INTRODUCTION
Public Health is the science of protecting and improving the health of communities through education, promotion of healthy lifestyles, and research for disease and injury prevention. In order to develop programs that protect the health of your family and community, public health professionals analyse the effect on health of genetics, personal choice and the environment. It is concerned with threats to health based on population health analysis. The dimensions of health can encompass “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”, as defined by the United Nations’ World Health Organization. Overall, public health is concerned with protecting the health of entire populations. These populations can be as small as a local neighbourhood, or as big as an entire country. The interdisciplinary approaches of epidemiology, biostatistics and health services, incorporates through public health. Environmental health, community health, behavioural health, and occupational health are other important subfields.
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The consumption of alcohol can have beneficial or harmful effects depending on the amount consumed, age and other characteristics of the person consuming the alcohol, and specifies of the situation explained by Dietary Guidelines for Americans (2005). Alcohol means neutral spirits distilled at or above one hundred ninety degrees proof, whether or not such product is subsequently reduced, for nonindustrial use. The term ‘alcohol’, unless specified otherwise, refers to ethanol or ethyl alcohol. It is a thin, clear liquid with harsh burning taste and high volatility. Alcoholic beverage means any liquid suitable for drinking by human beings, which contains one-half of one per cent or more of alcohol by volume. Alcohol drinking is an integral part of family, social and occupational life for many people in the UK. While low to moderate consumption is not associated with excess risk, and may even be beneficial, excessive consumption, particularly in young people, is a growing cause for concern to policy-makers, health and social care professionals, and the public, it was assessed by Smith and Foxcroft (2009).
Why it is a Public Health Issue?
Alcohol misuse not only affects physical, emotional, but also social aspect of a person and an individual means the public. According to Faculty of Public Health (2008), for centuries and many people use it rationally although alcohol has been part the culture; its misuse has become a serious and worsening public health problem in the UK. The misuse of alcohol – whether as chronically heavy drinking, binge-drinking or even moderate drinking in inappropriate circumstances not only poses a threat to the health and wellbeing of the drinker, but also to family, friends, communities and wider society through such problems as crime, anti-social behaviour and loss of productivity. It is also directly linked to a range of health issues such as high blood pressure, mental ill-health, accidental injury, violence, liver disease and sexually transmitted infection.
Concept of Public Health
The two most common measures of disease in populations are prevalence and incidence. Sometime both terms are used in the description of a disease or disease outbreak. Prevalence, which has already been mentioned, is the member of people who have a disease at a given time; that is the number currently suffering from the disease or disorder. Incidence, on the hand, is the number of new cases of a disease, such as the other hand, is the number of new cases of a disease, such as influenza, being higher than usual for the year. This indicates the number of new cases is higher than what is typically expected, whereas a report indicating increased prevalence would mean the number of existing cases is higher asses by Evans. Epidemiology is the science that looks at the relationships between diseases occurring in populations and groups, typically in an attempt to reduce risks and, compress morbidity into the last years if the populations life span. Life span is the limit of natural life such that through all supports and efforts one has lived as long as is possible. Life expectancy means something different, in that this term applies to the average length of life one may live based on gender, race, where one lives, and so on.
Alcohol Consumption and Trends
There were several surveys discusses the trends of alcohol consumption. Some says it decreases and others increases, but according to The NHS Information Centre (2010), drinking behaviour among adults and children in England, in 2008:
71% of men and 56% of women (aged 16 and over) reported drinking an alcoholic drink on at least one day in the week prior to interview. 11% of men and 6% of women reported drinking on every day in the previous week.
38% of men drank over 4 units on at least one day in the week prior to interview and 29% of women drank more than 3 units on at least one day in the week prior to interview. 22% of men reported drinking over 8 units and 15% of women reported drinking over 6 units on at least one day in the week prior to interview.
The average weekly alcohol consumption was 16.8 units for men and 8.6 units for women.
28% of men reported drinking more than 21 units in an average week. For women, 19% reported drinking more than 14 units in an average week.
18% of school pupils aged 11 to 15 reported drinking alcohol in the week prior to interview; this figure is lower than 2001, when 26% of pupils reported drinking in the last week.
48% of pupils said they had never had a proper alcoholic drink, compared to 39% in 2003.
Pupils who drank in the last week consumed an average of 14.6 units
In 2006 to 2008, young people in London were less likely to have drunk alcohol in the last week (39%) than young people living in any other Government Office Region (51% to 63%)
Knowledge and attitudes to alcohol
In 2009, 90% of Great Britain (GB) respondents reported that they had heard of measuring alcohol in units.
There has been an increase from 54% in 1997 to 75% in 2009 in the proportion of people in GB who had heard of daily drinking limits. Throughout the period, differences between men and women have been slight.
