FactCheck: How many lives will alcohol strategy save?
“Last year there were 1.2 million admissions to hospital associated with alcohol.”
Andrew Lansley, 23 March 2012
“Estimates suggest that in a decade, removing one billion units from sales would result in almost 1,000 fewer alcohol related deaths per year.”
Department of Health press release, 23 March 2012
The government launched a two-pronged attack on problem drinking today.
A minimum unit price will be brought in for the first time, with the floor price reportedly due to be set at around 40p, intended to hit sales of the cheapest spirits and super-strength beers.
At the same time, the Department of Health (DoH) announced the details of a Public Health Responsibility Deal – essentially an agreement with the big drinks manufacturers to cut the strength of various lines of beer, wine and cider.
The press release was accompanied with a flurry of statistics pointing out the evils of drinking to excess. Do they all stand up?
Mr Lansley quoted the frightening figure that there were 1.2 million hospital admissions “associated with alcohol” last year.
That carefully-worded phrase covers a multitude of sins.
First of all, we should point out that 1.2 million admissions doesn’t mean that 1.2 million individuals are ending up in casualty thanks to booze.
One person can be admitted a number of times during the course of an episode of ill health, so the number of people will always be smaller than the number of admissions.
It’s also important to point out that this number is an entirely notional one based on statistical extrapolation, not on a headcount of actual drunken patients done by doctors and nurses.
Analysts decided that a certain fraction of people who, say, fall over and twist their ankle, do so because they are drunk. Extensive anecdotal evidence collected by FactCheck suggests that may well be true.
But what the analysts do next is to assign a value based on the estimated likelihood of a certain percentage of injuries or illnesses being caused or exacerbated by alcohol to every patient.
So if you fall over and twist your ankle for whatever reason you become a fraction – 0.22 per cent of a single drunk patient. And that number is then multiplied by all the people admitted to hospital for falls.
It follows that, if the total number of patients admitted to hospital goes up, then the portion of those admissions theoretically attributed to alcohol automatically goes up too.
So when we see headlines stating that the total of hospital admissions caused by alcohol has soared to a dangerous level, we ought to ask what’s happened to the admissions total.
That big scary number of 1.2 million hospital admissions hides a smaller, harder piece of evidence.
The NHS Information Centre says that, of the 1,057,000 alcohol-related admissions in 2009/10, only 265,200 were for diseases or injuries “wholly attributable” to alcohol consumption, rather than based on abstract fractions.
And cases where the alcohol-specific condition was the “primary diagnosis”, or the main reason for the admission, totalled just 68,400 in 2009/10.
That number has gone up in recent years but part of the rise may be due to more types of condition being included in the data since 2009, so that doesn’t tell us a whole lot about what’s really going on.
A thousand fewer deaths?
The total number of deaths related to alcohol consumption in England has been climbing steadily for years but actually fell for the first time by 2.7 per cent from 6,768 deaths in 2008 to 6,584 in 2009. The main reason was a 5.6 per cent decrease in deaths from alcoholic liver disease.
It’s not clear that figures from other parts of the UK are exactly comparable, but our best estimate for alcohol deaths for the whole country is about 10,000.
DoH say their agreement with the big brewers and supermarket chains will lead to a billion fewer units of alcohol on sale, and that will reduce alcohol-related deaths by 1,000 a year.
A billion units of alcohol disappearing from the shelves sounds like a lot, but it’s about 2 per cent of the total consumed in Britain each year, according to figures from the OECD and the British Beer and Pub Association.
They put the annual consumption of alcohol in the UK at 50 billion and 52 billion units respectively (a unit is 10ml of pure alcohol).
So DoH appear to think that a 2 per cent reduction in alcohol consumption will lead to a 10 per cent reduction in fatalities.
On the face of it, that doesn’t pass the common sense test, but there is apparently an academic basis for the prediction, and we don’t have much information to go on about how the calculations were done.
A DoH spokesman did tell us that the figures were obtained from “modelling done by Department of Health analysts/economists” based on research into the health effects of alcohol by experts at the University of Sheffield.
But this study by the same team suggests a 2 per cent reduction in consumption would save fewer than 200 lives.
We weren’t able to discuss the findings in detail with the team from Sheffield. When we do, we’ll update this blog.
Research done by the leading analysts at Sheffield University does provide academic ammunition for minimum pricing, suggesting that there should be fewer deaths and hospital admissions as prices rise and consumption falls.
But if that’s true, then the government’s recent position – that booze-related admissions have gone up while consumption has fallen – doesn’t make much sense.
Perhaps one explanation is the lack of robustness of those figures on how many people are really being hospitalised due to drinking.
We’re not going to give Mr Lansley a Fiction on the 1.2 million admissions but we think this theoretical number should be taken with the pinch of salt that many statistics deserve.
On the supposed life-saving effects of a cut in alcohol sales, we’ll have to sit on the fence until we get to the bottom on how DoH did their modelling.