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 affordabilityNHS 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 deathsan 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 sensitivewith 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
8 NHS Information Centre. Statistics on Alcohol, England
2009. Back
9
Sheron N, Olsen N, Gilmore I. An evidence based alcohol reduction
policy. Gut 2008 Jun 5. Back
10
Wodak AD, Saunders JB, Ewusi-Mensah I, Davis M, Williams R. Severity
of alcohol dependence in patients with alcoholic liver disease.
Br Med J (Clin Res Ed) 1983 Nov 12; 287(6403): 1420-2. Back
11
Smith S, White J, Nelson C, Davies M, Lavers J, Sheron N. Severe
alcohol-induced liver disease and the alcohol dependence syndrome.
Alcohol Alcohol 2006 May;41(3): 274-7. Back
12
Sheron N, Olsen N, Gilmore I. An evidence-based alcohol policy.
Gut 2008 Oct; 57(10):1341-4. Back
13
Harrison L, Gardiner E. Do the rich really die young? Alcohol-related
mortality and social class in Great Britain, 1988-94. Addiction
1999 Dec;94(12):1871-80. Back
14
White C, Edgar G, Siegler V. Social inequalities in male mortality
for selected causes of death by the National Statistics Socio-economic
Classification, England and Wales, 2001-03. Health Statistics
Quarterly 2009; 38: 19-32. Back
15
8 White C, Edgar G, Siegler V. Social inequalities in male
mortality for selected causes of death by the National Statistics
Socio-economic Classification, England and Wales, 2001-03. Office
for National Statistics; 2009. Report No.: No. 38 Summer
2008. Back
16
Herttua K, Makela P, Martikainen P. Changes in alcohol-related
mortality and its socioeconomic differences after a large reduction
in alcohol prices: a natural experiment based on register data.
Am J Epidemiol 2008 Nov 15; 168(10): 1110-8. Back
17
10 Department of Health. Safe, sensible, social-consultation
on further action. 2008 Jul 22. Back
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