The Dr Foster report on hospital admissions linked to drink or drugsdetails the latest instalment in our troubled relationship with alcohol. More than half a million people have been admitted over three years with alcohol- and drug-related harm and the cost to the NHS is £607m a year. The vast majority of these admissions were for alcohol-related illness, and they were not for trivial problems.
Alcohol damages the body in various ways, some clearly related to its use. With alcohol-related liver disease or dependency, alcohol is the primary cause and a clear diagnosis can be recorded for each patient. But “alcohol stealth diseases” cause harm in more subtle ways and are one of many factors, for example in more than half of deaths from epilepsy, and a third of suicides. In men, alcohol is linked to more than a quarter of deaths from high blood pressure, cardiac arrhythmias, and cancer of the mouth and oesophagus. In women, more than 8% of deaths from breast cancer are alcohol-related, although they are never recorded as such.
These stealth diseases are important in other ways. People need to drink a hell of a lot of alcohol over a long period to get liver cirrhosis, but for stealth diseases small rises in risk occur with low levels of alcohol consumption. The lifetime risk of breast cancer for a woman drinking one bottle of wine each week rises by 10%, but breast cancer is a lot more common than liver disease, and one in 100 women drinking at this level will develop breast cancer as a result.
Taking into account the harm caused by alcohol stealth diseases, 100,000 years of working life in England and Wales are lost because of alcohol. The comparable figures for heart attacks are 74,000, lung cancer 43,000, diabetes 8,000 and illegal drugs 3,000. Alcohol is a hugely important health issue, and in terms of years of life lost prematurely, clearly one of the most important.
One might imagine that in a half-sane world the NHS would take this pretty seriously. But of the 195 quality improvement indicators set by Sir Bruce Keogh (a cardiac surgeon) and colleagues for NHS England, 41 are for heart disease, 24 are for diabetes and 23 are for cancer. The 25 mental health indicators include the only one to mention alcohol, and there is no indicator at all for liver disease despite a doubling in liver death rates doubling since the 1980s.
The response of the Department of Health is equally abject. According to a recent report for Public Health England, the department plans to stop measuring alcohol stealth admissions in the new Public Health Outcomes Framework – a plan that typifies the government’s attitude to alcohol-related harm, and was given a rapturous welcome by the drinks industry.
It does not have to be this way: there is an incredibly strong evidence base for effective alcohol policy using four strategies for selling alcohol. These are the four Ps: price – alcohol is too cheap; place of sale – it is too easily available; promotions – the most effective tool for recruiting children as customers; and product – alcopops and cheap spirits have transformed our drinking culture, and vodka has become the youth drug, just as the drinks industry intended.
The Home Office proposed a measured alcohol strategy, centred on a minimum unit price, and personally supported by David Cameron, and no one seems to understand why it was dropped – although the lobbying from the drinks industry and its supporters was intense. Until we get a government that is more concerned about the health of the population than that of the drinks industry, and an NHS prepared to tackle alcohol-related harm with the same vigour which with it tackles cardiac disease, we can only expect the problem to get much worse.
Dr Nick Sheron is an NHS liver specialist in Southampton
