|
Printable
Version [PDF 131 KB]
| WORLD HEALTH
ORGANIZATION
|
|
REGIONAL OFFICE FOR
SOUTH-EAST ASIA
|
|
REGIONAL
COMMITTEE
|
|
Provisional
Agenda item 11
|
|
Fifty-ninth
Session
Dhaka, Bangladesh
22-25 August 2006
|
|
SEA/RC59/15 (Rev.2)
1 September 2006
|
ALCOHOL CONSUMPTION CONTROL – POLICY
OPTIONS
IN THE SOUTH-EAST
ASIA REGION
|
The attitudes and practices related to the use of
alcohol in Member States of the Region have been undergoing substantial
change possibly due to economic growth, increasing trade liberalization and
globalization. This is particularly so during the last two decades. There
is substantial evidence that consumption of alcohol both in urban and rural
areas is rising, particularly among youth and young adults.
Recognizing the increasing occurrence of public health
problems caused by harmful use of drugs and alcohol among the people, the
Regional Committee in 2001 adopted a resolution SEA/RC54/R2, urging Member
States to enhance the development of national policies and programmes on
Mental Health and Substance Abuse including Alcohol. Two policy documents
were released by WHO in 2004 on the global evaluation of alcohol
consumption patterns and national alcohol control policies that contained
information from countries of the Region.
In May in 2005, the Fifty-eighth World Health Assembly
reviewed the global situation and adopted a resolution WHA58.26 which
covered the public health problems caused by harmful use of alcohol. The
resolution stated that "harmful use of alcohol" referred to
"the public health effects of alcohol consumption, without prejudice
to religious beliefs and cultural norms in anyway." The resolution
also urged Member States to develop, implement and evaluate effective
strategies and programmes for reducing the negative health and social
consequences of harmful use of alcohol.
Alcohol control policies should be evidence-based.
Although interventions are available the cost-effectiveness of each
intervention should be considered before implementation.
This document is submitted to the Regional Committee to
review various policy options for reducing public health problems caused by
the harmful use of alcohol. It could also be used as a guide by Member
States in reviewing and realigning national strategies, policies,
programmes and plans of action for the prevention and control of the
harmful use of alcohol.
|
Contents
 Introduction
Harm from
alcohol use
Policy options
Effectiveness and
cost-effectiveness of interventions
 Taxation and other price
control measures
Regulating the physical
availability of alcohol
Measures against
drink-driving
Regulating
alcohol production and distribution
Advertising
restrictions
Promoting community
action
Education and persuasion
Modifying the
drinking context
Early
intervention and treatment services
Establishing
sustainable managerial mechanisms
Key players and their role
WHO initiatives
Proposed actions
Conclusion
Introduction
1. In
2002 WHO estimated in its World Health Report that there were about 2 billion
people worldwide who consume alcoholic beverages, and 76.3 million suffered
from alcohol use disorders. Globally, alcohol use causes 3.2% of all deaths
(1.8 million deaths) and 4% of Disability-Adjusted Life Years (DALYs) (58.3
million). These proportions are much higher in males (5.6% deaths and 6.5% of
DALYs) than females (0.6% deaths and 1.3% DALYs).
2. Recognizing
the importance of the public health problems caused by harmful use of alcohol
along with other substance abuse, the Regional Committee in September 2001
adopted a resolution – SEA/RC54/R2, urging Member States to further
strengthen the development of national policies and programmes on mental
health, drug and alcohol-related problems. The South-East Asia Regional
Office (SEARO) organized a consultation on prevention of harm from alcohol
abuse in Bali, Indonesia, in June 2002. The
meeting reviewed national programmes on prevention and control of harmful use
of alcohol, and identified four key strategic areas for Member States to
implement. These strategic areas were: (a) promoting advocacy campaigns for
reducing public health problems caused by alcohol use, (b) implementing
primary prevention and health promotion focusing on young people and
adolescents, (c) introducing early interventions by preventing people who
start alcohol use from progressing to habitual users, and (d) implementing
harm reduction measures.
3. In
2004 WHO released two documents on the global evaluation of alcohol
consumption patterns and status of national alcohol control policies. The
Fifty-eighth World Health Assembly in May 2005 reviewed the global situation
and adopted a resolution (WHA58.26) on – public health problems caused by
harmful use of alcohol. The resolution urged Member States to develop,
implement and evaluate effective strategies and programmes for reducing the
negative health and social consequences of harmful use of alcohol. The
resolution also stated that harmful use of alcohol referred to the public
health effects of alcohol consumption, without prejudice to religious beliefs
and cultural norms in anyway.
