Deaths in the UK from liver disease have doubled in recent years,

Alcohol deaths predicted to rise

Experts have warned that “as many as a quarter of a million people will die from alcohol abuse over the next two decades unless the government takes the problem as seriously as it did smoking,” reported The Daily Telegraph. It said that deaths in the UK from liver disease have doubled in recent years, while countries such as France have seen major reductions after introducing strict marketing regulations for alcohol.

This front-page story is based on an article published in The Lancet, which discussed the growing number of UK deaths due to liver disease and estimated how this would increase over the next 20 years if the problem went unchecked. The authors are alcohol experts, and work with the government and several organisations to reduce drink-related harm.

The authors’ projections are likely to be a good approximation of alcohol-related deaths for the next 20 years. The estimates do not factor in the impact of current alcohol-control policies, including maintaining alcohol duty at 2% above inflation.

A Department of Health spokesperson said:

"The government has wasted no time in taking tough action to tackle problem drinking, including plans to stop supermarkets selling below cost alcohol and working to introduce a tougher licensing regime."

“We are taking a bold new approach to public health. Our recent white paper set out our plan to ring-fence public health spending and give power to local communities to improve the health of local people. We will also be publishing a new alcohol strategy to follow on from the Public Health White Paper in the summer."

Where did the story come from?
This brief policy analysis was carried out by researchers from the University of Southampton, University Hospital Nottingham and the University of Liverpool. Two of the three authors are members of the Department of Health Responsibility Deal Alcohol Network, a network of individuals and organisations that work with and advise the government on reducing alcohol-related harm. All the authors are involved in groups that work to increase awareness of unsafe alcohol use and public understanding of responsible drinking.

No sources of funding are given. The article was published in the peer-reviewed medical journal The Lancet.

What do the authors discuss?
This opinion piece discusses alcohol-control policies in the UK and other countries in Europe.

The authors say that liver disease is responsible for most alcohol-related deaths (70%), estimated to be between 18,000 and 30,000 deaths a year in England and Wales. They also note that about 80% of deaths from liver disease are caused by alcohol. As such, they say that liver mortality is a good measure of alcohol-related harm and could be considered a measure for the success of an alcohol-related policy.

They say that the liver death rates in the UK have more than doubled, from 4.9 to 11.4 deaths per 100,000 people, since 1986. The authors note that this has not happened in other European countries, such as the Netherlands, Sweden and Norway, or in non-European countries, such as Australia and New Zealand. They suggest that a liver death rate for the UK of about 4 deaths per 100,000 people a year is “a reasonable and achievable aspiration”.

The authors’ modelled four different scenarios showing:

the number of liver deaths in the UK for the next twenty years if they continue to follow the course of the past 10 years
liver deaths in the UK if they parallel the reductions in liver deaths seen in France (the country with the most profound recent reductions in liver-related mortality
liver deaths in the UK if they follow the reductions seen in Italy in the past 10 years
how the UK population would fare if the reductions paralleled those seen in Europe in the recent past
From their models, the researchers estimate that if nothing changes in the UK, there will be an additional 160,000 to 250,000 deaths over the next 20 years, compared to what would happen if policy changes were enacted now to bring in similar reductions seen in France. They call for a framework to be introduced in the UK to establish the levels of liver mortality that the country should aim to achieve. This could form the basis of morbidity-reduction programmes related to alcohol misuse.

The authors discuss examples of situations where regulation has successfully reduced alcohol consumption. They note that heavily regulating the marketing of alcohol in France seemed to be particularly successful in reducing heavy consumption of cheap wine. They compare the pre-regulation situation in France of “piling high and selling cheap” to that of the current UK supermarket strategy.

The authors go on to discuss current and planned UK policy, saying the government’s intention to keep duty on alcohol at 2% above inflation is reassuring. They are critical of other plans, however, such as the ban on the sale of alcoholic beverages below cost and the increase in tax on beer over 7.5% strength, saying the effects of these would be “inconsequential”.

Conclusion
The piece highlights the problem of alcohol-related harm in the UK and calls for more expert involvement in setting the agenda for harm-reduction. The authors of this opinion piece are alcohol experts, all of whom are involved in groups that work to increase awareness of unsafe alcohol use and public understanding of responsible drinking.

The authors carried out some simple modelling, using rates of liver-related mortality over the past few years in the UK and other European countries. This gives a broad estimate of how many people may die due to liver disease over the next 20 years if current drinking trends remain as they are. This is likely to be a good approximation of alcohol-related mortality, however, the models do not factor in the impact of current alcohol-control policies, including maintaining alcohol duty at 2% above inflation.

A Department of Health spokesperson responded:

"The government has wasted no time in taking tough action to tackle problem drinking, including plans to stop supermarkets selling below cost alcohol and working to introduce a tougher licensing regime.

“We are taking a bold new approach to public health. Our recent white paper set out our plan to ring-fence public health spending and give power to local communities to improve the health of local people. We will also be publishing a new alcohol strategy to follow on from the Public Health White Paper in the summer."

http://www.nhs.uk/news/2011/02February/Pages/doctors-predict-uk-alcohol-deaths.aspx