Category Archives: Alcohol facts and figures

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”

 

 

Dereliction of duty: Are UK alcohol taxes too low?

pigouvian taxationThis is a new report from the Institute of Alcohol Studies, that claims that the Government’s own estimates of the social costs of alcohol imply that alcohol duty should be raised. The report summarises the economic theory underpinning alcohol taxation (including the theory of pigouvian taxation which I’m not even going to try to explain or pretend I understand!) and considers it a dereliction of duty.

Here’s the summary to their report:

There are three standard reasons why governments tax alcohol:

1. Externality Correction: to ensure that alcohol prices reflect the cost to third parties who are harmed by drinking
2. Paternalism: to reduce people’s consumption for their own good
3. Revenue Raising: to fund the government.
The UK Government estimates that externalities associated with alcohol cost England and
Wales £21 billion every year.
Alcohol duty in England and Wales currently generates only £9 billion, less than half of the
value of these externalities.
This suggests higher alcohol taxes can be justified on the basis of the harm drinking
causes to wider society alone, without considering the impact on the drinker themselves.
The lost enjoyment suffered by moderate consumers as a result of alcohol duty is
relatively small – we estimate £1.2 billion (less than 2% of market value) to be the absolute
possible ceiling of the impact. This is dwarfed by the benefits of duty, in terms of reducing
crime, healthcare savings and improving economic output, which total a value of at least
£4.4 billion.
Under certain assumptions, tax revenue should not just equal, but exceed the cost of
externalities:
•If externalities are disproportionately higher at higher  levels of consumption i.e. if moving from the fourth to the fifth drink is substantially worse than moving from the first to the second
•If we think that avoiding harm to third parties should be given greater weight than the enjoyment of drinkers.  There is a strong case for paternalistic taxes on alcohol, as it is highly plausible that many people drink excessively, and this over consumption can be deterred by alcohol taxes – this adds a further reason for raising duty.  Economists are divided as to whether alcohol taxes cause less distortion to the economy than other taxes and are therefore a particularly desirable way of raising government revenue.
The interaction of alcohol taxes with other policies is complicated – stricter licensing and drink driving regulations, all else equal, mean that taxes should be lower.
On balance, these arguments suggest to us that alcohol taxes in the UK are too low.
We believe the Government should be committed to higher alcohol taxes as a result
of its claim that alcohol externalities cost England and Wales £21 billion each year.
And this was the response from Alcohol Policy UK following the recent UK March Budget
A Government release on the duty impacts though says the freeze ‘is likely to lead to a minor increase in overall alcohol consumption in the UK’, as alcohol is of course price sensitive. Indeed on the headline hitting sugar tax announcement, Osborne stated “We understand that tax affects behaviour. So let’s tax the things we want to reduce, not the things we want to encourage.” Twitter of course raised questions, including whether sugary alcoholic drinks would be affected, or whether parallels could be drawn with the 2012 headline grabbing announcement of minimum pricing – subsequently dropped – which was also timed around a budget with less than impressive economic news.
Edited to add 6th June 2016:
Minimum pricing for alcohol targets harm better than tax rises

Whether alcohol tax rises would be an acceptable and effective alternative could determine the legality under EU law of Scotland’s law permitting a minimum unit price for alcohol. This analysis predicts tax rises would curb consumption and save lives, but not without perhaps unacceptably hitting the pockets of non-harmful drinkers | Drug and Alcohol Findings, UK

Bearing in mind there has been a rash of stories in the last few days about rising poisonings amongst teenagers and alcohol is behind this increase one has to question pricing as a factor as the first piece from The Independent does ….

Surge in girls’ alcohol poisoning behind rise in teenage poisonings

The authors said: “One potential explanation for the increase in alcohol poisonings over time is increased availability, with the relative affordability of alcohol in the UK increasing steadily between 1980 and 2012, licensing hours having increased since 2003, and numbers of outlets increasing alongside alcohol harm.”

Sharp rise in UK teen poisonings over past 20 years, particularly among girls

The number of teenage poisonings over the past 20 years in the UK has risen sharply, particularly among girls, according to a new study by researchers at The University of Nottingham | University of Nottingham, UK

Rise in ‘intentional’ alcohol poisoning among teens – BBC iPlayer radio

There has been a sharp rise in the overall number of teen poisonings over the past 20 years in the UK, particularly among girls and young women, according to a new report | BBC, UK

Edited to add: 15th July 2016

Small rise in booze duty might cut violence-fuelled emergency department visits by 6000/year, UK

Tax system reforms in England and Wales might be better than minimum unit pricing | MNT, UK

Adult drinking habits in Great Britain

ONS 2014This is the Office for National Statistics report for 2014 looking at the adult drinking habits in Great Britain.  It makes for interesting reading and you can find the whole report here.