4. In
recent decades, the traditional societal values in the South-East Asia Region
(SEAR), including discouraging alcohol consumption, are being gradually
replaced by so-called modernistic values and lifestyles. This is accompanied
by a rapid change in the way people think and live, resulting in different
lifestyles and behaviours compared to yesteryears. Member States of the
Region have become an emerging market with increased sales of alcohol. The
adverse impact on public health is likely to be high in the context of an
overall increase in consumption of alcohol.
5. This
document is submitted to the Regional Committee to review and to recommend to
Member States for adoption and adaptation of various policy options for reducing
public health problems caused by harmful use of alcohol. It could also be
used as a guide by Member States in reviewing and realigning national
strategies, policies, programmes and plans of action for the prevention and
control of harmful use of alcohol.
Harm
from alcohol use
6. There
is a spectrum of use among those who consume alcohol, which can range from
one-time use, occasional use, regular use, hazardous use, harmful use
(referred to as alcohol abuse by some experts in some countries) to
dependence. The proportion of people in different groups of this spectrum of
consumption varies considerably among different societies, population groups
and countries and there are differences even among individuals within each
country. “Harmful use” of alcohol refers to a pattern of use which leads to
adverse social, occupational, medical and public health consequences. The
implication of “harmful use” is broader than high volume and frequent
consumption, such as regular heavy drinking, habitual consumption, and
occasional binge-drinking. It includes other consumption patterns which also
pose implicit risks for the drinkers and those surrounding them as well as
for the society, particularly in the long term. These patterns include
consumption on light-to-moderate basis in inappropriate circumstances,
consumption by high-risk consumers (e.g. pregnant woman, etc), and regular
non-binge drinking that causes accumulated undesired results, such as chronic
diseases and poverty. The issue today is the innumerable problems associated
with harmful use of alcohol, ranging from domestic and family violence to
road traffic or other occupational accidents to physical or mental health damage.
These problems in the absence of dependent use are grouped as
“alcohol-related problems”.
7. Most
countries have a legal definition of an “alcoholic beverage” for the
application of national laws mainly for taxation purposes. If the limit on
alcohol content is set at higher level, some beverages with low level of
alcohol content may not be subject to any regulations. For example, if the
limit of alcohol by volume is set at a level by which low alcohol beer or
wine is not considered as an alcoholic beverage, these would be left out of
any sales or advertising restrictions. According to the Global Status Report on Alcohol Policy – 2004,1 the range for the legal definition of
alcoholic beverages across the world lies between 0.1 to 12.0% alcohol by
volume with a mean of 1.95%. Regional analysis showed that the level ranged
from any amount in Nepal to 5% in Bhutan.2
8. The
risk of many adverse consequences of alcohol use increases with increasing
quantities of alcohol consumed. This implies that the risk increases even at
the very low volume consumed. For example, research indicates that the risk
and severity of road traffic crashes increases with the blood alcohol
concentration (BAC). This suggests that driving under the influence of
alcohol, even when the BAC is within the legal limit, has a higher risk,
particularly among new and young drivers. With a BAC of 50mg% which is the
legal limit in most countries to drive a vehicle, the risk for road traffic
injuries is two-times higher than for drivers with no alcohol in the blood.
9. Even
occasional use of alcohol can be a gateway to future high-risk use, by
increasing tolerance and familiarity of users to drinking and drinking
environments, as well as addictive effects of alcohol itself.
10. Available
evidence suggests that the protective effect from regular light alcohol
consumption for Coronary Heart Disease (CHD) is not a valid risk-reduction
strategy at the population level. On the contrary, regular alcohol use is not,
and cannot be recommended as a public health strategy for CHD protection. For most countries, the net effect of alcohol on CHD is negative,3 particularly in areas of lower mortality from cardiovascular diseases, such as developing countries.4 There are other more cost-effective
interventions for prevention of CHD rather than regular light alcohol
consumption (cessation of smoking, appropriate diet and physical activities).
It should be noted that regular light consumption of alcohol predisposes
consumers to other adverse health and social consequences.
11. The
effects of alcohol use by an individual are noticeable in all spheres
(physical, psychological, social, and economical) of an individual’s life.
Since every person is part of a family, it has an impact on other members of
the family. Further, the collective and long-term effects of alcohol use are
felt in the society. Apart from 60 or so physical and mental disorders as
identified in International Classification of Diseases (ICD-10), harmful use
of alcohol could lead to violence, intentional and unintentional injury, road
traffic injuries, family impact and unemployment.
12. WHO
estimated in 2004 that the average Adult Per capita Consumption (APC) in 2001
was approximately 2 litres of pure alcohol, however, there is wide variation
across different countries, ranging from less than 1 litre in Indonesia to 8.47 litre in Thailand. After adjusting for
unrecorded consumption (illicit beverages as well as tax-evaded products)
which account for 45–50% of total consumption, the average APC would be
higher.
