the alcohol harm reduction strategy 2010 – 2020: ‘a good life and alcohol in salford’ scrutiny...
TRANSCRIPT
The Alcohol Harm Reduction Strategy 2010 – 2020:
‘A Good Life and Alcohol in Salford’
Scrutiny Committee Presentation David Herne NHS Salford Deputy Director Of Public Health
Andrew MacDonald DAAT Alcohol Coordinator NHS Public Health Team Alcohol Lead
The National Picture
The Alcohol Harm Reduction Strategy
“ This review has found that progress has been more elusive in reducing harm from alcohol... consumption of alcohol has increased since 1998, accompanied by a rise in alcohol-related hospital admissions and rates of liver disease, suggesting more aggressive, cross-departmental action will be needed in the future.”
Kings Fund April 2010
• Since 1998 there has been an overall increase in drinking that exceeds the recommended weekly limits.
• Change marked among adult women, described as a ‘robust trend’ General Household Survey / Health Survey for England (2009)
Kings Fund April 2010
• Overall, no sign that the government’s aims to reduce harmful alcohol consumption have been achieved.
• Much potential improvement lies outside the NHS, including greater control of advertising, pricing strategies, and initiatives to limit the physical availability of alcohol.
• Little evidence that existing policies on alcohol misuse is having any success.
• The question of whether policy should focus on strong state action (akin to smoking ban) as to pricing and availability of alcohol, or on individual behaviour change
• E.g. information or incentive programmes
• Given the scale of the challenge, there is a strong case for saying government need to draw on all available approaches where there is evidence of their effectiveness
Kings Fund April 2010
The Salford Picture
The Alcohol Harm Reduction Strategy
National Synthetic (ANARP)
23% harmful low to medium risk7.55% hazardous medium to high4% dependency high risk
In Salford there are approximately:40,400 hazardous drinkers (23%)13,200 harmful drinkers (7.5%)4,200 dependent drinkers (4%)44,000 (26.5%) binge drinkers (cross-over hazardous and harmful)
Newer evidence – underestimate 1:2?
Scale of Alcohol Problems?
Salford Ward Alcohol Related Hospital Admissions –against National Average (per 000)
Mental Disorder (3.08) Liver Disease (0.86)
Pendleton 14.30 2.07
Broughton 12.05 3.04
Weaste & Seedley 10.11 3.05
Blackfriars 9.98 1.92
Langworthy 9.56 3.88
Ordsall 9.10 2.65
Barton 9.06 2.12
Eccles 8.74 1.49
Claremont 8.68 1.01
Little Hulton 8.14 1.57
Winton 8.07 1.25
Swinton North 7.79 1.86
Pendlebury 6.62 2.55
Walkden North 5.69 1.33
Kersal 5.55 0.84
Cadishead 4.06 0.56
Irlam 3.88 0.29
Walkden South 3.21 0.38
Worsley & Boothstown 2.35 1.14
Swinton South 1.91 0.72
Wards with Highest Alcohol
related Liver / Mental Health Problems
Understanding drinking in Salford
The Alcohol Harm Reduction Strategy
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Harmful drinking
Underage
12/13 yrs
peersfun
being a rebelnew experiences
Trainee
14/16 yrs
acceptedrite of passage
proud parentpart of the scene
BingeDrinking17/25 yrs
socialfacilitator
drink to get drunkmeeting partner
Hazardous drinking
pleasurerelaxation/reward
escapism/boredomfollowing the norm
Moderatedrinking
responsibilitiesother leisure activities
family
Habitual
negative triggers – job loss, divorce, death
positive triggers –new partner/ job /child, referral
drinking careers...
women have generally had longer periods of interruption through pregnancy and childcare
National Alcohol Social Marketing Salford High Risk Segments
Segment % Age of Popln.
Characteristics
8 20% Blue collar workers, live in terraces or semi-detached houses rented from local authorities. High hospital admissions, likely to smoke and to drink bitter, lagerand spirits, mostly at home.
9 14% Parents in their late 20's to early 30's - have several young children. Many divorced and/or single parents. Likely to live in flats or terraced houses & be unemployed or unskilled. High hospital admissions, likely to smoke, eat fast food and drink vodka and canned lager.
12 14% Broad range of ages, likely to live in terraces in former industrial areas. Generally have the worst levels of overall health, with asthma, cholesterol and heart conditions as well as high acute hospital admissions. Likely to smoke and drink beer/ lager, at home and in pubs.
13 9% Young people in 20s - have a very high rate of acute admissions. Likely to live alone in local authority flats or hostels, be unemployed and some are single parents. Likely to smoke and drink large amounts of beer & spirits.
Profiling key audiences
Underage drinking highest among deprived groups
Binge drinking highest among 16 – 24 yr olds and those living away from home
Dependant drinking including 35 - 54 yr olds – all groups
Hazardous drinking including 25 - 44 yr olds – all groups
Harmful drinking highest among 35 - 64 yr olds – more upmarket
Men and more affluent populations likely to be heavier daily drinkers while more deprived groups suffer burden of ill health
Typical underage profile – Ben from Broughton
% Of Young People Involved In
0
5
10
15
20
25
30Heavy Alcohol Drinking
Underage DrinkingHeavy Smoking
Aids
Teenage Pregnancy
Soft Drugs
Hard Drugs
Gambling
ObesityBulimia
AgressionDepression
Suicide
Taking Risks
Stealing
Being Racist
Vandalism
Cheating
Being BulliedVictim Of Racism
Youths 11-19's
• Ben is almost 14 – he feels very grown up and resents still being treated like a kid. His friends are everything and he will do what it takes to fit in and not to stand out. He is bored and craves freedom and excitement, so experiments with drink he nicks from home or gets his mates brother to buy. He loves the buzz and risk. He connects to the world through his computer and mobile and music is his way of escaping. He enjoys watching Hollyoaks and Skins on TV and getting something for nothing like magazine freebies.
