ALCOHOL, HEALTH, AND HEALTH INEQUALITIES

1
ALCOHOL, HEALTH, AND HEALTH INEQUALITIES

• Alan Higgins
• Director of Public Health, Oldham
• And Lead GM Director of Public Health for Alcohol
• and
• Mike Jones
• Greater Manchester Public Health Network
• Programme Lead for Alcohol

2
Presentation

• Introduction
• England overview
• Overview of Alcohol in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

3
Alcohol Consumption Definitions

• Hazardous drinking is considered to be drinking
  between 15 and 35 units a week for women and
  between 22 and 50 units a week for men.
• Harmful drinking levels are considered to be
  drinking more than 35 units a week for women and
  more than 50 units a week for men.
• Binge drinking is defined as drinking eight or
  more units in one day for men and six or more
  units for women (double the recommended daily
  limit).
• Ref (DH 2005 NWPHO 2007)

4
Ref GM DPH Annual Report 2008
5
Ref GM DPH Annual Report 2008
6
It never did me any harm?

• Nationally 130,000 people/year admitted into
  hospital for alcohol related hypertensive
  diseases alone
• Overall responsible for
• 459,842 admissions
• 34,528 prevented
• Lifetime drinking at top of sensible drinking
  limits results in 1 in 100 people dying from an
  alcohol related disease
• Effects greater in women

Cancer of the Larynx 29
Breast Cancer 7
Haemorrhagic Stroke 24
Alcoholic Liver Disease 100
Fire Injuries 38
Spontaneous Abortion 22
Intentional Self-Harm 34
Epilepsy 54
Ref Jones et al, 2008
7
Can we afford it?

• North West
• 4 of deaths attributable to alcohol
• Nationally
• Alcohol accounts for
• 17 of all deaths 16-54 years
• gt25 of males death 16-24 years
• Life lost per alcohol related death Male 20.2
  years Female 15.1 years
• Deaths and admissions
• tend to ignore damage to others

Jones et al, 2008
8
Presentation

• Introduction
• England overview
• Overview of Alcohol in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

9
England Overview

• Hospital Admissions for alcohol related harm
• 800,000 admissions 2006/07 showing a 9 increase
  on 2005/06

Source North West Public Health Observatory
(2007)
10
England Overview
LAs experiencing the largest impact across
seven alcohol indicators

• Manchester
• Salford
• Liverpool
• Middlesbrough
• Rochdale

• 6. Hammersmith and Fulham
• 7. Kingston upon Hull
• 8. Halton
• 9. Tameside
• 10. Oldham

7 out of 10 in North West with 5 in Greater
Manchester
Source North West Public Health Observatory
(2008)
11
England Overview
12
England Overview - International
Comparison Pure alcohol consumption, litres per
capita
Years
Ref WHO www.euro.who.in/HFADB
13
Presentation

• Introduction
• England overview
• Overview of Alcohol Use in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

14
Greater Manchester

• Hazardous and harmful drinking estimates in
  Greater Manchester are higher than England and
  North West averages
• Stockport, has the highest levels of hazardous
  drinking
• Manchester has the highest levels of binge and
  harmful drinking in Greater Manchester

15
Overview of Alcohol Use in Greater Manchester
Source North West Public Health Observatory
(2008)
16
Alcohol Hospital Based Admissions

• PSA 25/Vital Sign
• Rates of alcohol-related hospital admission in
  Greater Manchester are above regional and
  national averages for males and females
• In Greater Manchester, Manchester and Salford
  have the greatest number of alcohol-related
  hospital admission for both sexes
• Trafford has the lowest

Source North West Public Health Observatory
(2008)
17
Alcohol Hospital Based Admissions
Source North West Public Health Observatory
(2008)
18
Percentage of cases where alcohol use is linked
to offending by LA in GM April to June and July
to September 2008

• Percentage of cases where alcohol use was linked
  to offending in Greater Manchester have generally
  remained stable between April to June
• In July to September Bury percentage has
  increased notably to 40, overtaking Salford as
  having the greatest percentage of cases

