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Draft global strategy to reduce harmful use of alcohol Summary of the Report

Setting the scene

Alcohol is the fifth leading risk factor for premature deaths and disabilities in the world; in 2004, 2.5 million people worldwide died of alcohol-related causes including 320 000 young people between 15 and 29 years of age – representing 3.8% of all deaths and 4.6% of the global burden of disease. Harmful drinking is a major avoidable risk factor for neuropsychiatric disorders and other noncommunicable diseases such as cardiovascular diseases, cirrhosis of the liver and various cancers. It is also associated with several infectious diseases: HIV/AIDS, tuberculosis and pneumonia. A significant proportion of the disease burden arises from unintentional and intentional injuries. Fatal injuries attributable to alcohol consumption tend to occur in relatively young people. Whilst there exists a substantial scientific knowledge base for policy makers on the effectiveness and the cost effectiveness of strategies to prevent and reduce alcohol related harm, policy responses are often fragmented and do not always correspond to the magnitude of the impact on health and social development.

Challenges

The current worldwide health, cultural and market trends mean that harmful use of alcohol will continue to be a global health issue. The need is for intersectoral action - development, transport, justice, social welfare, fiscal policy, trade, agriculture, consumer policy, education and employment. Preventing and reducing harmful use of alcohol is often given a low priority among decision-makers despite compelling evidence of its serious public health effects. There is a discrepancy between the increasing availability and affordability of alcohol in many low and middle-income countries, affecting their capability to meet the resultant public health burden. Production, distribution, marketing and sales of alcohol create employment and generate considerable income for economic operators and tax revenue for governments at different levels. Public health measures can be seen as harming economic interests and reducing government revenues. Policy makers face the challenge of giving an appropriate priority to the promotion and protection of population health while taking into account other goals, obligations and interests. In this respect, it should be noted that international trade agreements generally recognize the right of countries to take measures to protect human health, provided they are not discriminatory or disguised restrictions on trade.

Population-wide rates of alcohol consumption are markedly lower in poorer societies than in wealthier ones. However, for a given amount of consumption, poorer populations may experience disproportionately higher levels of alcohol attributable harm. There is a great need to develop and implement effective policies and programmes that address such social disparities and to generate and disseminate new knowledge about the complex relationship between alcohol and social and health inequity, particularly in developing countries.

Objectives

The strategy has five objectives:

  • raised global awareness of the magnitude and nature of the health, social and economic problems caused by harmful use of alcohol, and increased commitment by governments to act to address the harmful use of alcohol;
  • strengthened knowledge base on the magnitude and determinants of alcoholrelated harm and on effective interventions to reduce and prevent such harm;
  • increased technical support to, and enhanced capacity of, Member States for preventing the harmful use of alcohol and managing alcohol-use disorders and associated health conditions;
  • strengthened partnerships and better coordination among stakeholders and increased mobilization of resources required for appropriate and concerted action to prevent the harmful use of alcohol;
  • improved systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes.

The strategy considers that national and local efforts to reduce harmful use of alcohol can produce better results when they are supported by regional and global action within agreed public health policy frameworks.

GUIDING PRINCIPLES

The principles lying behind the strategy are:

  • Public policies and interventions to prevent and reduce alcohol-related harm should be guided and formulated by public health interests and based on clear public health goals and the best available evidence.
  • Policies should be equitable and sensitive to national, religious and cultural contexts.
  • All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions to prevent and reduce harmful use of alcohol.
  • Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted.
  • Protection of populations at high risk of alcohol-attributable harm and those exposed to the effects of harmful drinking by others should be an integral part of policies addressing the harmful use of alcohol.
  • Individuals and families affected by the harmful use of alcohol should have access to affordable and effective prevention and care services.
  • Children, teenagers and adults who choose not to drink alcohol beverages have the right to be supported in their non-drinking behaviour and protected from pressures to drink.

National policies
The harmful use of alcohol, and its related public health problems, is influenced by the general level of alcohol consumption in a population, drinking patterns and local contexts.

