An Alcohol Harm Reduction Strategy for Christchurch

Where Are We Now & Why Are We Here?

November 2014

An Alcohol Harm Reduction Strategy

Overview

• How did we get here?

• Impact of alcohol – why are we here?

• The AHRS process (?)

2

What have we got?

• The go ahead from CDHB and CCC to co-develop an Alcohol Harm Reduction Strategy for Christchurch

How did we get here?

Timeline• 2009: Groundwork undertaken through

Healthy Christchurch– Key actions identified

• 2012: Co-ordinator post appointed in health sector– Enable CDHB to assume a leadership role in

reducing alcohol-related harm

Healthy Christchurch Actions

What came of them…• Tri-agency enforcement partnership • A joint alcohol working group established • Improved surveillance • Advocate for national/local policy • Effective primary care response In Progress

• A local Alcohol Harm Reduction Strategy

Why the wait for the AHRS?

• CDHB committed to develop an alcohol harm reduction strategy in May 2013

• Strategy development process ‘parked’ to focus on Local Alcohol Policies (LAPs)

• Initial alcohol key stakeholder strategy planning session took place in November 2013– Good overview of stakeholders priorities– CDHB/CCC commitment affirmed

How much are we drinking?

Average drinker?

• 9.85 litres of pure alcohol was purchased per NZ adult in 2012 (taxation data) AND 80% of adults report drinking in the past year

• That’s 18.68 standard drinks per adult drinker per week (before untaxed alcohol) - c.f. guidelines

• But only 19% of drinkers report drinking hazardously (NZHS2012) then…– These hazardous drinkers would be drinking 6 bottles

of wine per week on average (44SD)

8

9

Weekly Consumption (Standard Drinks)

Modelling self-reported drinking ratesf

* Average guideline (M/F)

4412.5*0 15 30

..81% of drinkers...…………………..19% of drinkers………………………. . . . . . .

10

Weekly Consumption (Standard Drinks)

Modelling actual rates (based on sales)f

…60% of drinkers….. …..40% of all drinkers……………………………………………………………………………..……..

What if 40% are hazardous drinkers?

Weekly Consumption (Standard Drinks)

f

12.5*0 15 30Weekly Consumption (Standard Drinks)

f

4512.5*0 15 30

So what is alcohol doing to us?

How do we know?

Look at what Population A drinks Look at what Population B drinks

Rule out every other variable you can think of

Compare their hospital admissions

Get an exact measure of alcohol’s contribution to 60+ conditions by age category and sex (Alcohol Attributable Fractions)

Apply that to your own hospital admissions to work out how alcohol consumption is impacting on health for any variable captured by that admission

ExamplesAlcohol Cirrhosis 100% Oesophageal cancer 18 – 38% Hypertension 3 – 30%Road Traffic Accidents 2 – 46%

A useful way to look at alcohol-related harm

ACUTEImmediate

AccidentsAssaults, Self harm,

drowning, etc

EnforcementControl

Engage in ED

WHOLLYMid Term*

Mental disorders (dependence),

Other chronic diseasesAlcohol poisoning (acute)

Primarily AOD services

CHRONICLong Term Conditions

42 conditions (cancers, CV, bowel)

Engage in health system

Prevention

How alcohol harm in changing over time in Christchurch?

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2009 2010 2011 2012 20130

200

400

600

800

1000

1200

1400

393.9482.6 511.6 515.1 543.2

453.1

476.6 484.6577.9

619.7122.8

133.5 134.2

150.1157.0

AAF Weighted Hospital Admissions - Christchurch Residents Aged 20+ - Age Standardised Rate Per 100,000 Population, 2009 to 2013

AcuteChronicWholly

rate

per

100

,000

pop

. 969.8

1092.71130.4

1243.01319.9

• Approximately 7% of the total health burden and increasing by 7% per year• Currently in the region of an $100M per year to the health system in

Canterbury

How alcohol harm varies by area (unit)

15

Arrival Month

Detected Alcohol Related Event Count

Estimate of alcohol associated events in ED*

Aug-12 266 459Sep-12 246 424Oct-12 258 445Nov-12 270 466Dec-12 305 526Jan-13 238 410Feb-13 257 443Mar-13 334 576Apr-13 251 433

May-13 235 405Jun-13 277 478Jul-13 276 476

Aug-13 256 441Sep-13 259 447Oct-13 293 505Nov-13 301 519Dec-13 289 498Jan-14 258 445

Total 4869 8395

Table/Graph of monthly recorded and estimated actual alcohol-related events in Christchurch ED (August 2012 – January 2014)

0

100

200

300

400

500

600

700

Aug-

12

Sep-

12

Oct

-12

Nov

-12

Dec-

12

Jan-

13

Feb-

13

Mar

-13

Apr-

13

May

-13

Jun-

13

Jul-1

3

Aug-

13

Sep-

13

Oct

-13

Nov

-13

Dec-

13

Jan-

14

Pres

enta

tion

s

Arrival Month

Christchurch Hospital Emergency Department% of Presentations where Alcohol is indicated

• Recorded admission (green line) indicates alcohol incidence that staff detected• *Recent research estimates actual alcohol incidence (blue line) to be over 70% higher

(where alcohol involved but not detected) at approx. 5600 incidents per year

NB: Alcohol-related admissions often impact disproportionately on ED resources

AREA EPISODESLinwood 126Sydenham 112Phillipstown 102Cathedral Square 99Addington 92Hornby South 89Avon Loop 89Sockburn 86Aranui 83Ensors 83Ilam 81Riccarton 79Edgeware 69Spreydon 67Rawhiti 66Barrington North 65Hillmorton 63St Albans East 62Shirley East 58North Beach 58

Top 20 Census Area (units) for alcohol-related ED admissions (August 2012 – January 2014)

• Admissions are recorded by residence for each TLA and Census Area (in Christchurch)

• 41% of all recorded alcohol-related ED admissions for Christchurch residents are accounted for by the top 20 Census Areas (16% of all areas) listed here

Share of all alcohol-related ED admissions• Christchurch (inc. Banks P) 82%• Waimakariri 6%• Selwyn 5%• Canterbury 95%

12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:000

50

100

150

200

250

300

350

Graph of recorded alcohol-related events at Christchurch ED by arrival hour averaged over week (data from August 2012 - July

2013)

• Highlights peak in alcohol-related events between 10pm and 5am the next day• Alcohol-related attendance can be observed above the daily averages from Friday 6pm

to Sunday 4pm. This accounts for 54% of weekly incidence.

Graph of monthly recorded alcohol-related events in Christchurch ED by age band and gender (August 2012 – January 2014)

• 58% of all events occur in the under 30s• 66% of all events are due to males

And what can we do about it?

…even before the Alcohol Strategy is launched

21

Activity underway

Activity in the work programme

The new Alcohol HR Strategy

• The process will be as important as the end product– Champions identified, awareness raised, views

and ideas shared, new prevention initiatives and partnerships developed, resources identified, targets set, etc.

• Milestones– Perhaps a strategy launch by November 2016 ???

Anything else?

1st December 2014

Questions ?