A blog of two parts, first a glimpse into a common public health topic and then something I hope may be a bit different.
A retired doctor friend told me a story. He was invited to be on an interview panel for a consultant appointment in the 1980s. The interviews were held in the new Boardroom at Crichton Royal Hospital. After the candidates had been seen in the morning, a good lunch was provided and then a black-clad waiter with white gloves opened a wood cabinet from which he produced a silver tray with sherry and glasses which were offered around the panel and successful candidate for a celebratory drink. Different times now!
For years alcohol was one of the few causes of death that was increasing in Scotland. Completely opposite to the success stories in heart disease, stroke and cancers through better treatment and prevention, deaths from alcohol seemed to be going through the roof. Looking at the chart, you see that alcohol-specific death rates for females and males have been consistently higher in Scotland than in England & Wales. The female rates are lower than the male rates, and the female rate for Scotland is actually similar to the male rate in England & Wales. And as well as these very specific deaths, there are many more where alcohol is a contributing cause.
Death of course is the most severe outcome, but alcohol can also lead to a host of other problems impinging on the NHS, from long-term harm to health, falls and injuries, to domestic violence, unsafe sex, unwanted pregnancy, and problems at work or job loss.
Why are alcohol-related deaths so high in Scotland and what can be done about the problems?
Lots of things are tried or proposed, for example:
- Local or national awareness-raising campaigns
- Opportunistic advice when patients consult a health professional
- Brief interventions on alcohol in settings like Accident & Emergency
- Alcohol and drug treatment service
- Attempting to restrict availability of alcohol through the licensing system for off-licences (supermarkets, shops selling alcohol) and on-licences (hotels, pubs, clubs)
- Proposed minimum pricing of units of alcohol.
Do these work? Unfortunately there’s little evidence that campaigns make any more than a whit of difference. I suspect they’re more about salving consciences that something is being done, rather than actually doing it.
By far the most effective public health actions tend to be the big population measures, like tackling availability or price of alcohol, but these invariably run into strong opposition and can become mired down in commercial or contrary interests. The derogatory term ‘nannying’ is often used.
Are the opposite views unbridgeable, depending on whether we give more weight to preventing harm or to protecting individual autonomy for people to harm themselves if they choose? Are there any easy answers at all? At least there’s some comfort that rates seem to be falling in recent years.
Sometimes questions like these seem so difficult that I’m going to segue instead into another public health principle, increasing wellbeing. The Edinburgh book festival (https://www.edbookfest.co.uk/) is one of the highlights of my own year, a real heart-sing event. Last month at the festival my mind was stimulated by (amongst others) philosopher Roger Scruton, journo Jeremy Paxman and Rebecca Mead of the New Yorker magazine.
Rebecca Mead’s theme was that reading classic literature has lifelong benefits. That set me wondering what are possible benefits of reading to busy NHS staff? I’m talking here about reading fiction, rather than the day’s deluge of work emails or NHS D&G’s required reading sent out to all staff, as these are, of course, supposedly non-fiction!
What benefits might there be? I can think of:
- Learning about how health professionals do their jobs, grapple with ethical questions or deal with lack of resources.
- Learning about patients and how diseases or disabilities affect their lives.
- Getting information about different lifestyles we might not have experience of ourselves.
- Getting inside characters’ heads might help to develop the subtle trait of empathy.
- May help improve communication skills (can develop our own vocabulary and range of expression and help us see different communication options and styles).
- Possibly (if Rebecca Mead is right) may enhance our own wellbeing, personal growth and development of wisdom throughout life.
I’m sure book lovers amongst you will think of other benefits as well. And the best thing is that all of this learning can be achieved in comfortable home surroundings (with one small glass of favourite tipple if you must), and without having to attend the latest recommended professional development course.
And so, back to the beginning. One thing reading can do is give you wider perspectives and individual insights into alcohol use. Pharmacologist Ronald Siegel thinks it’s a universal human drive to want to get ‘out of one’s head’ with mind altering substances. It seems to be so persistent through history that he equates it with our drives for food, sleep and sex. Could that be right? If so, attempts to control or price alcohol to reduce problems might not work.
Getting out of one’s head to an extreme degree is portrayed by a number of authors. I can’t help drawing attention to a couple of books set in Russia, where protagonists become drawn into a culture of regularly drinking to oblivion – both are fantastic reads quite apart from their alcohol insights: Among the Russians by renowned travel writer Colin Thubron (a previous Edinburgh Book Festival speaker) and Consolations of the Forest by French author Sylvain Tesson.
And just to finish on getting out of one’s head through drugs rather than alcohol, there’s a stunning short story collection: Julia and the Bazooka by Anna Kavan, who was a heroin addict for much of her life. The bazooka is a euphemism that Kavan uses for her syringe which went with her everywhere. The stories give a powerful insight into what life must be like for a dependent opiate user.
Oh and if you’re already a bibliophile or any of this has whetted an interest, the Wigtown book festival is in a week’s time…
Andrew Carnon is Joint Interim Director of Public Health at NHS Dumfries and Galloway