ALCOHOL S BURDEN (with special attention to Africa and the NCDs) Isidore S. Obot, PhD, MPH Professor of Psychology, University of Uyo Director, Centre for Research and Information on Substance Abuse (CRISA), Uyo/Abuja, Nigeria
Outline Introduction Why alcohol is associated with harm Alcohol s attributable death and DALYs The economic and social costs The burden of NCDs Confronting NCDs: evidence for action The best buys Conclusion
DALYs lost attributable to 10 leading risk factors for the age group 15 59 years in the world, 2004
Why the high burden?
Evidence shows that: (i) the volume of lifetime alcohol use and (ii) a combination of frequency of drinking and amount drunk per drinking occasion increase the risk of alcohol-related harm, largely in a dose-dependent manner
Alcohol is an intoxicant Alcohol is an intoxicant affecting a wide range of structures and processes in the central nervous system Alcohol interacts with personality characteristics and sociocultural expectations Alcohol is a causal factor for intentional and unintentional injuries and harms to people other than the drinker, including interpersonal violence, suicide, homicide, crime and drink-driving fatalities, Alcohol is a casual factor for risky sexual behaviour, sexually transmitted diseases and HIV infection.
Alcohol is a dependence producing substance Alcohol is a dependence-producing drug, similar to other substances under international control, through its reinforcing properties and neuro-adaptation in the brain
Alcohol is a toxic substance Alcohol has direct and indirect effects on a wide range of organs and systems. Beverage alcohol is classified as a carcinogen by the International Agency for Research on Cancer. Alcohol increases the risk of cancers of the oral cavity and pharynx, oesophagus, stomach, colon, rectum and breast in a linear dose-response relationship.
Alcohol is an immunosuppressant Alcohol increases the risk of communicable diseases, including tuberculosis and community acquired pneumonia.
Alcohol and young people The adolescent brain is particularly susceptible to alcohol. There is evidence that drinking can impair educational attainment due to effects on cognitive functions.
Harms associated with alcohol We can measure the negative impact of alcohol on at least three different areas: 1. Economic costs 2. Harm to the individual 3. Harm to the society
The more you drink
Harm to the individual: Alcohol and non-communicable diseases Cancer Cardiovascular disease (heart disease and strokes) Diabetes Chronic respiratory diseases
NCDs: Behavioural risk factors and their determinants Risk Factors Tobacco Harmful use of alcohol Unhealthy diet (salt and fat) Physical inactivity Social Determinants Socio-economic status Environment (social and physical) Socio-cultural Gender Poverty
4 diseases + 4 risk factors NCDs Cardiovascular diseases Tobacco use Risk factors Unhealthy diets Physical inactivity Harmful use of alcohol Diabetes Cancer Chronic lung disease
Burden of NCDs 40% of all deaths in Africa are attributable to NCDs and injuries 20% due to premature deaths from preventable conditions 13% due to other deaths 7% due to injuries
Risk of female breast cancer by alcohol consumption Source: Allen et al, 2009
Lifetime risk of an alcoholrelated death (1/100) 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 Men daily Women daily Men weekly Women weekly 10 20 30 40 50 60 70 80 Grams alcohol per day or per week Lifetime risk of dying from alcohol-related death by gram alcohol/day or /week for Australian men and women. Source: National Health and Medical Research Council, Australia, 2009
Alcohol-attributable deaths per million inhabitants by income group and the world, 2004
Economic wealth and alcohol-attributable deaths and burden of diseases and injury across 14 WHO Regions.
Relationship between recorded adult per capita alcohol consumption and GDP
Global distributions of all alcohol-attributable deaths by disease or injury, 2004
Alcohol attributable deaths in Africa Alcohol accounts for 3.3% of all deaths in Africa (or 372,500). Cause of death % Unintentional injury Intentional injury Tuberculosis Cardiovascular disease HIV/AIDS Lower respiratory infections Cancer Neuro-psychiatric diseases 26 17 17 10 9 8 6 3
Costs of alcohol to Australian society (Billions of dollars) Source: Laslett et al 2010
Cumulative lost output from NCDs + mental health Source: Bloom et al 2011
Thailand Korea Canada Scotland Health Law Other Productivity U.S.A. France 0 200 400 600 800 1000 Economic costs per head (2007 $US PPP) attributable to alcohol by cost category
Evidence for action There is at present clear and growing evidence for the following: Alcohol s harm to the drinker, others, and society Availability of effective interventions
No beneficial effects of alcohol in Africa Analysis of death and disease burden in 2009 showed: High detrimental effects of alcohol due mainly to alcohol attributable unintentional and intentional injuries Higher burden among men than women Higher burden in AFR E than in AFR D and No beneficial effects of alcohol Source: Roerecke, Obot, Petra & Rehm (2009)
REDUCTION OF THE HARMFUL USE OF ALCOHOL: A STRATEGY FOR AFRICA Priority areas Awareness and community action Public education Health sector response Information, surveillance and research Drink-driving legislation and countermeasures Marketing regulation Access, availability and affordability Illegal and informal production
Tomorrow will be my day with Guinness The Ticket
Conclusion NCDs have become a developing world problem. 85% of people who die from NCDs between the ages of 30 and 69 years live in a developing country. The estimated cumulative lost output in developing countries associated with NCDs between 2011-2025 is 7 trillion US$. The overall cost of scaling up action by implementing a set of best buys interventions to prevent premature deaths is 170 billion US$. Effective interventions exist for different risk factors. For alcohol, reduction in levels of consumption and prevalence of HED are beneficial to public health.
Resources WHO/World Economic Forum (2011). From Burden to Best Buys : Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries WHO/AFR (2011). Handbook for action to reduce the harmful use of alcohol in the WHO African Region WHO Global status report WHO Global strategy on reducing harmful use of alcohol Lancet series: Priority actions for the non-communicable disease crisis Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases WHO discussion paper: Development of an updated Action Plan for the Global Strategy for the Prevention and Control of Noncommunicable Diseases covering the period 2013 to 2020 Parry et al. (2011). Alcohol consumption and non-communicable diseases: epidemiology and policy implications. Addiction, 106, 1718-1724. WHO (2011). Scaling up action against noncommunicable diseases: How much will it cost?
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