european action plan to reduce the harmful use of alcohol 2012 …€¦ · european action plan to...
TRANSCRIPT
European Action Plan to reduce the harmful use of
alcohol 2012-2020
Dr Lars Møller
Dr Erio Ziglio
Dr Francesco Zambon
World Health Organization
Regional Office for Europe
Burden of NCD in Europe Burden of disease by broad cause group and region, 2004
Sou
rce:
WH
O (
20
09
) Th
e gl
ob
al b
urd
en
of
dis
eas
e: 2
00
4 u
pd
ate.
NCD
Best buys package
population-based approaches
• Smoke-free environments
• Warning about the dangers of tobacco use
• Bans on tobacco advertising
• Raising taxes on tobacco
• Raising taxes on alcohol
• Restricting access to retail alcohol
• Bans on alcohol advertising
• Reducing salt intake and salt content of food
• Replacing trans-fat in food with polyunsaturated fat
• Promoting public awareness about diet and physical activity
Per capita alcohol consumption, 2005
Recorded alcohol consumption in the EU (in litres
pure alcohol per capita 15+)
– stable but high (more than twice the world average)
0
2
4
6
8
10
12
1998 2000 2002 2004 2006 2008 2010
Total
Beer
Wine
Spirtis
Other
Adult per capita alcohol consumption in the EU,
candidate countries, Norway and Switzerland (2009)
0
2
4
6
8
10
12
14
16
18
Turkey
FYR Macedonia
Iceland
Malta
Norway
Sweden
Cyprus
ItalyNetherlands
Greece
Switzerland
Bulgaria
Belgium
Finland
EU United Kingdom
France
Croatia
Luxembourg
Denmark
Germany
Ireland
Austria
Lithuania
Montenegro
SpainPortugal
Poland
Estonia
Hungary
Slovakia
Slovenia
Romania
Czech Republic
Litres
Alcohol consumption by type of alcoholic
beverage: two examples
Italy Kazakhstan
Alcohol consumption: “high risk drinkers”* in Italy
by Regions, PASSI surveillance, 2011
* Consumo elevato abituale, o fuori pasto o binge drinking
Being drunk during the past 30 days, boys (2011)
0
5
10
15
20
25
30
35
40
IcelandAlbaniaRussian Fed. (M
oscow)
Faroe Islands
EstoniaM
ontenegro
Sweden
Norw
ayRom
aniaBelgium
(Flanders)
Bosnia and Herz. (RS)
Greece
ItalyPolandPortugalSerbiaU
SA AverageM
onacoCyprusFinlandLatviaSloveniaFranceM
altaU
kraineIrelandLithuaniaBulgariaCroatiaU
nited Kingdom
Czech Republic
Germ
anyH
ungaryLiechtenstein
Slovak Republic
SpainD
enmark
%
Being drunk during the past 30 days, girls (2011)
0
5
10
15
20
25
30
35
40
Montenegro
AlbaniaBosnia and H
erz. (RS)
IcelandRom
aniaSerbiaRussian Fed. (M
oscow)
Belgium (Flanders)
CyprusFaroe Islands
Greece
ItalyPolandU
SA EstoniaLiechtenstein
PortugalAverageN
orway
Germ
anyLatviaSw
edenCroatiaU
kraineBulgariaCzech Republic
LithuaniaM
altaFranceH
ungaryM
onacoSlovak Republic
SloveniaFinlandIrelandU
nited Kingdom
SpainD
enmark
%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% population % alcohol
consumed
Moderate drinkers
Hazardous drinkers
Harmful drinkers
Three-quarters of the alcohol sold is drunk by hazardous/harmful drinkers
The Pareto principle
1/5 of consumers consume 4/5 of any product
Three-quarters of the alcohol sold is drunk by hazardous/harmful drinkers
The Pareto principle 1/5 of consumers consume 4/5 of any product
In the EU among the 20% highest
consumers we estimate that
75.000 men and
17.000 women deaths are attributable to
alcohol.
