Draft global strategy to reduce harmful use of alcohol
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1 Draft global strategy to reduce harmful use of alcohol Luxembourg January 27, 2010
2 Leading causes of attributable global mortality and burden of disease, 2004 Attributable Mortality % 1. High blood pressure Tobacco use High blood glucose Physical inactivity Overweight and obesity High cholesterol Unsafe sex Alcohol use Childhood underweight Indoor smoke from solid fuels 3.3 Attributable DALYs % 1. Childhood underweight Unsafe sex Alcohol use Unsafe water, sanitation, hygiene High blood pressure Tobacco use Suboptimal breastfeeding High blood glucose Indoor smoke from solid fuels Overweight and obesity million total global deaths in billion total global DALYs in 2004
3 Deaths attributed to 19 leading factors, by country income level, 2004
4 Proportion of alcohol-attributable deaths in WHO subregions 2004 Alcohol-attributable deaths, % - 2% 2% - 5% 5% - 10% 10% - 14%
5 Huge variations in deaths in different sub-groups in the world in 2004 Male total deaths Total deaths females Unsafe w ater, sanitation, hygiene Unsafe sex Underw eight Overw eight and obesity High cholesterol Physical inactivity High blood glucose Alcohol use High blood pressure Tobacco use Alcohol use Vitamin A deficiency Urban outdoor air pollution Sub-optimal breastfeeding Low fruit and vegetable intake Unsafe w ater, sanitation, hygiene Underw eight Indoor smoke from solid fuels High cholesterol Unsafe sex Overw eight and obesity Tobacco use Physical inactivity High blood glucose High blood pressure Total deaths males in the world Total female deaths 80+ in Europe Low fruit and vegetable intake High blood glucose Alcohol use Child sexual abuse Unsafe health care injections Physical inactivity Unsafe w ater, sanitation, hygiene Illicit drug use Occupational risks Overweight and obesity High blood glucose High cholesterol Physical inactivity Unsafe sex High blood pressure Alcohol use
6 Male deaths age in 2004 in the Americas Child sexual abuse Iron deficiency Low fruit and vegetable intake High blood glucose Physical inactivity Illicit drug use Occupational risks Unsafe sex Alcohol use Thousands
7 ALCOHOL ATTRIBUTABLE FRACTIONS (%) FOR MALE DEATHS BY AGE GROUPS AND REGIONS AFR AMR EMR EUR SEAR 10 WPR
8 Population attributable fraction (%) for total female deaths by age groups and regions in the world AFR AMR EMR EUR SEAR WPR
9 Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, 2004
10 Proportion of alcohol-attributable DALYs in WHO subregions 2004 Alcohol-attributable DALYs, % - 2% 2% - 5% 5% - 10% 10% - 19%
11 DALYs by World Bank income groups in 2004 HIGH INCOME UPPER MIDDLE INCOME Low f ruit and veget able int ake Occupat ional risks Illicit drug use High cholest erol Physical inactivity High blood glucose High blood pressure Overweight and obesit y Alcohol use Tobacco use Occupational r isks Low f ruit and vegetable intake Physical inactivity Hi gh chol ester ol Hi gh bl ood gl ucose Over wei ght and obesi ty Hi gh bl ood pr essur e Tobacco use Unsaf e sex Alcohol use LOWER MIDDLE INCOME LOW INCOME Sub-optimal br eastf eeding Zi nc def i ci ency Hi gh chol ester ol Hi gh bl ood gl ucose Unsaf e water, sanitation, hygiene Alcohol use Physical inactivity Occupational r isks Over wei ght and obesi ty Hi gh bl ood gl ucose Tobacco use Hi gh bl ood pr essur e Alcohol use Hi gh bl ood pr essur e Vitamin A def iciency Indoor smoke f rom solid f uels Sub-optimal br eastf eeding Unsaf e sex Unsaf e water, sanitation, hygiene Under wei ght
12 DEATHs (000) EURO DALYs (000) Occupational risks Illicit drug use Urban outdoor air pollution Occupat ional risks Low fruit and vegetable intake Low f ruit and veget able int ake Alcohol use High blood glucose High blood glucose Physical inactivity High cholesterol High cholest erol Physical inactivity Overweight and obesit y Overweight and obesity High blood pressure Tobacco use Alcohol use High blood pressure Tobacco use
