WHO Europe - framework for alcohol policy

Member States at the Fifty-fifth session of the Regional Committee for Europe in Bucharest in September 2005 had a lengthy debate on a resolution to continue its alcohol strategy for the region. Members had before them a report on alcohol in the WHO European Region; an outline of alcohol policy: current status and the way forward; and a background paper for the framework for alcohol policy.

The WHO European Region has the highest alcohol consumption of all the WHO regions – twice as high as the world average. Around 600,000 Europeans died of alcohol-related causes in 2002, representing 6.3% of all premature deaths in the Region that year; more than 63 000 of those deaths were of young people aged 15–29 years. The relative contribution to disability was even higher, alcohol use accounting for 10.8% of the total disease burden. This made alcohol use the third leading risk factor for death and disability in the Region.

It is estimated that adults in the European Region drink on average 12.1 litres of pure alcohol per person per year, i.e. more than twice the global level of 5.8 litres. Even though women account for only 20–30% of overall consumption, it was still the highest proportion in the world. The report recognised the large variations in per capita consumption among the countries in the Region, although the variations became much less significant if abstainers were excluded from the calculations.

The Framework report stated that Governments now had much stronger evidence than they had 2 years ago on which to base alcohol policies and referred to a recent review that rated 32 strategies or interventions in terms of their degree of effectiveness.

Broadly effective strategies included alcohol control policies, drink–driving countermeasures and brief interventions for hazardous and harmful drinkers. Measures for which it had been difficult to find a direct positive effect on drinkingpatterns or problems included education in schools, public service announcements and voluntary regulation by the alcohol industry.

The latter measures should be used only as part of a comprehensive strategy to tackle alcohol-related harm. What was needed in the longer term were sustainable alcohol policies and programmes that reduced both hazardous and harmful patterns of drinking; reduced the overall volume of drinking; separating drinking from certain activities and situations (such as driving or operating machinery, at the workplace and during pregnancy): and the provision of adequate help for people with alcohol problems and their families.

The report maintained that the ability of governments had been substantially weakened to use some of the most effective tools to prevent and reduce alcohol-related problems due to the growth of trade agreements, common markets and the processes of globalization. There was need, from a public health perspective, for concerted international action to clearly recognize that alcohol is a special commodity in terms of the very substantial harm associated with its use.

Future action and goals needed to be set within a policy action framework. This would encompass the European Charter on Alcohol, the European Alcohol Action Plan (EAAP) and the Declaration on Young People and Alcohol, as the principal documents for alcohol policy development in the Region.

The Framework proposals recognised that drinking customs and habits were deeply rooted in many European cultures. Effective action required the development and application of evidence-based recommendations and strong political commitment.

The Framework saw the necessity that alcohol policies and actions had to be based on the best scientific evidence about effectiveness and cost-effectiveness, and be sensitive to cultural diversity. It strongly advocated that where the science was uncertain, the precautionary principle should be applied and priority given to protecting the health and welfare of the population.

Regional and global solutions to the problems should be explored to deal with increasing levels of crossborder trade and price differences. It was important that Member States acknowledge other countries’ laws and regulations which were aimed to prevent or reduce alcohol-related harm.

The Framework reaffirmed the important principle agreed by the Ministerial Conference in 2001 that public health approaches to alcohol problems needed to be formulated by public health interests without any formal or informal veto from other actors.

Developments and initiatives by the European Union, with its 25 member states, had important consequences for public health policy development in the Region. There had been several notable public health initiatives by the European Union (EU) in recent years: its partnership in the WHO Ministerial Conference on Young People and Alcohol (2001), Council Recommendation on the drinking of alcohol by young people, Council Conclusion on a Community strategy to reduce alcohol-related harm, reiterated in 2004, and the alcohol component of the Public Health Programme all showed the growing and active role of the EU in preventing or reducing alcoholrelated harm in Europe.

Mention was made of Eurocare’s project “Alcohol policy network in the context of a larger Europe: Bridging the Gap”, co-financed by the European Commission for the years 2004 to 2006. The project included partners in 30 European countries and cooperates with other regional organizations. The main aims of the project were to create an alcohol policy network in the EU member countries and to strengthen the development of an integrated Community strategy to reduce alcohol-related harm in the context of a larger Europe. The network has produced a set of “Bridging the Gap Principles” for a policy on alcohol in Europe.

Challenges

The Framework recognised important challenges for policy in the future:

The large traveller’s allowances for personal use within the EU, have restricted the ability of several national governments to control sales to residents and have forced down alcohol tax rates in some countries.

Extensive region-wide marketing strategies by the drinks industry, many of which appeal to young people, demonstrated the transnational nature of modern marketing.

The further growth of trade agreements and the continuation of the processes of globalization.

Member States are recommended to develop or review their national strategies and action plans. The ten areas for action in the European Alcohol Action Plan continued to be of central importance for the implementation of national alcohol policies and should be seen as an integral part of the Framework. These areas are: information and education; public, private and working environments; drink–driving; availability of alcohol products; promotion of alcohol products; treatment; responsibilities of the alcoholic beverage industry and hospitality sector; society’s capacity to respond to alcoholrelated harm; nongovernmental organizations; and formulation, implementation and monitoring of policy. Local communities need to adopt policies that set targets, identify responsible agencies and forms of accountability, and adequately involve NGOs.