We estimate that
5.4% of men and
1.5 % of all women are alcohol dependent
Alcohol dependence - characteristics
• Having increased tolerance for alcohol
• Experiencing withdrawal symptoms when not drinking
• Consuming alcohol in greater amounts than intended
• Making unsuccessful attempts to cut down or control
alcohol use
• Spending a great deal of time obtaining alcohol
• Giving up or reducing former social, occupational, or
recreational activities
• Continuing to drink despite knowledge of the physical
and psychological damages
Alcohol-attributable disease and injury (green
mainly protective)
Chronic disease:
Cancer: Mouth & oropharyngeal cancer, esophageal cancer,
liver cancer, female breast cancer
Neuropsychiatric diseases: Alcohol use disorders, unipolar
major depression, primary epilepsy
Cardiovascular diseases: Hypertensive diseases, ischemic
heart disease, ischemic stroke, hemorrhagic stroke
Gastrointestinal diseases: Liver cirrhosis
Conditions arising during perinatal period: Low birth weight,
FAS
Alcohol-attributable disease and injury
Injury:
Unintentional injury: Motor vehicle accidents, drownings, falls,
poisonings, other unintentional injuries
Intentional injury: Self-inflicted injuries, homicide, other
intentional injuries
Alcohol-attributable disease and injury
Life time risk of death from alcohol related injuries
European Status Report on Alcohol and
Health 2010, WHO
Alcohol-attributable disease and injury
Estimated relative fatality risk for drinking drivers by age
and sex in single-vehicle crashes
Drinking and driving, Road Safety Manual, WHO, GRSP 2007
Alcohol-attributable disease and injury
Pedestrian fatality risk as a function of the impact speed of a car
World Report on Road Traffic Injury Prevention, WHO, 2004
High exposure, high burden of mortality and
disease, EU
• For men between ages of 15 and 64, 1 in 7
deaths are caused by alcohol (clearly
premature deaths given the life expectancy in
Europe)
• For women of the same age category, 1 in 13
deaths are caused by alcohol
Regional variation of alcohol-attributable deaths to
all deaths, 15-64 year olds
Proportion of deaths for major disease
categories attributable to alcohol
Proportion of alcohol-attributable deaths
caused by harm to others, 2004, 15-64
years old
Social costs of alcohol – 1.3% of GDP (EU)
EUR 155.8 billion in 2010
European Alcohol Action Plans from 1992
Sixty-third World Health Assembly, 17–21
May 2010
Endorsed the global
strategy to reduce
the harmful use of
alcohol.
World Health
Assembly resolution
WHA63.13
European action plan to reduce the harmful use
of alcohol (EAAP) 2012–2020 – 10 action areas
• Leadership, awareness and commitment, as sustainable intersectoral
action requires strong leadership and a solid base of awareness and
political will
• Health services’ response, as these services are central to tackling health
conditions in individuals caused by harmful alcohol use
• Community action, as governments and other stakeholders can support
and empower communities in adopting effective approaches to prevent and
reduce harmful alcohol use
• Policies and countermeasures on drink–driving, as it is extremely
dangerous to drivers, passengers and other people using the roads
• Availability of alcohol, as public health policies to regulate commercial or
public availability have proved to be very effective in reducing the general
level of harmful use and drinking among minors
EAAP 2012–2020 – 10 action areas
• Marketing of alcoholic beverages, as systems are needed to protect
people, particularly children and young people, from advanced advertising
and promotion techniques
• Pricing policies, as most consumers, particularly heavy drinkers and
young people, are sensitive to changes in the prices of alcohol products
• Reducing the negative consequences of drinking and alcohol
intoxication, in order to minimize violence, intoxication and harm to
intoxicated people
• Reducing the public health impact of illicit and informally produced
alcohol, as its consumption could have additional negative health
consequences due to its higher ethanol content and potential contamination
with toxic substances
• Monitoring and surveillance, as relevant data create the basis for the
appropriate delivery and success of responses
European status report on
alcohol and health 2010
0 10 20 30
Availabiltyᵃ
Affordabilityᵃ
Illegal alcoholᵇ
Public awareness-raising
Regulation of marketingᵃ
Drink-driving policies
Harm reduction in environment
Advice and treatment
Community actionsᵃ
Workplacesᵃ
Monitoring and research
Number of countries
Stronger
Unchanged
Weaker
a Data missing from one country. b Data missing from two countries.
Changes in alcohol policy areas over the five years since 2006 (N=29)
Policy development at national level
0
5
10
15
20
25
30
Beer Wine Spirits
Nu
mb
er o
f co
un
trie
s
Beverage type
Inconclusive
Decrease
Stable
Increase
Trends in price of beer, wine and spirits relative to the consumer price
index, previous five years (N=29), 2010
Price and tax measures
Development of alcohol policies in the WHO
European Region
Health inequities and alcohol
Equity, Social Determinants and Public Health Programmes, WHO, 2010
The analytical framework
Health inequities and alcohol
Equity, Social Determinants and Public Health Programmes, WHO, 2010
Application to alcohol attributable harm
Alcohol and the new WHO European Policy for
Health, Health 2020
Health 2020 has two strategic objectives:
• Reducing inequalities
• Better governance
Health 2020 has four priority areas:
• Life-course approach
• Burden of disease
• Health system
• Resilient communities
Health 2020 includes many of the elements in the new European
Alcohol Action Plan 2012-2020
