Health Promotion (Alcoholic Liver Disease)

Question 1

Describe the epidemiology of liver disease in Scotland.

Answer 1

-17% more alcohol is bought per adult in Scotland than in England and Wales.
-Every 15 minutes, someone in Scotland is hospitalised with an alcohol-related illness.
-Mortality and Morbidity associated with Liver Disease is trending upwards.
Overall, more liver-related deaths are attributable to ALD than NAFLD, however the rise of NAFLD can be attributed to rise in obesity, metabolic syndrome and type 2 diabetes.

Question 2

What are the political barriers to reducing alcoholic liver disease in Scotland?

Answer 2

• Political parties and politicians want to be in office, if they want to be voted for they have to be liked, increasing restrictions on alcohol would not make them popular.
• Economic factors + Cultural factors = Political Barriers
• However, there is annincreasing recognition at government level that things need to change.

Question 3

What are the economic barriers to reducing alcoholic liver disease in Scotland?

Answer 3

• Alcohol related industries employ ~155,000 people in Scotland (6% of employment).
• 10,000 of these are employed directly in alcohol production.
• The remainder are employed in secondary alcohol enterprises.
• At a UK level, alcohol taxes account for 7% of all customs and excise revenue.

Question 4

What are the cultural/behavioural barriers to reducing alcoholic liver disease in Scotland?

Answer 4

• Drinking alcohol is very embedded in the culture in Scotland, it is what we do on nights out, celebrating and if we go on holiday.
• In the Scottish Social Attitudes Survey 2004, 2/3 of the respondents agreed that drinking is a major part of the Scottish way of life.
• There is a perceived social stigma to not drinking.

Question 5

What are the organisational barriers to reducing alcoholic liver disease in Scotland?

Answer 5

• Different organisations (Scottish Government, UK Government, Retailers, NHS, Police, Local Authorities, Voluntary Sector Agencies) have different aims and objectives. They also have different ways of working.
• Institutional Change - there are so many departments involved that it would be hard to change.
• A shift in attention to, and understanding of, alcohol. - should follow lead of tobacco and be seen as a public health problem to be solved rather than enouraged.
• A shift in the socioeconomic context.
• The resolution of the battle ideas - encourage harm reduction than abstention.

Question 6

What is the Tannahill Model of Health Promotion?

Answer 6

See drawing on pages.

Question 7

Define the Ottawa Charter for health promotion.

Answer 7

• Develop Personal Skills
• Strengthen Community Action
• Reorient Health Services
• Build Healthy Policy
• Create Supportive Environments

Question 8

What professionals and agencies play a role in reducing alcoholic liver disease?

Answer 8

• Government - call for action in reducing alcohol consumption, supporting families and communities, positive public attitudes and choices, and improved treatment and support.
• Supreme court - minimum unit pricing legislation - 50p/unit.

Question 9

Stages of alcoholic liver disease.

Answer 9

• 1- Alcoholic Fatty Liver - build of fat in the liver, can occur quickly, reversible with abstinence.
• 2- Alcoholic Hepatitis - if mild can be reversible, major cause of death from liver disease, unrelated to infective hepatitis
• 3- Liver Cirrhosis - significant scarring of the liver, generally not reversible, 50% mortality within 5 yearsif continue to drink.

Question 10

What is the High Risk Approach to reducing alcoholic liver disease?

Answer 10

• in which people at particularly high risk are identified through screening, and offered appropriative advice and treatment.
• useful when it may be difficult to change behaviour at a population level or when there is concentrated risk within the population.

Question 11

What is the Population Approach to reducing alcoholic liver disease?

Answer 11

• in which the aim is to lower the average level of risk factor in the whole population.
• useful when the disease/risk factor is distributed among large proportions of the population or the result of not intervening to prevent the disease even in one person is very severe.
• policies, regulatory and statutory enforcement interventions

Question 12

What is the Targeted Polulation Approach to reducing alcoholic liver disease?

Answer 12

This involves identifying communities at greater risk of disease and using population strategies within these targeted groups.