Advocacy was necessary to raise public awareness of the extent of alcohol-related harm in the community and to gain public acceptance of effective policy measures. A strong case could be made for restricting availability through an effective taxation policy, limiting the number of outlets for alcohol, and limiting the hours of sale. Programmes for responsible beverage service could also effectively reduce problems, if they are combined with active enforcement by police and licensing authorities. Availability plays a particularly important role in youth drinking, where the enforcement of age limits on alcohol sales has proved to be an effective tool in reducing drinking.

Education and information should be combined with other measures in a comprehensive strategy. Education of minors is best implemented by state agencies and other independent education agencies which have the necessary professional expertise and focus their activities on a healthy young generation.

While research on the long-term effectiveness of school-based information on behaviour has been disappointing, parental programmes appeared more promising. Delaying the onset of drinking was important.

A focus day on preventing alcohol-related problems

The Framework suggested the possibility for raising awareness in society of the negative health and social consequences of alcohol by initiating a national focus day on preventing or reducing alcoholrelated problems. Used in combination with other more longterm measures, such a focus day could be an important instrument in increasing knowledge of the extent and magnitude of alcoholrelated problems and stimulate support for effective alcohol policy options.

European Coalition on Alcohol Policy Development

Member States and international organizations and institutions will be invited to join a coalition that could create the necessary support for and achieve the implementation of effective alcohol policies in the Region.

Triennial Framework progress report:

A progress report on the Framework should be produced every third year. The purpose of the report should not only be to estimate the levels of implementation and success of the Framework, but also to alert Member States to emerging challenges and threats to public health and to identify any need for adjustment of the Framework. The progress report should be produced in close collaboration with the network of national counterparts for alcohol policy and relevant collaborating centres.

Triennial high-level forum on alcohol policy in the Region:

A special high-level forum on alcohol should be organized by the Regional Office every third year. The purpose of such a forum would be to discuss the outcomes and recommendations of the progress report and to deliberate on critical or challenging issues regarding alcohol policy, with a particular focus on issues with cross-border implications and other issues that are difficult to resolve in the context of a single Member State.

The Regional Committee adopted the following resolution:

Framework for alcohol policy in the WHO European Region
The Regional Committee,
Reaffirming that the harmful use of alcohol is one of the major public health concerns, with the highest levels of consumption and harm in the WHO European Region;

Recalling its resolution EUR/RC42/R8, by which it approved the first and second phases of the European Alcohol Action Plan, and the European Charter on Alcohol adopted at the European Conference on Health, Society and Alcohol in Paris in December 1995;

Recalling its resolutions EUR/RC49/R8, by which it approved the third phase of the European Alcohol Action Plan, and EUR/RC51/R4 by which it endorsed the Declaration on Young People and Alcohol adopted at the WHO Ministerial Conference on Young People and Alcohol in Stockholm in February 2001;

Recalling World Health Assembly resolution WHA58.26 on public health problems caused by harmful use of alcohol;

Recognizing that the harm done by alcohol is a pan-European problem with serious consequences for publichealth and human and social welfare affecting individuals, families, communities and society as a whole, that calls for increased international cooperation and the participation of all Member States in a cost-effective, appropriate and comprehensive response which takes due consideration of religious and cultural diversities;

Acknowledging the existence of socioeconomic and cultural differences, specific biological and genetic features, and variations in physical and mental health;

Noting the need to promote and further strengthen the public awareness of and political commitment to effective measures to combat alcohol-related harm;

Recognizing the threats posed to public health by the factors that have given rise to increased availability and accessibility of alcohol in some Member States;

Recognizing the importance of ensuring that a multidisciplinary and multisectoral approach is a governing idea of the implementation of the Framework for alcohol policy in the WHO European Region;

Aware that public health concerns regarding the harmful use of alcohol need to be duly considered in the formulation of economic and trade policy at national and international levels;

Acknowledging the leading role of WHO in promoting international collaboration for the implementation of effective and evidence-based alcohol policies;

1 Endorses the Framework for alcohol policy in the WHO European Region outlined in document EUR/RC55/11 as a framework for strategic guidance and policy options for Member States in the European Region, taking into account existing political commitments as well as new developments, challenges and opportunities for national and international action;

2 Urges Member States:
a to use the Framework to formulate or if appropriate reformulate national alcohol policies and national alcohol action plans;

b to strengthen international collaboration in the face of increasing levels of common and transboundary challenges and threats in this area;

c to promote a multisectoral and evidence-based approach which recognizes the need for political commitment and the importance of encouraging mobilization and engagement of the community and civil society in the actions needed to prevent or reduce alcoholrelated harm;

d to promote alcohol-free policies in an increasing number of settings and circumstances, such as the workplace, in all traffic, young people’s environments and during pregnancy;

3 Urges international, intergovernmental and nongovernmental organizations, as well as self-help organizations, to support the Framework and to work jointly with Member States and with the Regional Office to maximize the impact of the Framework’s efforts to reduce the negative health and social consequences of the harmful use of alcohol;

4 Requests the Regional Director: a to mobilize resources in order to ensure adequate health promotion, disease prevention, disease management research, evaluation and surveillance activities in the Region in line with the aims of the Framework;

b to cooperate with and assist Member States and organizations in their efforts to prevent or reduce the harm resulting from alcohol consumption and thereby the level of alcohol-related problems in the Region;

c to mobilize other international organizations in order to pursue the aims of the Framework for alcohol policy in the Region;

d to continue, revise and update the European Alcohol Information System to reflect the new Framework for alcohol policy in the Region and to include a legal database in the system;

e to organize the production and publication of a review of the status of and progress achieved in addressing alcohol-related problems and policies in the Region, to be presented to the Regional Committee every third year.