Community initiatives

In a society where drinking alcohol is part of most people's social life, it is important to be able to measure both the impact of its misuse and the success of the efforts being made to tackle the problem. Alcohol, after all, is associated with a wide range of health and social problems , including violence, accidents, and chronic illness, which affects not only the individual but the communities where they live.

The Health Education Authority has published a book, Alcohol: measuring the impact of community initiatives,* which draws on research carried out in two communities as well on the experience of a wide range of professionals working to reduce alcohol related harms.

The book provides guidance on setting up the means to assess the impact of any measures taken in a community. At a time when more local authorities are looking to act alongside health authorities in dealing with the problems caused by alcohol as well as illicit drugs, this publication will prove invaluable.

* Alcohol: measuring the impact of community initiatives, Betsy Thom, Moira Kelly, Sarah Harris, and Angela Holling, Health Education Authority.

That Monday morning feeling

Further light on the impact of alcohol is provided by a new study from Scotland which suggests that up to 20 per cent more people die from heart attacks on a Monday than any other day. Weekend boozing and the thought of going back to work may well be contributing to this trend. An article in the British Medical Journal* makes much the same suggestion as to the link between these heart attacks and the stress of returning to work after two day's socialising. These findings have led to a demand for more research into the connection between excessive drinking and coronary heart disease.

The records of approximately 80,000 Scottish men and women who died of heart disease were investigated and it was discovered that the number of deaths peaked on Mondays. For example, deaths of women under 50 with no previous history of heart disease rose by a fifth. Among men of a similar age who also had no previous heart trouble, there was a 19 per cent increase on Mondays.

On the other hand, the researchers found that the lowest number of heart-related fatalities occurred on a Tuesday. Dr Christine Evans, the report's author, said that "Monday peak in deaths from coronary heart disease in Scotland may be partly attributable to increased drinking at the weekend, although other mechanisms, such as work-related stress, may be important.

"The possible link between binge drinking and deaths from coronary heart disease has potentially important public health implications and merits further investigation."

It was noted that people with previous admissions for heart problems had no significantly increased risk of death on Mondays. It is suggested that these people were more likely to recognise warning signs and get to a hospital if necessary. It is also likely that people with a history of heart disease were probably on medication which stabilised their condition.

It is a well established fact, and one attested to by hospital staff throughout the United Kingdom, that weekend over-indulgence also leads to a considerable rise in the number of people appearing in casualty departments the worse for drink - 64 per cent more on an average Saturday night that on weekdays.

*"I don't like Mondays' - day of the week of coronary heart disease deaths in Scotland: study of routinely collected data, Dr Christine Evans et al., The British Medical Journal, 22nd Jan 2000, Vol.320.