barcelona . spain - European Association for the Study of the Liver

BARCELONA . SPAIN
20 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 21
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012
attributable liver mortality. In northern Europe, a combination of primarily economic and market factors have
contributed to increased levels of total consumption and its associated harm, whilst in southern Europe
social changes and health awareness have contributed to the downward trend in alcohol-related liver
deaths from previously very high levels. For many years mortality rates in Northern and Southern Europe
looked to be converging, but have crossed over the trends are continuing. In the UK mortality rates and
hospital admissions driven cheap alcohol continue to increase. Alcohol consumption in the WHO European
Health Region remains the highest in the world and emerging trends, such as those seen among young
people in Italy, mean that policy action needs to be taken to ensure that the decrease in liver cirrhosis is
maintained. In global terms, Europe’s alcohol control policies are still not proportionate to the level of overall
harm from alcohol.
Taxation policy emerged as a crucial lever impacting upon alcohol consumption. In both the UK and Finland
lower tax rates have helped to contribute to making alcohol more affordable. In an EU context the relaxation
of restrictions in cross border trade has had very deleterious effects in terms of taxation, price and alcoholrelated
ill health.
The marketing activities of the alcohol industry and retailers have had a huge impact in young people.
Self regulation in this respect has failed, and other mechanisms need to be explored. The UK House of
Commons Health Committee has recommended a fully independent regulatory authority to control alcohol
marketing, and the EU would do well to examine these proposals carefully.
However the reduction in liver deaths in France has occurred alongside an increase in profitability of the
wine industry as a result of the industry model shifting from one based on quantity (the current UK model)
to one based on quality, and here the EU in the form of the common agricultural policy may have had a
beneficial effect, driving down the amount of cheap alcohol that is produced in order to protect farmers.
approaches are ineffective on the whole(4). The alcohol strategy has a number of components including the
EU Alcohol Forum, which again brings health and industry representatives together in a forum for action.
The EU liver community has been an active member of this forum via EASL and the RCP although other
than a promising work stream on the monitoring of marketing communications, hard outcomes have been
few and far between.
In 2011 the EU alcohol strategy will need to be renewed, initial soundings from the Commissioner for
Health were not promising, but a recent meeting of member states offered unanimous support for a new
alcohol strategy which will be informed by an independent evaluation of the previous five years work. The
support of EASL and the EU liver community will be vital over the next year or so as this process moves
forward. The simple truth is that of the 200,000 alcohol related deaths in the EU every year, much due
to liver disease, probably around two thirds are preventable if each country adopted effective policies to
reduce alcohol related harm. The question for the liver community is: “how big is our ambition to tackle liver
mortality and are we prepared to be advocates for the measures needed to achieve it”.
Relationship between liver death rates and population level alcohol consumption
Figure 1
The relationship between standard liver death rates (per 100,000) and overall alcohol consumption (pure
alcohol litres per capita, age 15+) in the 4 countries in the EU (pre 2004) with the largest rises or falls in
liver deaths between 1970 and 2008. Data is from the World Health Organisation, European Health for All
database (HFA-DB): http://data.euro.who.int/hfadb/
Given the tight relationship between death rates and consumption, a reduction on the overall %ABV of
alcoholic beverages is another mechanism whereby consumption can be reduced but profitability of the
wine industry maintained or indeed increased. For example wine at 8.5% ABV is taxed at the same level as
wine at 14% ABV under EU law – a nonsensical system that benefits neither consumer nor industry.
Current alcohol policy in Europe
Alcohol policy in Europe has two streams, at member state level the picture is mixed. Some countries,
notably France, have developed outstanding examples of inventive and effective evidence based alcohol
policy, for example the Loi Evin which has protected young people from the marketing pressures of the
drinks industry. Other countries, notably the UK, have effectively transferred large segments of alcohol policy
to the vested interests of the drinks industry via the ‘Responsibility Deals’. These are bodies comprising
representatives of the alcohol, food and retail industries which aim to introduce voluntary measures to curb
alcohol related harm. This untested approach has drawn approbation from the health community in the UK
who refused to sign the relevant agreements in 2010.
The EU Commission alcohol strategy commenced in 2006, and has five priority areas:
• Protect young people, children and the unborn child;
• Reduce injuries and death from alcohol-related road accidents;
• Prevent alcohol-related harm among adults and reduce the negative impact on the
workplace;
• Inform, educate and raise awareness on the impact of harmful and hazardous alcohol
consumption, and on appropriate consumption patterns;
• Develop and maintain a common evidence base at EU level.
Political imperatives and the subsidiarity of EU taxation has meant that the Commission has also been
heavily reliant on voluntary actions and self regulation by the drinks industry despite the evidence that such