First Pan American conference on alcohol policy

Country representatives, researchers and alcohol policy experts from 27 countries met in Brasilia, Brazil from November 28-30 for the first ever Pan American Conference on Alcohol Policy, cosponsored by the Pan-American Health Organization (the regional office of WHO for the Region of the Americas) and the National Anti-Drug Secretariat of the Brazilian government.

The Region of the Americas has one of the highest burdens of disease resulting from alcohol use of any region in the world. Across the entire region, 4.8% of deaths and 9.3 percent of the total burden of disease is attributable to alcohol.

In the low child and adult mortality countries of Latin American in particular, male mortality and years of life lost due to disability and death caused by alcohol (DALYs) are extremely high. For 15-29 year old males in these countries, 24.7% of deaths and more than 30% of DALYs are caused by alcohol.

Experts, practitioners and policy makers from 14 countries made presentations to the conference. Highlights included a speech by Jorge Armando Felix, Minister of the Institutional Security Cabinet and President of the National Anti-drug Council in Brazil, who opened the meeting by saying that it was important to monitor the impact of alcohol on work, life, and health. Brazil is creating an inter-ministerial group to work on an alcohol public policy since 11.2% of the population is alcohol dependent and 65.2% of middle and primary school children have tried alcohol.

Jurgen Rehm, commenting on the relationship between alcohol consumption and harm, stated that it is important to address patterns of drinking as well as overall level of drinking. For some disease conditions, there is a dose-response relationship to alcohol consumption.

For instance, if you drink 2 drinks a day you have a 12% higher risk breast cancer, and if you drink 4 drinks per day the risk of breast cancer is elevated by 24%. Global estimates of alcohol’s contribution to the burden of disease assume that some patterns of drinking may have health benefits, but less than 1% of the population is drinking in a pattern that is protective for the heart, and many people are drinking too much on certain days resulting in injuries, alcoholic cardiomyopathy and mental disorders.

Ronaldo Laranjeira demonstrated the effect of limiting bar opening hours in Diadema, Brazil. This district near Sao Paolo had been known as the homicide capital of the country because of its high murder rates. In 1999, the district had approximately 4,800 bars, more than 1 bar for every 800 inhabitants.

In 1999 there were 374 homicides in the district with 49.47% of the homicides occurring between 21.00 hrs – 06.00 hrs. In 2002 the authorities cut the hours of opening to 06.00 hrs to 23.00 hrs. Evaluation of the law’s effects showed that after two years it had led to a drop in homicides of 45% (some 273 lives saved) and a reduction in violence against women of 25.8% (224 aggressive incidents prevented).

Michelle Swenarchuk speaking about WTO trade rules said that although governments may adopt “necessary” measures to protect public morals and health, in 12 out of 14 trade disputes over domestic regulations, the challenged regulation was found not ‘necessary’ by trade panelists. She concluded that the health policy exception is not a reliable defense when a measure is challenged.

The World Spirits Alliance has set trade liberalization as a high priority. Among its objectives are significant liberalization and, where possible, elimination of tariffs including the removal of ‘peak’ tariffs; liberalization of non-tariff trade barriers and of restrictions on services including distribution and advertising; and enhanced measures to facilitate trade in distilled spirits. The EU is pressing countries to remove alcohol controls and restrictions. Current negotiations over the General Agreement on Trade in Services (GATS) are pressing for a ‘necessity test’ suggesting that ‘restrictions or prohibitions on marketing and advertising’ to be subjected to such a test.

Swenarchuk urged health officials to become involved in trade policy formations; to intervene in current GATS negotiations to prevent liberalization that undermined alcohol controls; and to promote increased political oversight of trade negotiations in order to introduce balance in trade policy goals.

Robert Sparks told the conference that in a media intensive society, meanings and values connected with drinking are increasingly shaped by the mass media, television, movies, music and consumer brand advertising. Major international drink corporations are using sport and event sponsorship increasingly to gain competitive advantage in the global market. Consequently there is a need to assess the impact of alcohol sponsorship and alcohol control policies in more global terms.

