Trends in European liver death rates: implications for alcohol policy

Abstract

Changing alcohol consumption has led to a three- to fivefold increase in liver deaths in the UK and Finland, and a three- to fivefold decrease in France and Italy. Increasing consumption from a low baseline has been driven by fiscal, marketing and commercial factors--some of which have occurred as a result of countries joining the EU. In contrast consumption has fallen from previously very high levels as a result of shifting social and cultural factors; a move from rural to urban lifestyles and increased health consciousness. The marketing drive in these countries has had to shift from a model based on quantity to one based on quality, which means that health gains have occurred alongside a steady improvement in the overall value of the wine industry. Fiscal incentives--minimum pricing, restricting cross border trade and more volumetric taxation could aid this shift. A healthier population and a healthy drinks industry are not incompatible.

Fig 1.

The relationship between standard liver death rate (SDR) (per 100,000) and overall alcohol consumption (pure alcohol litres per capita, age 15+) in the four countries in the EU (pre-2004) with the largest rises or falls in liver deaths between 1970 and 2008. Data from the World Health Organization, European Health for All database (HFA-DB): http://data.euro.who.int/hfadb/

Fig 2.

Trends in Finland, France, Italy, UK and the EU (pre-2004) overall in standard liver death rate (SDR) (under the age of 65) over time between 1970 and 2008. Data from the World Health Organization, European Health for All database (HFA-DB) and has been normalised to 100% in 1990.

Fig 3.

Effect of income inflation on the levels of duty on various alcoholic beverages since 1980. Trends in the duty on various alcoholic beverages were adjusted for changes in real disposable income – using a methodology developed by the NHS Information Centre (Statistics on Alcohol 2008) to calculate an Alcohol Affordability Index. The Beverage Duty Affordability Index is normalised to 100% in 1980 and was calculated as follows (using spirits as an example): Spirits Duty Index (SDI) = spirits duty normalised in 1980; Relative Spirits Duty Index (RSDI) = SDI/Retail Price Index (RPI) ×100; Spirits Duty Affordibility Index (SDAI) = Real Disposable Income (RDI)/RSDI × 100. Beverage duty data from Ref 6. RPI and RDI from Statistics on Alcohol 2008.

Fig 4.

Liver death rates and the shift from table wine to higher quality wine consumption in France. Wine consumption data and liver death rate are given in comparison with the year 2000. Wine value is the value of total wine production given in EU Purchasing Power Standard (PPS) – exports increased from 12% to 31% over the same period. Data are from Eurostat (http://epp.eurostat.ec.europa.eu) and the World Health Organization Statistical Information System (www.who.int/whosis).