global alcohol policy working in europe for the prevention of alcohol related harm
TRANSCRIPT
Global Alcohol PolicyGlobal Alcohol PolicyGlobal Alcohol PolicyGlobal Alcohol Policy
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Declarations of interest
Used to be Regional Advisor for both alcohol and tobacco policy, WHO Regional Office for Europe
Scientist and policy advisor for Eurocare
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Structure of presentation
1. Eurocare
2. The problem of alcohol
3. Some solutions for alcohol policy
4. Expectations of the WHO
5. What NGOs can bring
Eurocare was formed in 1990 as an alliance of non-governmental organisations concerned with the impact of the European Union on alcohol policy in Member States
Starting with 9 member organisations in 1990, it now has 46 members from 12 EU States, 5 non EU States and 3 International Organisations with members in 26 European countries
Brief Description of Eurocare: Brief Description of Eurocare:
Eurocare promotes the implementation of evidence based alcohol policy and provides support to its member organizations
Key publications include: Alcohol problems and the family, 1998 The beverage alcohol industry’s social
aspects organizations: A public health warning, 2002
Drinking and driving in Europe, 2003
Brief Description of Eurocare: Brief Description of Eurocare:
Eurocare will be implementing a 3 year European Commission funded project (Alcohol Policy Network in the Context of a larger Europe: Bridging the Gap): Creating an alcohol policy network in 27 European Member
States and applicant countries, Norway and Switzerland Preparing a report on alcohol in Europe Preparing an advocacy training manual Convening a European conference, Bridging the Gap,
Warsaw, Poland, 16-19 June 2004 Convening two summer advocacy schools, Slovenia 2005
and Catalonia 2006.
Brief Description of Eurocare: Brief Description of Eurocare:
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
These are net costs, accounting for heart disease
They do not include social harms
They do not include financial costs
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
1960 1970 1980 1990 2000YEAR
0
2
4
6
8
adul
t pe
r ca
p ita
co n
sum
ptio
n i n
l pu
re a
l coh
ol
WPR_BWPR_ASEAR_DSEAR_B
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
At the community level:
Drinking and driving
Intoxication
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WHO Region % dependent on alcohol
North and Central Africa 0.7
Southern Africa 1.6
North America 5.1
Latin America 3.5
South America 3.2
Middle East 0.0
Western Asia 0.0
Western Europe 3.4
Central Europe 0.8
Caucasus and Central Asia 0.2
Former Soviet Union 4.8
South-East Asia 0.4
Indian sub-continent 0.8
Australasia and Japan 2.1
Western Pacific, including China 0.9
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Towards a solution
It is not a complicated message
It is not don’t smoke,
But it is less is better
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Grammes alcohol per day
160140120100806040200
Re
lativ
e r
isk
1.6
1.4
1.2
1.0
.8
.6
Risk of CHD by g alcohol per day
Source: Corrao et al. (2000)
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Grammes alcohol per day
160140120100806040200
Re
lativ
e r
isk
1.6
1.4
1.2
1.0
.8
.6
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Grammes alcohol per day
20181614121086420
Re
lativ
e r
isk
1.0
.9
.8
Most of the benefit
One drink every second day
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Grammes alcohol per day
160140120100806040200
Re
lativ
e r
isk
1.6
1.4
1.2
1.0
.8
.6
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Alcohol is NOT an ordinary commodity
The science for alcohol policy is made
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Healthy Public Policy:
Taxation
Bans on advertising and marketing
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Strengthening Community Action:
Drink driving
Educational and prevention programmes
Manage availability
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Helping individuals:
Brief interventions in primary care
Treatment for dependence
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Match resources to the size of the problem
The purpose of alcohol policy is to reduce the harm done by alcohol. The greater the harm, the greater the need for policy.
4% of GBD; 5th in list of risk factors
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
There is a strong team
But, it seems divided and unclear at present
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Strong Regional Offices
Seems a posteriority rather than a priority
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Need a simple metric (like a billion deaths from smoking)
Globally, every drinker loses on average 11 days of healthy life per year.
