Industry

The Alcohol IndustryThis is an excellent factsheet produced by the Institute of Alcohol Studies looking at the alcohol industry (and as mapped here by IOGT).

This factsheet provides an overview of the alcohol industry:

  • Defines the different elements of the industry – raw materials suppliers, distributors and wholesalers, vendors and suppliers/contractors – but most significantly alcohol producers
  • Identifies the leading alcohol companies in the UK and globally and maps out how the industry has consolidated in recent years
  • Describes business models and identifies key commercial strategies of alcohol companies

As well as making and selling alcohol, many participants in the alcohol industry seek to influence politics and society in different ways. (see the image at the bottom of this post for an excellent example of this!) This fact sheet also looks at five ways in which the alcohol industry exercises this influence:[*]

  1. Constituency building
  2. Policy substitution
  3. Information and messaging
  4. Financial incentives
  5. Trade and litigation

Click on links below to view each section of the factsheet online:

Or click on the image below to download the entire factsheet as a PDF (updated April 2016):


[*] Savell, E. et al (2016), How does the alcohol industry attempt to influence marketing regulations? A systematic review, Addiction 111:1, pp. 18–32

This report is in direct contrast to the memes that are peddled on social media such as this one:

hangover free pricelessI would argue that a hangover and the drinking that caused it is costly to both our health, finances and society and destroys not enhances memories.  For me it is being sober and the freedom it brings from alcohol addiction that is is priceless – and I did say just that in this post here :)

The alcohol industry wants us to think that their product is harmless and enhances life when we know that for many that is the antithesis of the truth as this blog amply illustrates by sharing all the news and personal stories that counter that illusion.  It makes me so bloody angry the damage that images like this one create – making people who can’t manage alcohol feel broken and feeding their addiction further.  Just so dangerous 🙁

Edited to add 3rd July

Here’s a different approach! 😉

“Our products can make you ugly, fat, and unhappy” — alcohol marketing in Sweden

How timely is this!?  The fight back by the industry on the new drinking guidelines via lobbying of MP’s and the Chief Medical Officer as indicated in the parliamentary debate notes:

Alcohol Consumption Guidelines Westminster Debate

The chief medical officer had a successful meeting with the Portman Group yesterday

Plus their meme is fictional – this is the reality ……..

More than a million alcohol-related hospital admissions in 2014-15

There were an estimated 1.09 million hospital admissions2 3 for which an alcohol-related disease, injury or condition was the primary reason for admission or a secondary diagnosis, in 2014-15, compared to 1.06 million in 2013-14 | HSCIC, UK

Statistics on Alcohol, England, 2016 [NS]

This statistical report presents a range of information on alcohol use and misuse drawn together from a variety of sources. The report aims to present a broad picture of health issues relating to alcohol use and misuse in England and covers topics such as drinking habits and behaviours among adults (aged 16 and over) and school children (aged 11 to 15); drinking-related ill health and mortality; affordability of alcohol; alcohol-related admissions to hospital; and alcohol-related costs | HSCIC, UK

Alcohol-related deaths in England up 4% in one year

Local government body shocked by figures that show almost 1.1m diseases or injuries linked to drinking were recorded between 2013-14 and 2014-15 | Guardian, UK

Consumption theory, the four P’s & the Pareto Principle

the four p'sIn April Professor’s Nick Sheron and Sir Ian Gilmore wrote an analysis piece for the British Medical Journal entitled ‘Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales’.  What stood out for me was their analysis of consumption theory, the alcohol industries use of the 4 P’s of marketing and the Pareto Principle.  I’ve chosen to cherry pick and focus on these elements of their analysis as this information and the way it was presented was new to me.  Over to the experts:

Consumption theory:

The population consumption theory1 2 3 links population level alcohol consumption to alcohol related harm, forming a theoretical basis for modern alcohol control policy. As the late Professor Griffith Edwards stated, other things being equal, “the overall level of a population’s drinking is significantly related to the level of alcohol related problems which that population will experience.”2 The factors that drive alcohol consumption apply to harmful drinkers as well as low risk drinkers, and alcohol related harm is dose related, at both individual and population levels.

Patterns of consumption are known to be related to price. Mathematical coefficients, termed “elasticities,” linking the consumption of alcohol to price and taxation are used by the Treasury to model fiscal policy11 and by the drinks industry to lobby the Treasury.12 Further coefficients link alcohol related mortality and morbidity to consumption and price, and are central to the modelling of alcohol policy by the Organisation for Economic Cooperation and Development (OECD), World Health Organization, and the UK government.13 14 15 16 17

The population consumption theory suggests that alcohol related deaths have increased as a direct result of an increase in alcohol consumption.