Special attention needs to be given to reducing harm to people other than the drinker and to populations that are at particular risk from harmful use of alcohol, such as children, adolescents, women of child-bearing age, pregnant and breast-feeding women, indigenous peoples and other minority groups or groups with low socioeconomic status.

Member States have a primary responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Sustained political commitment, effective coordination, sustainable funding and appropriate engagement of sub-national governments and civil society are essential for success. Governments need to establish effective and permanent coordination machinery, such as a national alcohol council, comprising senior representatives of many ministries and other partners, in order to ensure a coherent approach to alcohol policies and a proper balance between policy goals in relation to harmful use of alcohol and other public policy goals. Health ministries have a crucial role in bringing together the other ministries and stakeholders needed for effective policy design and implementation.

Policy Options

Ten target areas that should be seen as supportive and complementary are available for national action:

leadership awareness and commitment
Sustainable action requires strong leadership and a solid base of awareness, political will and commitment. The commitments should ideally be expressed through adequately-funded comprehensive and inter-sectoral national policies that clarify the contributions and responsibilities of the different partners involved. The policies must be based on available evidence and tailored to local circumstances, with clear objectives, strategies and targets. The engagement of civil society is essential. Policy options and interventions include: developing comprehensive and adequately-funded national and sub-national strategies; establishing a body to be responsible for following up national policies, strategies and plans; coordinating alcohol strategies with other relevant government sectors; ensuring broad access to information, effective education, effective prevention measures and public awareness programmes among all levels of society.

health services’ response - central to tackling harm at the individual level among those with alcohol use disorders and providing prevention and treatment interventions to individuals and their families at risk of or affected by alcohol use disorders. An important role for the sector is to inform societies and their members about the public health and social consequences of the harmful use of alcohol, and to advocate for effective societal responses.

community action
Community level action can: identify gaps and priority areas for interventions; facilitate increased recognition of alcohol-related harm; promote appropriate responses to the local determinants of harmful use of alcohol and related problems; strengthen the capacity of local authorities to encourage and coordinate community action by the development of municipal alcohol policies; mobilize communities to prevent the selling of alcohol to, and consumption of alcohol by under-age drinkers, and to develop and support alcohol-free environments, especially for youth and other at-risk groups.

drink-driving policies and countermeasures
A significant public health problem that affects both the drinker and other innocent parties. Strategies that reduce harm include deterrent measures and measures that create a safer driving environment. Policy options: promoting sobriety check points and random breath-testing; administrative suspension of driving licences; graduated licensing for novice drivers with zero-tolerance for drink–driving; using an ignition interlock, as appropriate, to reduce drink-driving incidents; mandatory driver-education, counselling and treatment programmes.

availability of alcohol
Regulating the commercial or public availability of alcohol are important ways to reduce the general level of harmful use and provides an essential measure to prevent easy access to alcohol by vulnerable and highrisk groups.

marketing of alcoholic beverages
Reducing the impact of marketing is an important consideration in reducing harmful use. Alcohol is marketed through increasingly sophisticated advertising and promotion techniques,including linking alcohol brands to sports and cultural activities, sponsorships and product placements and new marketing techniques such as e-mails, SMS and podcasting, social media and other communication techniques. The transmission of alcohol marketing messages across national borders and jurisdictions on channels such as satellite television and the Internet, and sponsorship of sports and cultural events are emerging as a serious concern in some countries.

It is very difficult to target young adult consumers without exposing cohorts of adolescents under the legal age to the same marketing. The exposure of children and young people to appealing marketing is of particular concern, as is the targeting of new markets in low- and middle-income countries with a current low prevalence of alcohol consumption or high abstinence rates.

