Final report of the. 13 th Meeting of WHO National Counterparts for Alcohol Policy. Thursday, 5 May 2011

Transcription

1 Final report of the 13 th Meeting of WHO National Counterparts for Alcohol Policy Thursday, 5 May 2011

2 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europepw Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( World Health Organization 2011 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization.

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4 AMPHORA Expert meeting and WHO meeting of National Counterparts for Alcohol Policy in the WHO European Region 3-5 May 2011, Zurich, Switzerland Venue: Hotel City Zürich Crowne Plaza 23 May th Meeting of WHO National Counterparts for Alcohol Policy Thursday, 5 May 2011 FINAL REPORT The objectives of the meeting were to discuss the draft European Alcohol Action Plan, the forthcoming surveys on alcohol and health, and to enable the exchange of information between Member States on alcohol policy developments. Dr Lars Møller, Programme Manager a.i., Alcohol and Illicit Drugs of the World Health Organization Regional Office for Europe opened the meeting and welcomed the 45 Member State representatives. Ms Jean Nicol, Team Leader for Alcohol Policy from the Deparment of Health, UK chaired the morning session. Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Health Promotion, WHO Regional Office for Europe presented the Action Plan for the implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases The area of noncommunicable diseases (NCDs) is a high priority on the public health agenda in the European Region. NCDs are the leading cause of deaths globally (63% in ), with figures expected to rise worldwide, and the greatest increases expected in low- and middle-income countries. NCDs have been neglected in the context of global health for many years. The WHO European Regional Director has launched an initiative to develop a new European health policy, building on the traditions of the Health For All movement. The first draft of Health 2020 will be reviewed during the Regional Committee in September Alongside the developing of a new European Health Policy an Action Plan on NCDs is also being developed and presented at the RC61. 1 Global status report on noncommunicable diseases

5 Against this backdrop of increasing public health and high level political awareness to some of the major causes of NCDs. the World Health Assembly, in 2010, approved the Global Strategy for the Reduction of Harmful Use of Alcohol, which now provides the framework for the European Action Plan. A number of questions and observations were made by participants, including how the existing evidence base for tobacco could be adapted for alcohol, the possibility for joint interventions across professional sectors, working with experts to address fiscal and marketing issues and the promotion of cross ministerial collaboration and information sharing. Mr Michael Hübel, Head of Unit, Health Determinants, European Commission presented the Implementation for the European Commission's Alcohol Strategy It is important to have coherence between the EU and WHO on work concerning alcohol policy given the new complexities and new opportunities in health policy thinking. The main focus currently is economic recovery, but this is not possible without social policy investment, sustainable health systems and the impact of chronic illness is a major part of that. There is commitment from stakeholders to the EU approach. The EU has a beneficial role to play in the area of alcohol particularly in collaborating with WHO for example on common tools for monitoring and affecting broader policy areas such as transport, youth, audio visual media and advertising. Currently the European Alcohol Forum comprises 65 members with almost 200 commitments for action. An evaluation of the EU Alcohol Strategy is expected in 2012 (following the progress report in 2009). The joint EU/WHO survey on alcohol and health will be launched in 2011 with preliminary findings ready in Spring These will help shape decisions to define next steps at the end of Several participants commented on how useful the action-oriented EU strategy was and how important it is to harmonize the work of EU and WHO for added value and to ensure effective intervention on all levels (global, regional and national). Dr Lars Møller introduced the discussion on final changes to the European Alcohol Action Plan and the draft Resolution for the upcoming Regional Committee. Member States were requested to make comments verbally, and also in writing to Dr Møller by 13 th May 2011 if they are to be included in the document being sent to the Standing Committee for the Regional Committee. Professor Peter Anderson and Ms Mariann Skar were also invited to join the discussion, in their role as experts on alcohol research and policy. Fourteen Member States provided comments regarding the Action Plan. These can be summarised as follows: 1. Generally the document was deemed very useful and useable. 2. Terminology it was agreed that where there were inconsistencies, the same terminology used in the Global Strategy would be used (e. g harmful use will be retained, as scientific evidence supports the fact that there is no risk free limit to drinking alcohol). 5

