The health burden overall

Alcohol is now the third leading preventable cause of ill health in Europe, after smoking and hypertension, and is the leading preventable cause of morbidity and mortality in working age adults.1

Deaths from cirrhosis of the liver, an important indicator of population levels of alcohol-related harm, increased in England and Wales by a factor of five between 1950 and 2002, in contrast to reductions in most other European countries.2

Looking at age-standardised rates of mortality from chronic liver disease and cirrhosis as an average for EU members (before 2004) the data shows a steady decrease over approximately the last 40 years.

This is in contrast to rising levels in the United Kingdom, to a point where the rate in the UK exceeded that of the EU member average in 2006 (11.5 per 100,000 in the UK vs 10.8 per 100,000 for EU members). This is a pertinent shift considering the rate in the UK was 2.8 per 100,000 in 1970 compared to 20.4 per 100,000 across EU members.

However the EU member average changes when taking into account members joining since May 2004. The trajectory for this indicator shows a comparatively high and rising rate of chronic liver disease and cirrhosis – though at a slower projected rate of increase than for the United Kingdom (see figure 1).

In Western Europe over the last 10 years the United Kingdom and Finland have had nearly 2-fold increases in death rates from chronic liver disease and cirrhosis in men and women, while Italy and France have experienced a steady decline from a higher baseline in 1980.

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.3

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,4 5 6 combined with a culture of heavy, episodic drinking connected with weekends and celebrations, which are considered to have a particularly bad effect on health.7

 

 Figure 1: Age-standardised mortality from chronic liver disease and cirrhosis.

Average consumption of alcohol (litres of pure alcohol per capita, age 15+) in the UK in 2010 was 10.3 litres – higher than the average in both Italy (6.1) and Spain (9.8) but lower than Ireland (11.9) and France (11.7).8

Average per capita consumption in litres of pure alcohol (for 15+) was higher in the UK compared to the WHO European region average, for all years from 2003 – 2010.9

In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption.10

Underage drinking

In a survey of children aged 11-15 in 39 countries, children aged 13 and 15 in England were more likely to have drunk alcohol weekly, compared to the average. England also has a higher than average proportion of 15 year olds who first got drunk aged 13 or younger – ranking within the top 10 countries in the survey for early initiation to drunkenness.11

A comparative survey12 involving 36 European countries suggests a relative youth drinking problem in the UK:

  • In the UK, more than half (55%) of 15-16 year olds said they have been drunk at least once (57% of girls and 53% of boys). Girls (51%) were more likely than boys (44%) to report being drunk at least once in the last year – this is also one of the highest ranked amongst countries in the survey after Denmark, Finland and Slovakia.
  • Teenage girls in the UK aged 15-16 were in the top 3 most likely to have been drunk in the last month – 29% of girls said this was the case, compared to 24% of boys. The average across countries in the study was 15% for girls and 18% of boys.

 

References -

  1. Strang, J., Drummond, C., McNeill, A. et al (2014) Addictions, dependence and substance misuse In: Davies, S Annual Report of the Chief Medical Officer 2013: Public Mental Health priorities: investing in the evidence. [Online] Available from https://www.gov.uk/government/publications/chief-medical-officer-cmo-annual-report-public-mental-health  [Accessed 19 November 2014].
  2. ibid
  3. Allamani, A., Beccaria, F. & 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.
  4. Jackson, R., Johnson, M., Campbell, F. et al (2009) Interventions on control of alcohol price, promotion and availability for prevention of alcohol use disorders in adults and young people [Online] Available from https://www.nice.org.uk/guidance/ph24/documents/review-1-macrolevel-interventions-for-alcoholuse-disorders-effectiveness-review2 [Accessed 14 January 2015].
  5. University of Stirling (2013) Health First: an evidence-based alcohol strategy for the UK. Stirling: University of Stirling. [Online] Available from http://www.stir.ac.uk/media/schools/management/documents/Alcoholstrategy-updated.pdf [Accessed 14 January 2015].
  6. Poikolainen, K. (1980) Increase in alcohol-related hospitalizations in Finland 1969-1975. British Journal of Addiction 75(3): pp 281-291.
  7. Mladovsky, P., Allin, S., Masseria, C et al (2009) Health in the European Union: trends and analysis. Observatory Studies Series No. 19, United Kingdom: WHO on behalf of the European Observatory on Health Systems and Policies [Online] Available from ec.europa.eu/social/BlobServlet?docId=4742&langId=en [Accessed 26 November 2014].
  8. WHO (2014) Global Information System on Alcohol and Health (GISAH): Recorded alcohol per capita (15+ years) consumption in litres of pure alcohol, from 1990:2010. [Online] Available from http://gamapserver.who.int/gho/interactive_charts/gisah/consumption_adult/atlas.html [Accessed 19 November 2014]
  9. WHO Global Health Observatory Data Repository: Recorded alcohol per capita consumption, from 1990, Data by country. Filtered for all years 2003-2010, Europe only. [Online] Available from http://apps.who.int/gho/data/view.main.RAPC2012v [Accessed 20 November 2014].
  10. WHO (2014) Global status report on alcohol and health 2014. [Online] Luxembourg: World Health Organization. Available from http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763_eng.pdf [Accessed 19 November 2014].
  11. Currie, C., Zanotti, C., Morgan, A. et al (2012) Social determinants of health and well-being among young people. Health Behaviour in School-aged Children (HBSC) study: international report from the 2009/2010 survey [Online] Copenhagen: WHO Regional Office for Europe. Available from http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf?ua=1 [Accessed 19 November 2014].
  12. Hibell, B., Guttormsson, U., Ahlström, S. et al (2012) The 2011 ESPAD Report: Substance use among students in 36 European countries. [Online] Available from http://www.can.se/contentassets/8d8cb78bbd28493b9030c65c598e3301/the_2011_espad_report_full.pdf [Accessed 09 November 2016].