A Comment published Online First by The Lancet provides the latest projections on alcohol-related deaths in England and Wales over the next 2 decades, based on data up to 2010. The data suggest that if current trends continue (a worst-case scenario for the UK), there will be up to 210 000 avoidable alcohol-related deaths in the next 20 years, of which 70 000 will be avoidable deaths from liver disease and the rest from other causes including avoidable deaths from liver disease, accidents, violence, and suicide or from chronic diseases, such as hypertension, stroke, cardiovascular disease, and cancers of the breast and gastrointestinal tract. The Comment is by alcohol policy expert Professor Ian Gilmore, University of Liverpool, UK, former President of the Royal College of Physicians; and Dr Nick Sheron, NIHR Biomedical Research Unit and University Hospital Southampton NHS Foundation Trust, Southampton, UK and colleagues from the British Society of Gastroenterology.
This new projection is a slight improvement on what the same team of researchers predicted in a previous Comment published one year ago in The Lancet, based on data to 2008. That projection suggested a worst-case scenario of up to 250 000 avoidable alcohol-related deaths over the following 20 years, of which 77 000 would be deaths from liver disease. While any improvement is good news, the authors stress that this small change is hardly cause for celebration.
Alcohol-related liver deaths in England and Wales fell from 6470 in 2008 to 6230 in 2009, but then increased again to 6317 in 2010. The authors say: "Unfortunately, the recent moderate improvement might be related more to the recession than to current alcohol policy; the fact that deaths increased during 2009 indicates there is no room for complacency."
They add: "It remains entirely within the power of the UK Government to prevent the worst-case scenario of avoidable deaths. Although alcohol-related disease may take years to develop, fatalities generally reflect recent drinking." They highlight measures brought into effect in the former Soviet Union in the 1980s, which saw consumption fall by a third in 2 years with a resulting 12% drop in mortality.
The authors highlight the conflict of interest in current UK Government alcohol policy, which relies on the alcohol industry being party to a voluntary 'responsibility deal' promoting safe drinking. However, the first priority of all these companies, say the authors, is to maximise profits for shareholders. The authors add: "By contrast, the Scottish Government is pressing ahead with a raft of evidence-based measures to reduce alcohol consumption, such as banning special offers based on bulk purchase and instituting a minimum price per unit of alcohol."
The authors believe the UK is at a potential tipping point in taking on the shameful, preventable loss of life caused by alcohol that so often affects younger people—the peak age for alcohol-related deaths is in people aged 45 years and alcohol is a factor in 26.6% of deaths in men aged 16 years. There are signs that the UK Government might reconsider adoption of the evidence-based strategies of increasing price, reducing availability, and preventing marketing of alcohol to children and young people. The authors say: "Most importantly, the Prime Minister recently spoke in support of an effective minimum price per unit."
The authors conclude: "There are understandable concerns over the legal status of a minimum price per unit of alcohol and whether the general public is ready for tough action on the widespread availability of cheap alcoholic drinks. Can the UK Government, however, afford to duck effective action on alcohol that will have such a positive impact on crime and disorder, work productivity, and health? The UK Government will have to withstand powerful lobbying from the drinks industry, but the prize of reversing this tragic toll of alcohol-related deaths is there for the taking."
Professor Ian Gilmore, University of Liverpool, UK, and former President of the Royal College of Physicians UK. T) 44-20-3075-1254 / Out of hours: 44-7896-416409 E) I.Gilmore@liverpool.ac.uk
Dr Nick Sheron, NIHR Biomedical Research Unit and University Hospital Southampton NHS Foundation Trust, Southampton, UK. T) 44-2380-795099 E) Nick.Sheron@soton.ac.uk
Journal
The Lancet