Article

The social costs of alcohol abuse in New Zealand

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Abstract

This study updates and extends previous New Zealand research on the social costs of alcohol abuse. This economic cost study used the human capital approach. New Zealand, 1991. The total New Zealand population. The estimated cost of alcohol abuse for 1 year included direct and indirect costs. Costs such as lost production resulting from premature death and sickness, reduced working efficiency and excess unemployment comprised indirect costs. Direct costs included hospital costs, accident compensation payments, police and justice system costs. A range of social cost estimates was constructed based on various prevalence rates of alcohol abuse, discount rates for lost production and the excess unemployment rate. Using a range of assumptions regarding the proportion of each event attributable to alcohol, the sum of social costs ranged from $1045 million to $4005 million in 1991. The direct costs ranged from $341 million to $589 million, respectively. While providing an indication of the societal impact of alcohol abuse, these costs pertain to a relatively narrow range of alcohol-related effects. The paper identifies a number of areas where further research is required.

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... = £0.52 as at 29 March 2019), of which NZ$16 million was related to absenteeism and NZ$41 million to presenteeism. In estimating alcohol-related production loss, Devlin et al. [15] attributed NZ$18 million to absenteeism and between NZ$228 million to NZ$366 million to reduced work efficiency. Easton [16] estimated the cost of reduced production (including unemployment) from alcohol-related morbidity at NZ$1.2 billion. ...
... To estimate alcohol-related absenteeism Devlin et al. [15] multiplied the annual incomes of those gainfully employed by the conservative estimate of 0.044% (taken from Jones et al. [14]), and used an impairment rate of 25% for 'alcohol abusers' (also used by Jones et al. [14]) to estimate productivity losses. Using an average alcohol abuse prevalence rate of 4.3% (6.5% for males and 2.2% for females) and discount rates of 5% and 10%, absenteeism costs were estimated at NZ $18 million and reduced efficiency between NZ$228 million and NZ$366 million. ...
... BERL [17] used average absenteeism rates (taken from Roche's 2008 paper [33]) and alcohol abuse prevalence rates of 6.5% for males and 2.2% for females (the same as Devlin [15]) to estimate alcoholrelated absenteeism costs, and a 25% impairment rate to estimate productivity losses. The total labour costs (in 2005-2006) relating to alcohol misuse were calculated at NZ$1.5 billion of which NZ$36 million were attributable to absenteeism and NZ$34 million to presenteeism. ...
Article
Introduction and aims: Alcohol use impacts workplace productivity in terms of absence and reduced performance by employees. This study's aims were to estimate the cost of lost productivity associated with alcohol use in New Zealand and to describe and quantify its impact on employers. Design and methods: An online survey was completed by 800 New Zealand employees and 227 employers across a range of industries. The costs of lost productivity directly attributable to alcohol use were estimated using days off work (absenteeism), lost hours of productive time while at work (presenteeism) and hours spent by employers dealing with alcohol-related issues. Ordinal logistic regression was used to explore the association between employee characteristics and reduced workplace productivity associated with alcohol consumption. Results: The estimated annual average cost of lost productivity per employee was NZ$1097.71 (NZ$209.62 absenteeism, NZ$888.09 presenteeism) and NZ$134.62 per employer. At a population level this equates to approximately NZ$1.65 billion per year. The significant predictors of reduced workplace performance were being younger (less than 25 years), male, having a stressful job and drinking more than the recommended standard number of drinks per session. Discussion and conclusions: Considering absenteeism costs alone will substantially underestimate the total productivity loss associated with alcohol use. Designing and effectively targeting a set of multifaceted policies to engineer change at both the workplace and societal levels will assist in reducing the costs of lost productivity.
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... Extensive research, mostly in high income countries, has explored the types and magnitude of harms experienced by people in the workplace as a result of their own alcohol consumption. Some of the key impacts and risks felt by the drinker include work accidents; reduced productivity and work performance due to absenteeism; and morbidity and premature mortality (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). ...
... Beyond working extra hours, a significant proportion of Lao People's Democratic Republic respondents who had co-workers reported experiencing reduced productivity, negative effects on job performance, and being involved in an accident perceived as due to a co-worker's alcohol consumption. Reduced productivity and performance and increased accidents at work among the working population as a result of co-workers' drinking are likely to contribute substantial additional costs to the Lao People's Democratic Republic economy (Jones, Casswell & Zhang 1995;Stewart et al. 2003;Devlin, Scuffham & Bunt 1997;Collins & Lapsley 2008;Pidd et al. 2006b). Overall, alcohol-related coworker harms may negatively impact the socioeconomic development of Lao ...
... 5. Further research could be conducted into the role of police in the prevention and management of alcohol problems among particular cultural groups. 6 ...
... (5) Alcohol abuse is also costly to the community, with indirect costs including lost production due to sickness and premature death, reduced work efficiency, and excess unemployment; and direct costs including hospital care, insurance compensation payments, police, and the justice system. (6) Alcohol-related problems are not evenly distributed throughout the population. For example, the prevalence of alcohol abuse or dependence (as defined in the Diagnostic and statistical manual of mental disorders (7)) is higher among males than females; among young people aged 18-24 than older people; among those who have never been married, or who were separated or divorced than those who are married or in a de facto relationship; and among the unemployed. ...
... Zealand society of alcohol abuse is between $1 and $4 billion dollars" (Devlin et al. 1997(Devlin et al. , 1502. In another report we read, 3 The gist of the debate can be found in Esa Österberg (1983). ...
... They are seldom included in the economic analyses, leaving items (1)-(4) which in cost-of-illness studies tend to comprise the social costs of alcohol consumption(Single et. al. 1996;Devlin et al. 1997;Xie et al. 1998; Strategy Unit report, UK, 2003;Gjelsvik 2004;Jarl et al. 2008;Rehm. et al. 2008;Collins & Lapsley 2008;Saar 2009; BERL Economics 2009).Having determined the type of cost associated with alcohol consumption, it remains to calculate how much of the different cost categories can be ascribed to alcohol consumption and how much has to be ascribed to other factors. ...