Both the content of alcohol marketing and the amount of exposure of young people to that marketing are crucial issues. A precautionary approach to protecting young people against these marketing techniques should be considered. Policy options include: setting up regulatory or co-regulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures. Regulating: the content and the volume of marketing; direct or indirect marketing in certain or all media; sponsorship activities that promote alcoholic beverages; restricting or banning promotions in connection with activities targeting young people.

pricing policies
Consumers, including heavy drinkers and young people, are sensitive to changes in the price of drinks. Pricing policies can be used to reduce underage drinking, to halt progression towards drinking large volumes of alcohol and/or episodes of heavy drinking, and to influence consumers’ preferences. Increasing the price of alcoholic beverages is one of the most effective interventions to reduce harmful use of alcohol. The existence of a substantial illicit market for alcohol complicates policy considerations on taxation in many countries. In such circumstances, tax changes must be accompanied by efforts to bring the illicit and informal markets under effective government control. Increased taxation can also meet resistance from consumer groups and economic operators, and taxation policy will benefit from the support of information and awarenessbuilding measures to counter such resistance.

reducing the negative consequences of drinking and alcohol intoxication
Includes policy options and interventions that focus directly on reducing the harm from alcohol intoxication and drinking without necessarily affecting the underlying alcohol consumption. This approach is often referred to as a harm reduction approach. Current evidence and good practices favour the complementary use of harmreduction interventions together with broader strategies to prevent or reduce harmful use of alcohol. In implementing these harm reduction approaches to managing the drinking environment or informing consumers, the perception of endorsing or promoting drinking should be avoided.

reducing the public health impact of illegal and informal alcohol
Consumption of illicitly or informally produced alcohol could have additional negative health consequences due to a higher ethanol content and potential contamination with toxic substances. It may also hamper governments’ abilities to tax and control legally produced alcohol. Actions to reduce these additional negative effects should be taken.

monitoring and surveillance
Local, national and international monitoring and surveillance are needed in order to monitor the magnitude and trends of alcohol-related harms, to strengthen advocacy, to formulate policies and to assess impact of interventions.

GLOBAL ACTION

Concerted global efforts must be in place to support Member States in the challenges they face at the national level. International public health advocacy and partnership are needed for strengthened commitment and abilities of governments and all relevant parties at all levels for reducing harmful use of alcohol worldwide.

Role of WHO and UN Partners WHO will:

provide leadership; strengthen advocacy; formulate, in collaboration with Member States, evidence-based policy options; promote networking and exchange of experience among countries; strengthen partnerships and resource mobilization; coordinate monitoring of alcohol-related harm and the progress countries are making to address it.

Action by WHO and other international partners to support the implementation of the global strategy will be taken according to their mandates. Major partners within the United Nations system like ILO, UNICEF, WTO, UNDP, UNFPA, UNAIDS, United Nations Office on Drugs and Crime, and the World Bank group will be urged to increase collaboration and cooperation to prevent and reduce harmful use of alcohol, especially in low-and middle-income countries.

International public health advocacy and partnership are needed for strengthened commitment and abilities of governments and all relevant parties at all levels for reducing harmful use of alcohol worldwide.

WHO will engage with other international intergovernmental organizations and, as appropriate, international bodies representing key stakeholders, to ensure that relevant actors can contribute to reducing the harmful use of alcohol.

WHO is committed to resource mobilization and pooling of available resources to support global and national action to reduce harmful use of alcohol in identified priority areas.

WHO will ensure that the Secretariat has processes in place to work with non-governmental organizations and other civil society groups, taking into consideration any conflicts of interest that some nongovernmental organizations may have; continuing its dialogue with the private sector on how they can best contribute to the reduction of alcohol-related harm. Appropriate consideration will be given to the commercial interests involved and their possible conflict with public health objectives.

