TOBACCO POLICY SPECIAL
get drunk and so this behaviour is often not identifi ed as a problem. However this large population (20% of all adults) are increas- ing their risk of developing many health conditions including several types of can- cer, liver disease and heart disease. In a report by 2020health, ‘From one to many: The risks of frequent excessive drinking’, we have specifi cally focussed on this popu- lation.
While many parallels can be drawn be- tween risky drinking and smoking, the difference is that whereas smoking is seen as harmful, drinking is not recognised as such, despite the risks being comparable. The public understanding of the harm of smoking was largely the result of a huge expenditure on mass media education campaigns and a simultaneous ban on to- bacco advertising. Spending on public edu- cation reached a peak of £25m in 2004-5, decreasing to £15m in 2009-10. Given the change in behaviour that resulted from the understanding of the risks of smoking, we believe that a national public health educa- tion campaign is now needed for alcohol to raise awareness of the harm done by risky drinking.
Our research found that even amongst GPs there is low interest in risky drinking, and a much lower priority given to alcohol than to smoking. A survey conducted as part of our research showed that whilst 62% of GPs would always ask patients about their smoking habits, only 18% of GPs would al- ways ask patients about alcohol consump- tion. A greater emphasis on alcohol as a risk factor for chronic conditions is needed to ensure that this problem is addressed in general practice allowing patients to be identifi ed and treated.
Compared to smoking, where many peo- ple now self-refer to NHS Stop Smoking Services, identifi cation of risky drinking is a major barrier to treatment. In 2008, less than 2% of risky drinkers were identifi ed by GPs. Our survey asked GPs to identify the reasons for the low identifi cation of risky drinkers within GP practices. 60% of GPs who responded to the survey stated lack of time with patients as the primary obstacle to increasing alcohol screening. Other rea- sons for low identifi cation include lack of incentives for alcohol screening in the cur- rent contract, a lack of suffi cient training for health professionals in dealing with alcohol problems and concerns with regard to the availability and cost of alcohol services.
The current health reforms shift local re- sponsibility for alcohol services, including the health aspect of these services, to local councils. Public health, working within the
“OUR RESEARCH FOUND THAT EVEN AMONGST GPs THERE IS LOW INTEREST IN RISKY DRINKING, AND A MUCH LOWER PRIORITY GIVEN TO ALCOHOL THAN TO SMOKING.”
councils, will need to ensure that alcohol services are provided across the spectrum of need. Whilst young binge drinkers and dependent drinkers
are highly visible
groups and already targeted in terms of service provision, services also need to be made available for risky drinkers to main- tain the health of the population.
Services to provide brief interventions can be delivered by the nurses working within the GP practice, but it has been suggested that a separate service may be a more ef- fi cient way to provide these interventions and alleviate the problem of lack of re- sources at the practice. Schemes where specialist nurses or health trainers come into GP practices to deliver brief interven- tions have been seen to work in several ar- eas. Internet-based interventions are also effective, and are cheap and easily scalable to a large number of patients. The advan- tage of having a centralised service for a locality is that referrals into this service can easily be made from GPs, A&E depart- ments, but also from public sector workers in other areas or outside of healthcare.
One of the successes in the argument for the high levels of regulation around smok- ing was the harm done not to the individu- al, but to those around him/her and to the rest of society. The concerns around pas- sive smoking led to major changes around the acceptability of smoking in public places. Alcohol also incurs a high cost to the families and friends of those drinking at high levels and to society as a whole. In monetary terms it has been estimated that alcohol costs our society £55bn per year. This includes the cost to health – 7% of hos- pital admissions and 35% of attendances are due to alcohol – the cost to other public services, and a £7bn cost to employers due to absenteeism and presenteeism, as well as the cost to individuals and families.
Given this high cost of alcohol to society, there should be an increase in regulation concerning the sale and advertising of al- cohol. Tobacco advertising is now severely restricted, however the same does not hold for advertising of alcohol. In fact the UK lags behind most other European countries in the restrictions placed on alcohol ad- vertising. It will be very diffi cult for public health to convey messages about the health risks of high alcohol consumption if at the same time drinks companies are continu- ing to spend millions on campaigns rein- forcing positive attitudes to alcohol.
The UK Government need to distance themselves from the alcohol industry and focus more clearly on the health of the nation. More action on a national level is needed to support the work done through public health campaigns and with individ- ual patients locally.
TELL US WHAT YOU THINK
opinion@nationalhealthexecutive.com
national health executive Nov/Dec 11 | 27
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100