From the Inside: executive summary from the Sainsbury Centre from Mental Health is based on interviews with 98 prisoners in five West Midlands prisons. It finds that the ‘average’ prisoner has a combination of mental health, substance use and other problems. Mental ill health is not the exception but the rule. Women prisoners suffer especially high levels of distress when they are separated from their children.

It sets out what prisoners themselves say they need to improve their mental health: ’someone to talk to’, ’something to do’ during the day and practical help to plan for what they will do after they are released.

Approaches to Alcohol and Drugs in Scotland: A Question of Architecture (Executive Summary) from the think tank Scotland Future Forum takes a systemsmapping approach to how Scotland can reduce the damage to its population through alcohol and drugs by half by 2025.   It has a compantion volume in 12 Dimensions of a Manageable Problem.

It states that drug use has been historically seen as a justice issue but should be treated as a health, lifestyle and social challenge. A greater proportion of resources should be allocated to treatment research, monitoring and evaluation. The concept of drug consumption rooms and heroin-assisted treatment to combat the high levels of drug-related deaths and hepatitis C infection is considered along with law enforcement.  The report finds prison unproductive and unsustainable for low-level alcohol and drug offences.  It also recommends cannabis should be taxed and highly regulated to help reduce availability and harm.

Statistics on Alcohol: England, 2008 presents a range of information on alcohol use and misuse which are drawn together from a variety of published sources and includes additional analysis undertaken by the NHS Information Centre for health and social care which is presented in a user friendly format. The report aims to present a broad picture of health issues relating to alcohol in England and covers topics such as drinking habits and behaviours among adults and school children, drinking related ill health and mortality, affordability of alcohol and alcohol related costs. Government plans and recommendations in this area are also summarised in the report.

Key facts

Drinking among adults

• in England in 2006, 72 per cent of men and 57 per cent of women reported drinking an alcoholic drink on at least one day in the week prior to interview. Twelve per cent of men and seven per cent of women reported drinking on every day in the previous week

• in Great Britain in 2007, 69 per cent of people reported that they had heard of the government guidelines on alcohol consumption. Of these people, 40 per cent said that they did not know what the recommendations were.

Drinking among school children

In England in 2006, among pupils aged 11 to 15:

• 45 per cent of pupils said they had never had a proper alcoholic drink (a whole drink and not just a sip), an increase compared to 39 per cent in 2001

• 15 per cent of pupils thought it was okay to get drunk at least once a week, this figure was 30 per cent for 15 year olds.

Drinking-related ill-health and mortality

In England:

• in 2007, there were 112,267 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings; an increase of 20 per cent since 2003 when there was 93,241 prescription items

• in 2006/07, there were 57,142 NHS hospital admissions with a primary diagnosis specifically related to alcohol. This number has risen by 52 per cent since 1995/96. Of these admissions, 4,888 (nine per cent) involved patients under 18 years of age

• in 2006/07, NHS hospital admissions per 100,000 population varied regionally throughout England. In 2006/07 the North West Strategic Health Authority had the highest rate of 170 admissions with a primary diagnosis specifically related to alcohol per 100,000 population, and the East of England Strategic Health Authority showed the lowest rate of 72 admissions per 100,000 population.

The addendum guidance sets out the process for assurance of the delivery of the capital development programme for inpatient and residential substance misuse (drug and alcohol) services 2007/08 and 2008/09, including guidance on the reallocation of funds. The National Treatment Agency (NTA) via Regional Forums is managing this process.

Individual responsibility for health and self-care are key themes in recent health policy development in England. The King’s Fund have addressed the issue with three papers:

• Paying the Patient: Improving health using financial incentives identifies programmes based on both positive and negative incentives, finds that financial incentives are effective in encouraging people to perform clearly defined, time-limited, simple behavioural tasks, and also in encouraging participation in lifestyle programmes.However, healthier behaviour is not maintained and financial incentives are not effective when the behaviour change required is complex, for example, giving up smoking.
• Low-income Groups and Behaviour Change Interventions: A review of intervention content and effectiveness considers interventions targeted specifically at low-income groups, this paper asks which interventions are effective in getting people to quit smoking, eat healthily and exercise. It reveals that the most frequently used techniques are providing information and encouraging people to set goals, which can be particularly effective at changing behaviour in disadvantaged groups.
• Using Information to Promote Healthy Behaviours looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes. Information-based health campaigns are a major part of the government’s health promotion strategy. A £75 million marketing programme has recently been announced to encourage healthy behaviour in children. This paper looks at the theory and selected evidence of interventions in practice, and what this can tell us about the role of information in behaviour change programmes.

Two more papers are due in the Kicking Bad Habits series before a final report is drafted.

