2 Public health need and practice
In Britain, the amount of pure alcohol sold per adult rose from 9.53 litres in 1986/87 to a peak of 11.78 litres in 2004/05, before dropping to 11.53 litres in 2007/08 (HM Revenue and Customs 2008). This approximates to 22 units (176 grams) per week for each person aged over 15 years.
Levels of self-reported hazardous and harmful drinking are lowest in the central and eastern regions of England (21–24% of men and 10–14% of women). They are highest in the North East, North West and Yorkshire and Humber (26–28% of men, 16–18% of women) (North West Public Health Observatory 2007).
A recent paper has also indicated that alcohol-related mortality within the UK varies according to a person's country of birth. For example, there is a higher alcohol-related mortality rate among those born in Ireland, Scotland and India compared to those born in Bangladesh, China, Hong Kong, Pakistan, the Middle East, West Africa and the West Indies (Bhala et al. 2009).
Although the amount most people drink poses a relatively low risk to their health, an estimated 24% of adults drink a hazardous or harmful amount (The NHS Information Centre 2009). (For definitions of harmful and hazardous drinking see glossary.)
In 2007, 72% of men and 57% of women in England had an alcoholic drink on at least 1 day during the previous week (Robinson and Lader 2009). In addition, 41% of men and 35% of women exceeded the daily recommended limits on at least 1 day in the previous week (Robinson and Lader 2009).
Among those aged 15 and under, 18% had drunk alcohol in the previous week (Diment et al. 2009). Although the proportion of schoolchildren who have never had an alcoholic drink has risen (from 39% in 2003 to 48% in 2008), those who do drink are consuming more.
Between 2007 and 2008, mean alcohol consumption among young people aged 11 to 15 (specifically, those who had drunk alcohol in the previous week) increased from 12.7 units (102 g) to 14.6 units (117 g) (Diment et al. 2009). Regional analysis shows that consumption is highest among those living in the North East (17.7 units) and the North West (16.3 units). It is lowest in London (11.3 units) (The NHS Information Centre 2010).
In addition, nearly 10,000 children and young people (under the age of 18) are admitted to hospital each year as a result of their drinking (Department for Children, Schools and Families 2009).
In the past 20 years, the price of alcohol has been rising at around the same rate as for other consumer products. However, incomes have risen much faster. As a result, between 1980 and 2008 alcohol became 75% more affordable (The NHS Information Centre 2009). Since 1987, for example, beer and wine have become 139% and 124% more affordable respectively when bought from an off license (Booth et al. 2008).
Overall, 80% of alcohol is purchased by 30% of the population (Booth et al. 2008). This suggests that the current low pricing policy in supermarkets mainly benefits those drinking at hazardous and harmful levels. In some cases, alcohol products are sold below cost. It is not possible to say exactly who pays for this subsidy, but it may be that moderate drinkers pay higher prices for other goods as a result.
Alcohol consumption is associated with many chronic health problems including psychiatric, liver, neurological, gastrointestinal and cardiovascular conditions and several types of cancer. It is also linked to accidents, injuries and poisoning (Rehm et al. 2010). Drinking during pregnancy can also have an adverse effect on the developing foetus. The resulting problems can include lower birth weight and slow growth, learning and behavioural difficulties and facial abnormalities (British Medical Association Board of Science 2007).
In 2005 it has been estimated that 14,982 deaths were attributable to alcohol consumption (Jones et al. 2008).
Alcohol is also linked to a number of social problems. In 2006/07, it was associated with over 500,000 recorded crimes in England (North West Public Health Observatory 2007). It may also be a contributory factor in up to 1 million assaults and is associated with 125,000 instances of domestic violence (DH 2009). Up to 17 million working days are lost annually through absences caused by drinking – and up to 20 million are lost through loss of employment or reduced employment opportunities (Prime Minister's Strategy Unit 2003).
The impact on other family members can be profound, leading to feelings of anxiety, worry, depression, helplessness, anger and guilt. For example, it can lead to financial worries and concern about the user's state of physical and mental health, as well as their behaviour. It can also affect the family's social life and make it difficult for family members to communicate. (Orford et al. 2005).
Alcohol-use disorders (see glossary) are associated with relationship breakdown, domestic abuse, poor parenting, unsafe and regretted sex, truancy, delinquency, antisocial behaviour and homelessness (Prime Minister's Strategy Unit 2003).
Alcohol-related harm is estimated to cost society between £17.7 billion and £25.1 billion per year (DH 2008a).
It costs the NHS in England up to £2.7 billion a year to treat the chronic and acute effects of drinking (DH 2008b). It is also estimated that up to 35% of all emergency department attendances and ambulance costs are alcohol-related (Prime Minister's Strategy Unit 2003). In 2007/08 there were 863,300 alcohol- related admissions, a 69% increase since 2002/03 (The NHS Information Centre 2009).
The interaction between social class and alcohol is complex.
Managers and other professionals self-report that they consume the most alcohol (an average of 19.9 units (160 g) a week compared with 16.7 units (134 g) a week for people in routine and manual groups). The difference is even more marked when the figures are broken down by gender: female managers and professionals drink an average of 10.7 units (86 g) a week, compared with 7.1 units (57 g) a week for women in routine and manual groups (Goddard 2008).
However, the adverse effects of alcohol are exacerbated among those from lower socioeconomic groups, as they are more likely to experience its negative consequences. (This is not necessarily as a result of drinking themselves, but can be due to other people's drinking.) In addition, factors such as a poor diet and a general lack of money mean that people in lower socioeconomic groups who do drink heavily cannot protect themselves as well as those in more affluent groups against the negative health and social consequences.
Compared with those living in more affluent areas, people in the most deprived fifth of the country are:
two to 3 times more likely to die of causes influenced, in part, by alcohol
three to 5 times more likely to die of an alcohol-specific cause
two to 5 times more likely to be admitted to hospital because of an alcohol-use disorder (North West Public Health Observatory 2007).
Since 2004, the detrimental effects of alcohol-use disorders has resulted in several government policy initiatives. In addition, the need to prevent and reduce alcohol-use disorders has been incorporated into several public service agreements (PSAs). For examples, see the list below.
'Alcohol harm reduction strategy for England' (Prime Minister's Strategy Unit 2004).
'Choosing health: making healthy choices easier' (DH 2004).
'PSA 14: increase the number of children and young people on the path to success' (HM Treasury 2007a).
'PSA 23: make communities safer' (HM Treasury 2007b).
'PSA 25: reduce the harm caused by alcohol and drugs' (HM Treasury 2007c).
'Safe. Sensible. Social. The next steps in the national alcohol strategy' (DH 2007).
'Youth alcohol action plan' (Department for Children, Schools and Families 2008).