Article
The article reviews the history of the discussion concerning the effect of alcohol consumption on the national economy. The point of departure is a discussion prompted by the prohibitionists in the Nordic countries and US who succeeded in bringing a ban on alcohol into reality. It made sense in those circumstances to ask the question. Two different situations were compared, a society where alcohol was forbidden and one where it was not. After the prohibitionists' hope of an alcohol-free society became a lost cause in the 1930s, interest in these calculations waned for a spell. Interest was re-ignited in Finland, Norway and Sweden in the 1960s and '70s, however, spreading to North America and Australia in the 1980s and '90s. A set of international guidelines was issued on how to estimate the social costs attributable to alcohol consumption. In practice, there was a heavy bias in favour of costs, while the income side, with the exception of alcohol's presumed beneficial effect on cardiovascular diseases, was left out. Cost-of-illness studies were employed here, in which a contemporary society was compared with a fictive one, where alcohol had never existed. This article argues that such studies are not very meaningful in a research context and represent a capitulation to the desire of politicians to give political decisions a semblance of neutrality based on a common-sense approach to economics.
... According to the newest research in 2017, the prevalence of tobacco deaths was 110.7 deaths per 100 000 people., followed by alcohol deaths (33.0 deaths per 100 000 people) [2]. Several studies have addressed the negative impact of alcohol consumption and smoking on human health and society [3][4][5][6][7][8]. ...
Preprint
Background: Drinking and smoking have economic consequences and are the main risk factors of mortality and morbidity. Disease-specific deaths attributable to using substances present the primary health indicator in this study. This analysis focuses on mortality in productive age, 15 to 64 years since those deaths are considered the highest economic burden. Method: In the analytical part, data from the Registry of deaths of the Czech Republic for 1994 to 2017 were used. The number of deaths attributable to smoking and drinking was calculated using attributable fractions, based on literature review. This research aimed to reveal the gender differences in deaths attributable to drinking and smoking, according to age, and the differences in deaths regarding smoking or drinking. Results: The mortality attributable to smoking and drinking differs across age groups and genders. The highest median share of tobacco-related deaths is in the age group, 60—64 years. The highest median share of alcoholic deaths is in the age group of 50—54 years. Conclusions: There are significant differences between genders in both, smoking and drinking. A prevention program should be targeted to different age groups.
... These four methods, Sum_All Medical, Sum_Diagnosis Specific, Matched Control, and Regression, were defined before commencing the literature review and were not altered while completing the literature review, indicating that they adequately summarised the available methods currently used in COI studies. The Sum_All Medical method is used in all but three of the disease categories; the Sum_Diagnosis Specific method is used in all but legal accommodation; [44] presenteeism; [82] 12 Catch-all accident compensation payments, police and justice system costs; [199] law enforcement costs, fire damage, traffic accident damage, reduced property values, productivity losses due to absenteeism; [202] special diet at home; [212] incarceration, lower earning, policing, legal, cost to crime victims; [267] child care costs, outbreak management, affected restaurants; [281] rehabilitative services, educational services; [286] public and private expenditures for crime; [296] clothing/ laundry; [317] teacher training, average annual salary cost, funerals [383] three methods represented, and the specific disease sub-categories included HIV/AIDS, irritable bowel syndrome, obesity, schizophrenia, stroke and urinary incontinence. ...
Article
The number of cost-of-illness (COI) studies has expanded considerably over time. One outcome of this growth is that the reported COI estimates are inconsistent across studies, thereby raising concerns over the validity of the estimates and methods. Several factors have been identified in the literature as reasons for the observed variation in COI estimates. To date, the variation in the methods used to calculate costs has not been examined in great detail even though the variations in methods are a major driver of variation in COI estimates. The objective of this review was to document the variation in the methodologies employed in COI studies and to highlight the benefits and limitations of these methods. The review of COI studies was implemented following a four-step procedure: (i) a structured literature search of MEDLINE, JSTOR and EconLit; (ii) a review of abstracts using pre-defined inclusion and exclusion criteria; (iii) a full-text review using pre-defined inclusion and exclusion criteria; and (iv) classification of articles according to the methods used to calculate costs. This review identified four COI estimation methods (Sum_All Medical, Sum_Diagnosis Specific, Matched Control and Regression) that were used in categorising articles. Also, six components of direct medical costs and five components of indirect/non-medical costs were identified and used in categorising articles. 365 full-length articles were reflected in the current review following the structured literature search. The top five cost components were emergency room/inpatient hospital costs, outpatient physician costs, drug costs, productivity losses and laboratory costs. The dominant method, Sum_Diagnosis Specific, was a total costing approach that restricted the summation of medical expenditures to those related to a diagnosis of the disease of interest. There was considerable variation in the methods used within disease subcategories. In several disease subcategories (e.g. asthma, dementia, diabetes mellitus), all four estimation methods were represented, and in other cases (e.g. HIV/AIDS, obesity, stroke, urinary incontinence, schizophrenia), three of the four estimation methods were represented. There was also evidence to suggest that the strengths and weaknesses of each method were considered when applying a method to a specific illness. Comparisons and assessments of COI estimates should consider the method used to estimate costs both as an important source of variation in the reported COI estimates and as a marker of the reliability of the COI estimate.
... De kosten van alcoholgebruik zijn voor verschillende landen via de top-down methode vastgesteld. In Europa zijn er schattingen gemaakt voor onder andere Portugal (Lima en Esquerdo, 2003), West-Duitsland (Brecht et al., 1996), Frankrijk (Reynaud et al., 2001) en Schotland (Varney en Guest, 2002 Single et al., 1998), Nieuw Zeeland (Devlin et al., 1997) en de Verenigde Staten (Rice, 1999;Harwood et al., 1998 ...