Source North West Public Health Observatory
(2008)
19
Percentage of cases where alcohol use is linked
to offending by Local Authority in Greater
Manchester April to June and July to September
2008
Source North West Public Health Observatory
(2008)
20
Rate of alcohol-specific hospital admission for
under 18s by LA in GM compared with England and
the North West, 2005/06

• LAPE reveal that in 2005/06, Rochdale, Bolton and
  Salford experienced the greatest number of
  alcohol-related hospital admission in under 18s
• All Greater Manchester Local Authorities were
  above the England average for alcohol-related
  hospital admissions in under 18s,
• Bury, Manchester, Stockport and Trafford were
  below the North West average

Source North West Public Health Observatory
(2008)
21
Rate of alcohol-specific hospital admission for
under 18s by LA in GM compared with England and
the North West, 2005/06
Source North West Public Health Observatory
(2008)
22
Presentation

• Introduction
• England overview
• Overview of Alcohol in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

23
GMASG priorities

• 1. Enhanced data set for alcohol indicators
• Quarterly report which identifies available
  alcohol intelligence across Greater Manchester
  (JMU)
• The data is separated into six categories
• Consumption
• Health related impacts of alcohol
• Crime
• Young people
• Alcohol treatment
• Examples of initiatives to tackle excessive
  alcohol consumption

24
GMASG priorities

• 2. Social Marketing
• Understanding alcohol consumption in the home
• Dr Foster commission to carry out research
• Report to be published late January 2008
• Early indications show
• ABC1 drink because they can afford it, often
  know the save drinking messages but choice to
  ignore
• C2DE drink, dont understand the messages and
  continue to drink due to poor quality of life

Source Dr Foster Intelligence Commissioned by
AGMPCTs
25
GMASG priorities

• 3. Service Provision Review
• Postcode lottery in GM
• Mapping of services against actual spend
• Mapping of associated services involvement in
  alcohol treatment e.g. homeless services
• Review of collaborative commissioned services
• What is the equivalent of stop smoking services
  for moderate drinkers?

26
GMASG priorities

• 4. Data sharing between AE and other partners
• Some good examples but not systematic or
  benchmarked
• Introduction of Trauma and Injury Intelligence
  Group methodology (TIGG)
• Linked to Home Office knife crime pilot
• Linked to other statutory service e.g fire and
  rescue service
• Audit Commission workshop - Feb 2009

27
GMASG priorities

• 5. Workplace Health
• Small business
• Pilot project Tameside (Before April 09)
• Statutory agencies
• Targeting PCTs LA
• Large companies
• Identifying and working with companies such as
  Heinz (Wigan), Kellogg's (Trafford)

28
GMASG priorities

• 6. Brief Interventions
• Training Needs Analysis (Before April 09)
• Review existing training
• Use regional tool to establish training package
• Develop training plan ensure gaps are filled
• Ensuring training is provided across GM to the
  same standard
• DoH online training

29
GMASG priorities

• 7. GM wide Promotional Opportunities
• Coordinate National Campaigns
• Secure a consistency of messages
• I Love Me
• The Big Drink Debate
• Communications and Marketing Support

30
GMASG priorities

• 8. Secure additional resources
• Regional funding
• Secured for three years 2009/10 year 2
• PCT funding
• Further funding request to support collaborative
  work programme
• Home Office funding
• Knife Crime

31
Presentation

• Introduction
• England overview
• Overview of Alcohol in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

32
Key Issues

• Challenge social normalisation of alcohol use and
  abuse

33
(No Transcript)
34
(No Transcript)
35
Key Issues

• Challenge social normalisation of alcohol use and
  abuse
• Recognise changing pattern of drinking

36
(No Transcript)
37
(No Transcript)
38
Key Issues

• Challenge social normalisation of alcohol and
  abuse
• Recognise changing pattern of drinking
• Protect Children

39
(No Transcript)
40
Creating a new generating of drinkers

• Nationally average weekly consumption of 11-15
  year olds
• doubled in last 20 years (12 units/week)
• Boys and girls drink similar levels
• Attitudes (9-11 year olds)
• 25 think beer drinkers consume 4-6 pints/evening
• 3 in 5 think drink to forget your problems
• North West
• 30 (15-16 years) binge drink at least weekly
• Total 56,900
• Bingeing
• Money in pocket, access, cost

