Better Health For All

By Woody Caan, Editor, Journal of Public Mental Health

The impact of parental drinking on the health and development of children (e.g. Caan W. Alcohol and the family. Contemporary Social Science 2013; 8: 8-17) has been recognised for decades but has never produced government policy that reduces harm. For example, in its final days, the National Institute for Social Work profiled a representative, national caseload of children and families. By far the most common characteristic of families assessed by social services (for any concern) was a parent dependent on alcohol. On behalf of the old UK Public Health Association alcohol group, I met with the British Association of Social Workers to discuss policies that would span public health and social work, but even when we identified quick wins (such as better care and assessment in emergency care for those young people with a history of abuse, who self harm when intoxicated) we failed to change policy.

It is not surprising that the 2003 government genetics & health strategy, Our Inheritance, Our Future, failed to address the common observation that many families with a pedigree of alcohol-use disorders repeat the same history across generations. There have never been official UK guidelines on effective child-health interventions after parental alcoholism is identified, although there are many recommendations from NGOs on both sides of the Atlantic.

The US company Kaiser Permanente first studied Adverse Childhood Experiences (ACEs) and their cumulative, long-term impact on adult health. From the beginning, having one or more adults with an alcohol use disorder within a child’s home environment was seen as a serious adversity. (Note: diverse studies have sometimes explored either parental addiction or shorter-term ‘alcohol abuse’, while the grown-up recollection of parenting in childhood tends to be fragmented and not like a clinical assessment.) In 2016, the Public Mental Health Network hosted by the Royal College of Psychiatrists decided to make ACEs our priority. In 2016, Public Health Wales produced a large-scale report on childhood adversity that includes parental drinking as a cause of both mental and physical harm.

What gives me hope for change in 2017? In February, three Members of Parliament (Jon Ashworth, Caroline Flint and Liam Byrne), supported by the Archbishop of Canterbury, all described their own experience of parental alcoholism and issued a manifesto for action. Subsequently, I sent the current Under Secretary of State for Public Health a letter in support of those MPs, with a little public health evidence. On 15 March that minister, Nicola Blackwood, replied to me that she was “committed to developing a strategy to help alleviate this serious issue”. The Public Health Minister also wants professionals like us to share our knowledge “as the new strategy is being developed”.