UK comparisons with other countries
What does the ‘drinking culture’ in the UK look like compared to other countries?
UK drinking compared
In 2016, alcohol consumption per capita (APC) (i.e. litres of pure alcohol per person [15+ years] per year) in the UK was 11.4 litres—equivalent to around 175 grams or 22 units of alcohol per week.[1] This is slightly above the 11.3 litre per capita consumption of the European Union countries (including Norway and Switzerland),[2] but exceeds the world per capita consumption of 6.4 litres of pure alcohol per year.[3]
Of EU countries (including Norway and Switzerland), Lithuania had the highest alcohol per capita consumption (15.0 litres) in 2016, while Italy had the lowest (7.5 litres) (Figure 1).
The health burden overall
In 2016, approximately 3 million deaths, or 5.3% of all global deaths, were attributable to alcohol consumption.[4]
In 2016, alcohol consumption was the seventh leading risk factor for premature death and disease worldwide,[5] and was the top risk factor among the world’s population aged 15–49 years.[6]
According to the Chief Medical Officer for England, 50% of the disease burden in England is due to one of four modifiable health behaviours, including poor diet, tobacco, excessive alcohol, and physical inactivity.[7]
Deaths from cirrhosis of the liver are an important indicator of population levels of alcohol-related harm. Between 1980 and 2013, liver deaths from known causes increased by four times in the United Kingdom, with 84% of the increase due to alcohol-related liver disease.[8] This is in contrast to reductions of liver disease in other European countries.[9]
Changes in national drinking culture
The way people drink in different countries, and how much they drink, is changing over time. There is not a static 'national drinking culture' in contrast to how this is often being portrayed in popular media - with heavy drinking in Northern countries contrasted with moderate consumption in Southern Europe. In fact, not very long ago, it was exactly the other way round.
Since the 1970s changing alcohol consumption has led to a three- to fivefold increase in liver deaths in the UK, and a three- to fivefold decrease in France and Italy.[10] These changes in opposite directions challenge popular notions of static ‘drinking cultures’ including the idea that in Southern Europe there has always been a culture of harmless light drinking, integrated into everyday life. The radical positive change in Southern European drinking patterns has been explained as part of a wider societal transformation since the 1960s, with growing urbanisation and related changes in working conditions as well as increased health awareness in the population.[11]
In contrast, the change in the UK and other Northern European countries, moving from a lower base in the 1980s towards higher levels of drinking and alcohol-related harm is generally explained by increased availability and affordability of alcohol,[12],[13],[14] combined with a culture of heavy, episodic drinking connected with weekends and celebrations, which are considered to have a particularly bad effect on health.[15]
Therefore, it is important to note that the effect of societal changes on alcohol consumption differ between countries and there is no direct link between changes in living conditions and drinking. The process is indirect, mediated by each country’s historical and cultural background.[16]
Underage drinking
According to the 2013/14 Health Behaviour in School-age Children (HBSC) survey, which surveys children aged 11-15 years old in 42 countries, children aged 13 in England (4%) and Scotland (3%) were less likely to have drunk alcohol weekly, compared to the HBSC average (5%). Wales had a slightly higher proportion of 13 year olds who had drunk alcohol on a weekly basis (6%).[17]
England (28%), Wales (31%) and Scotland (32.5%) had a higher proportion of 15 year olds who have been drunk on two or more occasions than the HBSC average (22%), with Scotland and Wales ranking within the top 10 countries for early initiation to drunkenness.[18] In England, 15-year-old girls (31%) were more likely than boys (25%) to have been drunk on two or more occasions.[19]
As demonstrated in Figure 2, the prevalence of weekly drinking among 15-year-olds in England (9.4%), Scotland (12.2%) and Wales (11%) is lower than the HBSC average (12.9%).[20]
References
[1] Figure includes both recorded (9.8) and unrecorded (1.1) alcohol consumption. World Health Organization. (2018). Global status report on alcohol and health 2018. Geneva: WHO [Online]. Available at: http://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1. [Accessed 4 January 2019].
[2] World Health Organization. Regional Office for Europe. (2018). Fact sheet on alcohol consumption, alcohol-attributable harm and alcohol policy responses in European Union Member States, Norway and Switzerland. Denmark: WHO Regional Office for Europe [Online]. Available at: http://www.euro.who.int/__data/assets/pdf_file/0009/386577/fs-alcohol-eng.pdf?ua=1. [Accessed 4 January 2019].
[3] World Health Organization. (2018). Global status report on alcohol and health 2018. Geneva: WHO [Online]. Available at: http://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1. [Accessed 4 January 2019].
[4] ibid
[5] Griswold, M.G., Fullman, N., Hawley, C., Arian, N., Zimsen, S.R., Tymeson, H.D., Venkateswaran, V., Tapp, A.D., Forouzanfar, M.H., Salama, J.S. and Abate, K.H. (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10152), 1015-1035.
[6] World Health Organization. (2018). Global status report on alcohol and health 2018. Geneva: WHO. [Online]. Available at: http://apps.who.int/iris/bitstream/handle/10665/274603/9789241565639-eng.pdf?ua=1. [Accessed 2 January 2019].
[10] Jewell, J. and Sheron, N. (2010). Trends in European liver death rates: implications for alcohol policy. Clinical medicine, 10 (3), 259-263.
[11] Allamani, A., Beccaria, F. and Voller, F. (2010). The puzzle of Italian drinking: trends in alcohol consumption, harms and policy: Italy 1990–2010. Nordic Studies on Alcohol and Drugs, 27, 465-478.
[13] University of Stirling. (2013). Health First: an evidence-based alcohol strategy for the UK. Stirling: University of Stirling. [Online]. Available at: http://www.stir.ac.uk/media/schools/management/documents/Alcoholstrategy-updated.pdf
[14] Poikolainen, K. (1980). Increase in alcohol-related hospitalizations in Finland 1969-1975. British Journal of Addiction, 75 (3), 281-291.
[16] Leifman, H. (2001). Trends in population drinking. In T. Norström (Ed.). Alcohol in postwar Europe: consumption, drinking patterns, consequences and policy responses in 15 European countries. Stockholm: Almqvist & Wiksell, 45-77.
[17] Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Augustson, L., Mathison, F., Aleman-Diaz, A., Molcho, M., Weber, M., and Barnekow, V. (2016). Growing up unequal: gender and socioeconomic differences in young people’s health and well-being. Health behaviour in school-aged children (HBSC) study: international report from the 2013/2014 survey. [Online]. Copenhagen: World Health Organization: Regional Office for Europe.
[18] ibid
[19] ibid