Trailed in today’s media the report Risky drinking in North West school children and its consequences: A study of fifteen and sixteen year olds is a study of 9,833 15-16 year old school children in the North West, examining relationships between risky drinking behaviours (binge drinking, frequent drinking, drinking in public places) and demographics, income, leisure activities and access to alcohol. Negative consequences of risky drinking such as violence and regretted sex are also investigated.

Top tips for health in Local Authorities commissioned by ChaMPs (Cheshire and Merseyside Public Health Network) and from the Liverpool Public Health Observatory offers practical tips on joint working between the NHS and Local Authorities in the areas of:

• Reducing health inequalities

• Tackling obesity: Creating opportunities for healthy eating

• Tackling obesity: Creating opportunities for physical activity

• Improving mental health and well-being

• Promoting sexual health

• Encourage the sensible drinking of alcohol

• Creating a smokefree environment

The press have had a field day (reports from 5th March, reports from 4th March) with Evaluation of the Impact of the Licensing Act 2003 from the Department for Culture, Media and Sport the report finds that:

• There is no evidence of 24 hour drinking, with only a minority of premises securing 24 hour licences and very few actually utilising those hours. Only limited changes to actual opening hours.

• The overall volume of incidents of crime and disorder has remained stable and not risen.

• There is no evidence of increases in overall alcohol consumption.

• There has been no serious adverse impact on the provision of live music.

Positives

• Transfer of alcohol licensing to local authorities is viewed as a success.

• The alcohol licensing system is more democratically accountable and residents are better able to influence licensing decisions.

• There is much better partnership working between local authorities, the police and other responsible authorities and licensees.

• The new powers, including the ability to review licences, have been welcomed by local authorities and the police, and are being used to good effect.

• Administrative arrangements for the new regime appear to have delivered the administration cost savings to businesses, third sector and other licence holders of around £99m a year.

Negatives

• There is no clear picture of consistent improvements in all areas.

• There is evidence of displacement of violent offences into the small hours.

• Use of the new legislation, in conjunction with other interventions and as part of a coherent strategy, may vary between different authorities and areas.

• There has yet to be a discernible change in the diversity of evening and late night venues, although there is some evidence of good practice and success in certain areas.

• While benefits in terms of bureaucracy and red tape have been delivered, some stakeholders are experiencing difficulties, which suggest that the regime could be more proportionate in its application.

• Reform has not led to the increases in events hoped for by Ministers, and the regime may be disproportionate for some types of live music events and other types of events.

The impact of the Licensing Act 2003 on levels of crime and disorder: an evaluation (Executive Summary) from the Home Office looks at the impact of 24 hours licensing onviolent crime. Key findings are:

• In the run-up to implementation, there was widespread concern that the legislation would lead to ‘24-hour drinking’ and an increase in associated problems. This hasn’t happened.

• No clear signs yet that the abolition of a standard closing time has significantly reduced problems of crime and disorder.

• Variable opening hours and show small uptake, while the majority of pubs have extended their hours, most of these extensions have been short.

• Limited evidence suggests that alcohol consumption has fallen slightly, although some people are drinking until later into the night.

• The overall volume of incidents of crime and disorder remains unchanged, indcation is that crimes involving serious violence may have reduced. However, the small proportion of violent crime occurring in the small hours of the morning has grown.

• Alcohol-related demands on Accident & Emergency (A&E) departments appear to have been stable in aggregate

• Police, local authorities and licensees generally welcomed the changes, the new powers it gave them, and the Act’s partnership philosophy. They did not report significant problems with implementation.

• Local residents were less likely to say that drunk and rowdy behaviour was a problem after the change than before it, and the majority thought that alcohol-related crime was stable or declining.

• The main conclusion to be drawn from the evaluation is that licensing regimes may be one factor in effecting change to the country’s drinking culture – and its impact on crime – but they do not appear to be the critical factor. The key issue is how they interact with other factors.

Alcohol misuse: tackling the UK epidemic from the BMA, considers the problematic levels of alcohol misuse in the UK and is not aimed at those who enjoy consuming alcohol in moderation. It examines the patterns and trends of alcohol consumption and goes on to review the range of adverse effects both on the individual and society that are associated with its misuse.

Alcohol consumption is causes a wide range of medical conditions and is a significant cause of morbidity and premature death worldwide. It contributes to a range of acute and chronic health consequences, from alcohol poisoning and injuries resulting from traffic crashes to cancer and cardiovascular disease. The more an individual consumes, the greater the risk of harm.

Alcohol misuse is associated with crime, violence and anti-social behaviour, and can impact significantly on family and community life. The cost of alcohol misuse in the UK is substantial, both in terms of direct costs (eg costs to hospital services and the criminal justice service) and indirect costs (eg loss of productivity and the impact on family and social networks).

