1. Alcohol and Health Inequalities Elizabeth Ambler Regional Alcohol Programme Manager Department of Health – East Midlands

2. Aims and Objectives Alcohol Related Harm – What is the scale of the problem? Alcohol and Health Inequalities National and Regional Response to Alcohol Related Harm Guided Group Work: Identification of effective mechanisms and interventions to address inequalities in alcohol related harm and treatment provision Feedback and Next Steps

4. Alcohol Related Harm – What is the Scale of the Problem? The consequences of drinking go far beyond the individual drinkers health and well-being They include harm to the unborn foetus, acts of drunken violence, vandalism, sexual assault and child abuse, and a huge health burden carried by both the NHS and friends and family who care for those damaged by alcohol

5. Alcohol Related Harm – What is the Scale of the Problem? Since 1970, alcohol consumption has fallen in many European countries but has increased by 40% in England The annual cost of alcohol-related crime and public disorder has been estimated at £7.3bn, the cost to employers has been put at £6.4bn Source CMO report 2008. Passive drinking: The collateral damage from alcohol

6. Alcohol Related Harm – What is the Scale of the Problem? There are around 16, 000 premature deaths each year in England and Wales associated with alcohol misuse – double the number since the early nineties Alcohol related hospital admissions are increasing at a rate of 70, 000 per year in England In the East Midlands in 2008/9 there were 79,872 alcohol related hospital admissions (an increase of 5% from the previous year)

7. Alcohol Related Harm – What is the Scale of the Problem? There are an estimated 1 in 13 people dependent on alcohol in the UK, with several million more drinking excessively to the extent where their health is at risk

8. Alcohol Related Harm in the East Midlands

10. Hospital Admissions in the East Midlands for Ethanol Poisoning

11. What are the Health Consequences of Alcohol? Drinking regularly over the low risk guidelines can lead to serious health problems including: - Certain types of cancer - High blood pressure - Heart disease and stroke - Liver disease

12. Non-Health Consequences of Alcohol 50-73% of assault victims injuries Around 50% of all serious road crashes Nearly 50% of domestic violence against females 47% of serious injuries 40% of self-poisoning Source: Alcohol Concern

13. Alcohol and the family Approximately 1 million children live with a parent who is dependent on alcohol

14. Inequalities and Alcohol Problem drinking is twice as common in the poorest as in the most affluent Deaths from diseases caused by alcohol show a clear gradient with socioeconomic position, with an almost fourfold higher rate in unskilled working men compared to those from professional groups Alcohol is a contributory factor to deaths from accidents, which also show a pronounced socioeconomic gradient

15. Inequalities and Alcohol Poor women are more likely than the affluent to report being drunk Higher levels of consumption of alcohol have been consistently observed in some deprived groups, such as unemployed people and those who are homeless Problem drinking is associated with delinquency, criminality and violence, including domestic violence and child abuse

16. Inequalities and Alcohol Heavy drinking in people in higher socioeconomic groups may be less harmful than in lower socioeconomic groups because they are protected from harmful effects by better diet, housing, health care and other factors People with alcohol-related problems who are disadvantaged in other ways, through having limited financial or social resources or being homeless, may have less access to appropriate treatment services for all their needs, including treatment of their alcohol- related health problems Source: The Acheson Report 1998

17. Inequalities in Health Consequences The most deprived fifth of the population suffer two to three times greater loss of life attributable to alcohol; three to five times greater mortality due to alcohol specific causes; and two to five times more admissions per hospital because of alcohol than the most affluent areas On average men living in the more deprived areas lose 17 months of life and women lose 7 months of life due to conditions related to alcohol compared with 6 months for men and 3 months for women living in more affluent areas Source: Intellingence East Midlands Briefing: Alcohol and the East Midlands

18. Intervention Tiers Tier 4 - Tertiary treatment services Tier 3 - Highly specialised services Tier 2 - Brief and further interventions Tier 1 - Universally targeted

19. Indices of Multiple Deprivation The seven domain indices are: Income Employment Health Deprivation and Disability Education, Skills and Training Barriers to Housing and Services Crime Living Environment

20. NI39 admissions by IMD

21. Alcohol specific admissions by IMD

22. National and Regional Response to Alcohol Related Harm Safe. Sensible. Social. The National Alcohol Strategy Priority actions: Support for local partnerships and communities Early identification interventions and treatment for drinking that could cause harm Tackling alcohol related offending Replacing glassware and bottles in high risk premises Underage sales Responsible retailing and promotions Promoting a culture of sensible drinking Support for harmful drinkers Preventing harm to those under 18

23. National and Regional Response to Alcohol Related Harm The Alcohol Improvement Programme The Alcohol Improvement Programme is commissioned by the Department of Health for 3 years from April 2008 Focuses on 7 High Impact Changes (HIC) to coordinate delivery of Alcohol Harm Reduction

24. Early Implementor PCTs NHS Planned delivery on ARHAs Implementation Support Priority access learning Evidence Trailblazers (SIPS), ANARP, MoCAM Effectiveness review, HES data,etc Trailblazers (SIPS), ANARP, MoCAM Effectiveness review, HES data,etc PCTs (Unplanned) delivery on targets through implementation of elements of the high impact actions learning Alcohol Interventions Improvement Centre Enabling change Priority support to early implementor PCTs. Tools: Learning sets, collaboratives, etc Learning Centre Collects, co-ordinates and disseminates learning and good practice. Tools: SIPS toolkits, HuBCAPP, e-learning resource NST(DH) Supports 18 challenged PCTs. Diagnosis, strategic reports & follow-up visits Review Support Regional co- ordinators (DH/SHA) Support local partnerships in delivery learning DH Policy Team Role: Work with outside bodies to facilitate frontline delivery. Develop policy, Develop Guidance, Commission, co-ordinate and contract manage support projects, channel expertise, learning NWPHO Provide local data on need and key evidence Start delivering ARHAs Receive priority support from AIP Implement high impact actions Support Influence

25. National and Regional Response to Alcohol Related Harm The High Impact Changes HIC 1 – Work in Partnership HIC2 – Develop activities to control alcohol misuse HIC 3 – Influence change through advocacy HIC 4 – Improve the effectiveness and capacity of specialist treatment HIC 5 – Appoint an alcohol worker HIC 6 – IBA, provide more help to encourage people to drink less HIC 7 – Amplify national social marketing priorities

26. National and Regional Response to Alcohol Related Harm The Alcohol Learning Centre An on-line one-stop-shop which collates, co-ordinates and disseminates learning and promising practice from across the NHS and the Third Sector It contains alcohol specific policy documents, guidance and tools and provides training resources to support frontline practitioners and commissioners

27. National and Regional Response to Alcohol Related Harm Regional Improvement Plan Understanding need/challenge Supporting networks Partnership self assessment Influence performance management Amplify national campaigns Social marketing/research Supporting providers Supporting commissioners

28. What is the Region Doing to Address Inequalities in Alcohol? Collaborative practice Dissemination and adaption of national strategy at a local level Assessment and evaluation of interventions Build up evidence base Avoidance of wheel reinvention Local, regional and national links. Utilise HubCapp

29. What is the Region Doing to Address Inequalities in Alcohol? Specific projects with offenders Specific work with BME/emerging communities groups Collaboration across all sectors

30. Guided Group Work Overarching theme: How can we work at regional level (DH and OneEM) to coordinate and up- weight approach to identify gaps in services and how to address them Topics/issues BME/hard to reach groups Children and young people Social marketing campaigns IBA integration into other settings Workplace policies Signposting to services