Chief Medical Officer's Report: The main issues

Undiagnosed high blood pressure Soaring rates of liver cirrhosis Neglected epilepsy patients Health inequality between north and south Increase in E.coli 0157 outbreaks

The report, a summary of "neglected" areas of the nation's health, also calls for more action to spot and treat people with high blood pressure, and to help patients with epilepsy.

However, the rise in the number of cirrhosis deaths is a "particular concern", he says.

Cirrhosis - the permanent scarring and damage of the liver - is irreversible, although treatment can prevent it from getting worse.

Among 35 to 44-year-olds, there has been an eight-fold increase in deaths among men, and seven-fold among women.

Cirrhosis of the liver now kills 1,600 women a year, compared to 1,200 seven years ago - more than cervical cancer.

While some of this increase can be blamed on the side-effects of long-term infection with hepatitis B and C, Professor Donaldson says that the most "convincing explanation" is alcohol.

'Culmulative damage'

He says: "There is a clear need for a comprehensive approach, across and beyond government, to address the consequences of problematic drinking.

Public awareness needs to be raised that certain patterns of heavy drinking are potentially dangerous

Professor Liam Donaldson

"Public awareness needs to be raised that certain patterns of heavy drinking are potentially dangerous in producing culmulative damage to the liver."

The government is working on an NHS alcohol strategy, which is expected to be published in 2004.

Professor Donaldson also calls for hepatitis screening to offered to all pregnant women, to stop the virus being passed on to their babies.

Women 'more susceptible'

Jean Coussins, director of the drinks industry-funded Portman Group, said: "The Portman Group's own research shows that up to 1m young men and women in that age group regularly drink deliberately to get drunk.

"Too many young adults see sensible drinking and having a good time as mutually exclusive pursuits."

Professor Peter Scheuer, vice-president of the British Liver Trust, said he was not surprised by the rising levels of cirrhosis, though he said alcohol was not the sole cause, and factors such as the increase in Hepatitis C had also contributed to the problem.

Too many young adults see sensible drinking and having a good time as mutually exclusive pursuits

Jean Coussins, director of the drinks industry-funded Portman Group

Professor Scheuer added the increase in cirrhosis amongst women was a "sociological" phenomenon rather than a medical one.

"Women are thought to be more susceptible and they get problems with alcohol earlier and quicker so they are more likely to develop cirrhosis of the liver for relatively small amounts of alcohol."

Blood pressure

Far more deaths are caused by patchy diagnosis and treatment of blood pressure, he said.

A new definition of high blood pressure means that an estimated 41% of men and 33% of women are suffering from it.

Most of these are not taking medication, or are being treated ineffectively - even though high blood pressure causes 3,000 deaths a year outright, and may contribute to 150,000 more from heart disease and stroke.

Professor Donaldson calls for more effort to spot high blood pressure, and a "major initiative" by the food industry to cut salt levels in food, as this can contribute to the problem.