The 4 P’s:

wkd marketing strategyIn marketing terminology sales of any product are driven by the four Ps—place, product, promotion, and price—and all these factors have changed considerably. Numbers of on-sales (pubs, etc) licences increased from 131 000 in 1980, to 148 000 in 2012; off licences increased from 42 000 to 56 000 and consumption shifted from pubs to alcohol bought to be consumed at home.4 The nature of the product changed as sales of weaker draught beers decreased and sales of strong lager and cider increased. Furthermore, as a wartime generation of whisky drinkers passed away, the spirits industry shifted its target demographic to a younger audience, introducing “alcopops.”24 25 26 Consumption of spirits and alcopops by children aged 10-15 increased fourfold, followed a few years later by a huge increase in sales of vodka and related spirits (fig 3).29 Wine consumption also rose as a result of cultural globalisation and the increased marketing and availability as supermarkets became the major alcohol retailers.30 31 Overall, the trends in alcohol related deaths coincide with trends in consumption of cider, wine, and to some extent white spirits and strong lager, and are consistent with the population consumption theory (fig 4).

The Pareto Principle:

pareto principleThe corporate global drinks industry likes to frame alcohol related harm as a minority problem affecting a small group of “alcoholics” who are unable to control their drinking. The population consumption theory represents an inconvenient truth and on the whole the industry refuses to accept the evidence that links price to consumption and harm.34 35 But another economic fundamental is relevant to the alcohol marketplace—the Pareto principle or 80:20 rule,36 which states that 20% of highest consumers consume around 80% of any product. Combined data from the 2011-13 Health Surveys for England show how the principle applies to the alcohol market (table 1).

Harmful and extreme drinkers comprise a tiny minority, 4.4% of the population, but consume one third of all alcohol sold; the combination of hazardous, harmful, and extreme drinkers provides almost 70% of drinks industry sales by volume. The drinks industry uses its influence on government to protect this market.12 34 This has brought about remarkable changes in affordability—as the ’90s economy boomed and wages increased, taxation of alcohol was reduced in real terms. By 2008 it was possible to buy almost four bottles of vodka for the price of one bottle in 1980—and four bottles represents the weekly alcohol consumption of an average patient presenting with alcohol related liver cirrhosis.38 As the affordability of stronger alcohol increased, so did liver and related mortality (fig 5).  From 2007-08 onwards the affordability of wine fell by 54%, spirits 50%, cider 27%, and beer 22%.

It may be surprising that changes in alcohol affordability could have a rapid effect on alcohol related deaths; it can take 10 years or more of very heavy drinking to develop liver cirrhosis. But this is exactly what would be predicted from experience in other countries. When the minimum price of alcohol increased by 10% in a Canadian province, a 32% decrease in directly attributable alcohol related mortality occurred within 12 months, and most deaths were from liver disease.45 Similarly, when Mikhail Gorbachev introduced alcohol reform in Russia in the 1980s, the maximum impact on mortality occurred within 18 months, including for liver disease.46 Alcohol related liver deaths occur from acute-on-chronic liver failure related to the severity of recent drinking.

Though the causative link between this changing trajectory of alcohol related deaths and economic factors remains unproved, the deaths are clearly alcohol related (fig 2) and occur in people drinking very large quantities of the cheapest alcohol available; the median alcohol consumption of patients with alcohol related cirrhosis is around 120 units/week, and in other dependent drinkers it is even higher.38 49

And here’s the kicker:

Incomes are starting to rise, and following a fierce campaign of lobbying by the Wine and Spirits Trade Association (WSTA) the duty escalator was dropped in 2014. In the budget of March 2015 alcohol duty was cut by a further 2% for spirits and cheap cider.38 An influential Ernst and Young impact analysis commissioned by WSTA omitted to mention any of the economic costs of alcohol related harm outlined by the OECD12 but appeared to persuade the Treasury that the health of the drinks industry was more important than that of alcohol consumers. Support for the “drop the duty” campaign came from unlikely sources; Jane Ellison, undersecretary of state for public health, was featured on the front page of drinks industry website Harpers.co.uk stating that she had forwarded a “drop the duty” email in support of the duty reduction to the chancellor of the exchequer.50

The whole analysis is worth a read and you can do so here.  How the Govt can continue to deny the impact and link between alcohol, pricing and health when Prof Sheron & Gilmore lay out the evidence so clearly is beyond me.

And this is what Alcohol Policy UK had to say about it:

Price & taxation: new analysis published as Scottish MUP decision expected

And the Institute of Alcohol Studies provided a report to look at the socio-economic costs that the Treasury thought were less important than the health of the drinks industry …..

The economic impacts of alcohol (PDF)

Edited to add: 10/10/16

4 Ps influence on children’s drinking behaviour “mixed”