... Alcohol and other drugs have also been identified as main contributors to current high rates of youth suicide in New Zealand (Beautrais 2000). An estimate of the social costs associated with alcohol use in 1991 ranged from NZ$1 billion to NZ$4 billion (Devlin et al. 1997). Finally, alcohol (together with other drug use and gambling) forms a strong but undoubtedly complex interrelationship with criminal behaviour. ...
Article
Full-text available
Tobacco, alcohol, other drug use and gambling impact significantly on the wellbeing of New Zealanders, and research plays a critical role in formulating appropriate responses. The project reported on in this paper aimed to identify ways in which the general infrastructure and supports for applied research in this sector could be improved to enable increases in both the quantity and quality of outputs. An advisory group made up of key researchers, end users and other stakeholders contributed to the preparation of a discussion document reviewing the current scene and outlining issues and opportunities for the future. The document identified strong needs for development in the areas of overall coordination, funding processes, research workforce and communication/dissemination. Feedback on the document was then sought via submissions and key informant interviews. Responses informed the preparation of a strategy advisory document, which recommended a two-step process for improving the research infrastructure: (1) fostering greater interaction and Social Policy Journal of New Zealand • Issue 26 • November 2005 17 1 Acknowledgements The project was made possible by a funding grant from the Mental Health Research and Development Strategy Steering Committee. We are especially grateful to Janet Peters, who provided ongoing liaison with the Committee. The authors gratefully acknowledge the contribution of those who participated in the Advisory Group through the two phases of the project. From this group we note particularly the contributions of, all of whom provided written material for the discussion document. We acknowledge Catherine Kissel for her contracted work on the key informant consultations and Janet Peters for her liaison with the funding committee. We also thank the staff of Social and Community Health in the School of Population Health at the University of Auckland, particularly Amor Hirao and Rajal Purabiya, who provided the organisational support for meetings and coordinated the production and distribution of the various documents. The views expressed in this paper evolved from the collective efforts of a stakeholder committee that included researchers, research provider organisations, treatment providers and government agencies. Although financial support came originally from the Ministry of Health, the views do not represent the views and positions of the directorates and committees of the Ministry. 27044 SocialPolicy NewText 17/11/05 10:44 AM Page 17 integration across the sector by bringing together researchers and other stakeholders from each of the four sub-sectors to explore the viability of developing a common identity and collective purpose; (2) building on the relationships formed in the first step, including implementing of a range of infrastructure development projects targeting funding mechanisms, research workforce development and communication/dissemination. The document also signals the eventual need to form a national coordinating committee to provide ongoing support for infrastructural development, to advance sub-sector strategies and to advise and liaise with government agencies on sector development.
... However, tobacco's main impact is unquestionably on physical health as evidenced by the high number of people who die from smoking-related illnesses (Doll, Peto, Wheatley, Gray, & Sutherland, 1994;Lopez & Peto, 1996). Alcohol has significant impacts on physical health (Edwards, et al., 1994), but it differs from tobacco in contributing more to harm at the level of psychological impacts and social relationships (Clark & Hilton, 1991;Devlin, Scuffham, & Bunt, 1997). For example, the impacts of alcohol dependence on family members, particularly children, can lead to enduring disruptions of psychological and social functioning (Cuijpers & Smit, 2001;West & Prinz, 1987). ...
Article
Full-text available
Gambling can harm a society's social and economic systems and negatively affect its political ecology. If not protected, democratic processes and institutions in jurisdictions with high levels of gambling are likely to undergo a progressive, cumulative degradation of function. These subtle, diffuse distortions result when a broad variety of individuals, working in isolation and reacting to pressures from gambling providers, incrementally compromise their roles and responsibilities. This article examines how these degradations can occur for people working in universities, government departments, media outlets, politics, and community organisations. It argues that any strategy to minimise harm from gambling should include explicit measures to protect the public from such distortions to democratic processes. The single most effective way to do this is to independently monitor people with public duties who have relationships to the beneficiaries of gambling consumption. The article concludes by proposing an international charter that sets benchmark standards for protecting a society from such degradations.
... In the year 1991, more detailed calculations were conducted for New Zealand. The total sum of societal costs ranged from $1,045 million to $4,005 million in that year (Devlin, Scuffham, & Bunt, 1997). In Canada, the costs of alcohol at the societal level are also very substantial. ...
Article
Adolescent alcohol use, especially at a young age, has many negative consequences, both on the individual and the societal level. After an introduction describing a conceptual model of predictors and consequences of adolescent alcohol use, the first two chapters in this dissertation report on two studies on alcohol intoxication related admissions of adolescents in Dutch hospitals. Data collected in 2007 and 2008 underline the societal relevance of the problem of adolescent alcohol use. The number of adolescents with alcohol intoxication increases and the symptoms become more severe. In the remaining seven chapters, predictors of adolescent alcohol use are the main topic. The social context of alcohol use is explored in a qualitative study in which adolescents described severe alcohol related incidents they had experienced. In the next study, parents were asked about their support for governmental alcohol control policies. Then an experimental study is described into the impact of alcohol commercials and alcohol product placement in a soap series. The last four studies involve three types of alcohol availability. Regarding economic availability, the prevalence and effects of price discounts in the catering industry were explored. The role of physical availability of alcohol was investigated in a study of private drinking places, focusing their national prevalence and the characteristics of their visitors. A third part of this study involves a large sample questionnaire in which alcohol consumption of adolescent visitors and non-visitors were compared. The last two studies focus on legal availability. These studies involve the shop floor compliance with age restrictions for alcohol sales. The first study investigates compliance levels in the Netherlands in general; the second study addresses the effects of a feedback letter intervention to improve compliance.
