Which groups does alcohol affect the most?

According to a recent UK government report, in England, among people aged 15 to 49 years, alcohol is the leading cause of ill-health, disability, and death. Alcohol misuse across the UK is a significant public health problem with major health, social and economic consequences, estimated at between £21 and £52 billion a year. Each year there are over 1 million admissions to hospital for alcohol-related conditions. Linda Bauld specialises in public health at the University of Edinburgh, and alcohol is one of the areas she looks at.

Linda - Alcohol is a serious issue, not just in our society but across the world. And in fact, 80% of UK adults drink alcohol. In many countries, it's far lower. The highest death rates from alcohol attributable mortality in the UK are amongst 50 to 64 year olds, women and men. And that's mostly because of the accumulated effects of alcohol over many years, drinking heavily. The figures you state though around young people, younger adults, are really important. And that's because young adults are less likely to die from other things that older people might die from. But also a small proportion of young adults may be drinking a lot and particularly drinking too much too quickly on a single occasion. And that can lead to accidents, misjudging, risky situations. Unfortunately, things like traffic accidents and mental health issues, importantly, and that's why you see this kind of mismatch. So the burden of harm is in older groups, but for younger people, for a small proportion, there are still serious risks.

Chris - That's age. What about across the social spectrum? Because obviously we know that different people lie on different parts of the social spectrum. Are the effects of alcohol particularly concentrated anywhere there?
Linda - Yeah, so we have something called the alcohol harm paradox. And what you see there is actually the more affluent you are, you're actually more likely to drink. So to give you an example, in the UK about 75% of the highest earners report drinking in the previous week compared to about 45% of the lowest earners. But when you look at death rates, for example male alcohol specific death rates are four times higher in the most deprived areas in England than the least deprived. And this is something that we don't fully understand, this harm paradox. We think it may be to do with a couple of things. The first thing may be this heavy episodic drinking that I may be pointed to for younger people. So there are particular harms if you do that repeatedly, but even on a single occasion there can be accidents and risks. And then the second feature may be just this interrelationship between the other things that people experience in more deprived areas and the alcohol on top of that. So something that scientists, there's a recent systematic review in Lancet Public Health around the harm paradox, still haven't fully understood.

Chris - What's the general trend though? Are alcohol related harms getting worse, staying about the same or are things improving?
Linda - So it's a mixed picture. Since about 2004, 2005, the amount of alcohol consumed in the UK, or the proportion of people reporting drinking ,has actually fallen. And that's particularly the case actually amongst younger drinkers. We have potentially a new generation of teetotal young people. And then you have other young people of a smaller proportion who are drinking a lot. So we haven't seen a huge rise in consumption. In fact, overall at the population level is going down. But when you look at the harmful drinkers there, you've got some very serious consequences. And particularly recently, Chris. So during the pandemic we've seen some of the highest level, in fact the highest recorded ever levels of direct alcohol causing deaths. So in 2020 there were around 9,000, just under 9,000, deaths from alcohol specific causes in the UK. An 18.6% increase compared with 2019. So something went on in the pandemic, which has slightly reversed some of the reductions we'd seen in recent years and that it may just have been due to the fact that heavy drinkers were at home. It was a very difficult time. They were drinking more, they'd maybe been drinking for many years and that period just caused real harm to them.

Chris - Is there any level of intake which is judged to not be health harmful? I just remember Dame Sally Davies, when she was England's Chief Medical Officer, she went viral when she was saying, 'I asked myself before I pick up a glass of wine, do I want breast cancer or do I want to, to have that glass of wine?' I get what she was saying, that there is a health impact, but you're trading that off against something that you enjoy. Do we have any insights into where that risk benefit lies?
Linda - Yes, and I always think we're on safer territory, those of us in public health, when we talk about populations rather than our individual experiences. But as Jane was saying, you know, we've been consuming alcohol for thousands of years. Is there a safe level? Is there a safe drinking? Actually the answer is no. And in public health, we don't really use the term safe because if you look at cancer, which is an area I've done quite a bit of work in it, including in relation to alcohol, actually the gradient of harm starts from tiny levels of consumption for breast cancer, for example. And it gets higher the further you go. So we don't say safe, we say low risk. For some conditions, there's been evidence over the years that tiny amounts of alcohol might reduce your risk of developing and dying from heart disease, ischemic stroke, even diabetes, although that is really contested. So I think the fundamental thing for all of us is to think about, in terms of health, trying to do low risk drinking. So either not drinking at all, which as I say, 20% of adults in the UK don't. Or drinking at safer levels, low risk levels. And that is the CMOs, the chief medical officers guidelines, which are about 14 units a week, which I know to many people doesn't sound like a lot. That's about a bottle and a half of wine, about seven pints of lager. So that's really what we try to encourage people to stay within. But I realize we've just come out of the Christmas New Year's season and that's tricky. And that's why a lot of people decide, for example, in January to take a break from alcohol, which is a good thing for their health.

Chris - Indeed. Linda, thank you very much for the comprehensive summary. That is the University of Edinburgh's Linda Bauld, she's a public health specialist.