1. Alcohol in Scotlanda public health perspective Dr Lesley Graham Public Health Lead, Information Services Division, National Services Scotland Alcohol Policy Team, Scottish Government

2. The role of public health evidence of the problem ‘framing’ the problems and solutions evidence for effective policies advocacy for policy into practice monitoring and evaluation of implementation

3. SOCIETY COMMUNITY THE INDIVIDUAL FAMILY Ecological Model

4. UK Alcohol ConsumptionLitres of pure alcohol consumption per capita in the UK 1900-2006

5. Alcohol Consumption in Scotland 1 in 4 (27%) men and nearly 1 in 5 (18%) women exceed double daily benchmarks (‘binge’ drinking) [SHeS 2008] younger age groups (16-24) drink most and are most likely to exceed weekly and double daily limits [SHeS 2008] little difference in exceeding limits by deprivation category for men although men in most deprived category drink more [SHeS 2008] women in the least deprived areas most likely to exceed limits and drink more [SHeS 2008] apparent little difference in excess consumption between Scotland and England [GHS 2007]

6. but known under-reporting in surveys (up to 50%) surveys ‘health cohort’ and can miss heavy drinking groups e.g. homeless/prisoners industry sales data show: in 2007, 12.2 litres of pure alcohol per capita (>18 yrs) was sold in Scotland compared to 10.3 litres in England, enough for every man and woman over 16 to exceed the adult male guidelines every single week[Nielsen 2007]

7. the wider environment liberalisation of licensing laws in Scotland in 1976 (‘permission to drink’) alcohol more available (more licensed premises and for longer hours) alcohol more affordable (69% more affordable since 1980)

8. Alcohol Related Harm • The average consumption of alcohol in a population is directly linked to the amount of harm[ECAS study Alcohol in Postwar Europe Nostrom et al] • Harm can be from the individual to societal level

9. Alcohol Related Deaths • 15 of the 20 local areas in the UK with highest male alcohol-related death rate 1998-2004 are in Scotland: • Glasgow City • Inverclyde • West Dunbartonshire • Renfrewshire • Dundee City • [ONS]

10. Chronic Liver Disease mortality rates per 100,000 population 1950-2006updated from Leon and McCambridge, Lancet 367 (2006)

11. Chronic Liver Disease Mortality by Deprivation, Scotland (Men) data from Leyland et al Inequalities in Scotland 1981-2001 MRC 2007

13. Alcohol and Social Harm • Alcohol misuse a contributory factor in 1 in 3 divorces • 65,000 children under 16 estimated to be living with parents with alcohol problems • 95% of people felt alcohol abuse in Scotland as a problem

14. Alcohol and Crime • 49% of prisoners were drunk at the time of their offence (76% of young offenders) [Scottish Prison Survey 2008] • 70% of assaults presenting to A&E likely to be alcohol related [QIS audit 2008] • Alcohol a contributory factor in two thirds of domestic violence [Home Office 2003]

15. Alcohol Policy: what works? ‘A considerable body of evidence shows not only that alcohol policies and interventions targeted at vulnerable populations can prevent alcohol-related harm but that policies targeted at the population at large can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. Thus, both population-based strategies and interventions, and those targeting particular groups.. are indicated’ [WHO Evidence based strategies and interventions to reduce alcohol related harm 2007]

16. Protective effects on vulnerable groups • The number of heavy drinkers in a population is directly linked to the average population consumption. So a fall in overall consumption will reduce the number of heavy drinkers [Ecological analysis of collectivity of alcohol consumption in England: importance of average drinker BMJ 1997;314:1164 Colhoun et al] • Tackling alcohol related harm will also tackle health inequalities

17. What measures work best? • Price • Availability • Drink driving counter measures • Brief interventions [Alcohol policy in the European region; current status and the way forward WHO EURO/10/05; Babor et al Alcohol: No Ordinary Commodity 2003; Anderson and Baumberg Alcohol in Europe 2007]

18. Changing the Culture ‘Epidemics appear, and often disappear without traces, when a new culture period has started; thus with leprosy, and the English sweat. The history of epidemics is therefore the history of disturbances of human culture’. [Virchow cited in Rose, The Strategy of Preventive Medicine Oxford Medical Publications 1992]