... The criteria listed in Table 12.8 apply to all meta-analyses used to estimate the relationship between per capita consumption and specific diseases (English et al. 1995). Alcohol-related consequences were thus identified by reviewing and evaluating large-scale epidemiological studies on alcohol and health, including epidemiological input into major reviews (Collins and Lapsley 1991;Corrao et al. 1999;Devlin et al. 1997;English et al. 1995;Gurr 1996;Harwood et al. 1998;Klingeman and Gmel 2001;Rice et al. 1991;Ridolfo and Stevenson 2001;Single et al. 1996Single et al. , 1999aSingle et al. , 1999bStinson et al. 1993; U.S. Department of Health and Human Services 2000). Papers were collected primarily from the peer-reviewed international literature. ...
Article
Aim: To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis. Design: Secondary data analysis. Measurements: Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality , i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region. Findings: Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden. Discussion/ Conclusions: The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.
... As no hard data are available for France, we refer to four studies recently conducted in other countries on this subject. These countries are Germany (Brecht et al., 1996), Canada (Single et al., 1998), the USA (Rice et al., 1991;Heien and Pittman, 1993), and New Zealand (Devlin et al., 1997). A comparative analysis of the structure of the costs generated by alcohol abuse in these four countries helps us to assess the scale of the social costs. ...
Article
— The health costs of alcohol-related problems in France were estimated using two cost evaluation approaches: (1) estimate based on the proportion of cases attributable to alcohol abuse (the alcohol abuse factor); (2) estimate based on prevalence of alcohol abuse for in- and out-patients. For a 10% prevalence of alcohol abuse in the general population, the minimum cost in 1996 was about US$ 2300 million; for a prevalence of 15% it was US$ 2700 million. This cost concerns the health disorders that are linked directly or indirectly to alcohol abuse. It did not allow for injuries from accidents caused by alcohol intoxication and undervalued the cost of out-patient care. Based on the prevalence of alcohol-related disorders seen at hospitals, a percentage of the total in-patient and out-patient costs due to effects of alcohol could be estimated. However, this did not permit an estimate of the cost of care in which alcohol abuse was a risk factor only. Based on the available data showing that between 3% and 10% of inpatients have a directly alcohol-related condition, estimates of in-patient treatment costs varied from US$ 1300 to 2100 million. Among adult out-patients, 20% present with a disorder in which alcohol is a factor or suffer from an alcohol-related illness, which corresponds to a cost of about US$ 1600 million. Thus, these methods yield minimum year's cost estimated between US$ 2500 and 3300 million. These costs are high, compared to the low level of financing for the specialized facilities offering treatment to people in difficulty due to alcohol excess, which was US$ 23 million in that year. As regards social and total costs, estimates from four Western countries have found that about 75% of the total costs of alcohol abuse was attributable to social harm, and 25% to medical costs. Applying this ratio to the French data gives an estimated total cost to French society of about US$ 13 200 million, i.e. 1.04% of the gross national product.
... Additionally, although most studies used a discount rate of 6%, we noted that the rates actually ranged between 3% and 10%. 43,44 The discount rate used to quantify the present value of the future cost is essential because the opportunity costs lost from premature mortality attributed to alcohol always constitute a substantial proportion of the overall costs. ...
... At the same time, these consequences impact directly lowering the productivity in different sectors of the economy imposing a burden on the society as a whole -i.e social costs of alcohol consumption-2 . In the past, several studies have been conducted on the cost of alcohol sickness (IOC), especially in the developed countries of North America [8][9][10][11], Europe [12][13][14][15][16], Oceania [17][18][19] and Asia [20] but also in a few developing countries from South Asia [21], South America [22][23][24][25][26][27][28], and Europe [29]. Most of these studies follow the "international guidelines for estimating the costs of substance abuse" which were set after consensus was reached on the correct way to make such estimates. ...
Article
Full-text available
This paper provides evidence on the costs imposed by crime and violence in five Latin American countries: Chile, Costa Rica, Honduras, Paraguay and Uruguay. Crime and violence stand out as one of the major social challenges to be dealt with in Latin America. However, the incidence of crime (and thus its social and economic impact) varies among countries. Based on a common theoretical framework across all five countries, we use a costs-accounting methodology and find that the cost of criminality varies from a striking 10.5 % of GDP in Honduras to a moderate 2.5 % in Costa Rica. Also, by quantifying the different components of the cost equation separately, we provide insight on which felonies are more costly and which agents are burdened most heavily by these costs.
... Cutting and piercing injuries are a leading cause of home injuries among young and working aged-adults. As is the case with injuries resulting from motor-vehicle crashes and falls [6,7,12,13,36,52,58], acute-alcohol intake contributes to unintentional cutting or piercing injuries among young and middle-aged adults. Our analysis suggests that it may treble the odds. ...
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Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home. A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts. Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers. Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.
... The empirical literature on alcohol costs, dealing with the relative risk methodology, focus mostly on the burden of disease alcohol abusers impose on society as a whole (Saloma, J., 1995;Brecht et al., 1996;Devlin et al., 1997;Single et al., 1998;Varney and Guest, 2000). As heavy alcohol consumption has been considered a sufficient or contributory factor for a great number of causes of death and disease, different authors have estimated the proportion of different major causes of disease that could be attributed to alcohol misuse. ...
