WHO challenges the drink industry

The drink industry needs to clean up its act and realise that its product poses a health threat to the young people of Europe. This was the message which came firmly out of the Ministerial Conference on Young People and Alcohol held in Stockholm in February. The Conference was attended by delegations from the health ministries of all the countries of the WHO European Region.

Dr Marc Danzon, Regional Director of the World Health Organization spoke about "society's deadly complacency about drinking." He asked why alcohol is "treated almost everywhere as a normal consumer product, widely advertised and available in major retail outlets, yet its consumption by young people increasingly mirrors patterns of drug use?" Dr Danzon pointed to the paradox that "the positive health effects of alcohol are widely reported, yet the many others pointing up its dangers are often ignored? "

In his hardhitting speech, Dr Danzon questioned the pretence "that there are two totally different and opposing types of drinking: the good way, which gives pleasure and eases social relations, and the bad, which leads to alcohol abuse?" He said that "the boundary between moderate and excessive drinking is a fluid one" and that people often move from one to the other without acknowledging the fact.

"In the European Region," continued the WHO Regional Director, "alcohol is responsible for 10% of the disease burden. Alcohol kills people brutally through the accidents, violence and suicides it triggers. It also kills them slowly by causing physical, mental and social harm."

Whilst acknowledging the economic importance of the alcohol industry, Dr Danzon questioned the right of the alcohol industry and its lobbies to do and say what they like. He quoted the example of alcohol promotion on sports grounds, where the brand name of the alcoholic beverage dominates.

Mr David Byrne, EU Health Commissioner, said that health issues such as alcohol misuse by young people, are increasingly occupying a central place on the public policy agenda in Europe today. Commissioner Byrne said that "combating alcohol-related harm is a public health priority in many Member States, and also at EU level." He pointed out that one of the main strands of the proposed new Public Health Programme [of the European Commission] considers inappropriate use of alcohol as one of the key health determinants to be tackled. The Commission decided to focus on alcohol in the light of evidence that alcohol consumption by young people, and the related harm, are already high in several EU countries, and that in some countries the problem seems to be growing."

Dr Gro Harlem Brundtland, Director-General World Health Organization, was equally forthright in her address to the conference which we publish here:

Youth is a time of opening new doors, trying new experiences, testing limits. For most of us, it is a tremendously rich and exciting part of life. As Aristotle said: `The young are permanently in a state resembling intoxication; for youth is sweet and they are growing'.

Unfortunately, real intoxication is also a factor of youth. And far too often, it brings an abrupt end to it. Worldwide, 5% of all deaths of young people between the ages of 15 and 29 in 1990 were attributable to alcohol use.

In Europe, one in four deaths of men in the age group 15 to 29 is related to alcohol. In parts of Eastern Europe, the figure is as high as one in three. All in all, 55 000 young people in this region died from causes related to alcohol use in 1999. That is a shocking and tragic waste. Globally, 140 million people are suffering from alcohol dependence. Around the world, alcohol takes a heavy toll, damaging public and private life with countless traffic fatalities and injuries, home fires, drownings, suicides and violent crimes. But also debt problems, ruined careers, divorces, birth defects, and children with permanent emotional damage.

While some progress has been made in reducing overall alcohol consumption in western parts of the European region, the situation in the eastern part is worsening, and there are alarming signs of deteriorating drinking habits among young people across the whole region.

Data from across the world suggests that a culture of sporadic, heavy or binge drinking among young people may now be increasing also in developing countries. While overall rates of adult per capita consumption are falling in many countries, young people are too often drinking excessive quantities of alcohol to intoxication in single drinking episodes.

The economic burden of excessive alcohol use is also significant. The cost of under-age drinking in the United States alone has been estimated by the US Department of Justice at nearly $53 billion in1996.

Another study showed that the annual costs for alcohol-related hospitalisation in the state of New Mexico were USD 51 million while the annual alcohol taxes were only USD 35 million.

According to the latest UN Human Development Report, alcohol-related vehicle crashes alone are estimated to cost the Namibian economy at least one percent of gross domestic product yearly. Alcohol use among young people is a serious problem, but we know that we can considerably reduce the harm caused by alcohol through effective action.

We have a wealth of experience from efforts to limit consumption. We know, for example, from experience that prohibition does not work. The evidence we have indicates that we need a mix of policies.

It is clear that measures that reduce access to alcohol are effective in reducing consumption. A minimum legal drinking age, restrictions in number of hours per day or days per week when alcohol can be bought, and policies on what kind of outlets are licensed to sell alcohol, all have an effect on total alcohol consumption.

