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Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales

BMJ 2016; 353 doi: (Published 06 April 2016) Cite this as: BMJ 2016;353:i1860
  1. Nick Sheron, head of clinical hepatology,1,
  2. Ian Gilmore, professor2
  1. 1Clinical and Experimental Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
  2. 2University of Liverpool, Liverpool, UK
  1. Correspondence to: N Sheron Nick.Sheron{at}
  • Accepted 29 March 2016

The economic downturn and rises in alcohol taxation seem to have stemmed the persistent rise in alcohol related deaths in England and Wales, but Nick Sheron and Ian Gilmore caution that changes to fiscal policy could see mortality increase once more

The population consumption theory1 2 3 links population level alcohol consumption to alcohol related harm, forming a theoretical basis for modern alcohol control policy. As the late Professor Griffith Edwards stated, other things being equal, “the overall level of a population’s drinking is significantly related to the level of alcohol related problems which that population will experience.”2 The factors that drive alcohol consumption apply to harmful drinkers as well as low risk drinkers, and alcohol related harm is dose related, at both individual and population levels.

According to HMRC duty and tax receipts, UK alcohol sales increased from around 400 million litres in the early 1980s, peaking at 567 million litres in 2008, an increase of around 42%, since when they have declined (fig 1).4 6 During this time alcohol related deaths in England and Wales tripled from 2314 in 1980, to 7312 by 2008, with most deaths being liver related (fig 2). The way alcohol is sold and the types of alcohol consumed have also changed over this period.

Fig 1 Cumulative consumption of alcohol in England and Wales. Consumption of beer and lager is split between weak and strong beverages with a cut-off around 4.24 5

Fig 2 Cumulative alcohol related deaths for England and Wales7 8 9 10

Patterns of consumption are known to be related to price. Mathematical coefficients, termed “elasticities,” linking the consumption of alcohol to price and taxation are used by the Treasury to model fiscal policy11 and by the drinks industry to lobby …

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