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Aim: This study estimates alcohol attributable fractions which are used to obtain a measure of health expenditures related to alcohol misuse in Portugal. Methods and Sources: Studies estimating alcohol-attributable expenditures focus usually on specific diseases or conditions. This study takes a broader approach by examining all expenditures considered as being attributable to excessive drinking, i. e., those resulting from utilization directly and indirectly related to alcohol associated diseases. Unlike studies using the relative risk methodology, where population alcoholattributable fractions (or etiologic fractions) are based on epidemiological studies identifying potential causes of death and disease associated with alcohol excessive consumption, this study has adopted the microeconometric methodology which gets estimates of attributable fractions running econometric regressions of the annual costs of medical care (medical appointments or hospital admissions) for individuals. It has an advantage over the risk approach in that it allows to control for the effect of factors other than alcohol consumption on medical care expenditures. Actually, it includes in the analysis those factors that are linked to health care expenditures but are not linked to any particular alcohol related disease. To perform our analysis we have used two data sets provided by the Portuguese Ministry of Health: the 1995 National Health Survey. These surveys provide detailed information on individual demographic, economic, health utilization, health attributes and also alcohol and smoking use. Both surveys use a probabilistic representative sample of the non-institutionalized Portuguese population and a questionnaire of about 180 questions. It is a representative sample of the five main administrative regions of Portugal (North, Centre, Lisbon and Tejo valley, Alentejo and Algarve).
... The estimated cost of alcohol abuse to New Zealand society is between $1-$4 billion (Devlin et al, 1997). This estimate includes reduced and lost production time from consumption and mortality, the cost of treating alcohol related disease, and ACC and policing costs. ...
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Guidelines for Recognising, Assessing and Treating Alcohol and Cannabis Abuse in Primary Care
... Os acidentes de trânsito relacionados ao uso de SPA geram uma série de custos econômicos e sociais para toda a sociedade. É um impacto negativo indireto do uso de SPA que pode representar, segundo estimativas internacionais para a Nova Zelândia, um valor de até 4 bilhões de dólares anuais decorrentes dos custos gerados por acidentes de trânsito relacionados exclusivamente com o abuso de álcool (Devlin, Scuffham & Bunt, 1997). No Brasil, estima-se um custo anual de R$ 5,3 bilhões relacionados aos acidentes de trânsito em grandes metrópoles (IPEA/ANTP, 2003) -aproximadamente 0,4% do PIB do país. ...
... Alguns países desenvolvidos já iniciaram pesquisas sobre este tema. Canadá, 1-3 Estados Unidos, [4][5] Alemanha, 6 Nova Zelândia, 7 Reino Unido 8 e França 9 vêm estudando o custo social da DA por intermédio de um tipo de avaliação econômica (AE) (considerada incompleta) denominada cost of Illness (custo da doença). ...
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A sociedade brasileira arca, atualmente, com um elevado custo econômico frente aos problemas decorrentes do uso abusivo de álcool. No Brasil, estudos econômicos relacionados ao abuso e/ou dependência química são escassos ou inexistentes, embora exista uma grande limitação de recursos e enormes problemas de saúde decorrentes. Este artigo tem como objetivo introduzir aos profissionais da saúde conceitos fundamentais da Economia da Saúde, tais como: avaliação econômica completa e incompleta, custo da doença, comparação de custos, tipos de avaliação (custo-minimização, custo-efetividade, custo-utility e custo-benefício), pontos de vista da análise (do paciente, da Instituição de Saúde, do Ministério da Saúde ou da sociedade), tipos de custos (diretos, indiretos e intangíveis) e outros. Além disso, serão descritos alguns dados de pesquisas sobre o impacto do consumo de álcool na sociedade brasileira. Não pretendemos esgotar os assuntos tratados, mas sim, enfatizar a necessidade de pesquisas nacionais que aliem a avaliação econômica à dependência alcoólica, tendo por finalidade propiciar o maior ganho de saúde possível, com a menor utilização dos escassos recursos destinados ao sistema saúde, na busca de maior eficiência.
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We review methods and assess the policy influence of a series of publiclyfunded Cost of Illness studies, mostly published since 1990. Our analysis shows that headline cost estimates, including the influential paper by Collins and Lapsley (2008), depend on an incorrect procedure for incorporating real world imperfections in consumer information and rationality, producing a substantial over-estimate of costs. Other errors further inflate these estimates, resulting in headline costs that are unrelated to either total economic welfare or GDP and therefore of no policy relevance. Counting only external, policy-relevant costs not only deflates overall figures substantially but also results in rank order changes among cost categories. Despite this, Cost of Illness studies appear effective in mobilizing public opinion towards increased regulation and taxation that is not justified by an expected increase in economic welfare: this is the cost of cost studies.
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Aim To estimate the direct and indirect costs of morbidity and mortality attributable to alcohol consumption in Germany from a societal perspective in 2002. Methods Using the concept of attributable risks and the prevalence-based approach, age and gender-specific alcohol-attributable fractions for morbidity and mortality were calculated for alcoholic disorder, neoplasms, endocrinological, nervous, circulatory, digestive, skin and perinatal disorders, injuries and poisonings. The literature provided data on alcohol consumption in Germany by age, gender and dose amount, and relative risks. Direct costs were calculated based on routine resource utilisation and expenditure statistics. Indirect costs were calculated based on the human capital approach using a discount rate of 5%. Results Alcohol consumption accounted for 5,5% of all deaths and 970,000 years of potential life lost. Total costs were €24,398 million, amounting to 1.16% of Germany’s GDP, or €296 per person. Direct medical and non-medical costs were €8,441 million. Indirect costs were €15,957 million (69% mortality and 31% morbidity costs). In contrast, protective health effects of alcohol consumption saved €4,839 million. Conclusions The magnitude of alcohol-attributable morbidity and mortality and associated costs demands more preventive efforts.
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This study investigated whether hospitalised fall-related injuries among young and middle-aged adults were associated with short term effects of alcohol intake, marijuana use and sleep deprivation. A case-crossover design was used to study 690 adults (aged 20 to 64 years) admitted to public hospitals within 48 hours of a fall-related injury, occurring at home, in three regions of New Zealand during August 2008 to December 2009. A matched-pair interval method of analysis was used to compare alcohol intake, marijuana use and sleep deprivation before the event with similar information in two control periods: 24 hours-before and 1 week-before the time of injury. After adjustment for other paired exposures, the estimated risk of injury was substantially higher after consuming alcohol within the preceding 6 hours, with a dose response gradient. After adjusting for confounding variables, the data did not support a significantly elevated risk of fall-related injury associated with sleep deprivation (<6 hours sleep in the preceding 24 hours), or marijuana use in the preceding 3 hours. The findings support the expansion of efforts to reduce the harmful effects of alcohol intake in the home environment.
