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Where in the country are some of the most acute problems of alcohol abuse? If your mind is wandering north westward or towards any major city centre think again. The answer is genteel Surrey, the archetypal leafy suburb and habitat of the respectable middle classes.

Think disposable income, stockbroker, hedge fund manager and marketing diva and it all begins to make sense.

Surrey had a problem with alcohol before the recent downturn set in. Bottle banks in the Waitrose car park were overflowing with the evidence of drinkers who might know their limits but were happy to sail past them on an ocean of chardonnay and pinot noir, blissfully unaware of the economic storm ahead. Drinkers dismissive of the lager swilling youth cluttering their pleasant high streets on a Saturday, were perhaps only a few mortgage defaults behind them in economic terms and streets ahead in the long-term liver damage stakes.

One group that historically weathers recession well is the drinks industry as the population, unable to work or think its way out of an economic hole, drinks its way into a stupor.

And now the stuffing has been knocked out of the financial markets and the creative industries are on their knees, repossessions are rising, savings and pensions have been decimated and the end may be two, three, five or even 10 years away, now what?

In Surrey, the PCT is gearing up for the changing pattern of demand for health services as the human consequences of recession start to make themselves felt. Before things took at turn for the worse, the PCT already had an alcohol strategy underway aimed not just at the usual suspects but the at the well-to-do stay-at-home drinker. They expect a rise not just in alcohol but in drug related problems, in mental health problems as a consequence of rising unemployment, and the steady erosion of physical well-being by stress and other psychological factors. They also expect the incidence of suicide to increase as the statistics suggest that inevitably it will.

Changing economic circumstances create changing health needs. Some of these are predictable, some are not. All will demand a response from the teams that commission and deliver primary care and community services, the ambulance service and acute sector, and the third-sector organisations who work with the disadvantaged, whose disadvantages only increase in times like these.

If it's difficult to sound a note of optimism, it's not impossible to imagine how things could be better – if we were to share learning about responses to these problems, work together on strategies to palliate their worst effects, work harder to understand the needs of different health populations and grapple with the perennial care issues made more intractable by economic hardship.

There is probably nothing that collective action can do to make the economic recession go away, but we shouldn't assume that all of its consequences are inevitable. Does the idea of a network dedicated to preventing a recession in public health sound hopelessly optimistic or should we all just hit the bottle instead?

Email Krishna Patel if you want to share alcohol reduction strategies, have information about or a need for help in setting up IAPT services, or have recession-busting health network ideas of your own.

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