‘friendship is the most important thing
in my life’
‘I like to enjoy life and don’t worry about the
future’
Sarah is 18 and has left school. She can’t get a job and doesn’t really know what she’s going to do in life. She likes to enjoy herself and regularly goes out drinking with her mates and goes out to get drunk – its trophy behaviour and something to talk about afterwards. She loves to keep up to date on the latest celebrity news and buys several glossy mags a week. Sarah doesn't worry about the future and loves to buy things on impulse. She doesn’t think that health checks are important as life is for living now. She feels like she knows it all and is strongly independent.
Typical binge profile – Sarah from Swinton
‘I am usually first amongst friends to know what’s going on’ (index
168)‘I like taking risks’ (index 245)
‘Rules are made to be broken’ (index 210)
‘I am easily swayed by other people’s views’
(index 298)
‘I worry a lot about myself’ (index 189)
Typical hazardous profile – Lou from LangworthyLou drinks most evenings to relax after a day juggling kids and work. She deserves it and there is not much else to do anyway. Like 8 out of 10 other women in her shoes, she drinks to relieve stress and feels she deserves it because there is not much else to do anyway – it fills a gap. She drinks cheap wine, mostly when the kids are in bed and she has put her feet up to watch TV. She is concerned about her weight and often diets or skips meals to compensate. She feels life is a struggle and when she goes out, she really goes for it to escape.
“I wake up covered in bruises and have no
idea where I got them from, we call then UID’s, unidentified drunken injuries”
“I really go for it at the weekends, I get a
babysitter and don’t come home until 4
o’clock”
Typical harmful profile – Pete from Pendleton
Pete is a builder and works hard all day to support his family. He was born and bred in Salford and going to the pub is just part of life. He has very traditional macho attitudes likes to get out of the house and have a laugh with his mates in the pub. He knows he probably drinks too much but doesn’t care – he’s only doing what everyone else does and needs the escape from the stress of providing for his family. He knows he should probably do more about his health but hates going to the doctors unless he is really unwell.
Typical harmful profile – William from Worsley
• William is a bank manager and has worked hard all his life to do the best for his family. He believes in duty and conscientiousness, is confident and status conscious, motivated by rewards and prestige. Alcohol is a part of life - he drinks to entertain clients, to de-stress after a day at the office and will pay more for quality beer and wine. He is aware of his waistline, tries to eat healthily and does think about calories and cholesterol. He eats out in gourmet restaurants with his wife and friends regularly. He enjoys quality red wine with dinner, followed by a good cigar and large whisky. He tends to have more health problems than most and does go to his GP for periodic check ups
“Drinking is just part of my everyday life”
Over 50% of daily drinkers are 55+. 62% are male and 56% are AB’s or C1’s.
C225%
C128%
AB28%
E6%D
13%
The biggest challenges:
-To encourage people to see they have a problem at all
-To get them to care enough about life to want to do something about it
The biggest opportunity:
- Prevent alcohol even becoming an issue in the first place- Change the social norm (will take a long time and commitment from all)
Social Marketing Conclusions
The Salford Strategy
The Alcohol Harm Reduction Strategy
Drivers of Alcohol Related Harm
Driver 1: Provision of high quality treatment
Driver 2: Alternatives to alcohol
Driver 3: Well managed supply
Driver 4: Appropriate attitudes safe alcohol use
Driver 5: A well managed environment
Strategic Objective 1: Provision of high quality treatment
Exemplar Actions: • Equitable substance misuse service over 25s • Effective treatment via GPs, Criminal Justice and
Hospital staff. Treatment will include screening, advice, community detoxification, talking therapies, residential detoxification, rehabilitation and recovery
• Self help groups for problem drinkers widely available• Social marketing Insight to develop manage emerging
issues e.g. women’s increased drinking and risks in pregnancy
• Wellness Service = easier access to holistic treatment offer encompassing alcohol, tobacco and healthy weight growing to link in with the Life Chances Pilot
Strategic Objective 2: Alternatives to Alcohol
Exemplar Actions: • Effective campaigns and interventions in homes,
schools, workplaces, public space, to develop self knowledge, self-awareness and self-efficacy
• Front line brief advice screening and interventions• Lifestyle campaigns and interventions reduce barriers to
seeking help • An equitable service for under 25s• Young people offered positive activities• Young people engage mainstream activity and lifestyles
Strategic Objective 3: Well managed Supply
Exemplar Actions: • Regional / National examples of good practice for
managing local supply• Develop a quality mark approach similar to the Best Bar
None scheme • Develop existing good practice on control of sales to
under 18s sales in line with national best practice in the local context
Strategic Objective 4: Appropriate Attitudes
Exemplar Actions:
• Social Enterprise local solutions on and off sales of alcohol and related services and activities
• Social marketing campaigns, interventions and services• Community projects to shift local attitudes to alcohol use
through Neighbourhood and Health Improvement teams
Strategic Objective 5: Well Managed Environment
Exemplar Actions: • Homeless drinkers - GM hospital discharge protocol• Alcohol Free Zones public places. • Social Enterprise led sale alcohol = alcohol is cheaper out
than at home, encouraging family life, social cohesion, managing consumption
• Education, training, employment, ‘volunteering / occupation’ via Social Enterprise e.g. time bank
• Alcohol Free Space for families, young people, adults, older people = help those in recovery
• Salford Workforce encouraged to set an example• Salford Employers Workplace Alcohol Policy within
Greater Manchester Action Plan e.g. Human Resources / Occupational Health ‘wellness’ staff.
Any thoughts?...