6 3. Structure sections of the report were identified as not fitting and as such will be realigned to the Global Strategy (e.g. public campaigning was included under leadership in the global strategy and under community in the regional strategy). 4. Consistency any inconsistencies in language will be realigned to the Global Strategy (e.g. litres and grams are both used as measurements of alcohol). 5. Indicators an annex to the action plan will be worked on and developed (after the Regional Committee), providing more specific and measurable outcome indicators, including how the various measurements should be calculated. 6. It was clarified that the document was designed to provide options for action in the various policy areas, and was not a progressive list of must dos for countries to follow. 7. The research and development agenda should be mentioned. 8. It was requested that a great focus also be placed on treatment, not just prevention. 9. Environments it was requested that environments, particularly the home environment (and negative impacts on family members), be given more prevalence throughout the document (in a similar way to the acknowledgement of the harm of passive smoking). 10. An alcohol focus day was proposed and has also been discussed at the WHO Executive Board and World Health Assembly, but there was no consensus on this issue. 11. WHO role the Programme Budget, including the scope of WHO activities in this area, is being developed and will be shared with interested Member States. The participants were thanked for their useful interventions and a revised version of the European Alcohol Action Plan will be presented to the Standing Committee of the Regional Committee at the beginning of June A brief discussion took place on the text of the Resolution: Four countries made comments, and summarized, to include to use the Action plan and the global strategy in section 2(a). Dr Andrey Grigorov, Counsellor of the Department of Medical Prevention and Health Care Organization of the Ministry of Health of the Russian Federation chaired the afternoon session, and introduced the six national presentations on recent developments in the area of alcohol policy. Switzerland. Ms Monika Rüegg of the Federal Office of Public Health (FOPH) informed the participants that there is currently a lot going on in the area of alcohol policy in Switzerland. The focus is on the 23% of the Swiss population who consume alcohol at a problematic level. A national information and publicity campaign will start on 21st May in the context of a trinational project together with Germany and Liechtenstein. During one week over 200 activities organised by various partners (NGOs, cantons, federations, etc.) will take place allover Switzerland. The goal of this week of dialogue on alcohol is to encourage discussion on alcohol related issues. One activity for instance will be centred an orange round table that starts in Berne and travels through Switzerland during this week. Stakeholders and citizens will be invited to join round table discussions. In the area of market regulation, the FOPH and the Swiss Alcohol Board use mystery shoppers to raise awareness on the age limit to buy alcohol (beer and 6

7 wine is 16 years of age and spirits 18 years of age in most cantons). This practice has been ongoing for 10 years with a decreasing amount of alcohol being sold to minors. The practice however, has been criticized and legally challenged in some cantons, based on the argument that the practice is equivalent to undercover investigation and the necessary legal basis is missing. Revisions are being made to the national alcohol act and the draft of the Federal Council envisions - apart from a stronger legal basis for mystery shopping and other measures - a ban on alcohol advertising in peak hours (on Fridays and Saturdays). The draft will then be debated in Parliament and entry into force is expected on 1 January 2013 at the earliest. Furthermore, FOPH is planning to publish an overview of alcohol policy measures in Switzerland and 10 European countries on their website by the end of May ( Russian Federation Dr Andrey Grigorov presented data from the Ministry of Health, stating that around 2 million patients were treated for alcohol addiction disturbances in The Government has adopted a Concept for implementation of state policies to reduce alcohol consumption and improve alcohol market regulation that will be implemented in 2 stages over the next decade. In addition, it has adopted a number of amendments to the federal law including empowering alcohol vendors to request proof of the purchaser s age, setting minimum prices on alcohol to reduce the amount of illicit alcohol being purchased and limiting alcohol sale hours. Currently, efforts focus on decreasing availability, decreasing hidden alcohol advertising and increasing activities against illicit alcohol. Kyrgyzstan Dr Dinara Saginbaeva of the Ministry of Health explained the current situation informing the participants that most of the 5 million population of Kyrgyzstan lives in rural areas, where socio economic data is very difficult to obtain. The estimated national average monthly salary is USD135 and there is high unemployment with 21.5% of the population living in poverty. There is political instability. Data for 2010 are not available and as such, the alcohol situation is probably worse than the data shows. Estimates reveal a per capita consumption of 4.2 litres of alcohol per year, but this is not a reliable figure as illicit alcohol production is very high. The statistics show an increasing number of visits to health establishments caused by alcohol related problems. Alcohol dependence is much higher in the capital than in other regions, it is likely the detection rates are also higher in the capital. However, it is clear that alcohol has become a prominent part of life. Since 1998 there has been a law regulating the production of alcohol, and a total ban on selling to children was established, with stricter sanctions for selling alcohol without appropriate labelling and other rules of regulation and trade. Drink-driving fines are low so they don t have a significant effect on prevalence. The Ministry of Health cannot cope alone on the problem of alcohol therefore more inter-sectoral action must be developed. The WHO action plan is fully supported and will serve as a good model for country work in Kyrgyzstan, starting with the establishment of a government level coordinating committee to address the issue of the alcohol policy. Belarus Dr Liudmila Naroichyk of the Republican Centre for Hygiene Epidemiology and Public Health presented the situation, explaining that there is an actual decrease in national population as the mortality rate is higher than the birth rate. Most of the 1.5% of deaths from external reasons such as suicide, poisoning, road traffic accidents and accidental drownings could be related to alcohol use. There has been a notable increase in sales 7

