Alcohol policies: strengthening implementation for improved

outcomes

Carina Ferreira-Borges, MPH, PhDProgramme Manager, Alcohol and illicit drugs

Alcohol and "substance abuse" in Sustainable Development Goals 2030

SDG Agenda: 17 goals (1 health), 169 targets (13 health) adopted at the United Nations Sustainable Development Summit in 25 – 27 September 2015

– 3.5.1 Coverage of treatment interventions (pharmacological, psychosocial and rehabilitation and aftercare services) for substance use disorders

– 3.5.2 Harmful use of alcohol, defined according to the national context as alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol

Are we on track for meeting the global target for harmful use of alcohol in the NCD Global Monitoring Framework and advancing

SDG health target 3.5?

NO!

Trends in total alcohol per capita consumption (APC) (15+ years) in litres of pure alcohol in WHO regions,

2000−2016

Global Monitoring Framework Scoreboard for EuropeMajor scope for accelerating achievement

1 2 3 4 5 6 7 8 9

Alcohol Consumption in European Region

HEAVY EPISODIC DRINKING* (%) AMONG CURRENT DRINKERS BY AGE GROUP, 2016

15-19 20-24 25-34 35-49 50-64 65-99

3439 37

3224

10

6872 70

66

56

30

55 58 5551

42

20

Female Male Total

More than half of the male drinkers between 15 and 64 years engaged in heavy episodic drinking in 2016 *

* 60 grams (5 standard drinks) or more of pure alcohol on at least one occasion in the past 30 days

Health consequences

Deaths (thousands) attributable to alcohol consumption, by cause, 2010−2016

Communicable, maternal, perinatal and nutritional conditions

Malignant neoplasms

Diabetes mellitus

Alcohol use disorders

Epilepsy

Cardiovascular diseases

Digestive diseases

Unintentional injuries

Intentional injuries

-100 0 100 200 300 400 500 600 700 800

Deaths

2010 2016

Leading risk factors by attributable DALYs 1990-2006-2016 for men(GBD Risk Factors Collaborators, Lancet, 2017, 390: 1345-422)

13 SDGs, 52 Targets Affected By Alcohol

The WHO European Region struggles with one of the highest levels of alcohol-related deaths in the world

Direct costs to the household frequently underestimated - poverty Loss of job/unemployment Massive costs: European Union - €156 billion yearly

1 million people died in the European Region as a result of alcohol

2500 people per day

Proportion of deaths caused by alcohol by age and sex in the WHO European Region in 2016

Compared to other major noncommunicable disease risk factors such as tobacco use, a relatively high proportion of alcohol harm occurs early in the life-course.

2018-2019

Policy and interventions

15

88 Solutions

16 Best-buys

Best-buys: Effective interventions with cost effectiveness analysis < I$ 100 per DALY averted in LMICs

Effective interventions with cost effectiveness analysis > I$ 100 per DALY averted in LMICs

Other recommended interventions from WHO guidance (cost effective analysis not available)

www.who.int/ncds/management/best-buys/en/

Clarity on what works best Best buys

Obstacles to implementation

Political choices

Health systems

National capacities

International finance

Impact of economic, market and commercial factors

Weak links with national SDG responses

Lack of access to medicines Best buys not integrated into PHC and UHC

Weak legal capacity Lack of capacity to interact with the private sector

Demands for technical support cannot be met

Industry interference Trade promotion to increase exports of health-harming

products without supporting countries to develop national responses

(WHA71 report on NCDs)

Trends in restrictiveness of marketing policies, 2008-2016

Levels of alcohol policy implementation in the WHO European Region in 2016

Discussing policy implementation in the WHO European Region - why aren’t we implementing?

Discussing policy implementation in the WHO European Region – Next steps

72nd World Health Assembly (Geneva, 20-28 May 2019)

• Extend the period of action plans on prevention and control of NCDs and on mental health (both 2013-2020) till 2030

• Paragraph 3.d of decision WHA72(11) requests the WHO Director-General to “to report to the Seventy-third World Health Assembly in 2020, through the Executive Board, on the implementation of WHO’s global strategy to reduce the harmful use of alcohol during the first decade since its endorsement, and the way forward”. During the discussions at the 72nd World Health Assembly, the WHO Director-General committed that “the report will be elaborated in full consultation and engagement with Member States” and requested that this be reflected accordingly in the official records.

Do alcohol and drugs really matter for public health? Are they different?

Trends in life expectancy in the US

But CVD and cancer mortality continue to decline!!

Acknowledgment : Jurgen Rehm

Causes of death

Poisoning/overdose

Suicide • Alcohol• Illegal drugs

Liver cirrhosis

• In Europe 75-80% alcohol-attributable• Illegal drugs HCV

• Opioids (prescription opioids, heroin)• Alcohol• Other pharmaceutical

For the overall losses in life expectancy in the last year, mainly the same reasons!

Acknowledgment : Jurgen Rehm

The growing evidence that alcohol and other drug policies can also produce changes in mortality and life expectancy should provide impetus to the application of evidence-based policies capable of not only preventing these epidemics but also reversing them.

Policies do matter!WHO Report http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2019/10/alcohol-related-deaths-drop-in-russian-federation-due-to-strict-alcohol-control-measures,-new-report-says

What was there (2003)- 30 litres alcohol per capita consumption in men and 11 litres in women- 90% heavy episodic drinking in men, 68% in women (drinkers only)- One out of two men of working age dies prematurely because of alcohol- Life expectancy is 59 for men and 72 for women

What was done (since 2003)- Restrictions of alcohol marketing (TV, radio, billboards…)- Restrictions of alcohol availability (night ban on off-premises sale, ban on internet sale)- Higher alcohol pricing (increase in excise rates, introduction of minimum unit price)- Introduction of an automated monitoring system for production and retail sale (real time tracking)

What were the outcomes (2016/2018)- 19 litres alcohol per capita consumption in men and 6 litres in women 40% drop for both sexes- 79% heavy episodic drinking in men, 44% in women (drinkers only)- Life expectancy is 68 for men and 78 for women increase 9 years on life expectancy for men

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 201863

65

67

69

71

73

10

12

14

16

18

20

22

Relationship between alcohol consumption and life expectancy

Life expectancy Alcohol consumption

Conclusion• With 3 million alcohol-attributable deaths in 2016 and well-documented

adverse impacts on the health and well-being of individuals and populations, it is a public health imperative to strengthen and sustain efforts to reduce the harmful use of alcohol worldwide.

• A significant body of evidence has accumulated on the effectiveness of alcohol policy options, but often the most cost-effective policy measures and interventions are not implemented or enforced, and the alcohol-attributable disease burden continues to be extraordinarily large.

• The wealth of data and analyses available can hopefully provide new grounds for advocacy, raising awareness, reinforcing political commitments and promoting global action to reduce the harmful use of alcohol.

ferreiraborgesc@who.int http://www.euro.who.int/alcohol

More information on the WHO website