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Alcohol-related death rate doubles in 15 years

Anew analysis of the mortality statistics for the UK shows that the death rate from alcohol defined conditions, mainly alcoholic liver disease,virtually doubled between 1991 and 2004.

It also shows that in Scotland, the death rates for both males and females were around double those for the UK as a whole. As can be seen from the table, 15 of the 20 areas with the highest male death rates from alcohol are in Scotland.

Across the UK, the alcohol-related death rate for males was double the rate for females, and the gap between the sexes has widened since 1991.

Among both men and women, the alcohol-related death rate rose most rapidly among those aged 35 – 54 between 1991 and 2004, though the death rate for both sexes was highest in the 55 – 74 age group.

At a local level, Glasgow City had the highest alcohol-related death rate among both men and women in 1998-2004. Fifteen of the 20 UK local areas with the highest male alcohol-related death rates were in Scotland, with three in England and two in Northern Ireland. Merthyr Tydfil, the highest-ranked local area in Wales, was 50th in the UK. For women, 14 of the top 20 local areas were in Scotland, with four in England and two in Northern Ireland. Denbighshire was the highest-ranking Welsh local area, at 26th in the UK.

Within England, men aged 55-74 in London had the highest alcohol-related death rate in both 1991-1997 and 1998- 2004, while women in the North West had the highest rates in both periods.

New Drinking Styles
The authors of the report suggest that the increase in alcohol-related mortality may be linked to changing consumption patterns such as ‘binge drinking’, changes in the type of alcohol consumed and changing drinking patterns in the young.

However, most scientific commentators would probably point to a factor not discussed in the report, the increase in the overall level of alcohol consumption during the period under review. Between 1991 and 2004, average per capita consumption rose by a quarter, from 9.3 to 11.6 litres of pure alcohol.

Social Deprivation
The new analysis shows a strong association between alcohol death rates and measures of social and economic deprivation. While the analysis was only undertaken in relation to England and Wales, its conclusions are consistent with previous research and the factor of economic deprivation is probably one of the main explanations of the higher alcohol mortality in parts of Scotland, particularly Glasgow.

In the new analysis, alcohol death rates were more than five times higher in men, and more than three times higher in women, for those living in the most deprived areas compared with those living in the least deprived.

Previous work has found a relationship between deprivation and deaths from liver cirrhosis, and higher general alcohol mortality has been reported for men in manual occupations compared to those in nonmanual occupations, especially at younger ages.
Health Statistics Quarterly 33 (Spring 2007).

Scotland up-dates alcohol harm reduction strategy
The publication of the alcohol death figures coincided with the release of an up-dating of the Scottish alcohol harm reduction strategy. A main element of the Updated Plan for Action on Alcohol Problems is the expansion of a test purchasing scheme to crack down on retailers who sell alcohol to under 18s.

The new Plan sets out a range of action on prevention, education, treatment, protection and controls. Government will work in partnership with Alcohol and Drug Action Teams, the NHS and other parts of the public and voluntary sectors to reduce alcohol-related harm.

The extension of the test purchasing scheme,whereby children under the legal purchasing age can be used to buy alcohol to check that licensing laws are being followed, comes after publication of an interim evaluation report of a successful pilot in Fife.

The Scottish Executive also published details of a new partnership to engage the drinks industry's resources and expertise in tackling alcohol misuse and promoting ‘responsible drinking’.

Test Purchasing
Announcing the extension of the test purchasing scheme, Health Minister Andy Kerr said: “Communities across Scotland are blighted by the problems associated with underage drinking, and rolling out test purchasing will give us a valuable tool in the fight against this. I know that the vast majority of retailers take their responsibility very seriously but we need to take action against the minority who sell alcohol without carrying out the proper checks.The findings of an interim evaluation report on the alcohol test purchasing pilot clearly show that the scheme can be carried out safely, fairly and effectively and we now want to replicate that success across Scotland. But as well as enforcement, we will continue our work to encourage all communities in Scotland, including young people, to develop a healthier relationship with alcohol.”