8 in alcohol, especially beer. Since a national action plan has existed for the prevention of alcoholism and drunkenness with awareness raising campaigns held in However, national traditions and customs seem to negatively affect the results. The main success was a 25% reduction in mortality related to alcohol, but many targets have still not been achieved. A new policy for has been approved by the Government and was developed in line with the principles of WHO global strategy. The goal is to maintain progress and strong spirit advertising has already been banned, but beer advertising is allowed. There are plans to restrict the locations where alcohol is sold and drinking in the workplace is forbidden. Drink driving regulations must be strengthened. Republic of Moldova Dr Tudor Vasiliev of the Ministry of Health informed the participants that of a population of 3.5 million, 83% are aged 15 years or older. Grape growing is big part of the economy and the Government depends on alcohol sales, a proportion of which is illicit, however, concrete data is not available. Many factors promote alcohol abuse, including ease of access, home made alcohol and limited legislation. The national policy on harmful products includes alcohol. Excise duty has now increased on imported spirits and tobacco. A law exists which restricts time and place of alcohol sales and in 2010 a law was passed prohibiting alcohol advertising. There are brief interventions in primary health care and breath alcohol tests exist for drivers. Awareness raising is ongoing, including in schools. In February 2011 a report was published paving the way for a new draft law enabling alcohol vendors to check buyers identification to reduce under age purchasing. New legislation in 2008 stated the maximum blood alcohol content to be 0.3%, with license removal and imprisonment for higher limits. Since 2005, a reduction in the number of drivers under the influence has been seen, as well as the number of alcohol related road traffic accidents. Sweden Ms Maria Renström from the Ministry of Health and Social Affairs informed the group that there has been a decrease in total alcohol consumption since 2004 especially in young men, resulting from targeted actions. The national strategy covers alcohol, tobacco and illicit drugs, and despite increased availability, consumption across all three areas has decreased. The base is legislation and enforcement. It has taken 10 years, but now a permanent structure exists for monitoring, including core indicators. The government strategy is multi-sectoral and with shared responsibility there is money to spend on implementation especially at sub national level where it is very important. The national overall goal, adopted by the Parliament is a drug (illegal) free society, reduced public health and social alcohol-related harm and reduced tobacco use. There are seven main targets with priorities for the next five years, including nationwide screening in maternity care for children born with dependences and to build up support for these families countrywide. Coordinators have been appointed sub-nationally, and will be working to implement this strategy over the next 4-5 years, moving away from a shortterm approach. The European Information system on alcohol and health. Dr Lars Møller explained that the first joint EU/WHO data collection started in 2008 and ended in The main objective was to update the European Alcohol Information System and ensure its compatibility with the European Commission database on 8

9 alcohol. The resulting five publications 2 have been instrumental in developing the action plan. The Handbook has been translated into Russian. Monitoring is an underpinning element of any strategy, to enable the ability to evaluate the effectiveness of the intervention. The forthcoming survey will include EU member states and candidate countries (n=33), however, for all WHO European Member States a smaller survey is planned. The data will be evaluated and the results should be ready by September A scientific publication is planned for February 2012 and an online data entry mechanism will be put into place for the 2012 survey. The goal will be to provide this information, on an annual basis, via the website as a way to share best practice and inform decision making, and will enable Member States to communicate with each other regarding the implementation and evaluation of certain interventions. Ms Marjatta Montonnen representing DG Health and Consumers of the European Commission provided more detail on the survey questions themselves, highlighting a number of new questions and providing a clear timeline for the process. Ms Jean Nicol of the Department of Health explained the simple process undertaken by the UK when developing their 2007 strategy. Each activity that was implemented between 2003 and 2010 was noted, by numbered paragraph in a document. Each activity was then linked to a document on the internet, enabling an easier find and locate mechanism. This document is in regular use for quick feedback to queries from politicians. There were several questions from participants regarding the survey and Dr Møller suggested the Member States refer to the website for further information, particularly on the responses they provided in the last survey ( Mr Dag Rekve of the Mental Health and Susbstance Abuse Programme of the World Health Organization in Geneva informed the group of the plans for implementation of the Global strategy. The main purpose of the strategy is to complement, guide and support the work of Member States, many of whom are still in the developmental phase. Having carried out the necessary research, the global structure is now in place to support regional and national activity implementation to reduce harmful use of alcohol. A dedicated website has been set up to facilitate information sharing and communication. However, due to large budget deficits at Headquarters, priority must remain on activities to support low and middle income countries, resource mobilization, monitoring and surveillance and international research projects. Several important issues are emerging which will affect policy decisions, including the correlation between alcohol exposure and infectious diseases; alcohol exposure and harm to others; the perceived positive effects of alcohol consumption; and potential movements in abstention rates and changes in female drinking patterns. More information on the Global Information System on Alcohol and Health (GISAH) can be found here 2 Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm; Handbook for action to reduce alcohol-related harm; Best practice in estimating the costs of alcohol Recommendations for future studies; European Commission s Communication on alcohol; WHO framework for alcohol policy Analysis to guide development of national alcohol action plans; European Status Report on Alcohol and Health 9

10 In closing the meeting, Dr Møller thanked the national counterparts for their attendance and positive inputs, the generous hosts of the meeting, the Swiss FOPH, the WHO colleagues, the technical experts, the WHO Director of NCDs, the rapporteur, and finally the interpreters who provide such valuable ongoing support to the Programme. 10