Here’s the main findings:

  • 28.9 million people report that they had drunk alcohol in the week before interview.
  • 2.5 million people drink more than 14 units of alcohol on their heaviest drinking day.
  • Almost 1 in 5 higher earners drink alcohol on at least 5 days a week.
  • Young people are less likely to have consumed alcohol in the last week than those who are older.
  • A higher percentage of drinkers in Wales and Scotland drink over the recommended weekly amount in one day.
  • Wine is the most popular choice of alcohol.

In Great Britain in 2014, there were 28.9 million people who reported that they drank alcohol in the week before being interviewed for the Opinions and Lifestyle Survey. This equates to 58% of the population.

Focusing on those who drank alcohol, 12.9 million (45%) drank more than 4.67 units (around 2 pints of 4% beer or 2 medium (175 millilitre) glasses of 13% wine) on their heaviest drinking day. This is a third of the recommended weekly limit – the value you would drink if you drank 14 units spread evenly over 3 days. Of these, 2.5 million (9%) drank more units in one day than the weekly recommended amount of 14 units (6 pints of beer or 1.4 bottles of 13% wine).

Young people were less likely to have consumed alcohol; less than half (48%) of those aged 16 to 24 reported drinking alcohol in the previous week, compared with 66% of those aged 45 to 64.

While overall being less likely to drink alcohol, young drinkers were more likely than any other age group to consume more than the weekly recommended limit in one day. Among 16 to 24 year old drinkers, 17% consumed more than 14 units compared with 2% of those aged 65 and over.

I was really struck by some of the graphics as they paint such a clear picture – so for example this one about earnings and alcohol consumption:

income and drinkingFocusing on frequent drinkers, those who drink on at least 5 days of the week, individuals with an annual income of £40,000 and over were more than twice as likely (18%) to be frequent drinkers compared with those with an annual income less than £10,000 (8%).

It presents a fascinating insight into teetotalism, drinking in the week before interview, frequent drinking and units drunk, including changes in drinking patterns in recent years.

And these were all the news stories that followed:

2.5m Brits bust weekly alcohol limit in a day

Around 2.5 million people in Great Britain – 9% of drinkers – consume more than the new weekly recommended limit for alcohol in a single day, latest figures from the Office for National Statistics show. The 2014 data predates the new limit of 14 units of alcohol per week for men which began in January 2015 | BBC, UK

Younger people drink less but binge when they do, figures show

ONS study reveals picture of UK’s drinking habits and shows higher earners drink at least five days a week | Guardian, UK

Wales tops alcohol binge drinking stats in ONS survey

People in Wales are more likely to be binge drinkers than anywhere else in Britain, new figures have revealed | BBC, UK

I’m sick of explaining why I am teetotal

The UK is slowly drying out but as a teetotaler, I can tell you our attitudes toward drink aren’t changing anytime soon | Independent Voices, UK

The party’s over for young people, debt laden and risk averse

The drinks industry seeks to solve the conundrum of the monastic twentysomething by “premiumisation” (getting them to spend more on the few drinks they will buy). We have to understand it as a challenge broader than the market | Guardian, UK

Any thoughts from you?

 

Effects of Different Alcohol Taxation and Price Policies on Health Inequalities

uk taxation and alcoholSo before we discuss this new research looking at and exploring the estimated effects of different alcohol taxation and price policies on health inequalities from a mathematical modelling study point of view I thought it beneficial to provide some context.  The graphs to the left show the tax receipts for the UK govt in 2015.  As you can see alcohol duty plays an important role in raising taxes for the govt and makes up 1/6th of the minor tax take, not so minor after all at £10.5 billion.

Here’s the study abstract:

Introduction

While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO “best buy” intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities.

Methods and Findings

An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol); and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA) and scenario analysis.

