Alcohol consumption WHO methodology Dr Alexandra Fleischmann, Mr Dag Rekve and Dr Vladimir Poznyak Management of Substance Abuse Unit (MSB) Department of Mental Health and Substance Abuse, WHO, Geneva October 2017 www.who.int
Who is WHO? UN specialized agency for health (1948) The directing and co-ordinating authority on international health work 194 countries (Ministries of Health) Headquarters in Geneva, 6 regional offices, 151 country offices
WHO s Role in population health statistics WHO is constitutionally mandated to: "establish and maintain.. epidemiological and statistical services" "assist in developing an informed public opinion among all peoples on matters of health" WHO reform process defined 5 core functions, including: collection, analysis and dissemination of evidence on health trends and determinants setting targets, monitoring progress, measuring impact in terms of lives saved, risks averted and coverage of essential services UN and World Health Assembly Resolutions provide mandates for: monitoring of health targets, e.g. SDG and NCD targets regular reporting on key indicators e.g. tobacco, alcohol
WHO and UN Global Health Statistics & Reports Population/births UN PopDiv, Biennial Life tables/ mortality UN PopDiv, Biennial WHO, Annual/Biennial Child mortality UN-IGME, Annual Maternal mortality MMEIG, Biennial / Annual HIV UNAIDS/WHO, Annual Tuberculosis WHO, Annual Malaria WHO, Annual Child causes of death WHO/CHERG, Annual/Biennial Cancers IARC/WHO, Biennial Specific causes WHO, Biennial/Irregular Specific risks WHO/Interagency, Various Causes of death all ages WHO, 2002, 2004, 2008, 2012 Disease burden WHO, 2002, 2004, 2012 Global health risks WHO, 2000, 2004 Globocan 2012 (IARC Dec 2013) Unsafe water and sanitation report (2014) Health for the world's adolescents (2014) World suicide report Global report on alcohol & health World Health Statistics Global status report on noncommunicable diseases Global Tuberculosis Report Global Malaria Report Global status report on violence prevention Global status report on road safety
Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) Reporting guidelines for new estimates of health status and some health determinants (including substance use) published in Lancet and PLOS Medicine in June, 2016 Developed by a working group convened by WHO, including IHME and other partners, with extensive outreach and comment periods Aim is to provide sufficient information for users to understand limitations & potentially reproduce analyses Some reporting items will be challenging for producers of estimates: existing datasets may not be documented in alignment with GATHER open-access of input data, and access to computer code are both required; these imply additional reporting burden when publishing estimates quantification of uncertainty is required: this is an active area of research
WHO Policy on official health statistics Ideally based on standardized analysis of primary datasets with adjustments for all known biases: clearance criteria met, including GATHER compliance and country consultation consultation does not require WHO and country reach consensus WHO estimates only revised based on received information that meets inclusion criteria compliance with transparency and reporting criteria WHO statistics may be published with a disclaimer that they may differ from official national statistics (which may be derived using alternate valid methods and assumptions)
Clearance of new health statistics Official WHO health statistics are cleared by Information, Evidence and Research. Financial and cost-effectiveness statistics are cleared by Health Governance and Financing. We evaluate: high-quality database of evidence methods are appropriate statistics are consistent with other health estimates compliance with transparency and reporting criteria expert review of methods and results country consultation if country-level estimates involved
Global strategy to reduce the harmful use of alcohol 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. Harmful use of alcohol is broad and encompasses the drinking that causes detrimental health and social consequences for: the drinker the people around the drinker society at large as well as the patterns of drinking that are associated with increased risk of adverse health outcomes.
What actions are needed to reduce the harmful use of alcohol? Global, regional and national actions on: levels of alcohol consumption patterns of alcohol consumption contexts of alcohol consumption 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.