One alcohol death every six hours
Mr Kerr said that in Scotland one person dies every six hours as a direct result of alcohol, and deaths from liver cirrhosis are rising at an alarming rate. “Alcohol doesn't just affect the drinker”, he added. “The links between alcohol misuse, anti-social behaviour and violence are clear. Alcohol misuse is estimated to cost our economy over £1 billion a year. This plan outlines a range of government action, as part of a long term process of cultural change. But that change can only take place, with the support of the Executive, where individuals are willing to change their behaviour and in a society where alcohol misuse is no longer acceptable. We must all take personal responsibility for our society's excessive consumption. A culture of drinking to get drunk is not one to be proud of, and we cannot afford to assume it's someone else's problem. I commend our industry partners for committing to join our efforts to tackle the problems. I am delighted that I can publish today the detail of our agreement with them.”

The actions outlined in the Plan include:

On protection and controls

  • extending the alcohol test purchasing pilot to all Scotland from 1 May 2007 onwards
  • providing support to ensure Licensing Boards can control the spread of licensed premises through the Licensing Act

On prevention and education

  • developing a new, research based substance misuse schools education programme to build on existing work
  • supporting further development of diversionary activities such as Youth CAFEs (community alcohol free environments)
  • completing a national series of public awareness publications about the short and long term effects of drinking alcohol

On Provision of Services

  • developing a pilot telephone service to help identify and support harmful and hazardous drinkers at an early stage when they come into contact with the NHS
  • investing in better research, including research on improving reporting and recording information on alcohol use in pregnancy
  • developing an alcohol and drugs work force development strategy to ensure staff across Scotland have the best possible training in dealing with people with alcohol problems.

Background

There were 1,513 deaths in Scotland in 2005 where alcohol was the underlying (direct) cause e.g. mental and behavioural disorders due to the use of alcohol, alcoholic liver disease, alcoholic pancreatitis. There were a further 859 deaths where alcohol was a contributory factor. Between 1950-1954 and 2000-2002 the rate of liver cirrhosis mortality in Scottish men increased by a factor of six and a factor of four for Scottish women. Cirrhosis mortality rates in Scotland are now amongst the highest in Western Europe.

In September last year the Executive announced a formal partnership with the alcohol industry, in what is hoped to be a long term, collaborative approach to “fostering a culture which recognises that responsible, moderate consumption can be part of a healthy lifestyle.”

Partnership Agreement:
Scottish Executive and the alcohol industry

Initial signatories:

  • Scottish Executive
  • Scotch Whisky Association
  • Tennents
  • Diageo
  • Scottish & Newcastle
  • Scottish Retail Consortium
  • Scottish Licensed Trade Association
  • BII Scotland
  • Scottish Beer & Pub Association
  • Scottish Grocers’ Federation
  • Wine & Spirits Trade Association
  • Gin & Vodka Association
  • National Association of Cider Makers

In recognition of our shared aim to reduce alcohol misuse in Scotland, the Scottish Executive and the alcoholic drinks industry have agreed a number of actions as a first step in what we hope will be a long term collaborative approach to fostering a culture which recognises that responsible, moderate consumption can be part of a healthy society.

This agreement covers both alcohol producers and retailers (covering both on and off sales) and the initiatives agreed are designed to harness the knowledge and expertise of representatives from across the alcohol industry.

All parties are bringing resources and commitment to the furthering of the aims of the partnership – with an emphasis on delivering tangible action and outcomes. The Drinkaware Trust will promote responsible drinking messages and provide education and campaigning resources across the UK. This partnership aims to deliver added value in Scotland and will work with the Drinkaware Trust to ensure that our activities are aligned and mutually supportive to achieve greatest impact.

The partnership also jointly recognises the need for enforcement of current licensing legislation to ensure a zero tolerance approach to the illegal purchase of alcohol and the resultant alcohol related disorder.

The Executive commits to taking further action in this respect, including the roll out of the test purchasing arrangements currently being piloted in Fife to prevent under age sales.

The Executive recognises that tackling alcohol misuse is not only a health issue, and, as referred to in the Updated Plan for Action on Alcohol Problems, commits to delivering resources from across the Executive to address this.

There are no quick fixes to what is a long term problem requiring a long term cultural change programme. Neither do the actions amount to the complete solution, but we believe that by working in partnership long term cultural change can be effected.We may continue to broaden this partnership to include others. Participation in this arrangement will not prevent parties also continuing their own work in this area.

The agreement is not legally binding. It is complementary to the Updated Plan for Action on Alcohol Problems and as with the Plan will be reviewed in due course.

The initiatives outlined below are the first in an ongoing programme. Others will be added and this list will be continuously updated and refined.