In a Press Release from the Office of National Statistics relating to the publication of

• Smoking and drinking among adults 2006
• Drinking: adults’ behaviour and knowledge in 2007

Key findings were:

• Alcohol consumption in 2006 was higher in England and in Wales than in Scotland: 13.7 and 13.5 units a week, on average, respectively, compared with 11.6 units.

• Men and women in households classified as ‘routine and manual’ drank less (11.6 units a week), on average, than those in other types of household. Those in ‘managerial and professional’ households drank the most (15.1 units a week).

• The overall prevalence of cigarette smoking among the adult population (persons aged 16 years and over) fell to 22 per cent in 2006, its lowest recorded level. This downturn follows a period of little change since the second half of the 1990s, when prevalence levelled out at about 27 per cent before resuming a slow decline in the early 2000s.

Tackling Alcohol in Liverpool: Liverpool Alcohol Harm Reduction Strategy 2007 - 2010 will see an extra £10 million allocated to alcohol related issues in the city by Liverpool PCT.  Key initiatives include:

• Rapid response paramedic scheme combining police and ambulance staff
• Development and commissioning of an interactive CD-ROM and teaching pack the encourage learning and discussion about the health and social issues relating to alcohol for 6 - 11 year olds.
• Commissioning Health@Work to tackle alcohol related harm in the workplace and people of working age.

• Alcohol and schools intervention
• Asthma (in children) - corticosteroids
• Hypercholesterolemia - ezetimibe
• Asthma (for severe persistant allergic) - omalizumab
• Grenz rays therapy for inflammatory skin conditions
• Percutaneous Pulmonary valve implantation for right ventricular outflow tract dysfunction
• Mini/Micro screw implantation for orthodontic anchora ge
• Laparoscopic techniques for hysterectomy
• Soft palate implants for simple snoring
• Soft palate implants for obstructive sleep apnoea
• Transcranial magnetic stimulation for severe depression

‘Public Health: Ethical Issues’ from the Nuffield Council on Bioethics (Executive summary, One page summary, Short Guide) considers the responsibilities of government, industry, individuals and others in promoting the health of everyone. It concludes that the state has a particular duty to help people lead a healthy life and to reduce inequalities. The Council propose a ‘stewardship model’, to achieve this.  Consideration of the acceptability of different public health measures, and the responsibilities of industries that promote products that affect our health are undertaken by the report. Recommendations for policy are made in four areas:

• Infectious disease

• Obesity

• Alcohol and tobacco

• Fluoridation of water

The media have picked up on the report here.

The Health profile of England 2007 provides a collation of national and regional data to provide a baseline against which people can compare data from their own Local Health Profile (LHP). The 2007 report updates tables showing regional comparisons and national trends for indicators presented in LHP, as well as a wide ranging snapshot of public health and well-being in England and a section on international comparisons.

• A general improvement in health outcome
  The report shows recent improvements in a number of critical areas, e.g.:
  • declining mortality rates in targeted killers (cancers, all circulatory diseases and suicides)
  • increasing life expectancy, now at its highest ever level
  • reducing infant mortality, now at its lowest ever level

Challenges remain to achieve and sustain progress, e.g.:
• rising rates of diabetes

• Similarly for the determinants of health,
  • Improvements in some important areas, e.g.:
  • the number of people who smoke
  • quality of housing stock
  • Areas of concern, e.g.:
  • increasing levels of obesity in adults and children
  • high levels of teenage pregnancy
• Health inequalities are often present
  • The report illustrates various geographical inequalities across the UK
• International comparisons give a wider context presenting national progress in comparison to countries of the European Union (EU), or to the 15 countries that were members of the EU prior to 2004 (EU-15), e.g.:
  • Premature mortality rates from the two biggest killers, circulatory diseases and cancer, are reducing faster in England than the average for the EU
  • Death rates from motor vehicle traffic accidents in the United Kingdom are amongst the lowest in EU
  • The prevalence of obesity in England is the highest in the EU
  • Death rates for chronic liver disease and cirrhosis have risen markedly, particularly since the mid-1990s, and for females, latest data show England has risen above the EU-15 average
  • The percentage of all live births to mothers under age 20 in the United Kingdom remains the highest when compared to other EU-15 countries.

You can see the mass media’s take on this report on 23rd October 2007.

Out of the North West Public Health Observatory are the Local Alcohol Profiles for England. With a simple map based interface the profiles offer geographical indicators relating to alcohol use. It links also to Alcohol Indications the eighth in a series of national reports produced for the Chief Medical Officer (CMO) by the Association of Public Health Observatories (APHO) it contains 36 different indicators of alcohol-related harm, health and behaviour across all nine English regions; with analysis of sub-regional inequalities where possible.

Media coverage from the 16th October can be viewed here (local news here).