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Do we need a FCAC?
Or some other mechanism to mobilize action?
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Make the science clear
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Calculate the economic burden
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Estimate the social burden
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Get some powerful partners
(?World Bank)
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
In dealing with the alcohol industry, ENSURE that WHO sticks to its guidelines
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Disseminate and implement these guidelines throughout:
The organization
The Regional Offices
The Collaborating centres
The country offices
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
The industry argues that they have a place at the policy table.
They don’t.
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
The industry argues that they are a public health body.
They are not.
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Don’t be duped by the alcohol industry and their social aspects organizations.
Effective policyEffective policy
Ineffective policyIneffective policy
OpposedOpposed by social by social aspects organizationsaspects organizations
SupportedSupported by social by social aspects organizationsaspects organizations
Taxation Negative elasticities between price of alcohol and cirrhosis, fatal and non-fatal traffic accidents and intentional injuries (as price goes up, harm goes down)1
Takes the view that taxation has no impact on alcohol-related harm; takes the view that the solution to the problem of misuse does not lie in restrictions which penalize everyone for the mistakes of a minority3
Legal drinking age Increased drinking ages reduce traffic fatalities; reduced drinking ages lead to increases in assaults2
Suggests that there is no consensus as to whether or not minimal drinking ages are desirable4 ; opposed to increasing legal drinking ages believing that it does not address those who abuse the product3
Outlet density Increased outlet density associated with traffic accidents, assaults and liver cirrhosis2
Opposed to limiting outlet density believing that it does not address those who abuse the product3
Days and Hours of sale Closure of stores associated with reduced alcohol related violence; extended trading hours associated with increases in road traffic accidents and alcohol-related violence2
Believes that programmes that restrict days and hours of sale are ineffective and do not go to the heart of the problem of alcohol-related violence; opposed to restricting days and hours of sale believing that they do not address those who abuse the product3
Proof of age schemes Evidence for the impact of policy measures such as proof of age schemes is not available
Supports campaigns against underage access, such as proof of age schemes5
X
X
XX
Price and the availability of alcoholPrice and the availability of alcohol
Effective policyEffective policy
Ineffective policyIneffective policy
OpposedOpposed by social by social aspects organizationsaspects organizations
SupportedSupported by social by social aspects aspects
organizationsorganizations
Physical environment Changing the physical environment of drinking places reduces alcohol related violence1
Takes the position that the vast majority of drinking episodes do not involve violence, and most violence does not involve drinking, but recognizes that in some individuals and groups, a pattern of behaviour may include both abusive drinking and violence; offers no concrete proposals2 Social environment Decreasing the
permissiveness of the environment (better staff control; less discount drinks) reduces alcohol-related violence1
Server training with legal sanctions Responsible server programs supported by legal sanctions reduce harms from intoxication1
Opposed to legal sanctions; accepts that server training leads to a reduction in licensee liability for damages resulting from illegal service by trained servers3
.
Server training without legal sanctions Responsible server programs not supported by legal sanctions do not reduce harms from intoxication1
Trains servers not to sell to underage drinkers, but without legal sanctions4
X
X
Creating safer drinking environmentsCreating safer drinking environments
Effective policyEffective policy
Ineffective policyIneffective policy
OpposedOpposed by social by social aspects organizationsaspects organizations
SupportedSupported by social by social aspects organizationsaspects organizations
Community action based on both environmental and educational approaches Comprehensive locally based community prevention programs have led to 10% reductions in alcohol involved car crashes, 25% reductions in fatal crashes and 43% reductions in alcohol related violence1
Opposed to environmental approaches, believing that they do not address those who abuse the product.
