Ian Hamilton: The inequality of deaths from alcohol

Having evidence of how to reduce alcohol related harm is not enough, political will is also required, says Ian Hamilton

The good news is we are collectively consuming less alcohol in the UK, but the bad news is revealed in the latest data from the Office for National Statistics, which shows that over the past two years record numbers of us have been dying due to alcohol. This is perhaps not what you’d expect if we are drinking less. This paradox might simply reflect the time lag between developing risky levels of drinking and then dying as a consequence. However, the consequences of harmful drinking are influenced by more than just time. 

A death due to alcohol can say as much about a person’s social conditions as it does about the toxic impact of the drug. From your risk of exposure to alcohol through to death, inequality marks every part of the journey. Where you are born and grow up affects your risk of problem drinking, with those in deprived communities facing an elevated risk compared to their peers in more affluent areas. 

Add to this the role that diet, exercise, and other lifestyle factors have in mitigating or amplifying the effect of drinking on health, and the odds are heavily tipped against people who are poor and face other disadvantages. Yet it doesn’t end there—inequality extends to the way support is provided for people with problems with alcohol. Even if you are willing to admit you have a problem, finding a service that provides the specialist help needed is dependent on where you live. People’s access to addiction services varies between areas—and not based on known geographical need. Alcohol deaths are concentrated in deprived areas, yet these are the same areas that have faced the deepest cuts to specialist support services. 

Not only is there a time lag between risky drinking and death, there is a lag between cutting public health budgets, which include specialist alcohol treatment services, and the consequences of that decision, which has seen a corresponding rise in deaths from alcohol. This is particularly depressing as we know that interventions aimed at reducing the harm alcohol poses to individuals can be successful if they are prioritised and adequately funded. Unfortunately, having evidence of how to reduce alcohol related harm is not enough, political will is also required.

It is an inconvenient truth for the alcohol industry that their products cause harm; they have funded or organised some relatively small scale campaigns in an attempt to reduce harmful use of their products. However, some of these campaigns have been criticised as being ineffective or producing confusing messages about the risks of drinking. 

In a move that cleverly reframes responsibility for harmful drinking away from the industry and onto the individual drinker, politicians are in chorus with the industry in promoting the ideology of individual responsibility and choice—a neat way of absolving the industry’s lack of action in reducing harm. 

The alcohol industry uses a range of marketing techniques to sell its product, none of which is effectively matched by policy makers and public health. They need to adopt an equally nimble and flexible range of interventions to reduce the impact of drinking on the population. Yet that’s unlikely to happen as alcohol marketing budgets and personnel outnumber public health budgets and staffing.

There are other subtle ways in which the perceived risks associated with alcohol are influenced. Think about the way we routinely refer to alcohol. Alcohol is given special status as a drug in our vocabulary as we refer to “drugs and alcohol,” suggesting that alcohol is somehow distinct from other psychoactive substances. This subtle but important demarcation helps support the idea that alcohol is separate and a “cleaner,” less toxic substance than other chemicals consumed.

We could reduce alcohol fatalities by increasing its price and reducing availability, yet policy has taken the opposite direction in recent years. This means that the price of alcohol, relative to income, has fallen at the same time as restrictions on opening times have relaxed. We know that the consumption habits of lower income groups seem to be most sensitive to the price of alcohol. Having a minimum price per unit of alcohol is one way of reducing consumption of cheap, high strength alcohol. After years of legal wrangling drawn out by the alcohol industry, the Scottish government introduced minimum unit pricing for alcohol last year. The early signs are encouraging, as this policy is thought to have reduced the amount of alcohol people purchased (and therefore consumed) in lower income households and households that bought the most alcohol. 

So far the Westminster government has failed to adopt a similar policy and the absence of a commitment to this policy in the Conservatives’ manifesto would suggest this isn’t a priority. Political inaction makes another rise in alcohol specific deaths inevitable, but the associated grief for these individual deaths won’t be spread equally in our communities.

Ian Hamilton is an academic at the University of York with an interest in addiction and mental health. He previously worked as a mental health nurse with people who had combined mental health and substance use problems. Twitter: @ian_hamilton_

Competing interests: I am affiliated with Alcohol Research UK.