Professor Mark A Bellis Professor of Public Health, Bangor University - PowerPoint Presentation

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Professor Mark A Bellis

Professor of Public Health, Bangor University

WHO UK Focal Point for Violence and Injury Prevention

m.a.bellis@bangor.ac.uk

The Alcohol Harm

Paradox

E

xposing

hidden drinking and explaining hidden harms

(ARUK Report 2015)

alcohol

Alcohol Research UK Flagship Grant

Variations in Alcohol Related Mortality

&

Drinking

Patterns by Deprivation

Under-reporting – Deprivation is associated with underreporting though missed units and omitted groups (e.g. homeless, military)Drinking Patterns – Similar amounts of alcohol are consumed but current and historical patterns of drinking differCompounding – Impact of Alcohol plus diet, exercise, housingHealth Services – Access and uptake of health interventions differ with deprivationPoverty gradient – Alcohol related ill health pushes people into poverty causing a concentration of harms in poorer areas

What could explain the Paradox?

(Bellis & Jones 2012, Probst et al, 2014)

Missing

8 Units

per drinkerper week

Drinking Surveys – A Partial Picture

Depending on Year

USA surveys accounted for 22-32% of Sales, Germany 39%, France 59%, Australia 80%England

Bellis et al, 2015; Health survey for England 2012; HMRC Clearance Data 2013

SourceGroupPop.Millions>16 yearsUnitsMillionsPer weekPer drinkerSales%HMRCAll36,072783.821.7HealthSurvey forEnglandMale18,741318.617.040.6Female17,331176.810.222.6All36,072495.413.763.2

Forgotten drinks

Estimation of drink size

UK Tourist consumption

Waste

Duty Free

Home Brew

Illegal alcohol

Special Occasions



including time abroad

Survey May 2103 –April 2014 (n =4,606) Phone based (Land and Mobile)Compliance 23.3%Additional MeasuresOther Health Harming BehaviourDiet, Exercise, SmokingBody Mass IndexFor ≥35 years, drunkenness and bingeing (aged 18-30 years)Deprivation (lowest 2 quintiles)Typical Drinking PLUS Special Events & PeriodsDrank nothingDrank a bit moreDrank a lot more

Special EventsCelebrating birthdayWeddingFestival, rock, pop concert or other showSporting event on TV or liveEngagement, hen, or stag partyFriends came to stay / you stayed with friendsSpecial PeriodsIn the summerOn holiday at home or abroadBank holiday weekendsWorking away from homeIn January (after New Year)‘Around’ Christmas and New YearOther religious periods, e.g. Lent, RamadanAfter a bereavement or funeralPeriods of unemployment or change in workAnything else that can be promoted

Bellis et al, 2015

Alcohol Harms Paradox – Survey

Adds equivalent of 12 million bottles of wine/week

Bellis et al, 2015

41.6% of gap between Sales and Survey

Equal

to

12

Million

bottles of wine per week

Net Additional Units - Special Occasions/week England

41.6

%

gap between Sales & Survey

Light drinkers (typical drinking <1 units/week) consume more alcohol (x3) on special occasions than typical

25-34 year olds with heavy (>35 units/week) typical drinking may add an average

18 units/week

through special occasions

Frequency of drunkenness on holiday and at home

18-35 year olds visiting Majorca, Cyprus and Crete

Telegraph, 2014, Hughes, Bellis et al, 2009

“

We're here for a reason

,

I'm

going to get

mortal

on the street and I don't care.

”

Magaluf Binge Crackdown

A 19 year old mental health

nurse from UK

Any

potential

cardio vascular benefit removed by monthly heavy session (60g alcohol)

Alcohol Paradox: Binge Drinking, Injury and Heart Disease

Roerecke

& Rehm 2008

Does Deprivation alter Drinking

Patterns independent of quantity currently drank

Minimal, male & female >0–1 unit; lower risk, male >1–21 units, female >1–14 units; increased risk, male >21–50 units, female >14–35 units; higher risk, male >50 units, female >35 units. *Analyses limited to those aged 35 years or over.

Adjusted Odds

All 1.73 (1.44-2.07)

Deprivation

***

*

ns

ns

Current Binge Drinker

(Average session 5+ Units)

***

***

ns

ns

Deprivation

History of Binge Drinking

(

Drunk (or 5+ session) ≥monthly at age 18 and 30 years)*

Adjusted OddsLower 1.87 (1.06-3.31)Increased 2.60 (1.32-5.14)

Bellis et al. 2015

Alcohol Harm Paradox – Other Options

History of frequent

d

rinking (four

or more days a

week)

No association with deprivation within drinking categories

Underestimating total consumption through special occasion drinking

Slightly higher in affluent

Starting drinking

regularly under 18

years (at least monthly)

No association with deprivation within drinking categories

First drunk

under 18

years (defined slurred speech, unsteady on feet)

No association with deprivation within drinking categories

Different drink types

Wine (



affluent), Spirits & Beer/Cider (



deprived)

Interactions between Alcohol and Other Health Harms

Alcohol misuse = drink ≥15 units/

wk; Obese = BMI ≥30 Hart et al, 2010

Relative risks of contributions of BMI and alcohol to liver disease mortality (adjusted for all risk factors)

Interactions between Alcohol and Other Health Harms

Other multiplicative interactions include conditions such as hypertension and Macular Degeneration

Tuyns et al 1988

Relative risks of contributions of smoking and alcohol to Laryngeal Cancer

Lower alcohol 0-40g/day;

H

igh alcohol 140+g/day; Lower tobacco 0-7 cigarettes/day; High tobacco 26+ cigarettes/day

No associated risk

Increased Risk

Drinkers

Unhealthy

l

ifestyle

Deprived 5.0%Non-dep 7.7%

N=642; X2=53.844, P<0.001

Deprived 6.8%

Non-dep 4.4%

Overweight

Deprived 8.1%

Non-dep 6.0%

Smoking

Deprived

8.7%

Non-dep 0.8%

Deprived 6.8%

Non-dep 1.5%

Deprived 33.1% Non-dep 16.8%

Deprived 11.2% Non-dep 12.1%

Deprived 16.8%Non-dep 33.1%

Smoker, daily or occasional; Body Mass Index, >25; Unhealthy lifestyle, ≤1 portion fruit or veg per day and/or <1 vigorous exercise session per week

Bellis et al. 2016

Public Health Syndromes?

Metabolic Syndrome

Local Authority Level Public Health Metrics for England, Bellis et al. 2011



Best Outcome Worst Outcome



Summary

Holiday Workout

And Repeat

Typical

d

rinking only part of the picture

Special occasions and periods are dynamic

Intense Industry PromotionNot just about “away from home’ timeInjury changes risks Especially in heavy drinking sessionsWeekday Bank Holiday x2 A&E night visitsCompelling reasons to consider alcohol, food, exercise and tobacco togetherMultiplicative risksPart of tackling health inequalities Industry joins up their strategiesWhat are Public Health Equivalents?

Professor Mark

A. Bellis

m.a.bellis

@bangor.ac.ukwith many thanks toLisa Jones, Karen Hughes, James Nicholls, Nick Sheron, Ian Gilmore, Michela Morleo, Ellis McCoy, Jane Webster, Harry Sumnall