The Secretariat will support Member States by:

  • providing an international clearing house for information on effective and cost-effective interventions to reduce harmful use of alcohol, including promoting and facilitating exchange of information about effective treatment services;
  • strengthening the Global Information System on Alcohol and Health and the comparative risk assessment of the alcohol-attributable disease burden;
  • developing or refining appropriate data-collection mechanisms, based on comparable data and agreed indicators and definitions, in order to facilitate data collection, collation, analysis and dissemination at the global, regional and national levels;
  • facilitating regional and global networks to support and complement national efforts, with a focus on knowledge production and information exchange;
  • continuing its collaboration with international networks of scientists and health experts to promote research on various aspects of harmful use of alcohol;
  • facilitating comparative effectiveness studies of different policy measures implemented in different cultural and developmental contexts;
  • facilitating operational research to expand effective interventions and research on the relationship between alcohol and social and health inequities;
  • promoting exchange of experience and good practice in financing policies and interventions to reduce harmful use of alcohol;
  • exploring new or innovative ways and means to secure adequate funding for implementation of the global strategy
  • collaborating with international partners, intergovernmental partners and donors to mobilize necessary resources to support low- and middle-income countries in their efforts to reduce harmful use of alcohol;
  • assisting in resource mobilization for community action in low- and middle-income countries.

NGOs and other bodies
International non-governmental organizations, professional associations, research institutions and economic operators in the area of alcohol, all have important roles in enhancing the global action:

Civil society has an important role in warning about the impact of harmful use of alcohol on individuals, families and communities and in bringing additional commitment and resources for reducing alcoholrelated harm. Non-governmental organizations are especially encouraged to form wide networks and action groups to support the implementation of the global strategy.

Research institutions and professional associations play a pivotal role in generating additional evidence for action and disseminating this to health professionals and the wider community.

WHO collaborating centres have an important role in supporting the implementation and evaluation of the global strategy.

Development agencies could consider reducing harmful use of alcohol as a priority area in low- and middle-income countries with a high burden of disease attributable to alcohol. Official Development Assistance provides opportunities to build sustainable institutional capacity in this area in low- and middle-income countries, as do mechanisms for collaboration between developing countries.

Economic operators in alcohol production and trade are important players in their role as developers, producers, distributors, marketers and sellers of alcoholic beverages. They are especially encouraged to consider effective ways to prevent and reduce harmful use of alcohol within their core roles mentioned above, including self-regulatory actions and initiatives. They could also contribute by making available data on sales and consumption of alcohol beverages.

The media play an increasingly important role, not only as conveyers of news and information but also as channels for commercial communications, and will be encouraged to support the intentions and activities of the global strategy.

IMPLEMENTING THE STRATEGY

Successful implementation of the strategy will require concerted action by Member States, effective global governance and appropriate engagement of all relevant stakeholders. The Secretariat will report regularly on the global burden of alcohol-related harm, make evidence-based recommendations, and advocate action at all levels to prevent and reduce harmful use of alcohol. It will collaborate with other intergovernmental organizations and, as appropriate, other international bodies representing key stakeholders to ensure that action to reduce harmful use of alcohol receives appropriate priority and resources.

The implementation of a global strategy to reduce harmful use of alcohol provides a supportive framework for the WHO regional offices to formulate, revisit and implement region-specific policies and, together with the country offices, provide technical support to Member States. Emphasis will also be put on coordination within the Secretariat so that all actions relevant to harmful use of alcohol are in line with this strategy.

For monitoring progress, the strategy requires appropriate mechanisms at different levels for assessment, reporting and re-programming. A framework with an impact-focused perspective is needed for assessing achievement of the strategy’s objectives.

WHO’s Global Survey on Alcohol and Health and the Global Information System on Alcohol and Health will be important parts of the reporting and monitoring mechanisms. The data-collecting tools of the latter will be adjusted to include the relevant reporting on the process and outcomes of implementation of the strategy at the national level.

Regular meetings of global and regional networks of national counterparts offer a mechanism for technical discussion of the implementation of the global strategy at different levels. In addition to taking stock of the process, these meetings could include detailed discussions of priority areas and topics relevant to implementation. Reporting on the implementation of the strategy will take place through regular reports to WHO regional committees and the Health Assembly. Information about implementation and progress should also be presented at regional or international forums and appropriate intergovernmental meetings.