The advantage of sponsorship for the alcohol industry is the political impression it gives of corporate good citizenship; exploits under developed markets and develops strategic alliances. Beer sponsorship in particular improves the image and desirability of beer promoting an image of fun and increases the number of beer drinking occasions.

“We are seeing a growing sophistication and integration of sponsorship linked marketing methods” said Sparks. Sports sponsorship functions as an implicit form of social marketing, attributes socially desirable qualities to alcohol products, and raises the question “Does alcohol sponsorship affect consumption?” Sparks maintained that youth have been found to be particularly vulnerable to sponsorship messages. Sponsorship insinuates beer and drinking into youth culture, outside the context of family controls and normalises association between masculinity, sport and beer. Sparks referred to the view of Patrick Stokes, the Chief Executive of Anheuser Busch, that sponsorship sells drinking as a functional component of socializing, dating and having fun. Sparks concluded that the challenge of such sponsorship required a crossnational global strategy.

Following three days of presentations and discussion, the conference participants adopted the following declaration:

BRASILIA DECLARATION ON PUBLIC POLICIES ON ALCOHOL

The participants of the First Pan American Conference on Alcohol Policies held in Brasilia, Brazil, on 28-30 November 2005:

Recalling and reaffirming the World Health Assembly Resolution (WHA) 58.26 of the World Health Organization, which urges Member States to develop, implement and evaluate effective strategies and programs for reducing the negative health and social consequences of harmful use of alcohol;

Recognizing that scientific evidence has established that hazardous and harmful consumption of alcohol causes premature death, disease and disability;

Concerned that in many countries there is significant unrecorded alcohol consumption, and recorded production and consumption of alcohol is at high and rising levels;

Recognizing that the harm done by alcohol is a national and regional public health and social problem in the Americas, despite the cultural differences between the nations;

Alarmed that alcohol is the leading risk factor for the burden of disease in the Americas and alcohol-related harms have been neglected in the Region;

Recognizing that alcohol is also a cause of violent deaths, intentional and unintentional injuries, particularly among youth;

Noting that alcohol is also a cause of death, disability and social harms to people other than the drinker;

Aware that the few studies that exist of the costs of alcohol use suggest that alcohol problems create heavy economic as well as health and social burdens;

Concerned that alcohol interacts with poverty to produce even greater consequences for those who do not have access to basic resources for health and sustenance;

Concerned that indigenous peoples, migrants, street children and other highly vulnerable populations in the Americas suffer disproportionately from the negative impact of alcohol;

Emphasizing the risk of harm due to alcohol consumption during pregnancy;

Recognizing the threats posed to public health by the increased availability and accessibility of alcoholic beverages in many countries in the Americas;

Concerned that alcohol advertising, promotion and sponsorship are reaching young people, and undercut efforts to reduce and prevent underage alcohol use;

Mindful of compelling evidence of the effectiveness of strategies and measures aimed at reducing alcohol consumption and related harm;

Recognizing that the approaches related to harmful consumption of alcohol should consider different models and especially the strategies for reduction of social harm and health harm;

Recognizing that international cooperation and the participation of all countries in the Region is needed to reduce the negative health and social consequences of alcohol consumption;

Recommend

Preventing and reducing alcohol consumption-related harms should be considered a public health priority for action in all countries of the Americas.

Regional and national strategies need to be developed, incorporating culturally-appropriate evidence-based approaches to reduce alcohol consumption-related harm.

These strategies need to be supported by improved information systems and further scientific studies of the impact of alcohol and the effects of alcohol policies in the national and cultural contexts of the countries of the Americas.

A regional network of collaborators on the reduction of alcohol consumption-related harms, nominated by the countries of the Americas, should be established, with the technical cooperation and support of PAHO.

Alcohol policies whose effectiveness has been established by scientific research need to be implemented and evaluated in all countries of the Americas.

Priority areas of action need to include heavy drinking occasions, overall alcohol consumption, women (including pregnant women), indigenous peoples, youth, other vulnerable populations, violence, intentional and unintentional injury, underage drinking, alcohol consumption-related injury and alcohol use disorders