Taking Action on Alcohol Harm the role of legislation Thursday, - - PowerPoint PPT Presentation

Taking Action on Alcohol Harm

the role of legislation

Thursday, April 15, 2010 - Stobart Stadium, Widnes

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Andrew Bennett NHS Wirral and Centre for Public Health

A local perspective of the impact of alcohol

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Taking steps to rethink drink Taking steps to rethink drink

‘The cause of death is birth, and on your way there you might want to enjoy things ….” David Hockney, ‘The cause of death is birth, and on your way there you might want to enjoy things ….” David Hockney,

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126,000 cases of Domestic Violence a year

Balanced picture? Balanced picture?

Each year alcohol is a factor in: Around 1 million assaults 33,000 admissions to hospital for liver disease

BCS, Kershaw et al 2008; Jones et al, 2008

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That was then … That was then …

• Alcohol available in

pubs and off licences

• nly
• Lower strength
• Relatively more

expensive

• First drink tasted nasty
• Drunkenness in public

frowned on particularly for women

• Drinking and driving

was legal

• Alcohol available in

pubs and off licences

• nly
• Lower strength
• Relatively more

expensive

• First drink tasted nasty
• Drunkenness in public

frowned on particularly for women

• Drinking and driving

was legal

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QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.

….. and this is now

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We’re drinking more alcohol… …strength & volume We’re drinking more alcohol… …strength & volume

One small glass wine (125ml) 8% = 1 Unit One large glass wine (250ml) 14% = 3.5 Units

Standard pint beer 4%=2 Units Strong pint beer 6.5%=3.5 Units

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It’s more available It’s more available

Number of on- and off-licensed premises: England & Wales, 1963-2004

90,000 100,000 110,000 120,000 130,000 140,000 150,000 160,000 170,000

Year

Number of premises

Fierce competition between supermarket chains has led to discounts and promotions

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It’s cheaper in real terms It’s cheaper in real terms

Since 1980 the real price of alcohol has fallen by nearly 70% in the UK. Alcohol can now be bought for as little as 11p a unit

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Drunkenness is encouraged Drunkenness is encouraged

• Sales from off-licenses and supermarkets

increasing

• Social acceptability of drunkenness
• Price and availability
• Promotions

Bar = £2.50–£3.00 Supermarket = £0.60- £0.70

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Home drinking Home drinking

• Research limited
• Growing trend
• Women are a key growth

area

• Now more popular than

the pub

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Unsafe levels Unsafe levels

• 33% of men and 16% of women (24% of

adults) drink above the NHS’s sensible drinking guidelines.

• This includes 6% of men and 2% of women

estimated to be harmful drinkers, which means that damage to health is likely.

• Among adults aged 16 to 74, 9% of men and

4% of women show some signs of alcohol dependence.

• 33% of men and 16% of women (24% of

adults) drink above the NHS’s sensible drinking guidelines.

• This includes 6% of men and 2% of women

estimated to be harmful drinkers, which means that damage to health is likely.

• Among adults aged 16 to 74, 9% of men and

4% of women show some signs of alcohol dependence.

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40% women & 45% men drink to unwind after stressful day Of women that drink hazardously - 81% do so to relieve stress

Know Your Limits/YouGov; Netmums, 2008

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4.3 51.1 44.6 1.7 37.6 60.7

10 20 30 40 50 60 70 In daily limits In weekly limits Over weekly limits

Planned consumption in one nig

Females Males

4.3 51.1 44.6 1.7 37.6 60.7

10 20 30 40 50 60 70 In daily limits In weekly limits Over weekly limits

Planned consumption in one nig

Females Males

• Pilot study in three UK

cities

• Heaviest drinkers are

excluded

• 53.3% pre-loaded
• 1 in 10 plan to consume
• ver 40 units
• Pilot study in three UK

cities

• Heaviest drinkers are

excluded

• 53.3% pre-loaded
• 1 in 10 plan to consume
• ver 40 units

Going out to get drunk

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Alcohol harm in the UK Alcohol harm in the UK

• 9000 deaths per year - increasing by 10%

each year

• Alcohol-related illness or injury currently

accounts for nearly a million hospital admissions per year - also increasing

• Most people who will die from drinking are

not alcoholics. Their health is damaged from regularly drinking too much over a number

