Portman Group responds to PHE methodology consultation which may significantly lower estimates of alcohol-related deaths/admissions by around a quarter

The Portman Group has responded to Public Health England’s consultation on proposed updates to its use of alcohol-attributable fractions (AAFs) which impact how it calculates alcohol-related mortality and hospital admissions in England. An AAF denotes the proportion of disease cases which are estimated to have been caused by alcohol.

PHE has said updating its methodology to account for declining alcohol consumption across the population, as well as harmful drinking patterns such as binge drinking, would result in current estimates of alcohol-related deaths and admissions being lowered by around a quarter.

Implementing the new methodology would mean that:

  • Current estimated alcohol-related deaths across England would be lowered by around 5,700 – equating to around nearly a quarter (23%) of deaths currently included.
  • Estimated hospital admissions for alcohol-related conditions (under the narrow definition) in England would fall by around 83,000 – again equating to around a quarter (23%) of admissions currently included.
  • Estimated hospital admissions for alcohol-related conditions (under the broad definition) would fall by around 320,000 – equating to around 25% of admissions currently included.

As an evidence-led organisation, we are in favour of the proposed changes presented by PHE, as it is based on an updated evidence base in order to present a more accurate picture and takes into account over a decade of progress of tackling alcohol-related harm.

We believe this update is especially important as it will allow policymakers to make better informed decisions and help to more effectively target policies towards those drinking at the heaviest and most harmful rates.

Recognising positive behaviour

The Portman Group feels that it is important that PHE makes clear that it is changing its methodology to account for positive behaviour change amongst the general population, whilst also recognising the harm that alcohol misuse can cause to individuals remains unchanged.

We would strongly encourage that wider estimates of alcohol-related harm based on these calculations (i.e., previous PHE estimates on the economic cost of alcohol misuse) are also updated to reflect over a decade of progress in tackling harm.

This would take into account wider trends such as:

  • Close to a fall of a half (47%) in alcohol-related violent crime in England and Wales since 2009/10[i];
  • A 33% fall in drink driving accidents across Great Britain since 2009[ii];
  • Almost three quarters (73%) fall in the proportion of pupils who drink at least once a week from 2006 to 2014, which has remained at 6% under the new methodology since 2016[iii].

Public health authorities in Scotland, Wales and Northern Ireland should also follow PHE’s lead to update their own estimates of alcohol-related harm, to take account of declining trends in harm across the whole of the UK.

Lastly, we would be keen for PHE to provide clearer communication regarding its use of alcohol-attributable fractions for alcohol-related indictors to estimate harm and risk. These are important for the lay population to understand and there should be a thorough and comprehensible explanation to the public and policymakers regarding the updated figures compared to the current statistics, which PHE says “may misrepresent the potential burden of alcohol on mortality and hospital admissions (and other statistics related to these)”. This will enhance public trust in the validity of this data, which is often cited by policymakers when discussing alcohol issues.

Overall, this consultation is a welcome chance for the Government to take ownership of over a decade of progress in tackling alcohol misuse at update its estimates of harm, as the UK increasingly becomes a nation of moderate drinkers.


[i] ONS: Nature of crime: violence, September 2020

[ii] UK Department for Transport: Reported road casualties in Great Britain, provisional estimates involving illegal alcohol levels, 2019, February 2021

[iii] NHS Digital: Smoking, Drinking and Drug Use among Young People in England, August 2019