Tuesday, 19 July 2011

Liver disease in young people rises: Health Minister James Reilly sits on the fence

Ireland has ‘dogs on the street’ who know stuff.  Its politicians meanwhile avoid knowing the same things, and when those things become unavoidable they buy themselves a little more time by commissioning a report. Many of the dogs, sadly unelected to the Dail, are now tweeting and the news is that alcohol and Ireland are becoming synonymous.  To take some recent examples of tweets from around the world (there are a dozen every day) - 'When can I move to ireland? I was just told how impressive drinking abilities are and I'd fit right in' says one. 'Binge drinking didn't ruin Ireland, binge drinking built Ireland hahaha' says another, or 'of course ireland doesn't have a drinking age...only a buying age that apparently is only loosely enforced'.

The Misuse of Alcohol Steering Group

The word on the street is now even better informed, thanks to a new Health Research Board report published on the 12th July, confirming what we had suspected all along: the alcohol problem is bad and getting worse.  It tells us that most Irish people now drink to excess, that liver disease especially among the young has increased and that alcohol related deaths are on the rise. Of the 3,336 alcohol related deaths recorded between 2004 and 2008, 672 were as a result of alcohol poisoning.  Of the rest, one in four who died were killed by liver disease.   As Dr Lyons who co-authored the report says in explanation of the figures, "per capita consumption of alcohol in Ireland is among the highest in Europe’ and now ‘the majority (56%) of Irish people drink in a harmful manner".  How long can the country continue to function if we go on like this? And these are cautious figures. The deaths do not record cases where victims were binge drinking or cases where alcohol was a factor but not identified.  Add to this the economic cost - 9% of hospital bed days and 15% of the HSE budget spent on alcohol-related illnesses, and a rising suicide rate with 60% alcohol-related, and there is little to be happy about.

But the good news is that at least the press are beginning to acknowledge the issue rather than to bury it.  On the back of the HRB report The Irish Times has two articles this week, one identifying the failure of school programmes to get to grips with the problem, entitled 'deaths involving alcohol on the rise'  and the other in the Irish Times  on Saturday highlights that 'more of this country's young people are dying from alcohol than anything else' setting the facts against a moving interview with the distraught mother of a young liver disease sufferer who died as a consequence of his drinking.  “It’s quite frightening the amount of damage one can do to one’s liver in a relatively short time of drinking excessively….Five pints per day will lead you to severe liver disease and sudden death at any time. You can do this damage in four years of consistent heavy drinking.”

The Irish Independent also covers the HRB report with an article telling its readers that ‘The majority of Irish people "drink in a harmful manner”.  And while giving the story space under the reluctant headline ‘Alcohol a factor in poisoning deaths’ The Examiner writes that ‘more than one-third of people who died of alcohol-related liver disease were below 34 years of age, new figures reveal’.

So if the dogs on the street, the HRB and the press are lined up calling for something to be done, our TD’s must surely be listening.  Sure enough the Herald.ie even has a few words from a politician. ‘Fine Gael TD Jerry Buttimer has expressed alarm at the findings. "It clearly shows that as a society we need to look at our lifestyle habits," he said’.  Lifestyle habits?  Yes sure, but what about the recommendations in the HRB report itself which very clearly re-iterate the World Health Organisation’s evidence and advice that taxation, minimum-pricing and regulation of sales and advertising are the minimum requirements of any government to get to grips with the alcohol problem.  ‘In Ireland’ The Irish Times reports, ‘alcohol-control policies are relatively weak and have remained a low priority for successive governments’. Consequently it has one of the greatest problems of drinking in Europe.  Did the people of Cork elect Deputy Buttimer to address this legislative gap or to lecture them about lifestyle habits?

Back in 2008 Vincent Browne wrote on politico.ie about a similar inaction on the part of the previous government.  'They laboured mightily and came up with lots of recommendations. They were against binge drinking, in favour of more moderate alcohol consumption, protecting children from alcohol, against alcohol-related harm.... The new task force will be or should be a carbon copy of the report of four years ago. And the likelihood is that the recommendations of the new task force will meet the same fate'.  And so it proved to be.  As the Irish Times puts it:  ‘There has been plenty of talk about tackling alcohol abuse but little meaningful action.  There have been two strategic task force reports on alcohol, but the key recommendations to increase prices, reduce the number of places it can be bought and tighten controls on advertising remain largely unimplemented. For example, plans to strictly regulate the marketing of alcohol by the Fianna Fáil-Progressive Democrats government were ditched in favour of allowing the industry to regulate itself’.

Can this be happening again?

In the Dail on 14th July Deputy Jerry Buttimer brought the sad issues raised by the HRB to ministerial attention.  Like a man pitching the Titanic story wthout mentioning the iceberg, Deputy Buttimer's carefully worded speech leans heavily on the word 'habits' and 'choices' while avoiding the words advertising, marketing, sponsorship, policy or regulation altogether .  And in the shocked tones of a newcomer to the whole alcohol issue the Deputy tells us that he is 'worrying' about the 'extent of the impact of alcohol' that has been 'revealed' to him by the 'first national report' to come his way.

Health Minister James Reilly waits for news of a report

Questioned twice recently on the issue of the previous alcohol report (number three in the queue), incoming Minister for Health James Reilly had already learned the jargon.   Ducking a direct question on 'widespread sponsorship of major sporting events by alcohol companies' from Deputy Graham Nash, theMinister said that the report (commissioned in 2009) ‘showed that there were two different views represented in the Working Group; but it was not charged with finding a means of reconciling these opposing views or to assess the relative merits of the arguments made’.  Let's get this straight.  A 'Working Group' took two years to discover that they should have been told to make a decision.  What sort of work are they doing?  But nothing lost, apparently.  Their report has now been 'referred to the Steering Group that is developing the National Substance Misuse Strategy to assist it in its deliberations’ and  ‘is under consideration and…will be finalised in the coming months’.  Another long finger job then?

In April the Minister told us ‘I expect to receive the Report of the Steering Group later this year’ and in the Dail this week it was again mentioned in a reply to Deputy Buttimer, ‘The report of the national substance misuse strategy will be finalised at the end of September 2011.  Following this, the Minister for Health will bring proposals to the Government which will address the broad range of measures required to prevent and tackle the harms caused by alcohol use and misuse’.

So the third report in ten years into the bleeding obvious, again delayed, and again promising a broad sweep of nothing in particular. Are there any grounds for hope? 

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