• f years

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Diseases attributable to alcohol

• Cancer of the

Larynx 29%

• Haemorrhagic

Stroke 24%

• Fire Injuries

38%

• Alcoholic Liver

Disease 100%

• Epilepsy 54%
• Lip/Oral Cancer

28%

• Breast Cancer

7%

• Cardiac

Arrhythmias 25%

• Spontaneous

abortion 22%

• Intentional Self-

Harm 34%

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Every minutes …… someone in the North West is admitted to hospital because they have drunk too much alcohol

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What’s the true cost of a drink? What’s the true cost of a drink?

• 1.2m violent incidents (around

50% of all violent crimes)

• One in 3 intimate partner violent

incidents committed under

• alcohol. 125,000 cases a year
• Up to 1,000 suicides
• 39% of deaths in fire
• 15% of drownings
• One in seven road traffic deaths
• Up to 1.3m children affected by

parental alcohol problem

• 1.2m violent incidents (around

50% of all violent crimes)

• One in 3 intimate partner violent

incidents committed under

• alcohol. 125,000 cases a year
• Up to 1,000 suicides
• 39% of deaths in fire
• 15% of drownings
• One in seven road traffic deaths
• Up to 1.3m children affected by

parental alcohol problem

Alcohol costs the economy up to £20 billion a year

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Children and young people Children and young people

• By 15 years most children have drunk

alcohol

• Hospital admissions among 15-19 year
• lds from alcohol increased 68%

between 2003 and 2007

• The majority of 15-16 year olds (71%)

associate alcohol consumption with positive consequences and having fun

• By 15 years most children have drunk

alcohol

• Hospital admissions among 15-19 year
• lds from alcohol increased 68%

between 2003 and 2007

• The majority of 15-16 year olds (71%)

associate alcohol consumption with positive consequences and having fun

• Early age of starting drinking is

associated with higher rates of problematic drinking in adulthood and a wide range of other adverse consequences

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• 31% men & 20% women

exceed weekly limits

• Of all drinkers, 1 in 4 men & 1

in 5 women exceed by twice the sensible daily limit

Bellis et al , In prep, HM Revenue and Customs, General Household Survey 2006

• Abstainers - approx 14% adults
• Drinkers weekly units (mean)
• by Survey = 16
• by Sales (Taxation) = 26 units

Excludes - Illegal sales, personal imports, consumption abroad, home brew (last estimated at 4 units/week)

• Abstainers - approx 14% adults
• Drinkers weekly units (mean)
• by Survey = 16
• by Sales (Taxation) = 26 units

Excludes - Illegal sales, personal imports, consumption abroad, home brew (last estimated at 4 units/week)

How much do we really drink? How much do we really drink?

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What do adults recommended limits mean? What do adults recommended limits mean?

units pure alcohol per day

Australian National Health and Medical Research Council ,2009 I gnores risks associated with accidents, violence, other collateral damage Daily consumption and Lifetime Risk of dying from an Alcohol Related Disease

1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14

Males Females

Lifetime risk per 100 drinkers Sensible means 1 in 100 die for 2 3 doubles a night

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NHS campaign reveals unseen alcohol damage

You could be three times more likely to have a stroke and three times more likely to get mouth cancer if you’re a man

regularly drinking more than two pints of lager a day

You are 50% more likely to get breast cancer and twice as likely to have high blood pressure, which could lead to a stroke or a heart attack, if you’re a woman regularly

drinking two glasses of wine or more a day

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Our alcohol challenge Our alcohol challenge

• Consumption has risen steadily during

the last two decades

• Women now drink as much as men
• Acceptability of drunkenness
• Alcohol is very cheap
• Heavily advertised
• Drink at home
• Available 24/7
• Consumption has risen steadily during

the last two decades

• Women now drink as much as men
• Acceptability of drunkenness
• Alcohol is very cheap
• Heavily advertised
• Drink at home
• Available 24/7

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Wirral - headline facts Wirral - headline facts

• The number of adults drinking above the NHS

recommended levels in Wirral is estimated to be more than 74,000; 22.3% of these are currently experiencing harm from their drinking

