Alcohol and Public Health: burden and global response. Maristela G Monteiro, MD PhD Senior Advisor on Alcohol and Substance Abuse

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1 .. Alcohol and Public Health: burden and global response Maristela G Monteiro, MD PhD Senior Advisor on Alcohol and Substance Abuse

2 Currently used model for alcohol and health outcomes Societal factors Drinking culture Alcohol policy Drinking environment. Health care system (Individual) Alcohol consumption Volume Patterns Quality Chronic conditions including AUDs Acute conditions Health outcomes (Population group?) Gender Age Poverty Marginalization Mortality sequelae

3 Adult per capita consumption in litres of pure alcohol 2005 Total consumption (recorded and unrecorded)

4 Prevalence of abstention in World 2005 Prevalence of abstention in World

5 Patterns of alcohol consumption : Least hazardous; Regular drinking, often with meals and without heavy drinking bouts 4: Most hazardous: Infrequent but heavy drinking

6 10 Leading Causes of Deaths by Risk Factor Globally in 2004 High Blood Pressure Tobacco use High glucose levels Physical Inactivity Overweight and obesity High Cholesterol Unsafe sex Alcohol Use Childhood Underweight Indoor smoke from solid fuels 2.5 millions deaths related to alcohol in % of all deaths worldwide

7 10 Leading Causes of DALYs lost by Risk Factor Globally in 2004 Childhood Underweight Unsafe sex Alcohol Use Unsafe water, sanitation and hygiene High Blood Pressure Tobacco use Suboptimal breastfeeding High blood glucose Physical Inactivity Indoor smoke from solid fuels 4.5% of all burden in DALYs related to alcohol

8 Attributable DALYs by sex and 10 most important risk factors for the year 2004 in the Americas Females % Males % Total % Alcohol Tobacco Overweight and obesity High blood glucose High blood pressure Physical inactivity High cholesterol Unsafe sex Illicit drugs Unsafe sanitation

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10 World Health Assembly resolutions addressing alcohol-related public health problems 1979: Development of the WHO Programme on alcohol related problems 1983: Alcohol consumption and related problems 1986: Prevention of mental, neurological and psychosocial problems 1989: Prevention and control of drug and alcohol abuse 2002: Mental health 2004: Health promotion and healthy lifestyles 2005 (58 th WHA): Public health problems caused by harmful use of alcohol

11 Process leading to the resolution of alcohol at the World Health Assembly 2008 WHA58 (May 2005): Resolution "Public health problems caused by harmful use of alcohol". WHA60 (May 2007): Report of the Secretariat on strategies to reduce harmful use of alcohol with global assessment of public health problems caused by harmful use of alcohol and discussions on the draft resolution. NO CONSENSUS FOR A STRATEGY Informal consultation (December 2007) with Member States on strategies on reduce harmful use of alcohol 9 policy areas for action identified. EB122 (January 2008): Considered a report from the Secretariat and the draft resolution calling for a global strategy to reduce the harmful use of alcohol.

12 Sixty-First World Health Assembly (2008) resolution "Strategies to reduce the harmful use of alcohol" After noting that they had not reached a consensus last year, delegates adopted a resolution calling upon WHO to produce a draft global strategy to reduce the harmful use of alcohol.

13 2002 Context of a process towards a global strategy to reduce harmful use of alcohol World Health Report WHA58 resolution "Public health problems caused by harmful use of alcohol" WHA61.4 resolution "Strategies to reduce the harmful use of alcohol" Action Plan for the Global strategy on noncommunicable diseases FCTC WHO Expert Committee on Problems Related to Alcohol Consumption Development of regional strategies in WPRO, SEARO (existing in EURO) Global strategy on harmful use of alcohol Global Survey on Alcohol and Health and ATLAS survey on PTR for SUD

14 Process for implementing the WHA 61.4 resolution and preparing a draft global strategy Stage I. Broad consultation process Web-based consultation (WHO public hearings) Consultation with economic operators Consultation with NGOs and health professionals Consultation with UN agencies and intergovernmental organizations

15 Process for implementing the WHA 61.4 resolution and preparing a draft global strategy (continued) Stage II. Draft strategy development Regional technical consultations with Member States with discussion document Draft document by the Secretariat in collaboration and consultation with Member States Informal consultation with Member States Draft strategy presented to the Executive Board Jan 2010 Approval by consensus in May 2010

16 Guiding principles Public health interest and evidence based Equity and cultural/religious sensitivity. All have the responsibility to reduce harms. Public health should be given proper deference in relation to competing interests Protection of populations at high risk of alcoholattributable harm and those exposed to the effects of harmful drinking by others Access to affordable and effective prevention and care services. Children, teenagers and adults who choose not to drink alcohol beverages have the right to be supported in their non-drinking behavior and protected from pressures to drink. All alcoholic beverages and surrogate alcohol.

17 10 POLICY AREAS Leadership and commitment Health services response Community action Drink driving policies Availability of alcohol Marketing of alcoholic beverages Pricing policies Reducing the negative consequences of drinking and alcohol intoxication Reducing the public health impact of illicit alcohol and informally produced alcohol Monitoring and surveillance

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