alcohol outlet density, health inequalities and policy traslation: findings from the uk
TRANSCRIPT
31/01/2017
1
Alcohol outlet density, health
inequalities and policy translation:
findings from the UK
Professor Jamie PearceChair in Health Geography
Centre for Research on Environment, Society and Health
University of Edinburgh
@jamie0pearce
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3
Structure
• Geographies of alcohol
• Alcohol retail environment
• Alcohol environment and health in Scotland
• Research translation
• What is missing?
Geographical Contribution
Pbase.com
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Place and Alcohol
• Individual behavioural perspectives
• BUT partial account for social & cultural factors integral to understanding drinking.
• policy response – ‘lifestyle drift’ rather than considered in wider context
• Drinking enabled & constrained by socio-geographical factors
• reality of drinking in everyday life
• how public health messages received, negotiated & mediated
• Individual factors and environments interact to produce spaces that are more or less favourable to drinking
• neighbourhoods, schools, workplaces, etc.
Geographical factors &
alcohol
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Inequalities as central
RESEARCH AIMS
• Scottish study examining:
• social & spatial distribution of alcohol
retailing
• associations between the geographies of
alcohol retailing and
(i) alcohol consumption Assess whether these patterns vary by individual level
socio-economic status
(ii) related health outcomes
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Methods
Controlled for sex, age, religion, marital & socio-economic status, urbanity, neighbourhood deprivation
ALCOHOL OUTLET DATA
• Premises selling alcohol
licensed under the Licensing
(Scotland) Act 2005
• Postcodes of all licensed
premises (16,159) from
Liquor Licensing Boards
(4,800 off-sales and 11,359
on-sales)
• Created a density measure
at the data zone level for the
whole of Scotland for total
outlets, off-sales outlets and
on-sales outlets
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Alcohol outlet density and
drinking behaviours• Linked outlet data to individual level responses to the Scottish
Health Survey (2008-2011 n = 28,765)
• Four measures of drinking:
• Exceeding recommended weekly and/or daily limits (43.5%)
• Harmful drinking (4.5%)
• Binge drinking (21.2%)
• Problem drinking (8.6%)
• Need to cut down
• Feeling ashamed
• Annoyed by criticism
• Shaky hands
• Drinking in morning
• Unable to stop drinking
0.9
0.95
1
1.05
1.1
1.15
1.2
1.25
1.3
1.35
1.4
0.7
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
0.8
0.9
1
1.1
1.2
1.3
1.4
0.8
0.9
1
1.1
1.2
1.3
1.4
1.5
Exceeding Recommendations Harmful Drinking
Binge Drinking Problem Drinking
Controlled for sex, age, religion, marital & socio-economic status, urbanity, neighbourhood deprivation
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Income inequalities
0
10
20
30
40
50
60
Exceeding Harmful Binge Problem
% o
f re
sp
on
den
ts
<£16,339
£16340-£31707
>£31708
Exceeding recommendations
0.37
0.34
0.38
0.43
0.42 0.42
0.45 0.45
0.510.52
0.51
0.53
0.30
0.35
0.40
0.45
0.50
0.55
0.60
1 2 3 4
Pro
bab
ilit
y o
f exceed
ing
reco
mm
en
dati
on
s
Lowest Income Middle Income Highest Income
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Harmful drinking
0.04
0.04
0.06
0.07
0.03 0.03
0.05
0.050.050.05
0.04 0.04
0.00
0.01
0.02
0.03
0.04
0.05
0.06
0.07
0.08
0.09
0.10
1 2 3 4
Pro
bab
ilit
y o
f H
arm
ful D
rin
kin
g
Lowest Income Middle Income Highest Income
Binge drinking
0.17
0.16
0.19
0.24
0.19
0.20
0.230.22
0.240.25 0.25
0.25
0.10
0.12
0.14
0.16
0.18
0.20
0.22
0.24
0.26
0.28
0.30
1 2 3 4
Pro
bab
ilit
y o
f b
ing
e d
rin
kin
g
Lowest Income Middle Income Highest Income
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Problem drinking
0.10
0.11
0.12
0.15
0.08
0.09
0.11
0.10
0.090.09 0.09 0.08
0.05
0.07
0.09
0.11
0.13
0.15
0.17
0.19
1 2 3 4
Pre
dic
ted
pro
bab
ilit
y o
f p
rob
lem
dri
nkin
g
Lowest Income Middle Income Highest Income
Alcohol outlet density:
mortality and morbidity
• Alcohol-related deaths between 2002 and 2011 from General Register Office for Scotland (GROS) n=12,835
• Alcohol-related hospitalisation indicator from the Health domain of the Scottish Index of Multiple Deprivation 2012 (SIMD)
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Alcohol-related death rates for off-sales outlet
availability groups
Increasing Density
Alcohol-related hospitalisations for off-sales
availability groups
Increasing Density
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Summary
• The lowest income groups are disproportionately affected by outlet density compared to both mid and higher income groups.
• For all outcomes there is an increase in probability for the lowest income tertile between the lowest and highest outlet density.
• No significant increase for the highest or middle income tertiles for any outcome, regardless of type of outlet.
• Alcohol-related death rates in neighbourhoods with the most alcohol outlets were more than double the rates in those with the fewest outlets.
• Across the whole of Scotland, alcohol-related hospitalisationrates were significantly higher in neighbourhoods with the most alcohol outlets.
Broader research translation
• Making data publically
available
• Twitter, presentations etc
• Blogs
• Infographics
• Commendation in the Scottish
Parliament supported by 27
MSPs
• Amendment proposed to a bill
to create retailers register
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Policy message
• Interventions that focus on changing individual behaviouralone, ignoring broader context, will not work.
• Interventions must be designed to reduce inequalities, otherwise they may increase the very inequalities they aim to tackle.
• Tackling alcohol-related harm requires a multi-pronged approach.
• Data should be freely available.
• Need to address the retail environment; in a Scottish context this means defining overprovision and more clearly supporting the public health licensing objective. How does this translate in an Irish context?
• Failure to do so may exacerbate health inequalities.
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Biggest challenges
• Public opinion and how it is shaped – Stigma
(including place based stigma)
• Understanding the causal pathway between
environment and health behaviours
• Evidence into policy - conversations
What is lacking?
• Critical global health
• Longitudinal/lifecourse approaches
• Activity spaces
• A focus on co-behaviours (smoking, diet etc)
• A greater focus on inequalities
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What is lacking?
• Critical global health
• Longitudinal/lifecourse approaches
• Activity spaces
• A focus on co-behaviours (smoking, diet etc)
• A greater focus on inequalities
Availability of Alcohol AND
Tobacco by deprivation
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Funders
• Niamh Shortt, Richard Mitchell, Catherine Tisch, Elizabeth Richardson, Tom Clemens & Esther Rind.
• This work was supported by the European Research Council [ERC-2010-StG Grant 263501]. The work developing the tobacco outlet measures was supported by the Scottish Collaboration for Public Health Research and Policy (SCPHRP).
• All data available at www.cresh.org.uk/webmap
• Twitter @jamie0pearce