Evidence into Action (and Action into Evidence) Dr Lesley Graham ISD

UK consumption

Alcohol Problems in Scotland Enough alcohol is sold in Scotland for every adult over 18 to exceed male weekly limits [Health Scotland 2010] Enough alcohol is sold in Scotland for every adult over 18 to exceed male weekly limits [Health Scotland 2010] Excess consumption is across all age and socio- economic groups [Scottish Health survey 2009] Excess consumption is across all age and socio- economic groups [Scottish Health survey 2009] 1 in 20 deaths attributable to alcohol [Grant, Springbett and Graham 2009] 1 in 20 deaths attributable to alcohol [Grant, Springbett and Graham 2009] Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related death [Alcohol Statistics Scotland 2009] Those from the most deprived areas in Scotland are 5 times more likely to die an alcohol related death [Alcohol Statistics Scotland 2009]

Chronic Liver Disease mortality rates per 100,000 population updated from Leon and McCambridge, Lancet 367 (2006)

Alcohol and Crime Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders [Scottish Prison Survey 2009] Half (50%) of prisoners in Scotland reported being drunk at the time of their offence, rising to three quarters (77%) of young offenders [Scottish Prison Survey 2009] Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009] Rise in proportion of young offenders who consider alcohol has contributed to their offending (48% in 1979; 58% in 1996 to 80% in 2007) [McKinlay et al 2009] 1 in 6 deaths on British roads are caused by drink driving [Road Casualties in Great Britain 2007] 1 in 6 deaths on British roads are caused by drink driving [Road Casualties in Great Britain 2007] Alcohol related crime is estimated to cost Scotland over £700 million per year [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010] Alcohol related crime is estimated to cost Scotland over £700 million per year [Societal Cost for Alcohol Misuse in Scotland in 2007 University of York 2010]

Alcohol and Violent Crime Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9] Where known, alcohol is a factor in more than two thirds (69%) of those accused of homicide [Homicide in Scotland 2008/9] 70% of assaults in A&E may be alcohol related [QIS 2006] 70% of assaults in A&E may be alcohol related [QIS 2006] In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010] In 62% of violent crime, victims said the offenders were under the influence of alcohol [Scottish Crime and Justice Survey 2010]

Effectiveness of Interventions MeasureEffective? Pricing+++ Availability Age Limit Age Limit Reducing Outlet Density Reducing Outlet Density+++++ Safer Drinking environments Server Liability Server Liability Enforcement Enforcement+++++ Advertising+/++ Treatment Brief Interventions (primary care) Brief Interventions (primary care) Brief Interventions (A&E) Brief Interventions (A&E)+++++ Information and education School education School education Product Labelling Product Labelling Public service messaging Public service messaging ? / + No (on own)

Increased knowledge and changed attitudes to alcohol + drinking Reduced acceptability of hazardous drinking and drunkenness Reduced availability of alcohol Individuals in need receive timely, sensitive & appropriate support A culture in which low alcohol consumption is valued and accepted as the norm Less absenteeism + presenteeism the workplace. Less alcohol related incapacity Reduced alcohol related injuries, physical and psychological morbidity + mortality Fewer brain-damaged children Increased educational attainment Safer & happier families and communities Reduced health, social care, justice costs Healthier individuals and populations Intermediate outcomesLong term outcomes Children in need receive timely and appropriate support Safer drinking + wider environments Increased workplace productivity Less alcohol related violence/abuse, offences and ASB Less absenteeism + presenteeism in educational establishments Fewer children affected by parental drinking Reduction in Individual and population consumption Changed patterns of consumption Reduced affordability of alcohol National outcomes Reduce significant inequalities Model 2: Model 3: Model 4: Model 5: Model 6: Model 7:

Key Events in alcohol in Scotland 2003: ISD alcohol team set up 2005 Alcohol Statistics Scotland published 2007: Scottish Health Action for Alcohol Problems established and publish Price, Policy and Public Health 2007: Health Scotland develop alcohol logic models 2007: SNP government 2009: Alcohol Framework 2010: Alcohol Bill 2011: alcohol and offender conference and publication of reports 2011: MESAS baseline report

What are the key elements for success?

Contact Dr Lesley Graham Public Health Lead for Substance Misuse ISD, NHS National Services Scotland Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB