NDPHS Background paper to 20th BSPC

Alcohol is a key public health and social concern across the society.IntroductionThis autumn, the high level section of the UN General assembly will deal with the globalchallenges related to the strong increase of non communicable deceases. An important partof this challenge is policy measures related to population level prevention. 4 major riskfactors have been identified in the WHO global strategy: Tobacco use, unhealthy diet, to littleexercise and harmful use of alcohol.Alcohol use is somehow complicated to address since the effects can be both preventive andharmful. Alcohol is a casual factor in 60 types of deceases and injuries and a componentcause in 200 others. A certain protective effect can be identified against cardiovascular hartdecease and some others, only for certain age groups, and only through moderateconsumption. Excessive use of alcohol is, on the other hand, a major risk factor for hartdecease. Harmful use of alcohol is the leading factor of death in males ages 15-59, mainlydue to injuries, violence and cardiovascular deceases. For cancer deceases there is no lowerlimit for the risk linked to alcohol.As a whole, alcohol is linked to many harmful consequences for society as a whole and forothers in the drinker’s environment. The harmful use of alcohol results in 2.5 million deathseach year.320 000 young people between the age of 15 and 29 die from alcohol-related causes,resulting in 9% of all deaths in that age group.Alcohol is associated with many serious social and developmental issues, including violence,child neglect and abuse, and absenteeism in the workplaceAlcohol consumption and problems related to alcohol vary widely around the world, but theburden of disease and death remains significant in most countries. Alcohol consumption isthe world’s third largest risk factor for disability and premature death. In middle-incomecountries harmful use of alcohol is the greatest of the selected riskfatcor.Almost 4% of all deaths worldwide are attributed to alcohol, greater than deaths caused byHIV/AIDS, violence or tuberculosis. Alcohol is also associated with many serious socialissues, including violence, child neglect and abuse, and absenteeism in the workplace.1Per cent of global DALY1, Global Health Risks (2009).The use of Alcohol in EUThe EU has the highest level of alcohol consumption in the world. The pattern of drinkinghas varied between the countries, but the pattern of excessive use, often described as bingedrinking seems to play a more important role now also in the Mediterranean region. Overall,it is estimated that 55 million people in the EU drink alcohol to harmful levels, and of theseindividuals, 23 million are considered to be addicted.Alcohol-attributable disease, injury and violence drain the health, welfare, employment andcriminal justice sectors across the EU. Some estimates the loss to €125bn a year. This is onlythe tangible cost to EU society and does not include the pain, suffering and loss of life due tothe causes of harmful use of alcohol.There is a close relationship between the change in per capita consumption and the change inprevalence of alcohol related harm including alcohol dependence. At the same time there aretendencies to a change in drinking patterns related to age, gender, frequency of drinkingoccasions, and quantities of consumption pr drinking occasion. These are all factors that1 The disability-adjusted life year (DALY) extends the concept of potential years of life lostdue to premature death to include equivalent years of "healthy" life lost by virtue of being instates of poor health or disability2influence the level of harm. While average alcohol consumption has been decreasing in theEU, in some countries the proportion of youth and young adults with hazardous consumptionpatterns has increased where as in other countries the consumption among the young hasdecreased while we see an increase in the adult population ’Under-age “binge-drinking” andhigh frequency under-age drinking may have long-term adverse health effects and alsoincrease the risk of social harm.Alcohol consumption rates and development in Europe vary significantly from country tocountry (see picture above). In spite of the overall declining trend in alcohol consumptionper capita in Europe, there are countries like Estonia, Finland, Latvia UK and others whichare experiencing rapid rise in alcohol consumption - and of harm. Therefore, we need to lookbeyond averages and also understand that even the average alcohol consumption in Europe isa considerable public health hazardOverall, the relationship between alcohol consumption, economic development and diseaseburden is complex. In low- to middle-income countries – up to about US$ 20 000 per capitapurchasing power parity-adjusted GDP – the higher the economic development, the higherthe consumption of alcohol and the lower the number of abstainers. The lower the economicdevelopment of a country or region, the higher the alcohol attributable mortality and burden3of disease and injury per litre