• Wirral has a high mortality rate, morbidity

rate and admissions to hospital as a result of excessive drinking. Emergency hospital admissions for alcohol specific conditions have been gradually increasing over the last five years

• The number of adults drinking above the NHS

recommended levels in Wirral is estimated to be more than 74,000; 22.3% of these are currently experiencing harm from their drinking

• Wirral has a high mortality rate, morbidity

rate and admissions to hospital as a result of excessive drinking. Emergency hospital admissions for alcohol specific conditions have been gradually increasing over the last five years

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Headline facts continued Headline facts continued

• Hospital admissions for alcohol related harm

are strongly associated with deprivation

• National and local data demonstrate a clear

association between alcohol misuse and

• crime. However, alcohol related crimes in

Wirral are lower than national and regional figures

• Hospital admissions for alcohol related harm

are strongly associated with deprivation

• National and local data demonstrate a clear

association between alcohol misuse and

• crime. However, alcohol related crimes in

Wirral are lower than national and regional figures

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Results so far, Alcohol headline target NI 39 Results so far, Alcohol headline target NI 39

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The Wirral Alcohol Challenge Event: Taking steps to rethink drink

11 February 20 10

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Taking Steps To Rethink Drink Taking Steps To Rethink Drink

Professional

Explore opportunities with colleagues and professional groups to raise awareness of alcohol misuse and associated harm Review workplace policies Deliver identification and brief advice to your public/service users Ensure workforce is competent and confident to deal with alcohol issues

Personal

Complete the AUDIT quiz Keep a drinks diary for a week Drink less

Corporate

Explore opportunities to address alcohol harm through changes in policy and practice within

• rganization

Promote alcohol help and treatment through partnership communication channels e.g. council tax flyer Stop using taxpayers money to buy alcohol

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Are you against the cheap availability of alcohol? Are you against the cheap availability of alcohol?

Y e s N

• 30%

70%

• 1. Yes
• 2. No
• 1. Yes
• 2. No

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When did you last take advantage of cheap alcohol? When did you last take advantage of cheap alcohol?

N e v e r O c c a s i

• n

a l l y R e g u l a r l y A l w a y s

17% 14% 30% 38%

• 1. Never
• 2. Occasionally
• 3. Regularly
• 4. Always
• 1. Never
• 2. Occasionally
• 3. Regularly
• 4. Always

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Thank you Thank you

a.bennett@ljmu.ac.uk

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Mike Jones Alcohol Programme Manager

Single Unit Price

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Summary

• Greater Manchester Alcohol Strategy

Structure

• What is a single unit price?
• What is the evidence
• Greater Manchester Response
• The introduction of a Byelaw

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Single Unit Price

• A unit of alcohol is used as a basis for

guidelines on consumption of Alcoholic Beverages

– In the UK, a unit is defined as 10 Millilitres (or approximately 8 grams) of absolute alcohol (ethyl alcohol)

• A introduction of a single unit price is seen

as the single most important measure in tacking alcohol related harm in the UK by the GMASG

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Sub-Regional Framework

The seven commissions, part

• f the Association of Greater

Manchester Authorities North West Alcohol Forum Home Office Department of Health Cheshire and Merseyside Greater Manchester Alcohol Strategy Group (GMASG) Lancashire and Cumbria

Health Community Safety Policy Evidence & Intelligence

Bury Bolton Oldham Manchester Rochdale Salford Stockport Tameside Trafford Wigan

Each borough has their own local Alcohol Strategy Group made up of their local partners Public Protection Health New Economy Specialist Acute Trust Alcohol Health Workers Forum Trading Standards Licensing Planning

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The Evidence

• Research from Sheffield University –

commissioned by the DoH

– Sir Liam Donaldson Report 2008 – House of Commons Select Committee on alcohol 2009 – NICE Guidelines to be published 2010

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The Evidence

A single unit price of 50p will reduce consumption :-

• per drinker by 6.9% on average. This

would lead to 97,900 fewer hospital admissions and 10,300 fewer violent crimes per year.

