Calling Time The Nation’s drinking as a major health issue 12 250 10 200 8 150 6 100 4 50 to income Price relative 2 Litres of alcohol per person aged 15+Litres 0 0 1960 1964 1968 1970 1976 1980 1984 1988 1992 1996 2000 A report from the Academy of Medical Sciences With support from March 2004 The independent Academy of Medical Sciences promotes advances in medical science and public health and campaigns to ensure these are translated as quickly as possible into benefits for society. The Academy’s 750 Fellows are the United Kingdom’s leading medical scientists from hospitals, academia, industry and the public service. The aims of the Academy are to: • give national and international leadership in the medical sciences; • promote the application of research to the practice of medicine and to the advancement of human health and welfare; • promote the aims and ethos of medical sciences with particular emphasis on excellence in research and training; • enhance public understanding of the medical sciences and their impact on society; • assess and advise on issues of medical science of public concern. The Academy of Medical Sciences was established in 1998 following the recommendations of a working group chaired by Sir Michael Atiyah, Past President of the Royal Society. There is an elected Council of 22 Fellows that includes the five Officers of the Academy: President Sir Keith Peters, FRS, PMedSci Vice-President (Clinical) Lord Turnberg, FMedSci Vice-President (Non-clinical) Sir John Skehel, FRS, FMedSci Treasurer Sir Colin Dollery, FMedSci Registrar Professor Patrick Vallance, FMedSci The Academy is a registered charity and a company limited by guarantee. The Executive Director is Mrs Mary Manning. For more information about the work of the Academy please see www.acmedsci.ac.uk Registered Charity No.: 1070618 Registered Company No.: 3520281 Registered in England ISBN No.: 1-903401-06-2 Designed and produced by Quattro 020 7766 5225 Calling Time: The Nation’s drinking as a major health issure A report from the Academy of Medical Sciences March 2004 Acknowledgements The Academy of Medical Sciences is most grateful to Sir Michael Marmot and the members of the Working Group for conducting this inquiry. It would also like to thank the Review Group and the Academy’s Officers for their instructive comments and support. The Academy is grateful to the Society for the Study of Addiction for their financial support. Disclaimer This Report is published by the Academy of Medical Sciences and has been endorsed by its Officers and Council. Contributions by the Working Group are made purely in an advisory capacity. The Review Group added a further ‘peer-review’ stage of quality control to the process of Report production. The members of the Working Group and Review Group participated in this Report in an individual capacity and not as representatives of, or on behalf of, their individual affiliated hospitals, universities, organisations or associations (where indicated in the Cover image: Consumption of alcohol in the UK appendices). Their participation should not be taken (per person aged 15+) relative to its price 1960-2002 as an endorsement by these bodies. (Tighe, 2003) 4 Calling Time Contents Page Summary 7 Recommendations 9 Chapter one - Introduction 11 Chapter two - Do changes in population level drinking lead to changes in alcohol-related harm? 19 Review of the new evidence Chapter three - Reducing the harm from drinking 25 Chapter four - Conclusions and recommendations 33 Appendix one - References 37 Appendix two - Working and Review Group members 43 Appendix three- Terms of reference 45 Appendix four - Acronyms and abbreviations 45 5 Calling Time Figures and tables Figure 1 - Alcohol consumption in the UK: 1900-2000. Per capita consumption of 100% alcohol Figure 2 - Rising trend in deaths from chronic liver disease: 1970-2000 Figure 3 - Changing death rates from cirrhosis in England and the EU: 1970-1998 Figure 4 - Age-specific alcohol-related death rates in England and Wales: 1991-2000 Figure 5 - Consumption of alcohol in the UK (per person aged 15+) relative to its price: 1960-2002 Figure 6 - UK advertising expenditure at current prices and correlations with alcohol consumption in 11-15 year old children: 1992-2000 Figure 7 - Relationship between mean alcohol consumption and prevalence of drinking more than 28 units (approx 224g) of alcohol per week: men Table 1 - Number of deaths from chronic liver disease, England Table 2 - Abstinence rates in the UK and population alcohol consumption 6 Calling Time Summary Alcohol is an accepted part of our society, enjoyed by consumption of alcohol has risen by 50% in the the majority of the UK adult population and has health UK since 1970, whereas in France and Italy it has benefits, particularly in the area of Coronary Heart more than halved. Disease (CHD). The Academy has selected this focus in the knowledge However, there is clear evidence of an increasing that tackling general