Evidence into Action (and Action Evidence into Action (and Action into Evidence)into Evidence)

Dr Lesley GrahamDr Lesley Graham

ISDISD

UK consumption 1900-2006

Alcohol Problems in ScotlandAlcohol Problems in Scotland Enough alcohol is sold in Scotland for every adult Enough alcohol is sold in Scotland for every adult

over 18 to exceed male weekly limitsover 18 to exceed male weekly limits [Health Scotland [Health Scotland 2010]2010]

Excess consumption is across all age and socio-Excess consumption is across all age and socio-economic groupseconomic groups [Scottish Health survey 2009][Scottish Health survey 2009]

1 in 20 deaths attributable to alcohol1 in 20 deaths attributable to alcohol [Grant, Springbett [Grant, Springbett and Graham 2009]and Graham 2009]

Those from the most deprived areas in Scotland Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related are 5 times more likely to die an alcohol related deathdeath [Alcohol Statistics Scotland 2009][Alcohol Statistics Scotland 2009]

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

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Age

sta

ndar

dise

d m

orta

lity

rate

per

100

,000

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Scotland

England and Wales

Scotland

England and Wales

Other Europeancountries

Other Europeancountries

Men aged 45-64 years Women aged 45-64 years

0

10

20

30

40

50

60

70

80

1950 1960 1970 1980 1990 2000

Alcohol and CrimeAlcohol and Crime

Half (50%) of prisoners in Scotland reported being Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three drunk at the time of their offence, rising to three quarters (77%) of young offendersquarters (77%) of young offenders [Scottish Prison Survey [Scottish Prison Survey 2009]2009]

Rise in proportion of young offenders who consider Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007)1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009][McKinlay et al 2009]

1 in 6 deaths on British roads are caused by drink 1 in 6 deaths on British roads are caused by drink drivingdriving [Road Casualties in Great Britain 2007][Road Casualties in Great Britain 2007]

Alcohol related crime is estimated to cost Scotland over Alcohol related crime is estimated to cost Scotland over £700 million per year£700 million per year [Societal Cost for Alcohol Misuse in [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010]Scotland in 2007 University of York 2010]

Alcohol and Violent CrimeAlcohol and Violent Crime

Where known, alcohol is a factor in more than Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicidetwo thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9][Homicide in Scotland 2008/9]

70% of assaults in A&E may be alcohol related70% of assaults in A&E may be alcohol related [QIS 2006][QIS 2006]

In 62% of violent crime, victims said the In 62% of violent crime, victims said the offenders were under the influence of alcoholoffenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010][Scottish Crime and Justice Survey 2010]

Effectiveness of Interventions MeasureMeasure Effective?Effective?PricingPricing ++++++

AvailabilityAvailability Age LimitAge Limit Reducing Outlet DensityReducing Outlet Density

++++++

++++

Safer Drinking environmentsSafer Drinking environments Server LiabilityServer Liability EnforcementEnforcement

++++++

++++

AdvertisingAdvertising +/+++/++

TreatmentTreatment Brief Interventions (primary care)Brief Interventions (primary care) Brief Interventions (A&E)Brief Interventions (A&E)

++++++

++++

Information and education Information and education School educationSchool education Product LabellingProduct Labelling Public service messagingPublic service messaging

? / +? / +

No (on own)No (on own)

No (on own)No (on own)

Increased knowledge and changed

attitudes to alcohol + drinking

Reduced acceptability of

hazardous drinking and drunkenness

Reduced availability of alcohol

Individuals in need receive timely,

sensitive & appropriate support

A culture in which low alcohol consumption is valued and accepted as the norm

Less absenteeism + presenteeism the

workplace.

Less alcohol related incapacity

Reduced alcohol related injuries,

physical and psychological

morbidity + mortality

Fewer brain-damaged children

Increased educational attainment

Safer & happier

families and communities

Reduced health, social care, justice

costs

Healthier individuals

and populations

Intermediate outcomes Long term outcomes

Children in need receive timely and

appropriate support

Safer drinking + wider environments

Increased workplace

productivity

Less alcohol related violence/abuse,

offences and ASB

Less absenteeism + presenteeism in

educational establishments

Fewer children affected by parental

drinking

Reduction in Individual and

population consumption

Changed patterns of

consumption

Reduced affordability of alcohol

National outcomes

Reduce significant inequalities

Model 2:

Model 3:

Model 4:

Model 5:

Model 6:

Model 7:

Key Events in alcohol in ScotlandKey Events in alcohol in Scotland

2003: ISD alcohol team set up2003: ISD alcohol team set up2005 Alcohol Statistics Scotland published2005 Alcohol Statistics Scotland published2007: Scottish Health Action for Alcohol Problems 2007: Scottish Health Action for Alcohol Problems

established and publish Price, Policy and Public Healthestablished and publish Price, Policy and Public Health2007: Health Scotland develop alcohol logic models2007: Health Scotland develop alcohol logic models2007: SNP government2007: SNP government2009: Alcohol Framework2009: Alcohol Framework2010: Alcohol Bill2010: Alcohol Bill2011: alcohol and offender conference and publication of 2011: alcohol and offender conference and publication of

reportsreports2011: MESAS baseline report2011: MESAS baseline report

What are the key elements for What are the key elements for success?success?

ContactContact

Dr Lesley GrahamDr Lesley Graham

Public Health Lead for Substance MisusePublic Health Lead for Substance Misuse

ISD, NHS National Services ScotlandISD, NHS National Services Scotland

Gyle SquareGyle Square

1 South Gyle Crescent1 South Gyle Crescent

Edinburgh EH12 9EBEdinburgh EH12 9EB

lesley.graham@nhs.netlesley.graham@nhs.net