alcohol and work peter anderson fase project liverpool 18 march 2009
TRANSCRIPT
Alcohol and work Peter Anderson
FASE project
Liverpool 18 March 2009
Structure of presentation 1.Work-place alcohol-related harm2.Policies and programmes to reduce work-place alcohol-related harm
But, first: 1.Very few publications and good quality studies!2.Need to re-package what was once a hot issue, but does not seem a hot issue now (except by the Commission!)
Structure of presentation 1.Work-place alcohol-related harm2.Policies and programmes to reduce work-place alcohol-related harm
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Societal level effects A Swedish study found that a 1-litre increase in total consumption was associated with a 13% increase in sickness absence among men (P<0.05). The relationship was not statistically significant for women.
Norström 2006
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Social costs Europe
Productivity
Health
Crime
Anderson & Baumberg 2006
Social costs France
Productivity
Health
Crime
Rehm et al 2009
Social costs Canada
Productivity
Health
Crime
Other
Rehm et al 2009
Social costs US
Productivity
Health
Crime
Rehm et al 2009
Social costs Australia
Work productivity
Home productivity
Health
Crime
Road accidents
Collins & Lapsley 2008
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Cardiovascular mortality in the Baltic States (EU3) 1980-2002, compared with the EU15.
Zatonski et al (2008)
5.9
11.4
33.3
0
5
10
15
20
25
30
35
40D
eath
rate
/10,
000
Death rates/10,000 fatal injuries, men 20-64 years
EU15 CEE Baltic States
Zatonski et al (2008)
29
19
38
29
48
42
0
10
20
30
40
50a
lco
ho
l/in
jurie
s (%
)
EU15 CEE Baltic States
MenWomen
share of alcohol injuries in all injuries, 2002
Zatonski et al (2008)
Zatonski et al (2008)
Liver cirrhosis mortality in different parts of Europe
Men Women
About 25% of the difference in life expectancy between the EU10 and the EU15 for men aged 20-64 years in 2002 can be attributed to alcohol.
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Manual workers area
Manual workers areas + individual
Unemployment area
Unemployment area + individual
Quartile 1
Quartile 2
Quartile3
Quartile4
Alcohol-related mortality rate ratios by area level variables, men aged 25-64 in Finland, 1991-1996
Blomgren et al 2004
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Manual workers area
Manual workers areas + individual
Unemployment area
Unemployment area + individual
Quartile 1
Quartile 2
Quartile3
Quartile4
Alcohol-related mortality rate ratios by area level variables, men aged 25-64 in Finland, 1991-1996
Blomgren et al 2004
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
1
6
11
16
21
26
Yearly Monthly Weekly
Risky
High risk
Adjusted ORs for absenteeism in previous 3 months by drinking category (short term risk levels)
Roche et al 2008
1
2
3
4
5
6
7
8
Low Risky High risk
Adjusted ORs for absenteeism in previous 3 months by drinking category (long term risk levels)
Roche et al 2008
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Adjusted ORs for absenteeism in previous 3 months by drinking category (long term risk levels)
Mangione et al 1999
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Economic Crash
On the one hand, changes in affordability, which is a function of relative price and disposable income
On the other hand, changes in social dislocation and social cohesion
Rabinovich et al 2009
1
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Manual workers area Unemployment area Family cohesion
Quartile 1
Quartile 2
Quartile3
Quartile4
Alcohol-related mortality rate ratios by area level variables, men aged 25-64 in Finland, 1991-1996
Blomgren et al 2004
Structure of presentation 1.Work-place alcohol-related harm2.Policies and programmes to reduce work-place alcohol-related harm
Policies and programmes to reduce work-place alcohol-related harm 1.Population-based interventions2.Structural factors3.Individually directed interventions
Policies and programmes to reduce work-place alcohol-related harm 1.Population-based interventions2.Structural factors3.Individually directed interventions
Avoidable burden studies Canadian study is based on the evidence of the effectiveness of interventions designed to reduce or alleviate the effects of alcohol use disorders to determine the maximum reduction in burden that can be achieved by the interventions.
Rehm et al 2008
Avoidable burden studies 1.Taxation increases2.Lowering BAC limit from 0.8g/L to 0.5g/L3.Zero BAC for all drivers under the age of 214.Increasing the minimum legal drinking age from 19 to 21 years5.Safer Bars intervention6.Brief interventions7.Change from a government monopoly to privatized alcohol sales Rehm et al 2008
Rehm et al 2008
Rehm et al 2008
-70000
-60000
-50000
-40000
-30000
-20000
-10000
0
Deaths/10 Admissions*10 Crime Unemployment
10% increase in priceMinimum price 5p/g
Impact of 10% increase in price and minimum price (5 pence/g alcohol)on health and social outcomes, England
Meier et al 2008
Policies and programmes to reduce work-place alcohol-related harm 1.Population-based interventions2.Structural factors3.Individually directed interventions
1
1.2
1.4
1.6
1.8
2
2.2
2.4
Neither Either Both
Women
Men
ORs for alcohol dependence at phase 3 by charateristics at phase 1: high effort, low reward
Head et al 2004
Policies and programmes to reduce work-place alcohol-related harm 1.Population-based interventions2.Structural factors3.Individually directed interventions
Individually directed interventions 10 studies comprised three broad types of interventions: 1.psychosocial skills training2.brief intervention, including feedback of results of self-reported drinking, life-style factors and general health checks3.and alcohol education delivered via an internet website
Individually directed interventions 9/10 studies with some positive outcome, but variable and often very poor methodology, and usually self- report measures of consumption and problems
Miller et al 2007
Miller et al 2007
Conclusions 1.Work-place alcohol-related harm2.Policies and programmes to reduce work-place alcohol-related harm
Work-place alcohol-related harm 1.Societal level effects2.Social costs studies and lost productivity3.Premature mortality4.Area level studies5.Individual level studies
a) Absenteeismb) Presenteeism
6.And, the economic crisis?
Policies and programmes to reduce work-place alcohol-related harm 1.Population-based interventions2.Structural factors3.Individually directed interventions
Recommendations 1.Given alcohol’s role in impairing cognitive and decision making functions (not reviewed), strong argument for alcohol-free work place
Recommendations 2.Given the dose response relationship, with no safe level, between alcohol and the risk of injury (not reviewed), strong argument for alcohol-free work place in high risk industries (construction, transport etc)
Recommendations 3.Given the impact of structural factors on increasing the risk of alcohol use disorders (as well as other health outcomes), strong argument for extensive (and difficult) structural changes in work management
Recommendations 4.Not much robust positive evidence for the impact of prevention programmes and interventions, but assessment of reduced work performance should include assessment of alcohol use disorders
Recommendations 5.But, powerful evidence that the good old alcohol policy measures (tax and so on) impact on absenteeism and presenteeism, and can reduce the alcohol-related burden of lost productivity