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Home > Ireland hit by a tidal wave of alcohol-related cirrhosis.

[Irish Medical Times] Ireland hit by a tidal wave of alcohol-related cirrhosis. (16 Dec 2015)


The RCPI has welcomed the Government’s Public Health (Alcohol) Bill as a huge step forward in tackling the country’s drink problem. Niamh Mullen interviews College President Prof Frank Murray, who has been championing a range of measures to help change the conversation about our damaging relationship with alcohol.

Prof Frank Murray, RCPI President and Consultant Gastroenterologist, has been central to getting Ireland’s hazardous drinking recognised as a public health issue. His motivation comes from his work as a specialist hepatologist at Beaumont Hospital, where he is dealing with what he describes as a “tidal wave of liver disease, due mainly to alcohol”.

Prof Murray and colleagues have been shocked by the increasing number of cirrhosis presentations over the past 20 years and struck by the changing demographic. “The pattern has changed from older men drinking in pubs to men and women, much younger, many drinking at home.”

Fifty years ago the Irish drank five litres of alcohol per person per year. Now we could be described as “twice as drunk”, consuming 11-12 litres each, having peaked at 15 litres. In the same period, consumption in France and Italy, for example, has reduced.

“We have had this rise, rise, rise over time and our liver mortality rate has doubled recently, which is what you would expect, because it takes 20 years of drinking to develop cirrhosis,” he explained.

About 1.3 million people in Ireland are drinking in a hazardous way, with 200,000 dependent on alcohol. Related harms, in terms of health, social care and crime, cost the state around €3.6 billion. Every year 1,000 deaths are directly attributable to alcohol consumption. In Scotland, where the figures are comparable, they put the toll at 20 lives per week.

The reason for all this, Prof Murray believes, is that alcohol has never been more available or affordable, with licenses increasing by 500 per cent in the past 20 years.

In 2012, after several informal conversations with equally concerned colleagues, Prof Murray set up the RCPI’s Policy Group on Alcohol, which he chairs. Last year, the College and Alcohol Action Ireland set up the first public health lobby on alcohol called Alcohol Health Alliance Ireland.

The College does not take a prohibitionist approach but aims to maximise health and well-being and reduce alcohol-related harm.

“People sometimes say we are scaremongering, that alcohol is part of our culture: it is part of being Irish; it is part of the craic and all that. Of course, alcohol is part of our culture and of course alcohol is part of being Irish, but not in the quantities we consume now. Something has changed,” Prof Murray said.

He was not anti-alcohol, he added, but suggested we should drink like the Italians. “We should drink less overall and we should drink in ways that are less associated with binge drinking.”

Huge step forward

The College is “overwhelmingly enthusiastic and positively disposed towards” the Public Health (Alcohol) Bill announced by the Government last week. “For the first time the Bill now makes alcohol a public health issue. That is a fundamental change,” he said.

The introduction of minimum unit pricing (MUP), at 10 cent per gram, is a key measure of the Bill. Scotland and parts of Canada have also introduced MUP. In British Columbia, a 10 per cent increase in the minimum price was associated with a 32 per cent fall in alcohol-related deaths. It also led to reductions in alcohol-related hospital admissions and traffic offences.

Some argue that those outcomes won’t translate to Ireland, that we are different, but Prof Murray told IMT that there was already evidence that alcohol sales were price sensitive. “The sale of alcohol has fallen and risen in response to its affordability.”

The great thing about MUP was that it targeted people who drank a vast amount of alcohol and younger drinkers without penalising moderate drinkers and those drinking in pubs, clubs and restaurants, he added.

Most people in Ireland drink alcohol under-age and a UK study has shown that nine- and 10-year-olds are more familiar with alcohol brands than any other brands. While he was disappointed the Bill did not ban the alcohol industry from sponsoring sporting events, Prof Murray believes we have seen the beginning of the end of sports promotion in Ireland. “I am disappointed but I understand it is part of a process. Everything wasn’t going to come in one Bill. What is in this Bill is a huge amount. I think it is a huge step forward. We have still got a target to go after.”

Media commentators have also pointed out that the Bill does not contain measures to tackle the digital marketing of alcohol to young people. Prof Murray said all aspects of alcohol promotion needed to be looked at and that marketing to young people had been incredibly successful. He agreed with remarks made by Health Minister Dr Leo Varadkar to the effect that action was needed on ads that glamorised alcohol consumption.

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