Alcohol-related liver disease : an issue of public health and social equity

A discreet but vital organ, the liver is today at the heart of a silent health alert. Dr Laura Weichselbaum recently wrote an article published in “JHEP Reports” (Journal of Hepatology Reports) explaining that alcohol-related liver disease affects disproportionally those populations who are socially and economically disadvantaged. A reality that deserves to be examined with humanity, lucidity... and a sense of collective responsibility.   

Risk behaviour related to life circumstances

Contrary to what is often thought, it is not about enjoying fine wines or occasional drinking on festive occasions. It is rather habits such as binge drinking coupled with a poor diet, a high body mass index and also heavy smoking that combine to form a dangerous cocktail.   Such risk behaviour is often exacerbated by life circumstances marked by economic and social insecurity, limited access to healthcare and an entourage insufficiently informed of the risks.  
 

“Today, many studies show that given the same alcohol consumption the damage to health is three times as high among disadvantaged people, even when other risk factors such as obesity or smoking are taken into account,”   says Dr Weichselbaum
 

Healthcare inequalities 

The data show that alcohol-related liver disease is over-represented among disadvantaged populations. This is not necessarily attributable to a higher alcohol consumption but rather to a frequent and simultaneous exposure to a number of risk factors. What is more, when a liver disease develops there is often no screening to detect it at an early stage due to insufficient medical follow-up. 

“Liver  disease is a silent disease. It is our duty as healthcare staff to be aware of the lifestyle of our patients so as to propose an appropriate  care pathway and possibly suggest screening.”  

Act early, act better for a more equitable health

The good news? It is possible to act:

• By increasing awareness without blame, so that everyone can understand the risks and warning signs.
• By proposing a more accessible screening, in particular by making GPs and specialists more aware of the risks associated with socio-economic status.
• By encouraging the populations concerned to get screened and providing more information on the risks associated with alcohol. 

And if taxation became a lever for prevention?

In some countries certain taxes have been levied to limit alcohol consumption.   

“Perhaps we should convince our Belgian decision-makers to impose targeted taxes on alcoholic beverages or drinks designed to encourage binge drinking and thereby limit risk consumption while at the same time financing public health actions.” 
 

Together, let’s look after our livers… 

Awareness, prevention and screening could avoid sometimes incurable liver disease. 

“I would remind you that while ideally alcohol consumption should be limited to a minimum, it is recommended not to drink more than 2 glasses a day for women and 3 for men.”