Alcohol and Health Inequalities

Alcohol and Health Inequalities

Elizabeth AmblerRegional Alcohol Programme ManagerDepartment of Health – East Midlands

Aims and Objectives• Alcohol Related Harm – What is the scale

of the problem?• Alcohol and Health Inequalities• National and Regional Response to Alcohol

Related Harm• Guided Group Work: Identification of

effective mechanisms and interventions to address inequalities in alcohol related harm and treatment provision

• Feedback and Next Steps

Alcohol Related Harm – What is the Scale of the Problem?

• The consequences of drinking go far beyond the individual drinkers health and well-being

• They include harm to the unborn foetus, acts of drunken violence, vandalism, sexual assault and child abuse, and a huge health burden carried by both the NHS and friends and family who care for those damaged by alcohol


• Since 1970, alcohol consumption has fallen in many European countries but has increased by 40% in England

• The annual cost of alcohol-related crime and public disorder has been estimated at £7.3bn, the cost to employers has been put at £6.4bn

Source CMO report 2008. Passive drinking: The collateral damage from alcohol


• There are around 16, 000 premature deaths each year in England and Wales associated with alcohol misuse – double the number since the early nineties

• Alcohol related hospital admissions are increasing at a rate of 70, 000 per year in England

• In the East Midlands in 2008/9 there were 79,872 alcohol related hospital admissions (an increase of 5% from the previous year)


• There are an estimated 1 in 13 people dependent on alcohol in the UK, with several million more drinking excessively to the extent where their health is at risk

Alcohol Related Harm in the East Midlands

Rate of ARHA per 100,000 population (EASR)

-

500

1,000

1,500

2,000

2,500

3,000

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Rat

e p

er 1

00k

po

p

England Nottingham City Derby City Leicester City

Alcohol Related Harm in the East Midlands

Rate of ARHA per 100,000 population (EASR)

-

200

400600

800

1,000

1,2001,400

1,600

1,800

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09

Rate

per

100k

England Bassetlaw

Derbyshire County Nottinghamshire County

Lincolnshire Leicestershire County and Rutland

Northamptonshire

Hospital Admissions in the East Midlands for Ethanol Poisoning

What are the Health Consequences of Alcohol?

• Drinking regularly over the low risk guidelines can lead to serious health problems including:

- Certain types of cancer - High blood pressure - Heart disease and stroke - Liver disease

Non-Health Consequences of Alcohol

• 50-73% of assault victims injuries• Around 50% of all serious road crashes• Nearly 50% of domestic violence against

females• 47% of serious injuries• 40% of self-poisoning

Source: Alcohol Concern

Alcohol and the family

• Approximately 1 million children live with a parent who is dependent on alcohol

Inequalities and Alcohol• Problem drinking is twice as common in

the poorest as in the most affluent• Deaths from diseases caused by alcohol

show a clear gradient with socioeconomic position, with an almost fourfold higher rate in unskilled working men compared to those from professional groups

• Alcohol is a contributory factor to deaths from accidents, which also show a pronounced socioeconomic gradient

Inequalities and Alcohol• Poor women are more likely than the affluent to

report being drunk• Higher levels of consumption of alcohol have

been consistently observed in some deprived groups, such as unemployed people and those who are homeless

• Problem drinking is associated with delinquency, criminality and violence, including domestic violence and child abuse

Inequalities and Alcohol• Heavy drinking in people in higher socioeconomic

groups may be less harmful than in lower socioeconomic groups because they are protected from harmful effects by better diet, housing, health care and other factors

• People with alcohol-related problems who are disadvantaged in other ways, through having limited financial or social resources or being homeless, may have less access to appropriate treatment services for all their needs, including treatment of their alcohol- related health problems

Source: The Acheson Report 1998

Inequalities in Health Consequences

• The most deprived fifth of the population suffer two to three times greater loss of life attributable to alcohol; three to five times greater mortality due to alcohol specific causes; and two to five times more admissions per hospital because of alcohol than the most affluent areas

