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Report
Examines Public Health Burden of Alcohol in UK
and Effectiveness of Policy Interventions
Alcohol is now the
leading risk factor for ill-health, early mortality and disability for
those aged 15-49 in England, according to a new report published by
Public Health England (PHE) last month. The British Department of
Health commissioned the report, asking PHE to provide a comprehensive,
evidence-based assessment of the public health burden of alcohol as
well as the effectiveness and cost-effectiveness of a variety of
policies aimed at reducing alcohol-related harm. The report was
published both online at the PHE website and in an abridged form in
The Lancet.
Public Health Burden
Worldwide, the use of alcohol causes a significant health, social and
economic cost to society, ranking among the five top risk factors for
disease, disability and injury. Speaking specifically regarding
England, Professor Kevin Fenton, the National Director of
Health and Wellbeing at PHE, said in a press release, “The harm
alcohol causes is much wider than just on the individual drinker.
Excessive alcohol consumption can harm children, wreck families,
impact on workplace colleagues, and can be a burden and drain on the
NHS and economy.” While acknowledging that much of the public health
burden of alcohol can be indirect and hard to quantify, the authors
quote the following statistics pertaining to England in the review:
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Currently over 10
million people are drinking at levels that increase their health
risks |
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Alcohol-related causes
lead to over 1 million hospitalizations annually in England |
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The average age at
death of those dying from an alcohol-specific cause is 54.3 years.
The average age of death from all causes is 77.6 years. |
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As a result of this
age-related effect, more working years of life are lost in England
as a result of alcohol-related deaths than from cancer of the
lung, bronchus, trachea, colon, rectum, brain, pancreas, skin,
ovary, kidney, stomach, bladder and prostate, combined |
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The economic burden of
alcohol is substantial, with estimates placing the annual cost to
be between 1.3% and 2.7% of annual GDP |
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Estimates of the
direct costs to the NHS in the UK stood at
£3 billion for conditions attributable to alcohol
consumption in 2005/06, equivalent to 3.2% of the total healthcare
costs |
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Lower socioeconomic
groups often report lower levels of average consumption, yet show
greater susceptibility to the harmful effects of alcohol an dare
more likely to die or suffer from a disease relating to their
alcohol use |
Policy interventions
For
most alcohol-related diseases and injuries, increasing quantities of
alcohol consumed lead to increased risk. This dose-response
relationship exists for all alcohol-related cancers, for example, and
highlights the great potential for policy interventions that decrease
alcohol consumption to positively impact public health in both the
short and long-term. Alcohol control policies are generally aimed at
one of three factors believed to strongly influence alcohol
consumption - affordability, availability and the social norms around
its consumption. The PHE review systematically assesses the latest
evidence on the effectiveness of a number of these policies.
Regulating
Affordability
The affordability of alcohol in the UK has steadily
increased, with alcohol currently 60% more affordable today than in
1980. There is broad consensus among research findings and public
health organizations that policies aimed at increasing the price of
alcohol, typically achieved through increased taxation, are the most
effective, cost-effective methods for prevention and health
improvement. For instance, a 2010 meta-analysis showed that doubling
tax rates would decrease alcohol-related mortality by an average of
34.7%, with traffic-crash deaths decreasing by 11.2%, sexually
transmitted infections by 5.5%, and violence and crime episodes by
2.2% and 1.4% respectively.
Regulating
availability
Although controlling the availability of alcohol is
considered a key approach to reducing harm, implementing these methods
effectively has proved challenging, often
yielding
mixed results. Policies that limit either the hours, days or locations
in which it can be sold can be effective, particularly with late night
sales. In addition, these policies have the potential to address
inequalities if they are targeted to locations with higher levels of
alcohol-related health problems or incidents.
Regulating Social
Norms Around Consumption
There are a wide range of interventions targeted at
social norms around the acceptability of alcohol consumption,
including policies aimed at regulating marketing of alcohol,
regulating drinking and driving and education and informational
campaigns. According to the authors of the report, the most effective
of these involve regulating the marketing of alcohol and reducing
drinking and driving. Evidence consistently shows a relationship
between exposure to alcohol advertising and subsequent alcohol
consumption in children and young people. While the report concludes
that self-regulation of marketing by the alcohol industry is not
effective, complete or partial advertising bans are a highly-effective
and cost-effective approach.
Evidence also suggests that strongly enforced legal
policies aimed at preventing drinking and driving are also effective
and cost-effective at reducing alcohol-related harm. The report cites
a number of examples demonstrating that setting or lowering legal
limits for blood alcohol levels while driving reduces the number of
alcohol-related traffic accidents. For instance, lowering the legal
limit from 100 mg per 100 ml to 80 mg (the current English legal
limit) in 19 US states from 1982-2000 reduced the number of
alcohol-related fatal traffic
traffic
accidents by 15%.
Interestingly, the authors conclude that there is
little evidence that education and information programs lead to
substantial long-term improvements in alcohol-related harm. However,
they note that these programs can increase public support for the
implementation of more effective policies.
For
more information, the full report can be viewed here:
https://tinyurl.com/hpetyp8
The abridged version published in the Lancet can be seen here:
https://tinyurl.com/jclam2y
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