• per 11-18 year old drinker by 7.3%. This

would lead to 500 fewer hospital admissions and 2,200 fewer violent crimes per year for that age category.

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The Evidence

• per 18-24 year old hazardous drinker by 3%.

– This would lead to 300 fewer hospital admissions and 1,600 fewer violent crimes per year for that age category. Hazardous drinkers are defined in the research as drinkers with an increased risk of psychological and physical consequences due to alcohol intake of between 21 and 50 units per week for men and between 14 and 35 units per week for women

• of harmful drinkers by 10.3%.

– This would lead to 63,200 fewer hospital admissions and 4,500 fewer violent crimes per year for that age category. Harmful

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GM Response

• The Greater Manchester Health Commission

has recognised the increased challenge of alcohol to the population’s health and the necessity for innovative solutions

– The Commission agreed to strongly advocate nationally and locally for a minimum unit price for alcohol of 50p, in accordance with the evidence and advice from the Chief Medical Officer, and to seek all powers necessary to be the first conurbation in England to implement this recommendation

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What does this mean?

• For reference, a 50p minimum unit price

would result in the following effects to price:

– A 750ml bottle of wine (12% alcohol) could not be sold for less than £4.50 – Six 500ml cans of lager (4% alcohol) could not be sold for less than £6 – A 2 litre bottle of cider (5.5% alcohol) could not be sold for less than £5.50 – A 700ml bottle of whisky (40% alcohol) could not be sold for less than £14

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GM Response

• Build a coalition of support
• GMASG

– October AGMA Board and Commissions – December Licensing Chairs

• Presentation to AGMA Executive Board
• Our Life produced information on

– Supermarket prices – Bylaw

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Introduction of a Byelaw

• Challenge the legal advice
• Ask individual LA to test out the Our Life

report and to indicate if they are happy to proceed

• Our role is to co-ordinate the approach
• Recognise that this is a local decision

for each borough

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Next Steps

• Presentation to all ten Community

Safety Partnerships

• Produce a paper on what a Bylaw is

and means for each borough

• Produce a draft Bylaw
• Await the results of the election

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Safe, Sensible, Social. Significantly reducing alcohol harm: An argument for minimum pricing in Blackpool

• Dr. Arif Rajpura

Director of Public Health Stephen Morton Alcohol Harm Reduction Policy Officer

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The start of the journey 2006

• Blackpool Town Centre Pub Watch agree a £1.50

minimum price voluntary code – Operates Thurs-Sun – Well maintained – Lightly enforced – Industry support Nightsafe – Industry support altn8 – Does not effect off sales

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2009 – carried out research on feasibility of minimum pricing

• Sought published information
• Reviewed Sheffield Research
• Explored taxation options
• Tested effectiveness on Model

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Abstinent & low risk Increasing Risk Risky net abst & low to increasing risk pa net to risky pa death abst & low death increasing risk death risky reaching drinking age pa net to v high risk pa death v high risk stop inc risk pa Very High Risk stop risky pa Binge drinkers net to binge pa stop very high risk net binge to risky pa stop binge pa death binge

Test Effectiveness using Modelling

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Enforcement Activity + Pricing + +

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Clarify legislation highlighting how minimum pricing can be achieved

• Initial advice was ‘Don’t bother!’
• Second set of legal advice

– Possible to use By Laws – Not anti competitive – Utilise Wellbeing By aw legislation – Support with enforcement Bylaw

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Sought endorsement

• CDRP
• Licencing Committee
• Police SMT
• Health Overview & Scrutiny Committee

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OSC to present motion at Council to establish a minimum price for a unit of alcohol in Blackpool to include all retailers

• Health OSC & CDRP presented motion to full council
• “Council explore opportunities to establish a minimum price

for a unit of alcohol in Blackpool to include all retailers”

• Motion agreed by all parties

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Develop new Alcohol Licencing Policy to include minimum pricing

• Develop with Licencing Committee
• Develop alongside enforcement

departments

• Seek political support
• Seek solicitors support

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Formed Sub Regional Pricing Scrutiny Committee

• Includes representation from

– Blackpool BC – Blackburn with Darwen BC – Lancashire County Council – Cumbria County Council – NHS Blackpool – Centre for Public Scrutiny – Witnesses

• Aims to establish the possible effectiveness and feasibility of

a Bylaw

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Other activity

• Regional DPHs met shadow ministers to discuss the

issue.

