The Alcohol Harm Reduction Strategy 2010 – 2020:

‘A Good Life and Alcohol in Salford’

Scrutiny Committee Presentation David Herne NHS Salford Deputy Director Of Public Health

Andrew MacDonald DAAT Alcohol Coordinator NHS Public Health Team Alcohol Lead

The National Picture

The Alcohol Harm Reduction Strategy

“ This review has found that progress has been more elusive in reducing harm from alcohol... consumption of alcohol has increased since 1998, accompanied by a rise in alcohol-related hospital admissions and rates of liver disease, suggesting more aggressive, cross-departmental action will be needed in the future.”

Kings Fund April 2010

• Since 1998 there has been an overall increase in drinking that exceeds the recommended weekly limits.

• Change marked among adult women, described as a ‘robust trend’ General Household Survey / Health Survey for England (2009)

Kings Fund April 2010

• Overall, no sign that the government’s aims to reduce harmful alcohol consumption have been achieved.

• Much potential improvement lies outside the NHS, including greater control of advertising, pricing strategies, and initiatives to limit the physical availability of alcohol.

• Little evidence that existing policies on alcohol misuse is having any success.

• The question of whether policy should focus on strong state action (akin to smoking ban) as to pricing and availability of alcohol, or on individual behaviour change

• E.g. information or incentive programmes

• Given the scale of the challenge, there is a strong case for saying government need to draw on all available approaches where there is evidence of their effectiveness

Kings Fund April 2010

The Salford Picture

The Alcohol Harm Reduction Strategy

National Synthetic (ANARP)

23% harmful low to medium risk7.55% hazardous medium to high4% dependency high risk

In Salford there are approximately:40,400 hazardous drinkers (23%)13,200 harmful drinkers (7.5%)4,200 dependent drinkers (4%)44,000 (26.5%) binge drinkers (cross-over hazardous and harmful)

Newer evidence – underestimate 1:2?

Scale of Alcohol Problems?

Salford Ward Alcohol Related Hospital Admissions –against National Average (per 000)

Mental Disorder (3.08) Liver Disease (0.86)

Pendleton 14.30 2.07

Broughton 12.05 3.04

Weaste & Seedley 10.11 3.05

Blackfriars 9.98 1.92

Langworthy 9.56 3.88

Ordsall 9.10 2.65

Barton 9.06 2.12

Eccles 8.74 1.49

Claremont 8.68 1.01

Little Hulton 8.14 1.57

Winton 8.07 1.25

Swinton North 7.79 1.86

Pendlebury 6.62 2.55

Walkden North 5.69 1.33

Kersal 5.55 0.84

Cadishead 4.06 0.56

Irlam 3.88 0.29

Walkden South 3.21 0.38

Worsley & Boothstown 2.35 1.14

Swinton South 1.91 0.72

Wards with Highest Alcohol

related Liver / Mental Health Problems

Understanding drinking in Salford

The Alcohol Harm Reduction Strategy

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Harmful drinking

Underage

12/13 yrs

peersfun

being a rebelnew experiences

Trainee

14/16 yrs

acceptedrite of passage

proud parentpart of the scene

BingeDrinking17/25 yrs

socialfacilitator

drink to get drunkmeeting partner

Hazardous drinking

pleasurerelaxation/reward

escapism/boredomfollowing the norm

Moderatedrinking

responsibilitiesother leisure activities

family

Habitual

negative triggers – job loss, divorce, death

positive triggers –new partner/ job /child, referral

drinking careers...

women have generally had longer periods of interruption through pregnancy and childcare

National Alcohol Social Marketing Salford High Risk Segments

Segment % Age of Popln.

Characteristics

8 20% Blue collar workers, live in terraces or semi-detached houses rented from local authorities. High hospital admissions, likely to smoke and to drink bitter, lagerand spirits, mostly at home.

9 14% Parents in their late 20's to early 30's - have several young children. Many divorced and/or single parents. Likely to live in flats or terraced houses & be unemployed or unskilled. High hospital admissions, likely to smoke, eat fast food and drink vodka and canned lager.

12 14% Broad range of ages, likely to live in terraces in former industrial areas. Generally have the worst levels of overall health, with asthma, cholesterol and heart conditions as well as high acute hospital admissions. Likely to smoke and drink beer/ lager, at home and in pubs.

13 9% Young people in 20s - have a very high rate of acute admissions. Likely to live alone in local authority flats or hostels, be unemployed and some are single parents. Likely to smoke and drink large amounts of beer & spirits.

Profiling key audiences

Underage drinking highest among deprived groups

Binge drinking highest among 16 – 24 yr olds and those living away from home

Dependant drinking including 35 - 54 yr olds – all groups

Hazardous drinking including 25 - 44 yr olds – all groups

Harmful drinking highest among 35 - 64 yr olds – more upmarket

Men and more affluent populations likely to be heavier daily drinkers while more deprived groups suffer burden of ill health

Typical underage profile – Ben from Broughton

% Of Young People Involved In

0

5

10

15

20

25

30Heavy Alcohol Drinking

Underage DrinkingHeavy Smoking

Aids

Teenage Pregnancy

Soft Drugs

Hard Drugs

Gambling

ObesityBulimia

AgressionDepression

Suicide

Taking Risks

Stealing

Being Racist

Vandalism

Cheating

Being BulliedVictim Of Racism

Youths 11-19's

• Ben is almost 14 – he feels very grown up and resents still being treated like a kid. His friends are everything and he will do what it takes to fit in and not to stand out. He is bored and craves freedom and excitement, so experiments with drink he nicks from home or gets his mates brother to buy. He loves the buzz and risk. He connects to the world through his computer and mobile and music is his way of escaping. He enjoys watching Hollyoaks and Skins on TV and getting something for nothing like magazine freebies.

‘friendship is the most important thing

in my life’

‘I like to enjoy life and don’t worry about the

future’

Sarah is 18 and has left school. She can’t get a job and doesn’t really know what she’s going to do in life. She likes to enjoy herself and regularly goes out drinking with her mates and goes out to get drunk – its trophy behaviour and something to talk about afterwards. She loves to keep up to date on the latest celebrity news and buys several glossy mags a week. Sarah doesn't worry about the future and loves to buy things on impulse. She doesn’t think that health checks are important as life is for living now. She feels like she knows it all and is strongly independent.

Typical binge profile – Sarah from Swinton

‘I am usually first amongst friends to know what’s going on’ (index

168)‘I like taking risks’ (index 245)

‘Rules are made to be broken’ (index 210)

‘I am easily swayed by other people’s views’

(index 298)

‘I worry a lot about myself’ (index 189)

Typical hazardous profile – Lou from LangworthyLou drinks most evenings to relax after a day juggling kids and work. She deserves it and there is not much else to do anyway. Like 8 out of 10 other women in her shoes, she drinks to relieve stress and feels she deserves it because there is not much else to do anyway – it fills a gap. She drinks cheap wine, mostly when the kids are in bed and she has put her feet up to watch TV. She is concerned about her weight and often diets or skips meals to compensate. She feels life is a struggle and when she goes out, she really goes for it to escape.

“I wake up covered in bruises and have no

idea where I got them from, we call then UID’s, unidentified drunken injuries”

“I really go for it at the weekends, I get a

babysitter and don’t come home until 4

o’clock”

Typical harmful profile – Pete from Pendleton

Pete is a builder and works hard all day to support his family. He was born and bred in Salford and going to the pub is just part of life. He has very traditional macho attitudes likes to get out of the house and have a laugh with his mates in the pub. He knows he probably drinks too much but doesn’t care – he’s only doing what everyone else does and needs the escape from the stress of providing for his family. He knows he should probably do more about his health but hates going to the doctors unless he is really unwell.

Typical harmful profile – William from Worsley

• William is a bank manager and has worked hard all his life to do the best for his family. He believes in duty and conscientiousness, is confident and status conscious, motivated by rewards and prestige. Alcohol is a part of life - he drinks to entertain clients, to de-stress after a day at the office and will pay more for quality beer and wine. He is aware of his waistline, tries to eat healthily and does think about calories and cholesterol. He eats out in gourmet restaurants with his wife and friends regularly. He enjoys quality red wine with dinner, followed by a good cigar and large whisky. He tends to have more health problems than most and does go to his GP for periodic check ups

“Drinking is just part of my everyday life”

Over 50% of daily drinkers are 55+. 62% are male and 56% are AB’s or C1’s.

C225%

C128%

AB28%

E6%D

13%

The biggest challenges:

-To encourage people to see they have a problem at all

-To get them to care enough about life to want to do something about it

The biggest opportunity:

- Prevent alcohol even becoming an issue in the first place- Change the social norm (will take a long time and commitment from all)

Social Marketing Conclusions

The Salford Strategy

The Alcohol Harm Reduction Strategy

Drivers of Alcohol Related Harm

Driver 1: Provision of high quality treatment

Driver 2: Alternatives to alcohol

Driver 3: Well managed supply

Driver 4: Appropriate attitudes safe alcohol use

Driver 5: A well managed environment

Strategic Objective 1: Provision of high quality treatment

Exemplar Actions: • Equitable substance misuse service over 25s • Effective treatment via GPs, Criminal Justice and

Hospital staff. Treatment will include screening, advice, community detoxification, talking therapies, residential detoxification, rehabilitation and recovery

• Self help groups for problem drinkers widely available• Social marketing Insight to develop manage emerging

issues e.g. women’s increased drinking and risks in pregnancy

• Wellness Service = easier access to holistic treatment offer encompassing alcohol, tobacco and healthy weight growing to link in with the Life Chances Pilot

Strategic Objective 2: Alternatives to Alcohol

Exemplar Actions: • Effective campaigns and interventions in homes,

schools, workplaces, public space, to develop self knowledge, self-awareness and self-efficacy

• Front line brief advice screening and interventions• Lifestyle campaigns and interventions reduce barriers to

seeking help • An equitable service for under 25s• Young people offered positive activities• Young people engage mainstream activity and lifestyles

Strategic Objective 3: Well managed Supply

Exemplar Actions: • Regional / National examples of good practice for

managing local supply• Develop a quality mark approach similar to the Best Bar

None scheme • Develop existing good practice on control of sales to

under 18s sales in line with national best practice in the local context

Strategic Objective 4: Appropriate Attitudes

Exemplar Actions:

• Social Enterprise local solutions on and off sales of alcohol and related services and activities

• Social marketing campaigns, interventions and services• Community projects to shift local attitudes to alcohol use

through Neighbourhood and Health Improvement teams

Strategic Objective 5: Well Managed Environment

Exemplar Actions: • Homeless drinkers - GM hospital discharge protocol• Alcohol Free Zones public places. • Social Enterprise led sale alcohol = alcohol is cheaper out

than at home, encouraging family life, social cohesion, managing consumption

• Education, training, employment, ‘volunteering / occupation’ via Social Enterprise e.g. time bank

• Alcohol Free Space for families, young people, adults, older people = help those in recovery

• Salford Workforce encouraged to set an example• Salford Employers Workplace Alcohol Policy within

Greater Manchester Action Plan e.g. Human Resources / Occupational Health ‘wellness’ staff.

Any thoughts?...