Evidence shows that drink-driving regulations combined with campaigns to explain why these measures are necessary are highly effective in reducing the deaths and injury from traffic accidents. But such measures are only effective if they are strictly enforced.

Restrictions on advertising reduce consumption. OECD countries with a ban on alcohol advertising had about 16% lower alcohol consumption and 23% lower number of traffic fatalities than countries with no advertising restrictions. For young people, five extra minutes of alcohol advertising on television per day is associated with an increase in daily alcohol intake of five grams, according to recent research.

We know that, if done right, community action programmes and information and counselling may contribute to creating awareness about the danger of alcohol. A WHO organized study in ten countries showed that simple counselling of people who were known to drink heavily, but who were not alcohol dependent, had a significant positive effect on both average alcohol consumption and intensity of drinking.

For youth we need positive alternatives: better access to sports and recreation in and out of school.

Information activities have little or no effect, however, unless they supplement policies which influence access and use of alcohol such as taxes and age limits.

Alcohol is a serious problem. It is also a challenge.

All health policies must have popular support based on an understanding of their importance. This is especially true of alcohol policy. Alcohol is deeply embedded in the culture and social activities of many societies. In these circumstances, a pro-health policy on alcohol frequently faces strong opposition.

Public support should not be taken for granted but has to be built systematically.

For example, people need to understand more fully that it is not only their own health and happiness that can be harmed by alcohol, but that other people's drinking also may have direct and indirect negative consequences for them. Examples are the victims of drunken-driving or drunken assault. Or, in a broader sense, the costs for every taxpayer of increased health care resources, and other types of alcohol-related expenses.

We also must develop an understanding that although drinking is a personal act and an individual responsibility, it is also behaviour shaped by our societies and something for which society as a whole has a responsibility. It is thus counterproductive to formulate health policy responses exclusively for the individual, while neglecting the public health perspective.

Clearly, a national alcohol policy will need to be rooted in national and local support. We need to pay more attention to the evidence base on what mechanisms are needed to win that support. This is especially important for the young.

The WHO European Charter on Alcohol that was adopted in 1995 explicitly states that `all children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumption and to the extent possible, from the promotion of alcoholic beverages'.Sadly, this is becoming increasingly difficult. Not only are children growing up in an environment where they are bombarded with positive images of alcohol, but our youth are a key target of the marketing practices of the alcohol industry.

Over the past 10-15 years, we have seen that the young have become an important target for marketing of alcoholic products. When large marketing resources are directed towards influencing youth behaviour, creating a balanced and healthy attitude to alcohol becomes increasingly difficult.

When I was in medical school, my student colleagues arranged a party where they served a dark beer which none of us girls had ever seen before. Some of the boys had secretly mixed large amounts of 96% medical alcohol into it, making it dangerously strong for all of us who unsuspectingly drank it.

Luckily, feeling dizzy, I discovered their trick early enough to still be standing on my feet. I was furious. Furious, because somebody even my fellow medical students who should know better - could do such a thing. Furious that we were being manipulated to get drunk against our will.

I can still clearly sense the fury I felt that evening. And I get the same feeling of manipulation when I see some of the marketing techniques that are being used to introduce alcohol to very young people.

By mixing alcohol with fruit juices, energy drinks and premixed `alcopops', and by using advertising that focuses on youth lifestyle, sex, sports and fun, the large alcohol manufacturers are trying to establish a habit of drinking alcohol at a very young age. Look at most web sites for alcohol products - they are clearly attempting to attract the young, with computer games, competitions and offers of prizes and teenage fashion shows.

Go to night clubs and teenage discos and you will find often dangerous marketing techniques. In Great Britain, young people interviewed for a research project told how they often were offered deals that include `buy one, get one free' and even the so-called `never ending vodka glass': buy one, get unlimited refills.

satellite television is now bringing commercials for alcohol into every home, even here in Scandinavia, where alcohol advertising has been banned for decades.

We need to strengthen our work to counter these influences.

Action must be taken, by Member States, by international organizations; by the alcohol industry; and by young people themselves to counter the negative trends in their own countries. We must also act to avert replicating or exceeding the already high levels of alcohol-related harm in the industrialised countries among young people in developing countries.

WHO will be an active and supportive partner in this work.

Based on these concerns, I am calling for a concerted review by international experts of this issue of marketing and promotion of alcohol to young people. I would like to announce that WHO will be hosting a meeting to move this issue forward, in collaboration with the Government of Valencia in Spain later this year.

WHO will also be establishing a strategy advisory committee on alcohol to address this serious public health problem.

Our job here over the next three days is to plan future action, and in doing so, make a significant contribution to improving global health.