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Evidence into Action (and Action into Evidence) Dr Lesley Graham ISD UK consumption 1900-2006 Alcohol Problems in Scotland Enough alcohol is sold in Scotland for every adult over 18 to exceed male weekly limits [Health Scotland 2010] Excess consumption is across all age and socioeconomic groups [Scottish Health survey 2009] 1 in 20 deaths attributable to alcohol [Grant, Springbett and Graham 2009] Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related death [Alcohol Statistics Scotland 2009] Chronic Liver Disease mortality rates per 100,000 population 1950-2006 updated from Leon and McCambridge, Lancet 367 (2006) Men aged 45-64 years 80 Age standardised mortality rate per 100,000 80 70 60 Scotland Other European countries Women aged 45-64 years 70 60 50 50 40 40 Scotland 30 30 20 20 England and Wales 10 0 1950 1960 1970 1980 1990 2000 Other European countries 10 0 1950 England and Wales 1960 80 70 1970 1980 1990 2000 Alcohol and Crime Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders [Scottish Prison Survey 2009] Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009] 1 in 6 deaths on British roads are caused by drink driving [Road Casualties in Great Britain 2007] Alcohol related crime is estimated to cost Scotland over £700 million per year [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010] Alcohol and Violent Crime Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9] 70% of assaults in A&E may be alcohol related [QIS 2006] In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010] Effectiveness of Interventions Measure Effective? Pricing +++ Availability Age Limit Reducing Outlet Density +++ ++ Safer Drinking environments Server Liability Enforcement +++ ++ Advertising +/++ Treatment Brief Interventions (primary care) Brief Interventions (A&E) +++ ++ Information and education School education Product Labelling Public service messaging ?/+ No (on own) No (on own) Intermediate outcomes Model 2: Model 3: Children in need receive timely and appropriate support Long term outcomes A culture in which low alcohol consumption is valued and accepted as the norm Less absenteeism + presenteeism in educational establishments Safer drinking + wider environments Fewer children affected by parental drinking Reduced acceptability of hazardous drinking and drunkenness Model 4: Model 5: Model 6: Model 7: Increased knowledge and changed attitudes to alcohol + drinking Reduced availability of alcohol Reduced affordability of alcohol Individuals in need receive timely, sensitive & appropriate support Increased educational attainment Less absenteeism + presenteeism the workplace. Less alcohol related incapacity Reduction in Individual and population consumption Less alcohol related violence/abuse, offences and ASB Increased workplace productivity Safer & happier families and communities Reduced health, social care, justice costs Changed patterns of consumption Reduced alcohol related injuries, physical and psychological morbidity + mortality Fewer brain-damaged children Healthier individuals and populations National outcomes Reduce significant inequalities Key Events in alcohol in Scotland 2003: ISD alcohol team set up 2005 Alcohol Statistics Scotland published 2007: Scottish Health Action for Alcohol Problems established and publish Price, Policy and Public Health 2007: Health Scotland develop alcohol logic models 2007: SNP government 2009: Alcohol Framework 2010: Alcohol Bill 2011: alcohol and offender conference and publication of reports 2011: MESAS baseline report What are the key elements for success? Contact Dr Lesley Graham Public Health Lead for Substance Misuse ISD, NHS National Services Scotland Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB [email protected]