alcohol consumption is politically burden of harm from alcohol misuse: the Government contentious and an area in which it is difficult for has recognised this in asking the Prime Minister’s governments to intervene. But this is where there is Strategy Unit (PMSU) to develop a national alcohol evidence of opportunities to reduce harm, as part of harm reduction strategy, and the Academy of Medical a wider strategy. Sciences welcomes this. Compelling recent evidence supports previous findings In their Interim Report, the PMSU estimated that of a strong correlation between mean or median alcohol consumption in the United Kingdom is alcohol consumption and heavy or ‘problem’ drinking. responsible for a range of medical and social These cross-sectional data are supported by time-series consequences: analyses that demonstrate changes in per capita consumption are directly reflected in changes in harm. annual alcohol-related costs of crime and public • For instance, in Canada a one litre per annum rise in disorder £7.3 billion, workplace costs £6.4 billion, mean alcohol consumption was associated with a 30% and health costs £1.7 billion; increase in alcoholic cirrhosis of the liver. • 150,000 hospital admissions each year; • up to one-third of all accident and emergency Any benefit of a reduced population consumption attendances; of alcohol on deaths from cirrhosis or other alcohol- • about 2.9 million, or 7%, of the adult population related diseases has to be offset against the potential dependent on alcohol; loss of beneficial effects of alcohol on CHD. While • seven out of ten respondents to a poll saw drinking there may be beneficial effects of moderate drinking in public places as a problem in their locality; in the individual, this may outweigh health risks only • 47% of victims of violence believed that their in older people. At a population level, and at the assailant was under the influence of alcohol; per capita consumption found in the UK, it is unlikely • between 1993 and 2001 the total number of that overall reductions in consumption would have an casualties from road accidents involving alcohol adverse effect on deaths or morbidity from CHD. rose by one-fifth; Strategies to reduce alcohol consumption may be • between 30% and 60% of child protection cases general or targeted in their approach, but both tend involve alcohol. Up to 1.3 million children may be to have more impact on heavier, at-risk drinkers. adversely affected by family drinking. Educational approaches have been disappointing, but It is not the Academy’s intention to duplicate this work this may have been swamped by contrary advertising. and it expects the PMSU’s strategy to provide an Price modulation, usually through tax increases, is integrated and multifaceted approach. Specific highly effective, particularly in under-age drinkers; a high-risk groups, such as adolescent binge drinkers, 10% rise in price of all alcoholic beverages has been and certain high-risk situations, such as drink-driving estimated to reduce mortality from alcohol-related and drinking in public areas, are likely to be targeted. conditions by between 7 and 37%. The focus of this Report is the overall national The large ‘personal’ allowances for alcohol imported consumption of alcohol, the evidence that this is a from the European Union are disproportionately major determinant of harm and the opportunities generous compared to cigarettes and would act against for effective public health intervention that follow any benefits from price rises. The ‘personal’ allowance from this. It cannot be ignored that the per capita equates to a two year supply for a male drinking at 7 Calling Time the maximum ‘sensible’ level, compared to a 40 day the burden of alcohol-related harm in the population. supply for a 20-cigarette-per-day habit. Policy measures to address this harm are likely to cut across government departments. It also takes us outside Other crucial areas where alcohol consumption might the normal range of concern of a body such as be influenced include: the number and types of retail the Academy of Medical Sciences, but a broad outlets for alcohol, the hours they are open, random reach is necessary to build an effective strategy breath testing and the control of the drinking to reduce alcohol related problems. The scientific environment, particularly at night in Britain’s inner evidence indicates that, for the health of the cities. public, action is required to reduce the Therefore, the Academy concludes that there is much consumption of alcohol at a population level. evidence to link per capita alcohol consumption with 8 Calling Time Recommendations Recommendation one: Recommendation two: The balance of harm and benefit to society is There must be an extensive debate, involving all influenced by the total amount of alcohol consumed. sectors of the population, about alcohol-related harm Per capita alcohol consumption should be a pillar and the policies that might reduce it.