An Alcohol Harm Reduction Strategy for Christchurch Where

An Alcohol Harm Reduction Strategy for Christchurch Where Are We Now & Why Are We Here? November 2014

An Alcohol Harm Reduction Strategy Overview • How did we get here? • Impact of alcohol – why are we here? • The AHRS process (? ) 2

What have we got? • The go ahead from CDHB and CCC to co-develop an Alcohol Harm Reduction Strategy for Christchurch

How did we get here? Timeline • 2009: Groundwork undertaken through Healthy Christchurch – Key actions identified • 2012: Co-ordinator post appointed in health sector – Enable CDHB to assume a leadership role in reducing alcohol-related harm

Healthy Christchurch Actions What came of them… • Tri-agency enforcement partnership � • A joint alcohol working group established � • Improved surveillance � • Advocate for national/local policy �� • Effective primary care response In Progress • A local Alcohol Harm Reduction Strategy

Why the wait for the AHRS? • CDHB committed to develop an alcohol harm reduction strategy in May 2013 • Strategy development process ‘parked’ to focus on Local Alcohol Policies (LAPs) • Initial alcohol key stakeholder strategy planning session took place in November 2013 – Good overview of stakeholders priorities – CDHB/CCC commitment affirmed

How much are we drinking?

Average drinker? • 9. 85 litres of pure alcohol was purchased per NZ adult in 2012 (taxation data) AND 80% of adults report drinking in the past year • That’s 18. 68 standard drinks per adult drinker per week (before untaxed alcohol) - c. f. guidelines • But only 19% of drinkers report drinking hazardously (NZHS 2012) then… – These hazardous drinkers would be drinking 6 bottles of wine per week on average (44 SD) 8

Modelling self-reported drinking rates f * Average guideline (M/F) . . 81% of drinkers. . . …………………. . 19% of drinkers……………. . . . 0 15 30 Weekly Consumption (Standard Drinks) 12. 5* 44 9

Modelling actual rates (based on sales) f What if 40% are hazardous drinkers? … 60% 0 of drinkers…. . 40% of all drinkers………………………………………. . 15 30 Weekly Consumption (Standard Drinks) 12. 5* 45 10

So what is alcohol doing to us?

How do we know? Look at what Population A drinks Look at what Population B drinks Rule out every other variable you can think of Compare their hospital admissions Get an exact measure of alcohol’s contribution to 60+ conditions by age category and sex (Alcohol Attributable Fractions) Apply that to your own hospital admissions to work out how alcohol consumption is impacting on health for any variable captured by that admission Examples Alcohol Cirrhosis 100% Oesophageal cancer 18 – 38% Road Traffic Accidents 2 – 46% Hypertension 3 – 30%

A useful way to look at alcohol-related harm ACUTE Immediate Accidents Assaults, Self harm, drowning, etc Enforcement Control Engage in ED CHRONIC Long Term Conditions 42 conditions (cancers, CV, bowel) Engage in health system Prevention WHOLLY Mid Term* Mental disorders (dependence), Other chronic diseases Alcohol poisoning (acute) Primarily AOD services

How alcohol harm in changing over time in Christchurch? AAF Weighted Hospital Admissions - Christchurch Residents Aged 20+ - Age Standardised Rate Per 100, 000 Population, 2009 to 2013 1400 1243. 0 rate per 100, 000 pop. 1200 1092. 7 969. 8 1000 133. 5 1130. 4 150. 1 476. 6 600 157. 0 134. 2 122. 8 800 1319. 9 484. 6 577. 9 619. 7 Acute Chronic 453. 1 Wholly 400 200 0 393. 9 2009 482. 6 511. 6 515. 1 543. 2 2010 2011 2012 2013 • Approximately 7% of the total health burden and increasing by 7% per year • Currently in the region of an $100 M per year to the health system in Canterbury 14

How alcohol harm varies by area (unit) 15

Table/Graph of monthly recorded and estimated actual alcoholrelated events in Christchurch ED (August 2012 – January 2014) Detected Estimate of Alcohol alcohol Related associated Arrival Event events in Month Count ED* Aug-12 266 459 Sep-12 246 424 Oct-12 258 445 Nov-12 270 466 Dec-12 305 526 Jan-13 238 410 Feb-13 257 443 Mar-13 334 576 Apr-13 251 433 May-13 235 405 Jun-13 277 478 Jul-13 276 476 Aug-13 256 441 Sep-13 259 447 Oct-13 293 505 Nov-13 301 519 Dec-13 289 498 Jan-14 258 445 Total 4869 8395 • Recorded admission (green line) indicates alcohol incidence that staff detected • *Recent research estimates actual alcohol incidence (blue line) to be over 70% higher (where alcohol involved but not detected) at approx. 5600 incidents per year NB: Alcohol-related admissions often impact disproportionately on ED resources

AREA Linwood Sydenham Phillipstown Cathedral Square Addington Hornby South Avon Loop Sockburn Aranui Ensors Ilam Riccarton Edgeware Spreydon Rawhiti Barrington North Hillmorton St Albans East Shirley East North Beach EPISODES 126 112 102 99 92 89 89 86 83 83 81 79 69 67 66 65 63 62 58 58 Top 20 Census Area (units) for alcohol-related ED admissions (August 2012 – January 2014) • Admissions are recorded by residence for each TLA and Census Area (in Christchurch) • 41% of all recorded alcohol-related ED admissions for Christchurch residents are accounted for by the top 20 Census Areas (16% of all areas) listed here Share of all alcohol-related ED admissions • • Christchurch (inc. Banks P) 82% Waimakariri 6% Selwyn 5% Canterbury 95%

Graph of recorded alcohol-related events at Christchurch ED by arrival hour averaged over week (data from August 2012 - July 2013) 350 300 250 200 150 100 50 0 12: 00 13: 00 14: 00 15: 00 16: 00 17: 00 18: 00 19: 00 20: 00 21: 00 22: 00 23: 00 00: 00 01: 00 02: 00 03: 00 04: 00 05: 00 06: 00 07: 00 08: 00 09: 00 10: 00 11: 00 • Highlights peak in alcohol-related events between 10 pm and 5 am the next day • Alcohol-related attendance can be observed above the daily averages from Friday 6 pm to Sunday 4 pm. § This accounts for 54% of weekly incidence.

Graph of monthly recorded alcohol-related events in Christchurch ED by age band gender (August 2012 – January 2014) • 58% of all events occur in the under 30 s • 66% of all events are due to males

And what can we do about it?

…even before the Alcohol Strategy is launched Activity underway Activity in the work programme 21

The new Alcohol HR Strategy • The process will be as important as the end product – Champions identified, awareness raised, views and ideas shared, new prevention initiatives and partnerships developed, resources identified, targets set, etc. • Milestones – Perhaps a strategy launch by November 2016 ? ? ?

Anything else?

st 1 December 2014

Questions ?