13 Alcohol attributable deaths and DALYs analysed from the perspective of the different diseases and injuries
14 Division by disease or injury of alcohol attributable deaths in the world for the year 2004 Self-inflicted injuries 3.98% Hypertensive heart disease 5.78% Oesophagus cancer 6.94% Violence 7.97% Liver cancer 8.16% Cerebrovascular disease 4.88% Other unintentional injuries 9.86% Road traffic accidents 11.85% Alcohol use disorders 3.89% Ischaemic heart disease 3.78% Mouth and oropharynx cancers 3.40% Poisonings 2.94% Drownings 2.69% Other 7.39% Cirrhosis of the liver 16.48% Falls 2.10% Epilepsy 2.05% Breast cancer 1.69% Colon and rectum cancers 0.81% Other neoplasms Unipolar 0.50% depressive disorders 0.01% Prematurity and low birth weight 0.14% Other intentional injuries 0.08%
15 Alcohol attributable fractions (%) of different death causes in the world in % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Alcohol use disorders Cirrhosis of the liver Liver cancer Oesophagus cancer Epilepsy Mouth and oropharynx cancers Violence Road traffic accidents Poisonings Hypertensive heart disease Drownings Other intentional injuries Other unintentional injuries Self-inflicted injuries Breast cancer Falls Other neoplasms Colon and rectum cancers Unipolar depressive disorders Prematurity and low birth weight
16 Division of alcohol attributable DALYs by disease or injury in the world for the year 2004 Other unintentional injuries 9% Cirrhosis of the liver 10% Violence 8% Liver cancer Epilepsy 3% 3% Self-inflicted injuries Ischaemic 3% heart disease 3% Cerebrovascular disease 2% Oesophagus cancer 2% Poisonings 2% Drownings 2% Hypertensive heart disease 2% Other 6% Falls 2% Unipolar depressive dis 1% Mouth and oropharynx 1% Road traffic accidents 12% Breast cancer 1% Colon and rectum c 0% Other neoplasms 0% Alcohol use disorders 34% Prematurity and low 0% Other intentional inj 0%
17 Alcohol attributable fractions (%) for DALYs of different diseases and injuries in the world in % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Alcohol use disorders Cirrhosis of the liver Liver cancer Oesophagus cancer Epilepsy Mouth and oropharynx cancers Violence Road traffic accidents Poisonings Hypertensive heart disease Drownings Other intentional injuries Other unintentional injuries Self-inflicted injuries Breast cancer Falls Other neoplasms Colon and rectum cancers Unipolar depressive disorders Prematurity and low birth weight
18
19 Structure of the strategy Setting the scene Challenges and opportunities Aims and objectives Guiding principles National policies and measures Policy options and interventions Area 1. Leadership, awareness and commitment Area 2. Health services response Area 3. Community action Area 4. Drink driving policies and countermeasures Area 5. Availability of alcohol Area 6. Marketing of alcoholic beverages Area 7. Pricing policies Area 8. Reducing the negative consequences of drinking and alcohol intoxication Area 9. Reducing the public health impact of illicit alcohol and informally produced alcohol Area 10. Monitoring and surveillance Global action: key roles and components Public health advocacy and partnership Technical support and capacity building Production and dissemination of knowledge Resource mobilization Implementing the strategy Links and interfaces with other strategies, plans and programmes Monitoring progress and reporting mechanisms
20 Challenges and opportunities Increasing global action and international cooperation. Ensuring intersectoral action. According appropriate attention. Balancing different interests. Focusing on equity. Considering the context in recommending actions. Strengthening information.
