How might Alcohol Brief Interventions be affecting health inequalities in England?

Colin Angus, University of Sheffield | May 2019 | 6 minutes

Alcohol Brief Interventions are a key aspect of attempts to reduce the harms of alcohol in England, yet until now we had almost no idea whether they are currently narrowing or widening the gap in alcohol harms between the most and least deprived groups in society.

New figures published by the Office for National Statistics recently showed that the gap in healthy life expectancy between the most and least well off in our society has increased to nearly 20 years. We know that rates of alcohol-related harm are highest in most deprived groups and, as a result, alcohol is an important contributor to this ‘health gap’. Alcohol Brief Interventions (BIs) are a key aspect of attempts to reduce the harms of alcohol in England, yet we have almost no idea whether BIs are currently narrowing or widening this gap. This is a cause for concern, because many public health interventions have been shown to widen health inequalities unless they are specifically targeted at more deprived groups.

Many public health interventions have been shown to widen health inequalities unless they are specifically targeted at more deprived groups.

Our new study, funded by Alcohol Change UK and published in BMJ Open, gives us the first clear answer to this question. We analysed survey responses from almost 9,000 adults from the Alcohol and Smoking Toolkit Studies, including data on drinking behaviour and whether the respondent had received advice and support about cutting down the amount they drank. We assessed how factors including age, gender, drinking level and socioeconomic position were associated with an individual’s chances of having received a BI and compared our findings with a similar analysis of smokers receiving similar support to help them cut down or quit smoking.

We found that overall only 6.1% of risky drinkers who had visited their GP in the past year had received some form of BI in the past year, a figure which compares very unfavourably with smokers, among whom 48.3% had received smoking cessation advice. We also found substantial variation in an individual drinker’s chances of receiving a BI, with men and older drinkers particularly likely to receive an intervention. Reassuringly, the heaviest group of drinkers were much more likely to have been offered advice and support for their drinking.

Fewer than 1 in 16 risky drinkers are receiving any level of help and support from their GP.

We found that overall only 6.1% of risky drinkers who had visited their GP in the past year had received some form of BI in the past year, a figure which compares very unfavourably with smokers, among whom 48.3% had received smoking cessation advice.

The answer to our main question was somewhat unexpected - we found that the most deprived group of risky drinkers were significantly more likely to have received a BI. All else being equal, a drinker in the lowest social group was more than twice as likely to receive an intervention than a drinker from the highest group. We found something similar for smokers, but the social gradient was much smaller, with only a 30% difference between the highest and lowest groups.

Colin Angus Chart

So what do these results mean? The good news is that Brief Interventions are being disproportionately delivered to drinkers in more deprived groups. As a result, it seems likely that current BI delivery is working to reduce health inequalities.

The bad news is that fewer than 1 in 16 risky drinkers are receiving any level of help and support from their GP, in spite of guidelines recommending that this be offered to all people drinking at these levels. Until these delivery rates can be brought closer to those of smoking cessation advice, the overall impact of BI delivery on health inequalities will almost certainly remain modest.