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British Livers and British Alcohol Policy
[Article Outline, References, and Link to Full Text PDF]

 
Robin Room; The Lancet; 367(9504); 10-11; 2006-01-07. Posted 2006-01-10; Modified: 2006-02-24.
[Identifier: http://www.doctordeluca.com/Library/AbstinenceHR/BritLiversAlcPolicy06.htm]
Related resources:
[http://www.doctordeluca.com/Library/LibPages/AbsModAcademic-lib.htm ; http://www.doctordeluca.com/ABS-MOD.htm ;
 
http://www.doctordeluca.com/Library/LibPages/AbsHR-Journalism-lib.htm]
 
See also:
Liver Cirrhosis Mortality Rates in Britain, 1950-2002 - David Leon and Jim McCambridge; The Lancet; 367(9504); 52-56; 2006-01-07
College Student Binge Drinking and the "Prevention Paradox"  - Weitzman and Nelson; J.Drug Ed.; 2004
 

[FULL TEXT of this Article in Adobe PDF format]

Article Outline

In today's Lancet, David Leon and Jim McCambridge [1] show that data which is routine can nevertheless be shocking. The UK used to be known to alcohol researchers for its relatively low rate of liver cirrhosis deaths. But Leon and McCambridge show that Great Britain has recorded the steepest rise in rates in western Europe. By the turn of the millennium, the rates in England and Wales had reached the middle of the European pack; those in Scotland were approaching the top position. Recent newspaper reports suggest the rise is accelerating. [2] Leon and McCambridge's table 1 shows about a 21% rise in the 1990s, while the mortality figures for 2004 show an 18% rise in deaths from alcohol-related diseases (mainly cirrhosis) just since 2000. [2]

While beverage type, as mentioned in the paper, and pattern of drinking [3, 4, 5 and 6] might both affect the risk of developing cirrhosis, there is no doubt that the cumulative amount of alcohol consumed has a primary role. But the UK Government has turned a determined blind eye to the problem and has failed to make the reduction of the population's alcohol intake a policy goal. Through the new alcohol licensing law and the official guidance on it, the national government has also done its best to tie the hands of local government on this issue. Thus the new licensing law for England and Wales rules out public health as a goal of licensing; as the official guidance on the law says,

“there is no power for the licensing authority to attach a condition [to the license] which is merely aspirational … For instance, conditions may not be attached which relate solely to the health of the customers rather than their direct physical safety”. [7]

This official insouciance is aided by the paucity of the evidence base for alcohol policy in the UK. Leon and McCambridge mention the problem of “the absence of high-quality alcohol consumption data, particularly on a regional and national basis”. Not only are there no regional alcohol sales statistics, there is also no credible estimate of the unrecorded alcohol being imported from across the Channel; responses on travellers' imports in a population survey commissioned from Sweden [8] gave an amount larger than official estimates of the total of untaxed alcohol, including large-scale smuggling as well as travellers' imports. [9] UK drinking surveys have, until recently, been unsuited to reporting on binge drinking, which meant that the analytical report underlying the alcohol strategy for England [10] relied on figures from the same Swedish study. [11] In the well-developed international literature studying the impacts of alcohol policies, [12] UK studies are conspicuously rare. Despite promises to the contrary, there is still no provision by the Government for studies to evaluate the effects of the new licensing law.

Leon and McCambridge's troubling findings suggest it is now time for a change of approach. The goal of improving public health should not be “merely aspirational”. One starting-point would be for the UK Government to get serious about funding policy-relevant alcohol research. Australia, Canada, and the USA, among others, have government-funded centres that focus on social, epidemiological, and policy research on alcohol; the UK does not. With such centres and other research funding, an evidence base for policy can be built. Evidence-based practice could become, as it was once before, [13] the watchword for alcohol policy in the UK.

I declare that I have no conflict of interest.

References

1. D Leon and J McCambridge, Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data, Lancet 367 (2006), pp. 52–56. [Note: this link added by DeLuca: http://www.doctordeluca.com/Library/AbstinenceHR/BritLiversAlcPolicy06.pdf (Accessed: 2006-01-10)]

2. S Bosely, Guardian. Rethink on pub hours urged as death rate soars. http://www.guardian.co.uk/medicine/story/0,,1549957,00.html (Aug 16 2005) (accessed Nov 11, 2005).

3. M Ramstedt, Per capita alcohol consumption and liver cirrhosis mortality in 14 European countries, Addiction 96 (2001) (suppl), pp. S19–S34.

4. S Stranges, JL Freudenheim and P Muti et al., Differential effects of alcohol drinking pattern on liver enzymes in men and women, Alcohol Clin Exp Res 28 (2004), pp. 949–956.

5. SW French, The role of hypoxia in the pathogenesis of alcohol liver disease, Hepatol Res 24 (2004), pp. 69–74. Abstract

6. M Carmiel-Haggai, AI Cederbaum and N Nieto, Binge ethanol exposure increases liver injury in obese rats, Gastroenterology 125 (2003), pp. 1818–1833.

7. Secretary of State for Culture, Media and Sport, Guidance issued under section 182 of the Licensing Act 2003 and Guidance to Police Officers on the Operation of Closure Powers in Part 8 of the Licensing Act 2003. http://www.culture.gov.uk/global/publications/archive_2004/guidance_issued_under_section_182_of_the_licensing_act_2003.htm (July, 2004) (accessed Nov 11, 2005).

8. H Leifman, Estimations of unrecorded alcohol consumption levels and trends in 14 European countries, Nordisk alkohol- & narkotikatidskrift 18 (2001) (English suppl), pp. 54–70.

9. HM Customs and Excise, Measuring indirect tax losses. http://customs.hmrc.gov.uk/channelsPortalWebApp/channelsPortalWebApp.portal?nfpb=true&pageLabel=pageVATShowContent&id=HMCE_CL_000996&propertyType=document (November, 2002) (accessed Nov 11, 2005).

10. Prime Minister's Strategy Unit, Interim analytical report: Strategy Unit Alcohol Harm Reduction Project http://www.strategy.gov.uk/downloads/files/SU%20interim_report2.pdf (2003) (accessed Nov 11, 2005).

11. H Leifman, Comparative analysis of drinking patterns in six EU countries in the year of 2000, Contemp Drug Prob 29 (2002), pp. 501–548.

12. T Babor, R Caetano and S Casswell et al., Alcohol: no ordinary commodity— research and public policy, Oxford University Press, Oxford (2003).

13. R Room, Classic texts revisited: George E.G. Catlin, Liquor Control, Addiction 99 (2004), pp. 925–927.

[FULL TEXT of this Article in Adobe PDF format]

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