Tackling Alcohol-Related Harms in England: A Public Health Priority

Alcohol-related harms in England are a significant and growing concern. With the Global Burden of Disease Study 2021 listing alcohol consumption as one of the top ten risk factors for disability worldwide, it’s clear why this issue deserves ongoing attention. Alcohol-specific deaths in England have risen sharply since 2020, with the COVID-19 pandemic accelerating existing trends and amplifying health inequalities. This post explores the state of alcohol-related harms in England, identifies key risk factors, and outlines public health policy options for reducing the burden.

Alcohol-related harms refer to the negative health and social impacts caused by alcohol consumption. These range from chronic illnesses, like alcohol-related liver disease, to social problems and premature mortality.

Recent data highlights the changing nature of alcohol-specific deaths in England. Melissa Oldham and colleagues identified a sharp rise since the start of the COVID-19 pandemic. Men and people in socioeconomically disadvantaged areas have experienced the most pronounced increases, deepening existing health inequalities. The burden is most severe among groups already at higher risk before 2020.

The Escalating Impact of Alcohol-Specific Deaths in England

Alcohol-specific deaths in England have shown worrying trends over the past two decades. Since 2020, the rate has risen by nearly 26% among men, with those from deprived backgrounds seeing an even higher absolute increase. The pandemic appears to have intensified the so-called “Matthew effect”, where disadvantages compound over time, particularly for those most at risk.

Research pinpoints alcohol-related liver disease as the main driver behind this surge, with deaths from this condition rising by over 27%. Chronic liver disease now contributes more to excess mortality than other alcohol-caused conditions. When considering alcohol-specific deaths in England, liver disease stands out as a priority area for health intervention.

However, alcohol-related liver disease also worsens outcomes from other liver conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD) and chronic viral hepatitis, further magnifying the harms. The challenge for health services is enormous. Early diagnosis and treatment are essential, but limited capacity in liver care and existing regional differences in access to services make this a complex issue to solve.

Several issues are contributing to the continued rise of alcohol-related harms in England:

Socioeconomic inequality: The sharpest absolute increases are among those already disadvantaged. Alcohol-specific deaths track closely with deprivation levels, underlining the need for targeted support.
Pandemic effects: The COVID-19 crisis led to sustained increases in heavy drinking, as people turned to alcohol to cope with stress and economic uncertainty.
Underestimated burden: Heavy drinkers increased their consumption the most, while stigma and underreporting may mean the rise among women and vulnerable populations is even higher than recorded.
Health system limitations: Pressure on liver care services hinders early diagnosis and effective intervention, particularly as the number of patients rises alongside other chronic liver diseases.

Alcohol-related harms in England are increasingly associated with chronic liver disease. As alcohol-related liver disease accelerates, the capacity of health-care systems to provide timely screening, treatment, and support is under serious strain. This situation emphasises the urgent need not only to prevent new cases but to ensure existing patients get the care they need without delay.

To further complicate matters, alcohol consumption can worsen other liver diseases. Therefore, public health interventions must adopt a holistic approach, improving overall liver health and addressing underlying social determinants.

What Works? Policy Measures that Reduce Alcohol-Specific Deaths in England

A range of effective public health policies have demonstrated success in tackling alcohol-related harms in England and other high-burden countries. The strongest evidence backs comprehensive alcohol control measures, which include:

Stricter Regulations and Minimum Pricing

Tighter alcohol marketing rules: Limiting the reach and appeal of alcohol advertising, especially where it can influence young people or high-risk groups, can reduce overall consumption.
Minimum unit pricing: Setting a baseline price for alcohol makes cheap, high-strength drinks less accessible, a move proven to cut drinking in lower socioeconomic groups. This approach can help achieve the greatest reductions in alcohol-specific deaths in England by narrowing health gaps.

Improved Access to Treatment and Prevention

Alcohol treatment programmes: Expanding access to specialised care is crucial. The engagement of at-risk individuals with expert support can reduce high-risk drinking patterns and prevent deaths.
Proactive screening: Early detection of alcohol misuse and liver disease through regular health checks leads to better outcomes.

Targeted Community Approaches

Support for vulnerable groups: Addressing the specific needs of communities facing the highest risk, including those with financial hardship or limited healthcare access, creates more equitable outcomes.
Educational campaigns: Raising awareness of the risks posed by alcohol builds an informed public that can make healthier choices.

Addressing Gaps

Despite growing knowledge, there are still critical gaps. The true burden may be underestimated where stigma or limited screening obscures the real picture, particularly among women and marginalised groups. Increased investment in research and better data collection are needed to identify invisible harms.

Source: The Lancet Public Health