The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on mortality rates are as follows: current tax increase, −3.2%; value-based tax, −2.9%; strength-based tax, −6.1%; minimum unit pricing, −7.8%) and lesser impacts among drinkers in professional/managerial occupations (for heavy drinkers: current tax increase, −1.3%; value-based tax, −1.4%; strength-based tax, +0.2%; minimum unit pricing, +0.8%). Results from the PSA give slightly greater mean effects for both the routine/manual (current tax increase, −3.6% [95% uncertainty interval (UI) −6.1%, −0.6%]; value-based tax, −3.3% [UI −5.1%, −1.7%]; strength-based tax, −7.5% [UI −13.7%, −3.9%]; minimum unit pricing, −10.3% [UI −10.3%, −7.0%]) and professional/managerial occupation groups (current tax increase, −1.8% [UI −4.7%, +1.6%]; value-based tax, −1.9% [UI −3.6%, +0.4%]; strength-based tax, −0.8% [UI −6.9%, +4.0%]; minimum unit pricing, −0.7% [UI −5.6%, +3.6%]). Impacts of price changes on moderate drinkers were small regardless of income or socioeconomic group. Analysis of uncertainty shows that the relative effectiveness of the four policies is fairly stable, although uncertainty in the absolute scale of effects exists. Volumetric taxation and minimum unit pricing consistently outperform increasing the current tax or adding an ad valorem tax in terms of reducing mortality among the heaviest drinkers and reducing alcohol-related health inequalities (e.g., in the routine/manual occupation group, volumetric taxation reduces deaths more than increasing the current tax in 26 out of 30 probabilistic runs, minimum unit pricing reduces deaths more than volumetric tax in 21 out of 30 runs, and minimum unit pricing reduces deaths more than increasing the current tax in 30 out of 30 runs). Study limitations include reducing model complexity by not considering a largely ineffective ban on below-tax alcohol sales, special duty rates covering only small shares of the market, and the impact of tax fraud or retailer non-compliance with minimum unit prices.

Conclusions

Our model estimates that, compared to tax increases under the current system or introducing taxation based on product value, alcohol-content-based taxation or minimum unit pricing would lead to larger reductions in health inequalities across income groups. We also estimate that alcohol-content-based taxation and minimum unit pricing would have the largest impact on harmful drinking, with minimal effects on those drinking in moderation.

To read the full research article go here.

Bearing in mind that I featured a great piece only recently looking at alcohol and health inequality once again the case for minimum unit pricing is robust and these findings conclude that they would not impact on those who drink moderately which has been the biggest and loudest reason given not to implement to date.

And once again Scotland lead the way in collaboration with the University of Sheffield:

Model-based appraisal of the comparative impact of Minimum Unit Pricing and taxation policies in Scotland (PDF)
To achieve the same reduction in alcohol-related deaths among hazardous and harmful
drinkers as a 50p minimum unit price, a 28% increase in alcohol taxation would be required.

But no we seem to be heading in the opposite direction yet again!

The HMRC Alcohol Strategy Modernising alcohol taxes to tackle fraud and reduce burdens on alcohol businesses (PDF)

Of course we need to REDUCE the tax burden on alcohol businesses instead 🙁

Lancet psychiatry: Articles on young people and substance use

the lancetWithin the UK there are two hallowed publications within medicine –  the British Medical Journal (BMJ) and The Lancet.  This series was published within The Lancet Psychiatry in February.  The fact that it was a series of research publications indicates how serious an issue substance misuse within young people is.

Here are the links to the full series of publications which are all freely available once you have registered your email with the journal.

February 18, 2016
Why young people’s substance use matters for global health
Wayne D Hall, George Patton, Emily Stockings, Megan Weier, Michael Lynskey, Katherine I Morley, Louisa Degenhardt
 
The increasing global health priority of substance use in young people
Louisa Degenhardt, Emily Stockings, George Patton, Wayne D Hall, Michael Lynskey
 
Editorial
Drug policy: getting over the 20th century
The Lancet Psychiatry
 
Prevention, early intervention, harm reduction, and treatment of substance use in young people
Emily Stockings, Wayne D Hall, Michael Lynskey, Katherine I Morley, Nicola Reavley, John Strang, George Patton, Louisa Degenhardt
 
This is the summary for the above article:

We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision—which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people.

As a nurse who is training to be a child and adolescent psychotherapeutic counsellor and who has a special interest in substance misuse and desire to work with this vulnerable client group because of my own history I feel this is a really really important topic.  Many local NHS services do not have a specialist child and adolescent substance misuse service (CASUS) which is true for my county here in Suffolk but I know there is one in our neighbouring county Cambridgeshire.  I hope that Liam Byrne’s work within Parliament will start the process to help change that ……

Ministers lobbied 40 times in three months on alcohol issues

lobbying of parliamentSo over the next ten days I’m going to present a story that starts here with the 40 times the drinks industry lobbied the Irish govt over a 3 month period and then over the next 10 days we consider the collateral damage to public health as presented to me in a weeks worth of news stories that I read including drink driving, alcohol and A&E, alcohol and the workplace and then alcohol and families.  We’re approaching Easter so it feels like a good time to reflect before we hit the next high days and bank holiday event.

Government Ministers and their officials were lobbied on alcohol-related issues more than 40 times in a three-month period, an analysis of the new register of lobbying shows.

Most of the lobbying concerned the Government’s planned legislation to counter alcohol abuse but other topics included the importance of Irish drink exports and the campaign to allow pubs open on Good Friday.

