The UK, the Netherlands, Sweden, Norway, Australia, and New Zealand have similar cultures, genetic backgrounds and drinking cultures, and, until the mid-1980s, had similar death rates from liver disease. However, while liver death rates in most of these countries have remained low since then, the UK has seen a doubling of its liver death rate from 4.9 per 100,000 population to 11.4. In a Comment published Online First by The Lancet, three experts, including Royal College of Physicians Past President Ian Gilmore, discuss the thousands of deaths from liver disease that can be avoided if the UK adopts appropriate alcohol policies.

The authors (Gilmore, Nick Sheron, University of Southampton, UK, and Chris Hawkey, Queen's Medical Centre, University Hospital, Nottingham, UK) look at several projected scenarios in which the UK follows its current projection to a worst case scenario in 2019, or instead reverses its trend to match that of European countries such as France that have shown huge reductions in liver death rates over the past few decades. This reversal would also over the next decade bring the UK back in line with Australia, New Zealand, and the other countries mentioned above.

Their main findings are (please also refer to diagram in full Comment): Using the Office of National Statistics figure for alcohol-related liver deaths in 2008 as the baseline, by 2019 the green (best case) scenario reaches the target (2500 deaths each year) with 22 000 fewer liver deaths in total by 2019 The black scenario (worst case) results in 8900 additional deaths by 2019 Over 20 years, the difference between black and green scenarios would be 77 000 liver deaths (80% under age 65). Taking the wider harms of alcohol into account, (health problems other than liver deaths) conservative estimate of the difference between black and green scenarios probably amounts to between 160 000 and 250 000 lives lost or saved over a 20-year period in England and Wales. The authors discuss the price, place of sale (availability), and promotions, saying that these three factors, plus a fourth which the marketing industry terms 'product' constitute the basic components of all marketing activity. They cite regulation-based activity that has helped control UK alcohol consumption in the past, and say: "These and other data show the influence of price and indicate that the regulation of population-level alcohol consumption is a duty of responsible government."

France has, say the authors, achieved its phenomenal success in reducing death rates by increasing alcohol quality and profit and limiting availability of cheap alcohol products. But they add on the UK: "Currently the UK drinks producers and retailers are reliant on people risking their health to provide profits: figures from the Department of Health show that three-quarters of the alcohol sold in the UK is consumed by hazardous and harmful drinkers."

The authors highlight a number of things about current UK policy: They support the current UK coalition government's intention to maintain the 2% above inflation duty escalator for the time being, other recent announcements give cause for concern about their commitment to use the lever of price. Plans to ban the sale of alcohol beverages below cost (duty plus value added tax) and to increase duty on beer over 7•5% strength are inconsequential because of the tiny fraction of sales that fall into either category. They are concerned about the involvement of private commercial companies such as ASDA and Tesco and Diageo in the Responsibility Deal Board chaired by the UK Health Secretary. (This board was set up with no specific representation from alcohol health experts. Since the paper was accepted the UK Government has allowed a health representative (Mark Bellis) to co-chair the Responsibility Deal Alcohol Network, as a result Dr Bellis also attends the RD Board) The authors conclude: "Irrespective of the means the UK Government chooses to design and implement their public health strategy, the key test must be the impact on hard outcomes. We have seen a change of emphasis from setting targets for process measures to outcomes measures, an approach quintessentially applicable to alcohol. Alongside debates on the effectiveness of individual measures, an outcomes framework should be created that establishes the level of liver mortality that the UK aspires to achieve."

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The Lancet