WHO Global NCD Action Plan 2013-2020 Key risk factors Tobacco use Harmful use of alcohol Unhealthy diet Physical inactivity Key cost-effective interventions (updated appendix 3, WHA70.11 ) Harmful use of alcohol Increase excise taxes on alcoholic beverages Enact and enforce bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media) Enact and enforce restrictions on the physical availability of retailed alcohol (via reduced hours of sale) Enact and enforce drink-driving laws and blood alcohol concentration limits via sobriety checkpoints Provide brief psychosocial intervention for persons with hazardous and harmful alcohol use
NCD global monitoring framework: alcohol-related targets and indicators One target: At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context by 2025 Indicators: total (recorded and unrecorded) alcohol per capita (15+ years old) consumption age-standardized prevalence of heavy episodic drinking alcohol-related morbidity and mortality
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol 3.5.1 Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders 3.5.2 Harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol
SDG data flows Source: UNSD
Total per capita (15+) alcohol consumption globally in 2016 Reported by WHO to the UNSD as part of the SDG reporting Source: WHO World Health Statistics 2017
Conceptual causal model of alcohol consumption and health outcomes Societal Vulnerability factors Level of development Culture Drinking context Alcohol consumption Volume Pattern Health outcomes Chronic Acute Individual Vulnerability factors Age Gender Family factors Alcohol production, distribution, regulation Mortality by cause Socio-economic consequences Harm to others Socioeconomic status WHO Global Status Report on Alcohol and Health 2014
Alcohol surveillance and information systems Reporting to UN Sustainable Development Goals (SDGs) WHO World Health Statistics WHO Global strategy to reduce the harmful use of alcohol WHO NCD monitoring framework Products WHO Global status report on alcohol and health WHO Global information system on alcohol and health GISAH Data WHO Global survey on alcohol and health Government documents and statistics FAO, intergovernmental organizations National/ international surveys Journal articles, grey literature Economic operators
Global Surveys on Alcohol and Health 2002 Global Alcohol Policy survey 2008 Global Survey on Alcohol and Health 2012 Global Survey on Alcohol and Health (online data collection) 2016 Global Survey on Alcohol and Health (online data collection): Sections of 2016 global alcohol survey: - Alcohol policy - Alcohol consumption - Surveillance systems
Total alcohol consumption TOTAL* ALCOHOL PER CAPITA (15+ years) CONSUMPTION (apc) in litres of pure alcohol = RECORDED** apc + UNRECORDED apc *minus - tourist consumption (tourist flow in and out of countries for all countries) ** Recorded apc = three-year average World Health Organization NMH/MSD/MB
apc POPULATION DATA SOURCE UN World Population Prospects, medium variant TOURIST DATA SOURCE Tourism Statistics of the UN Statistics Division Refer to international tourist arrivals at frontiers excluding same-day visitors World Health NMH/MSD/MS
Population growth by UN region Estimates, 1950-2015 and medium-variant projections 2015-2100 United Nations Population Division 1/28/2018 21
Recorded apc DECISION TREE FOR DATA SOURCES 1. Government data (if at least five years, reference) 2. Industry data in the public domain (if based on interviews in countries) 3. FAOSTAT 4. Industry data in the public domain (if desk review) If doubts, the Steering Committee can decide to use preferable source based on consensus and in consultation with the government. World Health NMH/MSD/MS
Recorded apc DATA SOURCES government data (~40 countries) industry data in the public domain (~60 countries) FAO (~20 countries) combination of industry and FAO (~70 countries) No data: Monaco, San Marino, Marshall Islands, Palau, South Sudan, Sudan World Health NMH/MSD/MS
Recorded apc World Health NMH/MSD/MS
Recorded apc ALCOHOL CONTENT (% alcohol by volume) beer = barley beer 5% wine = grape wine 12%, must of grape 9%, vermouth 16% spirits = distilled spirits 40%, spirit-like 30% other = sorghum, millet, maize beers 5%, cider 5%, fortified wine 17% and 18%, fermented wheat and fermented rice 9%, other fermented beverages 9% World Health NMH/MSD/MS
Unrecorded apc REFERS TO: home or informally produced alcohol (legal or illegal) smuggled alcohol surrogate alcohol, which is alcohol not intended for human consumption alcohol obtained through cross-border shopping, which is recorded in a different jurisdiction World Health NMH/MSD/MS
Unrecorded apc DECISION TREE FOR DATA SOURCES 1. nationally representative empirical data 2. specific other empirical investigations 3. expert opinion, including special exercise with nominal group technique World Health NMH/MSD/MS
Quality assurance of data For the Global Surveys on Alcohol and Health and subsequent publications: close collaboration between WHO headquarters, WHO regional offices, and WHO country offices official nomination of alcohol focal point or alcohol national counterpart in the country by the Ministry of Health following submission, questions for clarification are asked (e.g. comparison to previous responses) country profiles are sent to alcohol focal points or alcohol national counterparts for consultation data closure dates and data sources are communicated; if better data, changes can be incorporated
Global Status Reports on Alcohol and Health 1999 Global Status Report on Alcohol 2001 Global Status Report on Alcohol and Young People 2004 Global Status Report on Alcohol Policy 2004 Global Status Report on Alcohol 2011 Global Status Report on Alcohol and Health 2014 Global Status Report on Alcohol and Health Sections of 2014 global status report: - Alcohol and public health - Alcohol consumption - Health consequences - Alcohol policy
Global Information System on Alcohol and Health (GISAH) Categories Levels of consumption Patterns of consumption Harms and consequences Economic aspects Alcohol control policies Prevention, research, treatment resources Youth and alcohol Key alcohol indicators relevant to SDGs Key alcohol indicators relevant to NCDs Link to alcohol policy timeline in EUR
GISAH theme page http://www.who.int/gho/alcohol/en/
Looking to the future WHO aim to synthesize data to obtain comparable health estimates using standard methods, assumptions and bias adjustments data are often not comparable across time, populations and data collection mechanisms (requires adjustment) data are often sparse (use modeling) increasing demand from countries and international organizations for frequent, timely and accurate estimates SDG era will result in a substantially expanded list of indicators requiring consultation and likely place greater demands on countries political pressure can become extreme. if WHO moves to increased use of externally generated statistics (eg. IHME), how does WHO continue to address these issues?
Staff situation for alcohol and drugs Developments since the endorsement of the global strategy, HQ only. 8 7 6 5 4 3 2 1 0 MSB staff 2010-2017 2010 2014 2017 G-staff P-staff Leave 33
Acknowledgements Centre for Addiction and Mental Health (CAMH), Toronto, Canada Addiction Suisse, Lausanne, Switzerland Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
WHO 20, Avenue Appia 1211 Geneva Switzerland THANK YOU Department of Mental Health and Substance Abuse, Management of Substance Abuse team www.who.int/substance_abuse www.who.int
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