Prof Frank Murray
Registrar RCPI
Consultant Gastroenterologist/Hepatologist, Beaumont Hospital/RCSI,
Dublin 9
Alcohol in Ireland.Major health burden.
Major economic burden.Major opportunity.
Policies that reduce the availability of alcohol though:
Price increasesor
Reducing outlets and hours of sale
Have been shown to be effective
• Europe is the heaviest drinking region in the world
• Alcohol is the main cause of liver disease in Europe
• The prevalence of alcoholic liver disease is rising in Ireland
Problems addressing the alcohol problem in Ireland!!!!
• Drinking alcohol can be harmless, in contrast to cigarettes
• Alcohol is strongly rooted in our society
• The alcohol industries receive the majority of their turnover in UK from harmful and hazardous drinkers
Alcohol in Europe• Europe is the highest drinking region in the
world• 200,000 deaths per year• Cost €125 billion per year. 1.3% of GDP• Third commonest cause of premature
death and disability
• Main cause of liver disease and death
DALY (Disability adjusted life year)
• The sum of the life years lost due to premature death or years lived in disability
Alcohol cause huge health problems
• WHO:– 4% of global mortality– 5% of global DALY
• Europe worse– 7% mortality– 12% of DALY
Alcohol cause huge health problems
• Worse in males: 17% of DALYs( vs 4%)
• Worst in young males
• Alcohol cause 35% of deaths aged 35-50
Alcohol responsibility for many youth deaths
• 25% of male
• 10% of female
Major disease burdens attributable to alcohol
Main cause of alcohol DALY• Liver disease
• 75% men
• 85% women
• There is a direct correlation between amount of alcohol consumed and cirrhosis mortality
Cirrhosis and
Portal Hypertension
CIRRHOSIS AND PORTAL HYPERTENSION
6040 80 100 120 140 1600
40
60
80
20
200
100
Months
Probability of survival
All patients with cirrhosis
Decompensated cirrhosis
180
Decompensation in cirrhosis Shortens Survival
Gines et. al., Hepatology 1987;7:122
Median survival~ 9 years
Median survival~ 1.6 years
SURVIVAL TIMES IN CIRRHOSIS
Mortality due to cirrhosis in Ireland
There is a big human cost here• Ill and dying patients• Often young• Often little opportunity to change • Families
Does not end there• Absenteeism• Loss of professional performance• Domestic violence• Unhappiness
3 main types of alcohol misuse• Hazardous • Harmful• Dependent drinking.
Hazardous drinking • Drinks over the recommended weekly limit
of alcohol• 21/17 units for men and • 14/11 units for women.
• It is also possible to drink hazardously by binge drinking, even if within weekly limit.
Harmful drinking • Drinks more than the recommended weekly
maximum amount of alcohol and experiences health problems that are directly related to alcohol.
• Cirrhosis • depression • an alcohol-related accident, such as a head injury• acute pancreatitis (inflammation of the pancreas)• high blood pressure• some types of cancer • heart disease
Dependent drinking
• Both physically and psychologically addictive• Become dependent on it• Feels unable to function without alcohol• Consumption of alcohol becomes an
important, or sometimes the most important, factor in their life
• Can experience withdrawal symptoms (both physical and psychological) if they suddenly stop drinking alcohol.
Binge drinking• 4 (female)• 5 (male) • units in 2h
– or
• 8 (male)• 6 (female)• units in 24 hours
• Rapidly increasing in prevalance
So most alcohol consumption is mostly drunk safely?…..
• 75% of alcohol consumed in UK is by hazardous and harmful drinkers in the UK
Absolute risk of death from alcohol-related disease
Adult alcohol consumption
Heavy episodic drinking of at least 60g of pure alcohol in last 7 days (women)
Irish consumption
• 11.9 litres of alcohol per adult (>15y) in 2010
• Over half Irish drinkers have a harmful drinking pattern
• Much more affordable
Irish costs of alcohol
• €3.7 billion
• Healthcare €1.2 billion (8% of total)
• Approx 2,000 hospital beds per night
• 7% of GP costs• 30% of Emergency Department costs
Fundamental problem in Ireland• Too much alcohol• Binge drinking• Availability• Number of outlets• Opening hours
Availability
Supermarkets• Promotions• Special offers• Packaging in larger units• Not quarantined, all over the shop
Concerts
Sports sponsorship
Under-age drinking
Marketing towards young people
Options• Do nothing• Do “something”• Take thought-through series of steps.
Leads to immediate health social and political gains
Systematic reviews and meta-analyses.Proven policies.
• Policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm.
• Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm.
Key messages
A substantive evidence base of systematic reviews and meta-analyses inform alcohol policy
Making alcohol more expensive and less available are highly cost-effective strategies to reduce harm
• Banning of alcohol advertising• Drink-driving countermeasures• Individually-directed
interventions to drinkers already at risk
are also cost-effective approaches
School-based education does not reduce harm, but public information and education programmes can increase attention to alcohol on public and political agendas
If more stringent alcohol policies are not put into place, global alcohol-related harm is likely to continue to increase
Actions• Reduce number of outlets dramatically• Increase cost-minimum unit pricing• Expand and enforce legislation re alcohol
consumption in public and public order offences
• All of proven international proven benefit
Successful legislated constructive social changes in Ireland
• Smoking ban• Reduction in alcohol driving
limit• Cycling helmets
RCPI alcohol group• RCPI established a national policy group to
address the health and social burden of alcohol in Ireland.
• The policy group brings together experts from a wide range of medical specialist bodies to speak with one voice on the issue of alcohol, to support
• Propose practical solutions backed up by a robust, international evidence base
• Focused on reducing the harm caused by alcohol to health and society.
Policies that reduce the availability of alcohol though:
Price increasesand
Reducing outlets and hours of sale
Have been shown to be effective
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