Pupils in England aged 11 to 15 are becoming less tolerant of drinking and drunkenness among their peers. For example, in 2008, 36% agreed that “it was OK for someone of their age to drink alcohol once a week”, compared with 46% in 2003. Over the same period, the proportion who thought “it was OK for someone of their age to get drunk once a week” also fell, from 20% to 12%.
Alcohol Misuse and other drinking patterns
The use of alcohol for a purpose not consistent with legal or medical guidelines called alcohol misuse. There are different patterns in drinking alcohol; one is harmful drinking, alcohol use that causes damage to physical and/or mental health. Harmful use commonly, but not invariably, has adverse social consequences. Hazardous drinking is a pattern of alcohol use that increases the risk of harmful consequences for the individual. In contrast to harmful use, hazardous drinking refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user. A pattern of drinking that exceeds some standard of moderate drinking said to be a heavy drinker. In the UK, heavy drinking is defined as consuming eight or more units for men and six or more units for women on at least one day in the week. Lastly, moderate drinking, an inexact term for a pattern of drinking that is by implication contrasted with heavy drinking. It denotes drinking that is moderate in amount and does not cause problems.
Drinking among Young People
Young people are less well equipped than adults to cope with the effects of alcohol, physically and emotionally. The same amount of alcohol will have a much greater effect on the body of a child or young person than on an adult, because their bodies are still growing and developing. Also, a young person doesn’t have the experience needed to deal with the effects of alcohol on judgement and perception. But, according to NHS federation survey (2009) it shows that in a recent survey, 14% of 15 and 16 year olds in the UK had been drunk 20 times or more during the last 12 months and 50% have been drunk at least twice. And 58% of 15 year olds who had drunk alcohol recently had suffered negative consequences such as getting into an argument, been ill, missing school, been injured or in trouble with the police. Among those aged 15 and under, 18% had drunk alcohol in the previous week Diment et al (2009). Although the proportion of schoolchildren who have never had an alcoholic drink has risen (from 39% in 2003 to 48% in 2008), those who do drink are consuming more. Between 2007 and 2008, mean alcohol consumption among young people aged 11 to 15 (specifically, those who had drunk alcohol in the previous week) increased from 12.7 units (102 g) to 14.6 units (117 g) Diment et al (2009). Regional analysis shows that consumption is highest among those living in the North East (17.7 units) and the North West (16.3 units). It is lowest in London (11.3 units) The NHS Information Centre (2010). In addition, nearly 10,000 children and young people (under the age of 18) are admitted to hospital each year as a result of their drinking Department for Children, Schools and Families (2009).
It is a major problem knowing the new generation are being exposed to this public health issue. By their innocent knowledge, they will be victims that in the longer term, drinking can have a negative effect on a young person’s school work, social life and friendships, as well as their general health. They’ll also be in trouble if they break the laws about buying and drinking alcohol.
Effects on Health and Social Services
Alcohol is associated with a wide range of criminal offences in addition to offences of drunk driving and drunkenness; in which drinking or excessive drinking defines the offence. Alcohol-related crime has been a matter of great public concern for some years. Public concern about ‘alcohol-related crime’ often relates to offences: involving a combination of criminal damage offences, drunk and disorderly and other public order offences involving young males, typically 18-30, but increasingly, also young females often occurring in the entertainment areas of town and city centres.
In the table above explains the effects of alcohol to deaths of people from 2000- 2009. The average of 15 to 19 per 100,000 populations died in a year for males and 7 to 9 for females.
According to NHS guidelines (2011), harmful drinking and alcohol dependence cause many mental and physical health problems, and social problems. In England, 4% of people aged between 16 and 65 are dependent on alcohol (6% of men and 2% of women). More than 24% of the English population (33% of men and 16% of women) consume alcohol in a way that is potentially or actually harmful to their health or wellbeing. Alcohol misuse is also an increasing problem in children and young people. Current practice across the country is varied, which leads to variation in access to a range of assisted withdrawal and treatment services. A shown an upward trend of hospitals stays in relation to the cause of drinking alcohol from 2002- 2009.
Alcohol plays a part in and around work, both as a perceived antidote to the pressures of the modern workplace and as a way to socialise or network with clients and colleagues. However, drinking can reduce the productivity of the UK economy in a number of ways. This occurs through:
increased sickness absence: drinking 7+ (for women) or 14+ (for men) units per week raises the likelihood of absence from work through injury by 20 per cent;
the inability to work (unemployment and early retirement); and
premature deaths among economically active people (people of working age).
Combined, these three factors account for a total alcohol-related output loss to the UK economy of up to £6.4bn.