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Alcohol use disorders are related to many negative health, emotional, societal, and economic consequences. These disorders are often difficult to treat because individuals suffering from them tend to be ambivalent about and resistant to change. Motivational interviewing provides health care providers with the appropriate tools to treat individuals who are resistant to change and can help with long-term lifestyle and behavioral changes. Motivational interviewing has also been shown to be helpful when a lifestyle approach to treatment is used.
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The Peabody Picture Vocabulary Test (PPVT-III) is a test which is currently used in New Zealand to measure receptive vocabulary skills (Stockman, 2000). This research investigated the suitability of the PPVT-III with 46 Māori children from three different age groups (5-11 years). Results revealed that the PPVT-III appeared to be suitable for use with Māori, although a number of suggestions were made as to ways in which the administration and interpretation of PPVT-III test scores could be adjusted when working with Māori. Additional research is required to establish whether changes to culturally biased items may improve the validity of the PPVT-III for use with Māori
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The preceding chapters have shown that alcohol use and misuse can have adverse consequences in such widely differing areas as physical and mental health, traffic safety, violence, and labour productivity. Some entail significant economic costs to society. During the past three decades, considerable efforts have been made to estimate these costs [for an overview, 1–3]. Recent investigations suggest that they represent annually a substantial part of the Gross Domestic Product of industrialized countries.
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A sociedade brasileira arca, atualmente, com um elevado custo econômico frente aos problemas decorrentes do uso abusivo de álcool. No Brasil, estudos econômicos relacionados ao abuso e/ou dependência química são escassos ou inexistentes, embora exista uma grande limitação de recursos e enormes problemas de saúde decorrentes. Este artigo tem como objetivo introduzir aos profissionais da saúde conceitos fundamentais da Economia da Saúde, tais como: avaliação econômica completa e incompleta, custo da doença, comparação de custos, tipos de avaliação (custo-minimização, custo-efetividade, custo-utility e custo-benefício), pontos de vista da análise (do paciente, da Instituição de Saúde, do Ministério da Saúde ou da sociedade), tipos de custos (diretos, indiretos e intangíveis) e outros. Além disso, serão descritos alguns dados de pesquisas sobre o impacto do consumo de álcool na sociedade brasileira. Não pretendemos esgotar os assuntos tratados, mas sim, enfatizar a necessidade de pesquisas nacionais que aliem a avaliação econômica à dependência alcoólica, tendo por finalidade propiciar o maior ganho de saúde possível, com a menor utilização dos escassos recursos destinados ao sistema saúde, na busca de maior eficiência.
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The purpose of this study was to estimate the socioeconomic costs resulting from alcohol drinking among adolescents as of 2006 from a societal perspective. The costs were classified into direct costs, indirect costs, and other costs. The direct costs consisted of direct medical costs and direct non-medical costs. The indirect costs were computed by future income losses from premature death, productivity losses from using medical services and reduction of productivity from drinking and hangover. The other costs consisted of property damage, public administrative expenses, and traffic accident compensation. The socioeconomic costs of alcohol drinking among adolescents as of 2006 were estimated to be 387.5 billion won (0.05% of GDP). In the case of the former, the amount included 48.25% for reduction of productivity from drinking and hangover, 39.38% for future income losses from premature death, and 6.71% for hangover costs. The results showed that the socioeconomic costs of alcohol drinking among adolescents in Korea were a serious as compared with that of the United States. Therefore, the active interventions such as a surveillance system and a prevention program to control adolescents drinking by government and preventive medicine specialist are needed.
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Alcohol-Related Disease Impact (ARDI) Software has been developed for the Centers for Disease Control (CDC) to allow States to calculate mortality, years of potential life lost (YPLL), direct health-care costs, indirect morbidity and mortality costs, and nonhealth-sector costs associated with alcohol use and misuse. The mortality related measures--mortality, YPLL, and indirect mortality costs--are computed for 35 diagnoses related to alcohol use and misuse. A review of clinical research studies and injury surveillance studies was conducted to produce estimates of the alcohol-attributable fraction (AAF) for each diagnosis. For these measures, age-specific and age-adjusted rates are also calculated. Health care costs, morbidity costs, and nonhealth-sector costs are prorated from national studies to the State or locality. This multiple-measure approach to quantifying a health problem is termed "disease impact estimation." National estimates of the disease impact of alcohol use and misuse have been produced using ARDI software and State-specific estimates are in preparation. Designed to CDC specifications, ARDI is completely menu-driven and operates within Lotus 1-2-3 software as a set of linked spreadsheets. ARDI adapts national epidemiologic and health economics methods for use by State and local health agencies. ARDI produces data on the health consequences of alcohol use and misuse for use by locally based policymakers, public health professionals, and researchers, while permitting comparison and compilation of these data across jurisdictions.
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The high prevalence of alcohol and drug abuse and mental illness imposes a substantial financial burden on those affected and on society. The authors present estimates of the economic costs from these causes for 1985 and 1988, based on current and reliable data available from national surveys and the use of new costing methodology. The total losses to the economy related to alcohol and drug abuse and mental illness for 1988 are estimated at $273.3 billion. The estimate includes $85.8 billion for alcohol abuse, $58.3 billion for drug abuse, and $129.3 billion for mental illness. The total estimated costs for 1985, $218.1 billion, include $51.4 billion for direct treatment and support costs; $80.8 billion for morbidity costs, the value of reduced or lost productivity; $35.8 billion for mortality costs, the value of foregone future productivity for the 140,593 premature deaths associated with these disorders, based on a 6 percent discount rate and including an imputed value for housekeeping services; and $47.5 billion in other related costs, including the costs of crime, motor vehicle crashes, fire destruction, and the value of productivity losses for victims of crime, incarceration, crime careers, and caregiver services. The cost of acquired immunodeficiency syndrome associated with drug abuse is estimated at $1 billion, and the cost of fetal alcohol syndrome is estimated at $1.6 billion. The estimates may be considered lower limits of the true costs to society of alcohol and drug abuse and mental illness in the United States.
