Projections of alcohol deaths - a wake-up call

According to WHO, morbidity attributable to alcohol in countries with an established market economy (10·3% of disability adjusted life years) comes second only to that of tobacco (11·7%).1 Liver disease is responsible for 70% of the directly recorded mortality from alcohol,2 and perhaps a quarter of the total attributable mortality; the true total is uncertain but is probably between 18?000 and 30?000 per year in England and Wales. Alcohol causes around 80% of deaths from liver disease,2 and trends in liver mortality reflect trends in overall alcohol-related harm; liver death rates are a measure of the damage caused to society by alcohol, and a good measure for the success of alcohol policy.Few can doubt that there is a particular problem in the UK. Compared with the UK, the Netherlands, Sweden, Norway, Australia, and New Zealand have similar cultures, genetic backgrounds and drinking cultures, and in 1986 they had broadly similar liver death rates. The most recent WHO liver death rates for these countries range from 2·6 per 100?000 (New Zealand) to 5·3 (Sweden); whereas in the UK liver death rates more than doubled from 4·9 to 11·4 since 1986.3 A liver death rate of around 4 per 100?000 is therefore a reasonable and achievable aspiration for an outcomes-based alcohol policy.We projected outcomes in terms of liver death rates according to four different policy scenarios (figure).4 With the black scenario, liver deaths increase at a similar rate to that seen in the UK as a whole over the past 10 years. A green scenario would see a reduction in UK death rates with the same gradient as that for France—the country with the most profound reductions in mortality. The intermediate scenarios, amber and red, would see liver deaths reduce along the gradients followed by the rates in Italy or in the European Union as a whol