ABC of Alcohol
ABC of Alcohol
Alcohol use: Consumption and costs
Peter McGovern and Eric Appleby
The changing face of alcohol consumption around the world.
Global alcohol morbidity and mortality.
The growing burden and impact of alcohol misuse in the developing world.
The rising health costs of alcohol at home and abroad.
Alcohol misuse is an issue that expands beyond its physical and psychological consequences. Overconsumption of, and addiction to alcohol, is a global health challenge. The social consequences of alcohol transcend class and its impact at the individual and population levels are of equal importance. At home it is a burden on the NHS budget ( Figure 1.1 ) and abroad an issue that stifles development in resource-poor countries. It is through understanding the nature of excessive consumption that health professionals can act as advocates for the best use of resources at home and abroad.
Figure 1.1 From the alcohol harm map 2013: City of Manchester.
Source: Alcohol Concern ( 2013). Reproduced by permission of Alcohol Concern.
Patterns of consumption
Although the United Kingdom over the past century has never been more than a moderate consumer in terms of the total amount of alcohol drunk per capita, it is nevertheless considered to have one of the more problematic relationships with alcohol, as a result of the drinking patterns and style that have developed. For the first half of the 20th century, the United Kingdom was relatively abstemious, but the decades after the Second World War saw a rapid increase, with per capita consumption almost doubling. This rise was highest within northern regions of the United Kingdom and was a divergence from the downward trend in southern European consumption. More recently the United Kingdom has reason to be positive in terms of alcohol consumption. Since 2008, there has been a downward trend in the proportion of adults drinking. In 1998, 75% of men and 59% of women had consumed alcohol in the week prior to a department of health interview. In 2011 this proportion dropped to 66% (men) and 54% (women). Over the past decade, there has been a 16% decline in the number of children of school age admitting to regular alcohol consumption. Attitudes are also changing, with fewer young people (9% between 2003 and 2010) agreeing that it was acceptable for a person of school age to get drunk. Unfortunately this shift has yet to translate into a reduction in accident and emergency (A&E) attendances in this age group.
Baby boomer boozers
The cohort of problem drinkers in the United Kingdom however is changing rapidly. Costly healthcare impacts of the binge drinking culture of the 1990's were traditionally associated with 16 to 24 year olds. This demographic have now been surpassed by 55 to 74 year olds, costing Pds. 825.6 million in hospital admissions per year, 10 times that of their younger counterparts. This group of middle aged, and often middle-class drinkers, consistently drink above recommended limits and have the greatest complex care needs. Despite rising consumption within this age group (often parents), there has been a parallel decrease in alcohol consumption among young people. The cultural phenomenon of binge drinking remains a pervasive force for young people but is less likely in children with stronger school bonds that are bought alcohol by their parents, rather than their own expendable income (Bellis et al., 2007).
Alcohol and low- and middle-income countries
A large proportion of global alcohol consumption (24.8%) is homemade, produced illegally or sold outside of normal governmental controls. This unrecorded alcohol is much more prevalent in low- and middle-income countries where unregulated