Specific initiativesalready agreed, involving individual partners as appropriate:

We will:

  • Build on best practice todevelop and promote commoncore sensible drinking messages, and informationabout the incompatibility ofalcohol consumption withcertain activities;
  • In pursuit of the above, share media and marketing expertise to promote those messages;
  • Share consumer research onpromoting sensible drinking and responsible retailing;
  • Consider the scope for joint events to focus public and media attention on the dangers of alcohol misuse, alongside wider messages of personal responsibility.
  • Work with the media and other stakeholders to discourage inappropriate endorsement or legitimisation of inappropriate alcohol consumption;
  • Develop a set of shared Scottish specific Standards, underpinning and strengthening in Scotland the approach already adopted at UK level;
  • Work with retailers and the National Licensing Forum to support a comprehensive server training programme in responsible drinking ahead of the 2009 Licensing Act implementation deadline;
  • Develop and implement exemplar alcohol policies in our own workplaces, which we will also share and promote more widely within the public and private sectors, including to Small and Medium Size Enterprises (SMEs);
  • Where appropriate, individual companies will pilot low alcohol alternatives in the Scottish market and use their joint creative energies to market the principle of consuming low alcohol alternatives, within the context of making informed choices and unit awareness.
  • Investigate the promotion of no alcohol alternatives in the retail sector;
  • Develop and produce guidelines to establish best practice on the promotion of alcohol via sponsorship;
  • Work together to develop and implement an intensive series of interventions, including community support, within geographically focussed pilots to establish the cumulative effect of a multi faceted and targeted approach to reducing alcohol harm;
  • Produce educational materials for parents to use with their children outside the school setting, also encouraging parents to consider their own drinking habits in discussing the issue with their children;
  • Hold a National Awareness Week with support from other partners such as the voluntary sector.

Scottish doctors demand end to ‘ridiculous pricing of alcohol’

Welcoming the publication of the new action plan to tackle alcohol problems in Scotland, Dr Peter Terry, chairman of the BMA in Scotland said:“We welcome the concerted efforts of the Scottish Executive to tackle Scotland’s drinking problem. Alcohol costs our economy around £1 billion every year, but the human cost is much higher. Around one in 30 of all deaths in Scotland are caused by alcohol related illness.

“It is clear that alcohol misuse doesn’t just have an impact on our health, but it affects society as a whole and we must do what we can to change the culture where Scots believe they can drink to excess without any thought to the consequences for their health.

“Doctors in Scotland welcome the extension of the test purchasing scheme. In a survey last year,97% of doctors said that tougher enforcement of age restrictions for purchasing alcohol was one of the most important measures that government could take to tackle underage drinking in Scotland, as well as tougher measures for shopkeepers who sell alcohol to children.

“Doctors also want to see an end to the ridiculous pricing of alcohol for off sales. When alcohol is cheaper than bottled water, we have to worry about what message we are sending our children.”

The BMA also welcomed plans to develop a new schools education programme. There has been a 60% increase in reported drinking by 15 year olds and more than a 100% rise in drinking by 13 year olds in recent years.

“Education on the dangers of alcohol misuse should begin at primary school, before children are tempted to drink,” added Dr Terry.

The BMA also called for action to be taken to make Scotland’s roads safer as part of the alcohol action plan with changes to drink driving limits.

Dr Terry said: “As part of an action plan we would call on the Scottish Executive to insist that the Westminster government introduce legislation to reduce drink drive limits to the European norm (from 80mg to 50mg per 100ml).”

In a survey of BMA Scotland members, doctors said that to tackle alcohol misuse in Scotland, the following measures should be taken:

  • Apply stricter enforcement of age restrictions, particularly for off sales. 97% of doctors say this is an important measure to deter young people from purchasing alcohol.
  • Implement stricter measures, such as immediate loss of license to sell alcohol, to prevent shopkeepers from selling alcohol to under age children. 96% of doctors support this measure.
  • Develop improved alcohol awareness education campaigns for schools, starting at primary school level. 91% of doctors support such a campaign.
  • Introduce a law that requires alcohol products to carry a label listing alcohol content, recommended daily units and warnings of excessive drinking. Products that do not comply should be withdrawn. 83% of doctors back labelling.
  • The price of alcohol should be increased to discourage excessive drinking. 70% of doctors agree.