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Alcohol abuse in the State of Minnesota has an impact on health, health care resources, and the economy. Alcohol abuse was related to 3.3 per cent (1,150) of deaths in Minnesota in 1983; of these, almost one-third were the result of fatal injuries. Alcohol abuse contributed to 12 per cent (33,909) of all years of potential life lost, two-thirds of which were secondary to injury. The estimated cost of alcohol abuse ranged from $1.4 billion to $2.1 billion, representing from 2.8 per cent to 4.3 per cent of all personal income of Minnesotans, from 32 per cent to 50 per cent of State expenditures, and from 26 to 39 times the alcohol excise tax revenues generated in 1983. Alcohol-related direct medical care costs were estimated to be at least $216 million, 3.8 per cent of Minnesota medical costs for 1983. Costs of reduced on-the-job productivity and short-term absenteeism related to alcohol abuse were estimated to be between $630 million and $1.2 billion. The documentation of the costs of alcohol abuse is an important step in the campaign to reduce alcohol-related deaths, morbidity, and health care costs.
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To obtain an estimate of the prevalence of fetal alcohol syndrome in New Zealand and to report information on paediatrician surveillance for alcohol related birth defects. New Zealand paediatricians were asked to complete a postal survey. Questions recorded the number of children with alcohol related birth defects under their care, and examined the respondents' surveillance for alcohol related birth defects. There were 63 children under 10 years of age with fetal alcohol syndrome under paediatric care in 1993. The majority of paediatricians considered the diagnosis only when risk features were identified: the most frequent being children of high risk mothers and children with dysmorphic features. Fetal alcohol syndrome exists in New Zealand. The prevalence of fetal alcohol syndrome as estimated in this study is lower than would be expected from international prevalence reports and is likely to be an underestimate. Current surveillance for alcohol related birth defects depends on an individual paediatrician considering the diagnosis only when faced with a perceived at risk infant or child, and there is likely under recognition. An increased awareness of the risks of alcohol consumption in pregnancy and the full spectrum of alcohol related birth defects is required.
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This paper estimates the economic cost of the extra health care in New Zealand associated with the misuse of alcohol. From a range of different studies it was estimated that 7.8% of hospital operating costs were attributable to alcohol consumption. These additional costs formed 85.5% of the total increase in health costs related to excess alcohol consumption. The estimate of this total, NZ$108.3m., represented 0.4% of New Zealand GNP for 1981–82.
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to establish a viable methodology for the linkage of patients information between general practice and the secondary health care sector. To demonstrate this by examining the activities and cost of health care to a general practice community. the linkage of computerised records was achieved using a unique alpha numeric identifier (the National Master Patient Index number). Using this link all patient activities for one general practice were analysed. Consultations and their outcomes in terms of pathology and radiology requests, prescriptions, and referrals to other health care providers were recorded. Secondary care activities analysed were outpatient, inpatient, day care, and accident and emergency attendances. the study population of 3611 patients produced 15,453 contacts in general practice (4.3 contacts per person per annum) and 2804 contacts with the secondary care system (0.8 contacts per person per annum). The total government expenditure was $824,567 for general practice care and $1,410,198 for secondary care, ie, $2,234,765 in total or $619 per person. this methodology for information linkage provides the potential for comprehensive examination of publicly funded health care in both general practice and hospital settings, thereby promoting better coordinated and more rational planning of services.
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The paper discusses issues surrounding the use of alcohol taxation as a means of reducing the costs imposed on New Zealand society by the abuse of alcohol. Econometric studies have indicated that, in common with most other industrialised countries, increases in the real price of alcoholic beverages in New Zealand reduce the per capita consumption of alcohol. Alcohol taxes are well-targeted towards those who are most likely to impose costs on society: 7% of drinkers drink approximately half of all alcohol consumed and therefore pay a large proportion of alcohol taxes. The common assertion that the burden of alcohol taxes falls disproportionately on low income groups is not supported by this analysis: alcohol taxation in New Zealand appears to be proportional rather than regressive.
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The misuse of alcohol imposes costs on society in a variety of ways. This paper presents a conservative estimate of the total resource cost of alcohol misuse in England and Wales concentrating on four major areas: the costs to industry and the National Health Service, material damage costs and the costs of criminal activity. It is estimated the social cost of alcohol misuse is in excess of £ 1500 million (1983 prices). Much research needs to be undertaken to improve the poor epidemiological bases on which these estimates depend.
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This paper estimates the economic cost of lost production in New Zealand due to the abuse of alcohol. Four categories of lost production are examined including excess unemployment amongst abusers, decreased efficiency of abusers in the workforce, temporary withdrawal from the work force due to alcohol induced illness or accident, and permanent withdrawal from the work force due to the premature death of abusers. Assuming full employment, a 4.3% prevalence rate of alcohol abuse, and a 3 : 1 ratio of male to female abusers, the study presents estimates of costs for a range of possible abuser employment levels. The findings indicate that the cost of lost production due to alcohol abuse was between $582 million and $770 million for the 1981/82 financial year. This was equivalent to between 2% and 2.3% of GNP for that year.
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The abuse of alcohol imposes a heavy burden upon our public hospital system. Although a lack of conclusive evidence precludes any accurate estimated of the costs that are incurred, our broad estimates do give some indication of the extent of these costs. Taking into account only those health problems where alcohol is recorded as a causal factor gives an estimated cost of public hospital services of approximately $21 million per year in excess of any costs which might otherwise be expected to arise in the absence of alcohol. Expanding the definition of alcohol-related disorders according to the results of survey data increases the estimated cost to at least $52 million per year and possibly to $115 million or more. These costs are far outweighed by the non-medical costs of excessive drinking such as lost production, crime and a deterioration in the quality of life of alcohol abusers and their families.