of pure alcohol consumed the economic costs of alcoholconsumption for society as a whole, including the costs to governments and citizens and, to acertain extent, to drinkers themselves. The studies typically do not try to disentangle whowithin society is paying the costs, although some separate out costs that are paid by variouslevels of government. In a recent analysis pulling together cost studies from four high-incomecountries and two middle-income countries, the total costs attributable to alcohol ranged from1.3% to 3.3% of GDP (Rehm et al., 2009). These costs are not only substantial whencompared to GDP, but also in relation to other risk factorsAlcohol and HealthAlcohol is a cause of some 60 different types of diseases and conditions, including injuries,mental and behavioural disorders, gastrointestinal conditions, cancers, cardiovasculardiseases, immunological disorders, lung diseases, skeletal and muscular diseases,reproductive disorders and pre-natal harm, including an increased risk of prematurity and lowbirth weight. For most conditions, alcohol increases the risk in a dose dependent manner,with the higher the alcohol consumption, the greater the riskAlcohol is the leading risk factor for death in males ages 15–59, mainly due to injuries,violence and cardiovascular diseases. Globally, 6.2% of all male deaths are attributable toalcohol, compared to 1.1% of female deaths. Men also have far greater rates of total burdenattributed to alcohol than women – 7.4% for men compared to 1.4% for women. Menoutnumber women four to one in weekly episodes of heavy drinking – most probably thereason for their higher death and disability rates. Men also have much lower rates ofabstinence compared to women.Women have traditionally used much less alcohol than men, and still the proportion ofabstainers among women is still quite high in many countries. WHO has now classifiedalcohol as first degree cancerogenic substance, in the same category with asbestos. Breastcancer and gastro-intestinal cancers are more common among alcohol users. FAS (FetalAlcohol Syndrome) is the most common congenital (birth) defect among newborns in oursocieties.The health impact of Alcohol is seen across a wide range of conditions, including 17,000deaths per year due to road traffic accidents (1 in 3 of all road traffic fatalities), 27,000accidental deaths, 2,000 homicides (4 in 10 of all murders and manslaughters), 10,000suicides (1 in 6 of all suicides), 45,000 deaths from liver cirrhosis, 50,000 cancer deaths, ofwhich 11,000 are female breast cancer deaths, and 17,000 deaths due to neuropsychiatricconditions as well as 200,000 episodes of depression. Young people shoulder adisproportionate amount of this burden, with over 10% of youth female mortality and around25% of youth male mortality being due to alcoholEuropean and Global Alcohol policyMost EU Member States have taken actions to reduce alcohol-related harm, and many ofthem have extensive policies in this field. Despite the implementation of health policies atboth Community and national level, the level of harm, especially among young people, onroads and at workplaces is still unacceptably high4The preventive alcohol policy must strive both for reducing the total consumption and toinfluence the drinking patterns, including reducing binge drinking. It is important that alcoholis avoided during childhood and adolescence, during pregnancy, in road traffic, in boating, inconnection with sports and in working life. General policies directed at the whole populationare not in conflict with actions aimed at influencing special groups.A population approach policy addressing price, availability and general health advice throughbrief interventions is supported by the alcohol research literature as the most efficientpreventive alcohol policy.The literature shows less strong evidence for information- and education programmes. Neverthe less education programmes should be an important element in a comprehensive strategyto reduce harmful use of alcohol.Alcohol research should be given increased resources. Free and independent research, whichdoes not depend on money from the commercial alcohol industry, is important for thecontinued development of alcohol policy. Alcohol research should be given increasedresources and should be cross disciplinary, with participation of researchers from social andbehavioral sciences, medicine, economics, traffic research and other areas.Successful implementation of alcohol policies is a critical means by which alcoholconsumption and its consequent harm can be reduced. Making these available and accessiblerequires political will and the national, sub-national and municipal infrastructure to facilitatepolicy formation and implementation.Regional and national commitments and actions are, therefore, required to address alcoholconsumption and harm and the wider social determinants of health. In this way, the problemis viewed as a wider societal issue, making it appropriate to consider interpersonal as well asintrapersonal harm from alcohol consumption.5