Alcohol and health: new reflections

I recently gave a new lecture on “alcohol and health”. Revising the topic was interesting and a reminder that Britain has always been rather different to other countries in its relationship to alcohol. Brits are just massive binge drinkers – and we tolerate a level of public drunkenness that is not seen elsewhere.   Interesting data from the latest OECD survey Alcohol consumption and harmful drinking: trends and social disparities across OECD countries shows that at around 12 litres (equivalent to about 120 bottles of wine), the UK comes out in 11th place in terms of overall consumption(defined as annual sales of pure alcohol in litres per person aged 15 years and over). We are behind Estonia (at the top) and France, but well above Australia and the US. The trends over time are interesting. The UK is up by about 5% over the period 1992-2012, less than Estonia, the Russian Federation, India and China which all increased by over 50%, but worse than Italy, France and Slovenia which all decreased over the same period.  Overall figures reveal a steady decrease over the past 30 years in countries where consumption was originally higher such as France, Italy, Spain, and Germany but in originally lower-consumption countries (including the UK) , data shows a continuous increase. For binge drinking we are right up there with the worst, with 28% of the population >15 admitting to drinking >6units at a go within the last month. Most worrying is that the biggest rise in binge drinking is in teenage girls, who have caught up and overtaken the boys with 44% of 15 year old girls and 39% of boys admitting to have been drunk on at least 2 occasions. The link with social economic status (SES) is interesting. More high SES people drink, but those with drinking problems are more likely to be of low SES. Men with drink problems tend to be of low SES but women of mid to high SES. Why does all this matter? The Lancet last year (Vol 384 November 29, 2014) published a major review on Liver disease in the UK that noted a 5 fold increase in deaths from Liver disease over the last 30 years – with the biggest increases in young people. With a quarter of the UK population being classed as “hazardous drinkers” this trend is set to get worse. The BMJ (BMJ 2015;350:h1301) does not think that the “Billion Unit” pledge made by the UK drinks industry in 2012 will work and has published a useful guide for clinicians summarising management (19th Feb BMJ 2015;350:h715).   Finally, there is a great source of information freely available on-line. The 2015 OECD Book “Tackling Harmful Alcohol Use” has 240 pages of analysis, facts and information.

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