21 Aims and objectives National and local efforts can produce better results when they are supported by regional and global action within agreed policy frames. Thus the purpose of the global strategy is to support and complement public health policies in Member States. The vision behind the global strategy is improved health and social outcomes for individuals, families and communities, with considerably reduced morbidity and mortality due to harmful use of alcohol and their ensuing social consequences. It is envisaged that the global strategy will promote and support local, regional and global actions to prevent and reduce the harmful use of alcohol. The global strategy aims to give guidance for action at all levels; to set priority areas for global action; and to recommend a portfolio of policy options and measures that could be considered for implementation and adjusted as appropriate at the national level, taking into account national circumstances, such as religious and cultural contexts, national public health priorities, as well as resources, capacities and capabilities.
22 Five objectives: (a)raised global awareness of the magnitude and nature of the health, social and economic problems caused by harmful use of alcohol, and increased commitment by governments to act to address the harmful use of alcohol; (b)strengthened knowledge base on the magnitude and determinants of alcohol-related harm and on effective interventions to reduce and prevent such harm; (c)increased technical support to, and enhanced capacity of, Member States for preventing the harmful use of alcohol and managing alcohol-use disorders and associated health conditions; (d)strengthened partnerships and better coordination among stakeholders and increased mobilization of resources required for appropriate and concerted action to prevent the harmful use of alcohol; (e)improved systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes.
23 Aims and objectives The harmful use of alcohol and its related public health problems are influenced by the general level of alcohol consumption in a population, drinking patterns and local contexts. Achieving the five objectives will require global, regional and national actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health. Special attention needs to be given to reducing harm to people other than the drinker and to populations that are at particular risk from harmful use of alcohol, such as children, adolescents, women of child-bearing age, pregnant and breastfeeding women, indigenous peoples and other minority groups or groups with low socioeconomic status.
24 Guiding principles (a) Public policies and interventions to prevent and reduce alcohol-related harm should be guided and formulated by public health interests and based on clear public health goals and the best available evidence. (b) Policies should be equitable and sensitive to national, (c) religious and cultural contexts. All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions to prevent and reduce harmful use of alcohol. (d) Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted.
25 Guiding principles (e) Protection of populations at high risk of alcoholattributable harm and those exposed to the effects of harmful drinking by others should be an integral part of policies addressing the harmful use of alcohol. (f) Individuals and families affected by the harmful use of alcohol should have access to affordable and effective prevention and care services. (g) Children, teenagers and adults who choose not to drink alcohol beverages have the right to be supported in their non-drinking behaviour and protected from pressures to drink. (h) Public policies and interventions to prevent and reduce alcohol related harm should encompass all alcoholic beverages and surrogate alcohol.
26 10 recommended target areas: (a) leadership, awareness and commitment (b) health services response (c) community action (d) drink driving policies and countermeasures (e) availability of alcohol (f) marketing of alcoholic beverages (g) pricing policies (h) reducing the negative consequences of drinking and alcohol intoxication (i) reducing the public health impact of illicit alcohol and informally produced alcohol (j) monitoring and surveillance
27 Global Action: Key Roles And Components Role of WHO, WHO secretariat and different stakeholders Priority areas for global action: Public health advocacy and partnership Technical support and capacity building Production and dissemination of knowledge Resource mobilization
28 Implementing the strategy Successful implementation of the strategy will require concerted action by Member States, effective global governance and appropriate engagement of all relevant stakeholders. All actions listed in the strategy are proposed to support the achievement of the five objectives. The Secretariat will report regularly on the global burden of alcohol-related harm, make evidence-based recommendations, and advocate action at all levels to prevent and reduce harmful use of alcohol. It will collaborate with other intergovernmental organizations and, as appropriate, other international bodies representing key stakeholders to ensure that action to reduce harmful use of alcohol receives appropriate priority and resources.
29 This paper was produced for a meeting organized by Health & Consumers DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumers DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.
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