The UK, the Netherlands, Sweden, Norway, Australia, and New Zealand have similar cultures, genetic backgrounds and drinking cultures, and, until the mid-1980s, had similar death rates from liver disease. However, while liver death rates in most of these countries have remained low since then, the UK has seen a doubling of its liver death rate from 4•9 per 100,000 population to 11•4. In a Comment published Online First by The Lancet , three experts, including Royal College of Physicians Past President Ian Gilmore, discuss the thousands of deaths from liver disease that can be avoided if the UK adopts appropriate alcohol policies.
The authors (Gilmore, Nick Sheron, University of Southampton, UK, and Chris Hawkey, Queen's Medical Centre, University Hospital, Nottingham, UK) look at several projected scenarios in which the UK follows its current projection to a worst case scenario in 2019, or instead reverses its trend to match that of European countries such as France that have shown huge reductions in liver death rates over the past few decades. This reversal would also over the next decade bring the UK back in line with Australia, New Zealand, and the other countries mentioned above.
Their main findings are (please also refer to diagram in full Comment):
The authors discuss the price, place of sale (availability), and promotions, saying that these three factors, plus a fourth which the marketing industry terms 'product' constitute the basic components of all marketing activity. They cite regulation-based activity that has helped control UK alcohol consumption in the past, and say: "These and other data show the influence of price and indicate that the regulation of population-level alcohol consumption is a duty of responsible government."
France has, say the authors, achieved its phenomenal success in reducing death rates by increasing alcohol quality and profit and limiting availability of cheap alcohol products. But they add on the UK: "Currently the UK drinks producers and retailers are reliant on people risking their health to provide profits: figures from the Department of Health show that three-quarters of the alcohol sold in the UK is consumed by hazardous and harmful drinkers."
The authors highlight a number of things about current UK policy:
The authors conclude: "Irrespective of the means the UK Government chooses to design and implement their public health strategy, the key test must be the impact on hard outcomes. We have seen a change of emphasis from setting targets for process measures to outcomes measures, an approach quintessentially applicable to alcohol. Alongside debates on the effectiveness of individual measures, an outcomes framework should be created that establishes the level of liver mortality that the UK aspires to achieve."
For Royal College of Physicians Past President Ian Gilmore or Nick Sheron, University of Southampton, UK, contact via RCP Press Office, Linda Cuthbertson T) +44 (0)20 3075 1254 / +44 (0) 7896 416409 E) linda.cuthbertson@rcplondon.ac.uk
Note to editors: The British Society for Gastroenterology (BSG) played a key role in preparing the figures in this comment. Professor Jon Rhodes, President of BSG says: "This paper highlights the stark future we face if the government continues to pander to the agendas of the drinks industry. We urgently need an integrated approach to alcohol care services across primary and secondary care combined with a joined up strategy which comprises a less affordable minimum unit price, targeted fiscal measures and independent regulation of alcohol advertising and promotion. History has demonstrated that it is relatively straightforward for governments to control alcohol consumption at a population level. The government needs to act quickly to take some serious steps to tackle this growing problem."
Note this quote from Prof Rhodes is not part of the Comment.
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