• On average men living in the more deprived areas lose 17 months of life and women lose 7 months of life due to conditions related to alcohol compared with 6 months for men and 3 months for women living in more affluent areas

Source: Intellingence East Midlands Briefing: Alcohol and the East Midlands

Intervention Tiers

Indices of Multiple Deprivation

The seven domain indices are: • Income • Employment• Health Deprivation and Disability• Education, Skills and Training• Barriers to Housing and Services• Crime• Living Environment

NI39 admissions by IMD

Alcohol specific admissions by IMD

National and Regional Response to Alcohol Related Harm

Safe. Sensible. Social. The National Alcohol Strategy

Priority actions:Support for local partnerships and communitiesEarly identification interventions and treatment for

drinking that could cause harmTackling alcohol related offendingReplacing glassware and bottles in high risk premisesUnderage salesResponsible retailing and promotionsPromoting a culture of sensible drinkingSupport for harmful drinkersPreventing harm to those under 18


The Alcohol Improvement Programme

• The Alcohol Improvement Programme is commissioned by the Department of Health for 3 years from April 2008

• Focuses on 7 High Impact Changes (HIC) to coordinate delivery of Alcohol Harm Reduction

Early Implementor PCTs

NHSPlanned delivery on ARHAs

Impl

emen

tatio

nS

uppo

rt

Prio

rity

acc

ess

lear

ning

learning

Evi

denc

e

Trailblazers (SIPS), ANARP, MoCAMEffectiveness review, HES data,etc

Trailblazers (SIPS), ANARP, MoCAMEffectiveness review, HES data,etc

PCTs (Unplanned) delivery on targets through implementation of elements of

the high impact actions

learningAlcohol Interventions Improvement Centre

Enabling changePriority support to early implementor PCTs.Tools: Learning sets, collaboratives, etc

Learning CentreCollects, co-ordinates and disseminates learning and good practice. Tools: SIPS toolkits, HuBCAPP, e-learning resource

NST(DH)Supports 18 challenged

PCTs. Diagnosis, strategic reports & follow-up

visits

Re

vie

w

Su

pp

ort

Regional co-ordinators (DH/SHA)

Support local partnerships in

delivery

learning

DH Policy TeamRole: Work with outside bodies to facilitate frontline delivery. Develop policy, Develop Guidance, Commission, co-ordinate and contract manage support projects, channel expertise,

lear

ning

NWPHO

Provide local data on need and key evidence

Start delivering ARHAs

Receive priority support from AIP

Implement high impact actions

Sup

port

In

fluen

ce


The High Impact Changes

• HIC 1 – Work in Partnership• HIC2 – Develop activities to control alcohol misuse• HIC 3 – Influence change through advocacy• HIC 4 – Improve the effectiveness and capacity of

specialist treatment• HIC 5 – Appoint an alcohol worker• HIC 6 – IBA, provide more help to encourage people to

drink less• HIC 7 – Amplify national social marketing priorities


The Alcohol Learning Centre• An on-line one-stop-shop which collates,

co-ordinates and disseminates learning and promising practice from across the NHS and the Third Sector

• It contains alcohol specific policy documents, guidance and tools and provides training resources to support frontline practitioners and commissioners


Regional Improvement Plan• Understanding need/challenge• Supporting networks• Partnership self assessment• Influence performance management• Amplify national campaigns• Social marketing/research• Supporting providers • Supporting commissioners

What is the Region Doing to Address Inequalities in Alcohol?

What is the Region Doing to Address Inequalities in Alcohol?

• Specific projects with offenders

• Specific work with BME/emerging communities groups

• Collaboration across all sectors

Guided Group WorkOverarching theme: How can we work at regional

level (DH and OneEM) to coordinate and up-weight approach to identify gaps in services and how to address them

Topics/issues• BME/hard to reach groups• Children and young people• Social marketing campaigns• IBA integration into other settings• Workplace policies• Signposting to services

Documents

Alcohol and Health Inequalities