The Minister for Health was the most frequently lobbied Minister on the alcohol issue, followed by Minister for Sport and Tourism Paschal Donohoe. Taoiseach Enda Kenny was also lobbied in face-to-face meetings on several occasions.

Along with drinks companies and their representative bodies, sports organisations such as the Irish Rugby Football Union and its Munster branch were also active in lobbying against any attempt to ban sports sponsorship by the sector.

Alexandre Ricard, chief executive of drinks multinational Pernod Ricard, met the Taoiseach at an event in Paris, where he impressed on Mr Kenny “the importance of supportive domestic policies as underpinning export success,” according to the register.

Irish Distillers, which is owned by Pernod Ricard, invited Tánaiste Joan Burton to speak at the opening of a micro-distillery in Midleton, Co Cork. Informal discussions took place on the “global success” of Jameson whiskey and the economic impact of the indigenous distilling industry.

Public relations

Among the public relations firms actively lobbying in relation to alcohol issues were Q4 PR, Hume Brophy and MKC Communications.

Industry group Ibec made its views known to a wide variety of Ministers, including the Taoiseach and Ministers Leo Varadkar, Paschal Donohoe, Michael Noonan, Alex White and Simon Coveney.

The IRFU wrote to Mr Varadkar and Mr Donohoe to underline its concerns about the Public Health (Alcohol) Bill and to seek a meeting.

The rugby organisation’s Munster branch appealed in an email to Mr Coveney and Mr Noonan not to change the legislation as it would have “a major adverse impact on our ability to continue as a professional sporting organisation”. A meeting was sought with the Ministers but never took place.

So busy behind the scenes lobbying by the drinks industry as the Irish govt were preparing the Public Health (Alcohol) Bill that I talked about here.  Bit like the behind the scenes discussions that took place here about minimum unit pricing ……..

Harmful drinking and dependence: PHE release resource

PHE 2016 harmful drinking resourcesAlcohol Policy UK wrote an excellent summary of the new PHE resources launched in January to support harmful drinking and dependence.  So good that I’m going to share in their entirety 😉

Public Health England (PHE) have released a new resource Health matters: harmful drinking and alcohol dependence – see PDF and links here.

The resource aims to support the ‘commissioning and delivery of evidence based treatment interventions to address harmful drinking and alcohol dependence in adults’, and includes infographics, video, a commissioning toolkit and a local service case study.

PHE say around 1.6 million adults in England have some level of alcohol dependence, many of whom may be suitable for treatment, although this question and much of the content are not explored in detail. As such the resource mainly sets out a broad level overview of the impacts of harmful drinking and main treatment response to addressing dependency. Key stats and issues associated with harmful and dependent drinking are highlighted, including mental health, employment, hospital admissions, health inequalities, key groups, and resources for developing treatment services.

Answering the tough questions?

Certainly championing investment in alcohol services may be considered valid; treatment is an ‘invest to save’ measure for which it can be argued that greater numbers should be receiving it, with alcohol services historically having played second fiddle to the drug treatment agenda. However local commissioners may feel there are many ongoing challenging and complex questions in the development of local systems that meet the needs of a range of harmful or dependent drinkers.

One such area may be how the needs of harmful drinkers with no or low severity of dependence might be better engaged. As part of NICE CG115 released in 2011, it identified that 84% of those with a level of dependency are only ‘mildly’ dependent, yet only 1.13% of this population receive specialist treatment, versus 33.69% with moderate or severe dependence. However such drinkers are unlikely to seek or access specialist treatment, in part because they may be unlikely to consider their drinking problematic, or at least not enough to warrant treatment. Whilst ‘extended brief interventions’ or ‘brief treatment’ approaches in non-specialist settings may be most appropriate, there still remains limited examples or guidance on this issue.

It should be noted that in 2011 NICE CG115 released an exhaustive review of the evidence and a comprehensive series of supporting tools and resources. NICE Quality Standard 11 also directly set out the expectations for local treatment provision. PHE too have since released other resources, most notably self-assessment tools, hospital guidance and JSNA support packs. However numbers in treatment have not climbed significantly, and assessing the impact of such guidance on commissioning practice may be questionable.

On a broader level, the effects of changes to the commissioning landscape and indeed ongoing cuts are still to be navigated. Last year Alcohol Concern’s review of alcohol treatment in England revealed a mixed picture; services may be holding steady for the time being, but challenges were by no means limited. PHE state they will be releasing further resources to help local areas identify and target drinking population needs. On how the picture develops, only one thing may be called with a degree of certainty – it will probably vary depending on where you look.

Thank you James (and Libby!) for a great summary and this video does a great job of explaining it all clearly and succinctly.  I was really struck by the numbers in the top featured image so I’m going to re-iterate them here: