Alcohol and Health Inequalities
Elizabeth AmblerRegional Alcohol Programme ManagerDepartment of Health – East Midlands
Aims and Objectives• Alcohol Related Harm – What is the scale
of the problem?• Alcohol and Health Inequalities• National and Regional Response to Alcohol
Related Harm• Guided Group Work: Identification of
effective mechanisms and interventions to address inequalities in alcohol related harm and treatment provision
• Feedback and Next Steps
Alcohol Related Harm – What is the Scale of the Problem?
• The consequences of drinking go far beyond the individual drinkers health and well-being
• They include harm to the unborn foetus, acts of drunken violence, vandalism, sexual assault and child abuse, and a huge health burden carried by both the NHS and friends and family who care for those damaged by alcohol
Alcohol Related Harm – What is the Scale of the Problem?
• Since 1970, alcohol consumption has fallen in many European countries but has increased by 40% in England
• The annual cost of alcohol-related crime and public disorder has been estimated at £7.3bn, the cost to employers has been put at £6.4bn
Source CMO report 2008. Passive drinking: The collateral damage from alcohol
Alcohol Related Harm – What is the Scale of the Problem?
• There are around 16, 000 premature deaths each year in England and Wales associated with alcohol misuse – double the number since the early nineties
• Alcohol related hospital admissions are increasing at a rate of 70, 000 per year in England
• In the East Midlands in 2008/9 there were 79,872 alcohol related hospital admissions (an increase of 5% from the previous year)
Alcohol Related Harm – What is the Scale of the Problem?
• There are an estimated 1 in 13 people dependent on alcohol in the UK, with several million more drinking excessively to the extent where their health is at risk
Alcohol Related Harm in the East Midlands
Rate of ARHA per 100,000 population (EASR)
-
500
1,000
1,500
2,000
2,500
3,000
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
Rat
e p
er 1
00k
po
p
England Nottingham City Derby City Leicester City
Alcohol Related Harm in the East Midlands
Rate of ARHA per 100,000 population (EASR)
-
200
400600
800
1,000
1,2001,400
1,600
1,800
2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09
Rate
per
100k
England Bassetlaw
Derbyshire County Nottinghamshire County
Lincolnshire Leicestershire County and Rutland
Northamptonshire
Hospital Admissions in the East Midlands for Ethanol Poisoning
What are the Health Consequences of Alcohol?
• Drinking regularly over the low risk guidelines can lead to serious health problems including:
- Certain types of cancer - High blood pressure - Heart disease and stroke - Liver disease
Non-Health Consequences of Alcohol
• 50-73% of assault victims injuries• Around 50% of all serious road crashes• Nearly 50% of domestic violence against
females• 47% of serious injuries• 40% of self-poisoning
Source: Alcohol Concern
Alcohol and the family
• Approximately 1 million children live with a parent who is dependent on alcohol
Inequalities and Alcohol• Problem drinking is twice as common in
the poorest as in the most affluent• Deaths from diseases caused by alcohol
show a clear gradient with socioeconomic position, with an almost fourfold higher rate in unskilled working men compared to those from professional groups
• Alcohol is a contributory factor to deaths from accidents, which also show a pronounced socioeconomic gradient
Inequalities and Alcohol• Poor women are more likely than the affluent to
report being drunk• Higher levels of consumption of alcohol have
been consistently observed in some deprived groups, such as unemployed people and those who are homeless
• Problem drinking is associated with delinquency, criminality and violence, including domestic violence and child abuse
Inequalities and Alcohol• Heavy drinking in people in higher socioeconomic
groups may be less harmful than in lower socioeconomic groups because they are protected from harmful effects by better diet, housing, health care and other factors
• People with alcohol-related problems who are disadvantaged in other ways, through having limited financial or social resources or being homeless, may have less access to appropriate treatment services for all their needs, including treatment of their alcohol- related health problems
Source: The Acheson Report 1998
Inequalities in Health Consequences
• The most deprived fifth of the population suffer two to three times greater loss of life attributable to alcohol; three to five times greater mortality due to alcohol specific causes; and two to five times more admissions per hospital because of alcohol than the most affluent areas
• On average men living in the more deprived areas lose 17 months of life and women lose 7 months of life due to conditions related to alcohol compared with 6 months for men and 3 months for women living in more affluent areas
Source: Intellingence East Midlands Briefing: Alcohol and the East Midlands
Intervention Tiers
Indices of Multiple Deprivation
The seven domain indices are: • Income • Employment• Health Deprivation and Disability• Education, Skills and Training• Barriers to Housing and Services• Crime• Living Environment
NI39 admissions by IMD
Alcohol specific admissions by IMD
National and Regional Response to Alcohol Related Harm
Safe. Sensible. Social. The National Alcohol Strategy
Priority actions:Support for local partnerships and communitiesEarly identification interventions and treatment for
drinking that could cause harmTackling alcohol related offendingReplacing glassware and bottles in high risk premisesUnderage salesResponsible retailing and promotionsPromoting a culture of sensible drinkingSupport for harmful drinkersPreventing harm to those under 18
National and Regional Response to Alcohol Related Harm
The Alcohol Improvement Programme
• The Alcohol Improvement Programme is commissioned by the Department of Health for 3 years from April 2008
• Focuses on 7 High Impact Changes (HIC) to coordinate delivery of Alcohol Harm Reduction
Early Implementor PCTs
NHSPlanned delivery on ARHAs
Impl
emen
tatio
nS
uppo
rt
Prio
rity
acc
ess
lear
ning
learning
Evi
denc
e
Trailblazers (SIPS), ANARP, MoCAMEffectiveness review, HES data,etc
Trailblazers (SIPS), ANARP, MoCAMEffectiveness review, HES data,etc
PCTs (Unplanned) delivery on targets through implementation of elements of
the high impact actions
learningAlcohol Interventions Improvement Centre
Enabling changePriority support to early implementor PCTs.Tools: Learning sets, collaboratives, etc
Learning CentreCollects, co-ordinates and disseminates learning and good practice. Tools: SIPS toolkits, HuBCAPP, e-learning resource
NST(DH)Supports 18 challenged
PCTs. Diagnosis, strategic reports & follow-up
visits
Re
vie
w
Su
pp
ort
Regional co-ordinators (DH/SHA)
Support local partnerships in
delivery
learning
DH Policy TeamRole: Work with outside bodies to facilitate frontline delivery. Develop policy, Develop Guidance, Commission, co-ordinate and contract manage support projects, channel expertise,
lear
ning
NWPHO
Provide local data on need and key evidence
Start delivering ARHAs
Receive priority support from AIP
Implement high impact actions
Sup
port
In
fluen
ce
National and Regional Response to Alcohol Related Harm
The High Impact Changes
• HIC 1 – Work in Partnership• HIC2 – Develop activities to control alcohol misuse• HIC 3 – Influence change through advocacy• HIC 4 – Improve the effectiveness and capacity of
specialist treatment• HIC 5 – Appoint an alcohol worker• HIC 6 – IBA, provide more help to encourage people to
drink less• HIC 7 – Amplify national social marketing priorities
National and Regional Response to Alcohol Related Harm
The Alcohol Learning Centre• An on-line one-stop-shop which collates,
co-ordinates and disseminates learning and promising practice from across the NHS and the Third Sector
• It contains alcohol specific policy documents, guidance and tools and provides training resources to support frontline practitioners and commissioners
National and Regional Response to Alcohol Related Harm
Regional Improvement Plan• Understanding need/challenge• Supporting networks• Partnership self assessment• Influence performance management• Amplify national campaigns• Social marketing/research• Supporting providers • Supporting commissioners
What is the Region Doing to Address Inequalities in Alcohol?
What is the Region Doing to Address Inequalities in Alcohol?
• Specific projects with offenders
• Specific work with BME/emerging communities groups
• Collaboration across all sectors
Guided Group WorkOverarching theme: How can we work at regional
level (DH and OneEM) to coordinate and up-weight approach to identify gaps in services and how to address them
Topics/issues• BME/hard to reach groups• Children and young people• Social marketing campaigns• IBA integration into other settings• Workplace policies• Signposting to services
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