Fuller et al, 2008 Bellis et al, 2008, in press
41
(No Transcript)
42
Alcohol Helping Demonise Youth

• Alcohol related harms 15-16 year olds drinkers
• 36 drink in public places
• 29 drunk related violence
• 12.5 alcohol related regretted sex
• 45 Memory Lapses
• Cheap alcohol consumption higher harms
• Value cider for 11p a unit
• Alternatives
• Affordable, Accessible, Appealing
• Challenge at all ages

43
Key Issues

• Challenge social normalisation of alcohol
• Recognise changing pattern of drinking
• Protect Children
• Challenge irresponsible industry

44
(No Transcript)
45
(No Transcript)
46
Key Issues

• Challenge social normalisation of alcohol
• Recognise changing pattern of drinking
• Protect Children
• Challenge irresponsible industry
• Its not just them..

47
Its just a few irresponsible drinkers?

• Around One Million hazardous drinkers
• Around 350,000 harmful drinkers
• Drinkers - compared to national average
• Fewer abstainers
• Highest region for exceeding daily limits (64
  drinkers)
• 2nd highest for bingeing at least one day a week
  (37 drinkers)

GHS, 2006, Persons over 16
48
Key Issues

• Challenge social normalisation of alcohol
• Recognise changing pattern of drinking
• Protect Children
• Challenge irresponsible industry
• Its not just them..
• Its not just an individual health problem

49
Its my business what I drink?

• Intimate Partner Violence
• gt 1/3 committed under alcohol
• Road Traffic Accidents
• 8,000-9,000 where people injured by drunk
  drivers
• Crimes
• North West, 73,000 alcohol related annually -
  50,000 are violent
• Other
• Elder Child Abuse Foetal Alcohol Syndrome
  Unwanted pregnancy

World Health Organization, Centre for Public
Health, NOFAS
50
Key Issues

• Challenge social normalisation of alcohol
• Recognise changing pattern of drinking
• Protect Children
• Challenge irresponsible industry
• Problem is not just young people binge drinking
• Its not just an individual health problem
• Economic Cost outweighs Regeneration Benefit

51
Can we afford it?
Incapacity benefit claimants main medical
reason alcoholism rate per 100,000 working age
population

• 11-17 million working days lost annually
• Up to 25 billion overall societal costs

Includes severe disability allowance Deacon et
al, 2007
52
Presentation

• England overview
• Overview of Alcohol in Greater Manchester
• The role of the Greater Manchester Alcohol
  Strategy Group (GMASG)
• Key Issues
• Actions

53
The Government will shortly consult on a range of
compulsory conditions including

• Banning offers like all you can drink for 10
• Outlawing pubs and bars offering promotions to
  certain groups, such as women only
• Ensuring that customers in supermarkets are not
  required to buy very large amounts of a product
  to take advantage of price discounts
• Ensuring staff selling alcohol are properly
  trained
• Requiring that consumers are able to see unit
  content of all alcohol when they buy it
• Requiring bars and pubs to have the minimum sized
  glasses available for customers who want them

54
In Greater Manchester, the GM Health Commission

• Seeks to provide visible political leadership
• Highlights to other commissions and AGMA
  arrangements what needs to be done

55
Some initial policy responses?

• Health information in all shops to be made part
  of the licensing agreement
• All new shops to have alcohol sold in a separate
  section
• Ban alcohol promotions on all LA events
• Ban advertising of alcohol on licensed taxis
• Get our own house in order alcohol at work
  policies.
• Limit the number of licensed premises within an
  area
• (Ref Scottish Licensing Act 2005)

56
What would a good drinking culture look like
across Greater Manchester What are we selling?

• More inclusive nightlife
• Better Health
• Less anti-social behaviour
• More productive economy

57
GM Commissions

• Economic Development and Skills
• Housing and Planning
• Public Protection
• Transport

58
Thankyou

• Alan Higgins
• ahiggins_at_nhs.net
• Mike Jones Mike.Jones_at_alwpct.nhs.uk