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There are no published New Zealand (NZ) studies on alcohol drinking and total mortality, despite its importance to alcohol health policy. To estimate the proportion of NZ deaths caused or prevented by alcohol drinking. The proportion of current alcohol drinkers from recent NZ surveys, and pooled relative risks from a review of the international literature on alcohol and mortality, were used to calculate disease-specific population attributable risks. The number of deaths caused (or prevented) by alcohol were calculated for 1987 New Zealand deaths. Person-years of life lost (or saved) were calculated using recent NZ life tables. The association between alcohol and total mortality was related to age. Alcohol was estimated to have caused 3.0% of all deaths among 0-14 year olds and 20.1% of deaths among 15-34 year olds, mostly from road injuries. In contrast, alcohol was estimated to have prevented 0.5% of all deaths among 35-64 year olds and 3.4% of deaths among > or = 65 year olds due to its protective effect against coronary heart disease. For all age groups, alcohol was estimated to have prevented 1.5% of deaths. However, the number of person-years of life lost among ages less than 35 years was greater than those saved in the older age groups, so that alcohol was estimated to have caused the loss of 9525 person-years of life for all ages combined. The adverse effects of alcohol on total mortality are confined to age groups less than 35 years. Public health policy to minimise deaths from alcohol should be concentrated on this group.
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The one-year prevalence and correlates of selected DSM-III-R disorders were determined in a sample of 930 18-year-olds. Using both diagnostic and impairment criteria 340 individuals (36.6%) were considered to have disorder. The most prevalent disorders were major depressive episode (16.7%), alcohol dependence (10.4%) and social phobia (11.1%). There was a high degree of co-morbidity among disorders; 46% of those with disorder had two or more. The prevalence of disorders was greater for females, with the exception of conduct disorder and alcohol or marijuana dependence. A variety of characteristics were associated with disorder, including poor social competence, disadvantage and self-rated health status. A third of those with disorder had their problems recognised by a "significant-other". The results are presented within the context of a perceived need for research in the area of adolescent and early adult mental health in order to minimise the toll of mental disorder in later life.
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To report the results of screening for alcohol use disorder in 611 general practice patients aged 30-69 years over a three year period. Patients attending a health screening appointment completed a self-administered questionnaire assessing alcohol consumption and concern about drinking, and liver function tests were arranged. Positive results were assessed and patients classified according to DSM IIIR criteria for alcohol use disorder into an alcohol abuse or dependence group. Those screening positive but not meeting criteria for alcohol use disorder were classified as at-risk drinkers. A positive alcohol screen was confirmed in 133 patients (22%), of whom 39 met the criteria for an alcohol use disorder, the remaining 94 classified at-risk. Weekly alcohol consumption above 20 drinks for men and 15 drinks for women identified 79% of those with an alcohol use disorder increasing to 83% by the addition of information about episodic heavy drinking. The inclusion of laboratory results improved the sensitivity of the overall alcohol screen to 93%, mostly by improving detection of alcohol abuse among men. The prevalence of alcohol use disorder among the 801 patients in this practice age group over three years was 13% for men and 2.5% for women. Half of these patients were identified only as a result of the screening programme. Screening for alcohol use disorder with items included in a health check proved very effective in this practice, identifying a significant number of previously undetected patients with alcohol abuse and dependence.
Article
All policy interventions have costs and benefits and the 'harm' created by the use of alcohol can only be mitigated at a cost. The purpose of economic analysis is to measure these costs and benefits in an explicit way and to use these results to inform policy. Policy makers like to use estimates of the social costs of alcohol use but such data are of little use in identifying which interventions reduce harm at least cost: knowing alcohol use costs in local currencies $6 million in Australia, $5.8 billion in the USA, $5.7 billion in Canada and $2 billion in the UK may fuel political debate but does not identify the intervention where investment produces the greatest increase in benefit at least cost. Integrated policies to raise taxes in relation to price and income changes have significant impacts on alcohol consumption and, if complemented with advertising controls and limits on availability have even larger effects. The quantity and quality of economic evaluations of health care interventions is inadequate. What little evaluation that has been undertaken indicates that low cost minimal interventions may be cost effective for the wider population of problem drinkers. Other more intensive interventions are likely to be cost effective only if well targeted on appropriate client groups. There are many effective ways of reducing alcohol consumption. The industry will lose and oppose change but improvements in health and other aspects of life (eg civil order) will be significant.
Article
Lost productivity accounts for a significant proportion of the total cost of alcohol. This study quantifies the costs associated with alcohol consumption using survey data collected from four alcohol surveys conducted in Auckland between November 1990 to May 1992. The total sample size was 4662, of which 2638 were drinkers in paid employment. A computer-assisted telephone interviewing system was used to interview a random sample that closely matched the Auckland population. Respondents gave information about their typical alcohol consumption and frequency of absences from paid employment which were a result of their drinking. They also gave a report of the number of times in the past 12 months when they felt their work had been impaired as a result of their drinking. The cost of absenteeism was recorded as the number of times a respondent reported time away from work multiplied by gross income. Estimates of reduced work efficiency were derived from US figures, which estimated a 25% reduction in work performance among heavy alcohol users; 3.7% of the sample reported alcohol-related absences and 12% reported reduced efficiency days. There was a significant difference in both the number and cost of absentee and reduced efficiency days reported between the top 10% and the bottom 10% drinkers. A conservative estimate of alcohol-related lost productivity among the working population of New Zealand (with a population of 3.4 million and a per capita absolute alcohol consumption of 9.7 litres) was found to be $57 million per year.