Alcohol misuse tends to change the roles played by family members in relation to one another, and to the outside world. Most families operate some form of division of labour – one person managing the family’s finances, the other supervising the children, one doing the gardening, the other doing the cooking, and so on. But as one member of the family develops more of a drink problem, the other members are likely to find themselves having to take over his or her role themselves. Eventually, one member may be performing all the roles – finances, disciplining, shopping, cleaning, household management, and so on. Another area of family functioning which is often affected by alcohol and alcohol misuse relates to the kind of communications that takes place between family members. It may be that the partner with the problem refuses to talk about it, even though it is clearly beginning to dominate his or her, and the families, life. Alternatively, alcohol may loosen the tongue and things might be said which would not have been said in a sober state. Or again, alcohol can itself become the main topic of conversation
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Public Health Need and Practice
The prevention of alcohol misuse can benefit 9 out of 10 adults drinking varying amounts of alcohol, therefore the Models of Care for Alcohol Misusers recommends that service planners for alcohol misuse should focus first upon the needs of the hazardous, harmful and dependent adult alcohol misusers. There are national media campaigns currently underway, which seek to raise awareness amongst the general population of the impact of excessive drinking on themselves and others. It endeavours to ensure consistent messages about sensible drinking are conveyed and that there is greater clarity for individuals understanding themselves how much alcohol they consume. The public should continue to be made aware of the harms associated with alcohol and have access to information about what is available locally through clear and accessible patient information.
There is a commitment in public health to develop a programme for improving alcohol treatment services based on an audit of demand and the Models of Care framework, funded via the pooled treatment budget of substance misuse DOH (2004). Alcohol treatment is currently provided by GPs and specialist addiction services, but most alcohol treatment services in England are found in the voluntary sector DOH (2005). In recent years there was an emphasis on the treatment for misuse of class A and B drugs, rather than alcohol. This has led to underfunding of services for alcohol misuse and the waiting time for treatment is much longer for alcohol misuse than for drug misuse HAGA (2008).
Government Policies
In the UK, the prevailing view is that a reduction in alcohol consumption to sensible or lower risk levels is sufficient even for those people who are dependent on alcohol. In 2004, the Department of Health published ‘Choosing Health, the Alcohol Needs Assessment Research Project’ (ANARP) DOH (2004), and the Alcohol Harm Reduction Strategy for England, followed in 2005 by Alcohol Misuse Interventions; Guidance on developing a local programme of improvement DOH (2005a). The next steps in the National Alcohol Strategy (2007) DOH (2007) reviewed progress since these publications and outlined further action to be taken to reduce alcohol-related ill-health and crime.
The Greater London Alcohol and Drug Alliance (GLADA) recently released a statement of priorities for alcohol in the capital. These are based on 3 strategic objectives:
To reduce alcohol-related harm to health, through awareness-raising, early intervention and better access to treatment and support
To reduce alcohol-related crime and disorder and anti-social behaviour through continuing to improve the management of the night-time economy and tackling the links
To reduce the risk of harm to children and young people as a result of their own or others’ drinking through developing alcohol work within targeted youth support and the Every Child Matters agenda
There is a guidelines set by the UK Government provide advice on daily and weekly maximum alcohol consumption levels. The guidelines recommend that men should not regularly drink more than three to four units of alcohol per day, and women should not regularly drink more than two to three units of alcohol per day. In terms of weekly limits, men are advised to drink no more than 21 units per week, and women no more than 14 units per week. Even though, there’s limit in alcohol consumption people still exceeds for own wants. In Britain, the amount of pure alcohol sold per adult rose from 9.53 litres in 1986/87 to a peak of 11.78 litres in 2004/05, before dropping to 11.53 litres in 2007/08 HM Revenue and Customs (2008). This approximates to 22 units (176 grams) per week for each person aged over 15 years. In 2007, 72% of men and 57% of women in England had an alcoholic drink on at least 1 day during the previous week. In addition, 41% of men and 35% of women exceeded the daily recommended limits on at least 1 day in the previous week Robinson and Lader (2009).
In order to deal with a problem, someone must first recognize that the problem exists. Because denial is the first and best defence, being able to recognize the need to cut back is crucial to being able to overcome it. Take short breaks from alcohol, learn to say NO, stay active to find diversion. Watch out for temptations and do not give up were advices from an article beating the bottle. Given the high number of potential stressors in society today, maintaining a strong control over oneself can be a very difficult task. Self-control is a key element to functioning at school, work or in social situations. It is a mostly learned and developed attribute of an individual’s daily life.
Conclusion
A greater clarity on the prevalence of alcohol misuse based on local intelligence, resources and funds dedicated to alcohol misuse, mapping of referral pathways, service providers and development of referral protocols should be prioritised by the Alcohol Strategy Group. Workforce training and development in order to provide alcohol services across the public and voluntary sector is essential to delivery of effective interventions in an effective and equitable manner. Working with the industry is vital to achieve reductions in alcohol misuse in a sustainable manner.
Although drinking alcohol here in UK is somewhat tradition, or it’s in the culture. Because in every gathering there’s alcohol and even in a regular meal includes alcohol. People needs and discipline to control not to abuse alcohol should be considered. In terms of health education, it would be useful to determine what young children want to know and how they would like this information to be delivered. Greater knowledge of the influence of the family on drinking is required.
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