House of Commons - Health Committee

Alcohol - Health Committee Contents

Addendum to the memorandum by the British Association for the Study of the Liver (AL 20A)

During the course of the a recent verbal evidence session of the Health Select Committee it was suggested by a supermarket witness that UK patients with liver disease were generally 'alcoholics' and that as a result their drinking behaviour would not be susceptible to changes in the price of alcohol.

This assertion is entirely incorrect and the British Society for the Study of Liver Disease (BASL) would like to cite the following evidence in support of the need to tackle cheap alcohol if we are to substantially reduce deaths from alcohol related liver disease.

First; alcohol related liver disease is the most common cause of alcohol related death in the UK from the age of 35 upwards, causing in excess of 5000 deaths each year, with death still rising in 2007 the latest year for which data has been published.[8] Liver death rates are directly related to the overall consumption of alcohol within a population as can clearly be seen in EU countries with the largest changes in either alcohol consumption or liver death rates.[9]

Second; most patients with alcohol related cirrhosis are not "alcoholics" as was stated but heavy regular drinkers with varying degrees of alcohol dependency; only a small minority have severe alcohol dependency.[10], [11]For very many of our patients the first indication that they have a problem is when they are admitted to hospital with fatal liver failure or fatal internal bleeding from oesophageal varices.

Third; liver death rates have nearly tripled since 1980 as a result of the increasing affordability of alcohol, and relationship between liver deaths and affordability of alcohol is extremely close was illustrated in the figure from GUT submitted in our first memorandum[12] (data on affordability—NHS Statistics on Alcohol 2006, and liver death rates WHO-HFA database). As can be seen the relationship between the two is extremely tight and highly statistically significant. A 70% increase in affordability was associated with a 150% increase in liver deaths—an elasticity of around 2.

Fourth; we believe the marked elasticity of liver death rates with regard to changes in the affordability of alcohol may be also related to the fact that mortality from liver disease is very strongly linked to income and social class.[13]

Figure 5

Liver mortality in England and Wales in various NS-SEC groups[14]

(1= most affluent, 7= least affluent).[15]

Fifth; the change in alcohol related mortality in different income groups following a 33% reduction in alcohol taxation in Finland suggests that the impact of fiscal change on death rates is felt strongly in all income groups with the exception of the most affluent, as might be expected. Far from being insensitive to changes in the affordability of alcohol, liver deaths rates are very sensitive—with the effect being greater in those income groups experiencing the most serious consequences.

Figure 6

Change in alcohol related mortality in Finland following the decrease in taxation that resulted from EU membership and the loss of import restrictions on alcohol.[16]

Sixth; BASL would like to point out that people develop alcohol related liver disease only after many years of regular heavy drinking. In the most recent study the median alcohol intake of patients developing significant alcohol related liver disease was 84 units/week. If the minimum price of alcohol was raised to 50p/unit as recommended by the Chief Medical Officer, this alcohol would cost £48/week compared with £10 for man drinking just under the Government recommended safe limit, almost a five fold increase. The only group in society heavily impacted by increases in the price of alcohol are the very heavy drinkers.

Finally; in the 2008 consultation document Safe, Sensible and Social (section 2.12, page 16), the Department of Health stated that three quarters of all alcohol sold in the UK is consumed by people who drink too much for their health.[17]

2.12. The rise in alcohol consumption has lead to the current rapid rise in alcohol harms. These harms are concentrated in the smaller share of the population who drink very large share of the total alcohol consumed. Analysis by DH suggests that 7% of the UK population who regularly drink more than twice the recommended limits drink 33% of all the alcohol consumed in the country. More than 10 million adults (26% of the population) drink regularly at levels that exceed government health guidelines. This accounts for 76% of UK alcohol consumption.

BASL respectfully submit that there is a balance to be found between the price of alcohol and the harm that it causes, and the balance needs re-adjusting.

November 2009