RPI detail here dksljfh alskdjfh alskdjfhas ldkhjhjdfasldkj

20000

30000

07/0806/0705/0604/0503/0402/03

0

100

200

300

400

500

600

198419831982198119801979197819771976197519741973197219711970

0

100

200

300

400

500

600

198419831982198119801979197819771976197519741973197219711970

blood

diabetes

endocrine / metabolic

liver

respiratory

neoplasms

cerebrovascular

ischaemic heart

circulatory

1965 1967 1969 1971 1973 1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005

The UK population changed their drinking habits reflecting the a�ordability of stronger alcohol at home…

…and the number of people admitted to hospital for alcohol-related liver disease has almost doubled in a decade.

UK LIVER DISEASE CRISIS

Survival rates have improved for almost every disease of every organ in the last few decades, with one notable exception: liver disease1.

What’s driving this?

Annual deaths related to hepatitis C have quadrupled since 1996. It is estimated that around 75% of infected cases are unknown4.

Introduce a minimum price of 50p to reduce alcohol consumption.

reductionin obesityrate for women

reductionin obesityrate for men

20% TAXon soft drinks

3.8% 2.4%

Identify the 15-20% of NAFLD* cases likely to progress to severe liver disease when screening for other obesity-related diseases.

Increase medical provision with more specialists and liver clinics distributed across the UK.

Vaccinate at-risk populations for Hepatitis B and target use of antiretrovirals for people with hepatitis B and C

PROJECTED MINIMUM PRICE PER UNIT OF ALCOHOL AND RESULTING PERCENTAGE DECREASE IN CONSUMPTION5

50p

5p

10p

20p

5p

20p20p

10p

20p

20p

20p

5p

20p

20p

10p

50p

20p

50p

0% -0.1% -0.4% -1.1%-2.4%

-4.3%

-6.7%

-11.9%

-17.5%

What have the UK’s European neighbours done?

So what changes do we need to make in the UK?

A steady fall in cirrhosis deaths in France over the last 30 years corresponds to a proportionate fall in alcohol consumption over the period7.

Conversely, a 33% reduction in Finnish alcohol taxation in 2004 resulted in soaring rates of liver disease8.

Introduce a tax on soft drinks to reduce sugar intake9.

POLICY MAKERS

MEDICAL CARE

Of the 25% of the UK population with obesity, a vast majority has non-alcohol related fatty liver disease1.

2 3

1

France and Italy have seen a dramatic reduction in liver mortality whereas the UK and Finland have seen liver deaths rise more than fivefold1.

PERCENTAGE CHANGE IN STANDARDISED UK MORTALITY RATES (AGE 0–64) NORMALISED TO 100% IN 19701

0%20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970 20101970

300%

600%

BLOOD DIABETES CANCERENDOCRINE /METABOLIC

HEART DISEASE

RESPIRATORY CIRCULATORY STROKE

ALL ITEMS

BEER OFF SALES*WINE & SPIRITS OFF SALES*

WINE & SPIRITS ON SALES*BEER ON SALES*

1987 1990 1995 2000 2005 2010 2013

350

100

150

200

250

300

PRICE OF BEER, WINE & SPIRITS VERSUS INFLATION2

2002/

03

2003/

04

2004/0

5

2005/

06

2006/0

7

2007/0

8

2008/0

9

2009/

10

2010

/11

2011/

12

50,000

Admissions

Admissions

Deaths per 100,000

Number of deaths

Hours worked

*NAFLD = non alcoholic fatty liver disease

Price re-based to 100

* On-sales means in pubs and restaurants, o�-sales means liquor stores and supermarkets.

40,000

30,000

20,000

25,000

35,000

45,000

ALCOHOL-RELATED HOSPITAL ADMISSIONS3

HOSPITAL ADMISSIONS FOR NON-ALCOHOLRELATED FATTY LIVER DISEASE1

DEATHS FROM LIVER FAILURE OR LIVER CANCER IN THOSE WITH HEPATITIS C6

20,000

10,000

0

5,000

15,000

500

300

0

200

100

400

1998 2000 2005 2010 20122010200520001996

PERCENTANGE CHANGE IN STANDARDISED DEATH RATES1

40

35

30

25

20

15

10

5

0

UNITED KINGDOM ITALY NETHERLANDSSWEDEN NORWAYIRELANDFRANCE FINLAND

20101970 1975 1985 20051980 1990 1995 2000

Additionally, people in France diagnosed with hepatitis C are 6–12 times more likely to receive treatment than those diagnosed in the UK.4

HOURS AN INDUSTRY WORKER HAS TO WORK TO AFFORD HALF A LITRE OF VODKA IN FINLAND8

TOTAL WINE CONSUMPTION IN FRANCE, NORMALISED TO 100% IN 20007

2

1.5

1

0.5

01965 1970 1980 1990 2008

1990 1995 2000 2005 2009

250%

150%

0%

100%

50%

200%

2000

For further information on the recommendations of the Commission or to read the full report, visithttp://www.thelancet.com/commissions/crisis-of-liver-disease-in-the-UK

SOURCES

1 Williams R, Aspinall R, Bellis M, et al. Addressing liver disease in the UK: a blueprint for attaining excellence in healthcare for liver disease and reducing premature mortality from the major lifestyle issue of excess alcohol consumption, obesity, and viral hepatitis. Lancet 2014; published online Nov 27, 2014. http://dx/doi.org/10.1016/S0140-6736(14)61838-9

2 ONS. Retail price index: all items versus beer, wine, and spirits, on and o� sales. 1987–2014. Newport; O�ce for National Statistics, 2014. http://www.ons.gov.uk/ons/datasets-and-tables/data-selector.html?table-id=2.1&dataset=mm23

3 HSCIC. Statistics on alcohol: England, 2014. Leeds; Health and Social Care Information Centre, 2014.

4 The Hepatitis C Trust. The UK vs Europe: losing the fight against hepatitis C, 2005. London; The Hepatitis C Trust and the University of Southampton, 2005.

5 British Medical Association. Reducing the a�ordability of alcohol: a briefing from the BMA Board of Science. London; British Medical Association, 2012.

6 Constella A, Goldberg D, Harris H, et al and Public Health England. Hepatitis C in the UK: 2014 report. London; Public Health England, revised July 31, 2014.

7 Jewell J, Sheron N. 2010. Trends in European liver death rates: implications for alcohol policy. Clin Med 2010; 10: 259–63.

8 Karlsson T, Mäkelä P, Österberg E, Tigerstedt C. A new alcohol environment. Trends in alcohol consumption, harms and policy: Finland 1990–2010. Nord Stud Alcohol Dr 2013; 27: 497–513.

9 Manyema M, Veerman LJ, Chola L. The potential impact of a 20% tax on sugar-sweetened beverages on obesity in South African adults: a mathematical model. PLoS One 2014; 9: e105287.

LIVER

20101970