• Asst Chief Constable discussed with the Home Secretary

during regular meeting.

• Sought Safer Lancashire agreement
• Sought Lancashire Alcohol Network agreement
• Worked with Our Life to develop DPH letter published in

Times

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Will we achieve it?

YES It’s just when

!

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Questions

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Alcohol: Impact of minimum pricing

Local predictions using the Sheffield (ScHARR) model

Janet Ubido, Researcher, Liverpool Public Health Observatory

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Sheffield (ScHARR) study

Possible scenarios:

• increasing the general price of alcohol

by different percentages,

• banning off-trade promotions,
• minimum pricing ranging from 15p to

70p (on and off trade) and

• differential combinations of on and off

trade minimum pricing (e.g. 40p off and £1 on trade).

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Valuation of harm reduction

• ver a 10-yr period (£bn)

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Policy context: Off-sales vs on- sales affordability (University of Sheffield)

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Who drinks the cheap alcohol?

64% of all cheap off-trade alcohol is consumed by harmful drinkers - and only 9% by moderate drinkers

University of Sheffield

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Minimum pricing affects harmful drinkers more

(University of Sheffield, 2008)

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Pricing policies do not punish sensible drinkers

• at least not proportionately -

the 50p minimum pricing policy would cost harmful drinkers £15 extra per month, with a small impact on sensible drinkers of around £1 extra per month

(University of Sheffield, 2008)

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How price policies target harmful drinkers

Harmful drinkers

• buy 15 times more alcohol than a moderate drinker
• Spend 10 times as much on alcohol than a moderate

drinker

• They prefer cheaper drinks, and pay 40% less per

litre of pure alcohol Any price policy will hit heavy drinkers more, and minimum pricing affects more of their preferred types of drink.

(University of Sheffield, 2008)

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Outcomes of introducing 50p minimum price per unit

• 7% consumption

Annual savings:

• 3,400 deaths, 98,000 hospital admissions
• 300,000 days of workplace absence
• 46,000 crimes

Total 10-year valuation: £13bn

• £1.4bn direct health cost savings & £4.9bn QALY

gains

• £413m direct crime cost savings & £616m QALY

gains

• Rest: includes unemployment, workplace absence

reductions

(University of Sheffield, 2008)

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Hospital Admissions for Alcohol‐related Harm Estimated reductions in admissions with a 50p min price PCT Estimated Annual Reduction in Admissions Estimated Annual Saving (£) Halton and St Helens 978 281,664 Knowsley 517 148,896 Liverpool 1,619 466,272 Sefton 830 239,040 Wirral 1,077 310,176 Merseyside total 5,021 1,446,048 Warrington 572 164,736 Cheshire 1,704 490,752 Cheshire & Merseyside total 7,297 2,101,536

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Deaths from alcohol attributable conditions Estimated reductions with a 50p min pricing policy PCT Number of deaths avoided in year 1 Full effect of annual deaths avoided by year 10 Halton and St Helens 14 33 Knowsley 7 16 Liverpool 24 58 Sefton 11 27 Wirral 16 39 Warrington 8 20 Cheshire 28 67 Cheshire & Merseyside total 109 261

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Minimum pricing campaign supporters

• Chief Medical Officer
• NW Directors of Public Health
• House of Commons Health Select

Committee (inquiry into alcohol)

• On-trade licensees
• Some supermarkets

But Government response so far ‘complacent’

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Next steps

• obtain agreement of all agencies in

principle to the introduction of a minimum price of 50p per unit in Cheshire and Merseyside

• explore use of local bylaw as identified

by Our Life

• involve the local community to

encourage them to back the policy

• continue lobbying national government

any queries - j.ubido@liv.ac.uk

Group discussion guide

What would the benefits be of using legislative

responses to tackling alcohol harm?

Are there any risks that would need to be considered

in pursuing these?

In what ways could these risks be reduced or

elimated?

Please nominate a note–taker to capture key discussion

• points. These will be written up after the event.

Thank you

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