Locally based community prevention programs based only on educational approaches Have limited or no effect1
Describes school based alcohol education, and drink driving education programmes as community based programmes6
Legal restrictions Although difficult to evaluate, there is evidence for a link between advertising and consumption at individual and aggregate level; econometric analysis suggest that advertising restrictions reduce motor vehicle fatalities2
Takes the view that there is insufficient evidence to support an association between advertising and levels or patterns of drinking; opposed to legislative marketing restrictions
Alcohol education in schools In general no, or very limited impact on use of alcohol; no evidence for an impact on harm3
Promotes and funds school based educational programme, in which “the pleasure of drinking responsibly is part of a balanced lifestyle” 7
Public education campaigns In general no, or very limited impact on use of alcohol; no evidence for an impact on harm4
Stresses the importance of educational programmes as the key policy choice to reduce alcohol-related harm6
Self-regulation Considerable evidence that self regulatory codes are not adhered to5;
The production and dissemination of self-regulatory codes a core area of work,8,9
X
X
Prevention and education programmesPrevention and education programmes
Effective policyEffective policy
Ineffective policyIneffective policy
OpposedOpposed by social by social aspects organizationsaspects organizations
SupportedSupported by social by social aspects organizationsaspects organizations
Legal drinking age Increased drinking age in US reduced traffic accidents by 5%-28%1
Suggests that there is no consensus as to whether or not minimal drinking ages are desirable2; opposed to increasing legal drinking ages believing that it does not address those who abuse the product (i.e. drink driving) 3
Regulating the conditions of sale Extending trading hours increases traffic accidents; targeted programmes at high risk premises reduce accidents1
Believes that programmes that restrict days and hours of sale are ineffective and do not go to the heart of the problem of alcohol-related accidents; opposed to restricting days and hours of sale believing that they do not address those who abuse the product (i.e. drink driving)3
Random breath testing High visibility can reduce deaths by between one third and one half1
Generally opposed to high visibility random breath testing4
Reducing legal BAC limit Reduces drink driving and fatalities across all levels of BAC1
Opposed to any reductions in legal BAC limits5
Public education campaigns No evidence for a beneficial effect on alcohol-related crashes1
Believes that educational programmes are the core component of drink driving programmes6
Interventions by servers, hosts and peers Ineffective, although increased protection of drinking peers1
Works with the hotel, restaurant, cafe and bar sectors to develop anti-drink driving initiatives3
Alternative transportation programmes Limited evidence suggests ineffective1
Alternative transportation programmes (designated river campaigns) are priority projects6
XX
X
X
Drink driving programmesDrink driving programmes
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
There cannot be common ground on drinking and driving
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
Eurocare recommendation:
6. Because of limited evidence for their effectiveness in reducing drinking and driving, public education efforts to persuade drinkers not to drive after drinking, programmes to encourage servers to prevent intoxicated individuals from driving, and organized efforts to make provisions for alternative transportation should not be the main cornerstones of drinking and driving policy.
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
There should be no discussion on self-regulation
It serves the needs of the industry
The reality is based on complaints rather than compliance
The advertisements still go ahead anyway
There is no enforcement
It is not independent, and reflects the ‘intentions’ of the advertisers
Does not reflect the marketing to young people
We should not waste any more time on self-regulationWe should not waste any more time on self-regulation
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
The Smirnoff day off speaks much louder to politicians than all the research
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?
Encourage litigation
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?Policy
Action Plans: Globally
Regionally
Country wide
Regional
Local
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?Community Action
Database of community programmes
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can WHO (and its MS) do?Health sector
Be clear and consistent on nomenclature (ICD 10)
Promote brief interventions
Reorient health care
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can the NGO sector do?
We are your friends;
But also your watchdog
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can the NGO sector do?
Support you in any or all of the above
Promote and disseminate the science that empowers alcohol policy
Develop advocacy and promote advocacy skills
Monitor the alcohol industry
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARMWORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
What can the NGO sector do?
And do we write formally to the WHO after this consultation, or what?
Thank you for your attention
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM
WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM