The Burden of Health Harm and the Evidence on How to Tackle It Locally and Nationally South London Health Innovation Network

The burden of health harm and the evidence on how to tackle it locally and nationally South London Health Innovation Network

Ian Gilmore Chair, UK Alcohol Health Alliance President, British Society of Gastroenterology • how we drink • Nationally • Regionally • Different patterns • Impact of age, gender

• the burden of harm

• the evidence on how to reduce harm

• national and local action (should be complementary)

• who should we work with?

• how you can be an advocate for change

WHO Global Status Report 2011

Why is consumption falling in UK

• number of abstainers in UK is increasing

• however average consumption per non-teetotal adult = 25 units/wk, from duty and excise data

• increase this by 15% for unrecorded / consumed abroad Drinking 5 or more days a week by age

Men more than women

ONS 2012 16-24yr olds binge more

ONS 2012 ESPAD data on amount drunk by 15-16 yr-olds on last drinking occasion

ESPAD 2007 DALYs lost attributable to 10 leading risk factors for the age group 15–59 years in the world, 2004

WHO Global Status Report on alcohol and health 2011 Male alcohol-related deaths by age group, England Alcohol-related deaths registered in UK, 2002-2012 Alcohol related deaths registered in 2012 by English region Alcohol related deaths registered in 2012 by UK nations Alcohol Related Admissions for Liverpool PCT (residents) 2002/03 to 2008/09 by Condition Group.

3500

3000

2500

2000 Chronic Conditions Rate CHRONIC Wholly Attributable Rate 1500 CONDITIONS Acute Consequences Rate

Rate per 100,000 1000 DEPENDENCE 500

0 2002/2003 2003/2004 2004/2005 2005/2006 2006/2007 2007/2008 2008/2009 Risk of female breast cancer by alcohol consumption

Source: Allen et al, 2009 Sheron 2010, Passive drinking Figure 2.6 Alcohol-related mortality among adults aged 25-64 in England and Wales, 2001-03, by National Statistics socio-economic classification (ONS)

men women

64 64 - 30

standardised death rate per 100,000 aged 25 per 100,000aged rate death standardised -

Age 0 1 1.1 1.2 2 3 4 5 6 7 NS-SEC category: 1=professional, 7=routine Costs of Alcohol to the UK

• OECD / WHO report suggests alcohol costs a country 2-3% of GDP through costs such as loss of productivity

• For UK this represents loss of £37.5bn (£625 per head pa)

• Income from tax on alcohol via HMRC is £10bn (£168 per head pa)

Competing frameworks for alcohol policy

•Alcohol is normal •Alcohol is not an ordinary product • Problems arise when a minority of people • The problem is not misuse it with the individual but the product • Therefore the solution is to change • Therefore the solution the behaviour of the is to make the minority through environment less pro- education alcohol and reduce the population consumption • cf gun lobby in USA

(Industry paradigm) (Public health paradigm) (from Evelyn Gillan, Alcohol Focus Scotland) International evidence shows consumption and harm are driven by:

• availability

• promotion by the alcohol producers and retailers

• price of alcohol Availability

Includes:

• hours of opening

• home deliveries

• density and site of outlets

• the siting of alcohol in-store

• the ability to take account of public health in licensing decisions

• regulation and enforcement of sales to the underage and drunk

Impact of placing alcoholic and non-alcoholic products at end-of-aisle

Beer sales increase: 23% Wine sales increase: 37% Spirit sales increase: 46%

Nakamura et al, Social Science and Medicine, 2014 Journal of Epidemiology and Community Health 2014 Underage and advertising: The evidence

• “alcohol advertising increases both the uptake of drinking and consumption in young people” (Science Committee of the EU Commission Alcohol Forum 2009)

Sports Sponsorship

Rule: ads cannot suggest that any alcoholic drink… can enhance mood, confidence, popularity, personal qualities, performance or sporting achievements

Ban on sponsorship of sports events by alcohol producers may be in some party manifestos for 2015 election

What to do about price? • increase duty / VAT

• use duty to promote lower strength

• tackle discounting / bulk offers

• ban on “below cost”

• minimum unit price

Impact of a 50p minimum unit price in CMO (England)’s report 2008

• Research into the effect of a 50p minimum price per unit shows for every year (England):

• 3,393 fewer deaths

• 97,900 fewer hospital admissions

• 45,800 fewer crimes

• 296,900 fewer sick days

• And a total saving of £15 billion over ten years (health, crime, social care.)

• Source: Chief Medical Officers Report 2008, Meier 2009

nb – this is 50p MUP at 2007-8 prices

Stockwell data from British Columbia

• 2011 addiction paper showed real life 10% increase in price led to 16% reduction in consumption of alcoholic beverages compared to non-alcoholic ones

• 2013 paper shows increase in MUP in British Columbia led to both immediate and delayed falls in alcohol- attributable deaths • Furthermore benefits in real life exceeded those predicted by the Sheffield model

• A 10% increase in MUP was associated with a 31% fall in wholly alcohol-attributable mortality

Stockwell et al, Addiction 2011 Zhao et al, Addiction 2013

Westminster Policy Emphasis 2010-present

• Personal choice

• ‘nudge theory’

• Local determination, not central control

• partnership working with alcohol producers and retailers –eg responsibility deal

QIPP for alcohol care teams

Quality and Productivity: Proven Case Study

Alcohol Care Teams: reducing acute hospital admissions and improving quality of care Provided by: The British Society of Gastroenterology and Bolton NHS Foundation Trust

Publication type: Quality and productivity example

QIPP Evidence provides users with practical case studies that address the quality and productivity challenge in health and social care. All examples submitted are evaluated by NICE. This evaluation is based on the degree to which the initiative meets the QIPP criteria of savings, quality, evidence and implementability; each criterion is given a score which are then combined to give an overall score.r The overall score is used to identify the best examples, which ahn e then sow n or NHS Evidence as ‘eco mmended’.

Our assessment of the degree to which this particular case study meets the criteria is represented in the evidence summary graphic below.

Evidence summary

Implementability

Evidence of change

Quality

Savings

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Page 1 of 11 This document can be found online at: http://www.evidence.nhs.uk/qipp Quality and Productivity: Proven Case Study

Alcohol Care Teams: reducing acute hospital admissions and improving quality of care Provided by: The British Society of Gastroenterology and Bolton NHS Foundation Trust

Publication type: Quality and productivity example

Our asseQIPPssment of the dforegree to walcoholhich this particular casecare study mee teamsts the criteria is represented in the evidence summary graphic below.

Evidence summary

Implementability

Evidence of change

Quality

Savings

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Page 1 of 11 This document can be found online at: http://www.evidence.nhs.uk/qipp To tackle alcohol-related harm –

Prevention is better than cure….

And action requires an innovative mix of research- based local and national initiatives