13. Given
the poor socioeconomic status of many rural communities, a disproportionate
amount of family income is spent on alcohol, leaving very little money for
food, education, housing and health that could perpetuate poverty. According
to economic studies, the cost of health and social consequences of alcohol
use up to 6% of GDP significantly outweighs the benefit form alcohol
consumption in terms of revenue generation in most countries.
14. Health
care cost for treating people with alcohol-related conditions and illnesses
are huge for individuals, families and even for Governments. The societal
cost of alcohol consumption is implicit, such as productivity loss and loss
of future earning due to premature death of the wage earner. Most of the
social and economic burden is borne by the society, not the drinkers. The
seeming gain from the existing alcohol policies which is the revenue from tax
on alcohol ends up being spent to counter the effects of alcohol use.
Policy options
15. Increase
in alcohol use in the Region imposes numerous challenges for policy makers,
professionals and the civil society. The growing evidence of harmful effects
on individuals, families and society as a whole has created a dilemma in the area of public health. As documented by WHO-SEARO,5
it is not just the people with alcohol dependence or the heavy drinkers who
overwhelm the health services, but also the infrequent, or social consumers.
16. Research
studies show that there are a wide range of policy options and interventions
for reducing public health problems caused by harmful use of alcohol are
available. These could be adapted and implemented in SEAR Member countries
and included in national alcohol control policies.
Effectiveness
and cost-effectiveness of interventions
17.
Research also shows that there is no single
policy which is effective in controlling harm from alcohol use, rather it is
a mix of policy options which are effective. A two-pronged strategy is
desirable. This could include (a) a population-based approach, with
legislative and managerial measures with concerted efforts for preventing
harmful use and reducing overall consumption of alcohol, and (b) an
individual risk reduction approach, aimed at high-risk settings and hazardous
individual behaviors, especially targeting existing or potential consumers.
18.
Strategies and interventions to reduce
alcohol-related harms are not equally effective. Furthermore, the
cost-effectiveness of interventions should be a highly priority during the
process of planning an alcohol policy, particularly in poor resource settings
in developing countries. Among policy options, the ten best practices of
alcohol policy, as contained in WHO report EB115/37, are: (1) minimum legal
purchasing age; (2) government monopoly of retail sales; (3) restriction on
hours or days of sale; (4) outlet density restrictions; (5) alcohol taxes;
(6) random breath test; (7) lower blood alcohol concentration limits; (8)
administrative licence suspension (9) graduated licensing for novice drivers,
and (10) brief intervention for high-risk drinkers. Generally, interventions
directed at the general population are more effective, but the two are
complementary and not alternatives. Furthermore, the most efficient public
health response to the burden of alcohol use depends on the prevalence of
hazardous alcohol use which is related to the overall per capita consumption.
Population-wide measures, such as taxation, are probably the most
cost-effective response in populations with moderate or high levels of
drinking (such as in developed countries). Whereas more targeted strategies
such as brief physician advice, roadside random breath-testing and
advertising bans are likely to be most cost-effective in populations with
lower rates of hazardous alcohol use such as in South-East Asia.6
19.
The following paragraphs present various
policy options which are available along with the evidence for the
effectiveness of each. Member countries can decide what is appropriate for
their own situation and culture, then adapt these prior to implementation.
The policy options proposed are based on evidence gathered from implementing
various control measures in the Region and in western countries.
Taxation and
other price control measures
20. Generally,
consumers respond to a price increase in alcoholic beverages. Data from
developed countries suggests that the impact is more among price-sensitive
consumers such as the youth rather than occasional drinkers. Heavy drinkers
also respond to price change. Studies from some countries suggest that an
increase in taxation on alcoholic beverages reduced the rates of
alcohol-related traffic injuries and mortality, and incidents of
alcohol-related violence in the community. Taxation on alcoholic beverages
should raise its retail price to the level that can alter consumption
decision, with an effective enforcement mechanism to prevent consumer’s
shifting towards cheaper illegal alcohol. With increasing income the impact
of one-time rise in price may be neutralized. Thus the taxation system should
be adjusted so that the price of alcohol beverages rise at or beyond the rate
of inflation and purchasing power.
21. With
rapid expansion of trade liberalization, taxation for alcohol products has
been more rationalized (usually reduced) by treating them like any other
commodity. Alcohol is a source of substantial revenue for governments. There
are examples (e.g. from some states in India) that restrictions on the
sale of alcohol have been removed because of loss of revenue. However, there
is also evidence from a research project sponsored by WHO, conducted in Bangalore, India,5 that in the long-term the
financial losses to the state are far greater than the immediate revenue. One
option is to allocate part of the taxes generated from the sales of alcohol
to support health promotion programmes. Thailand has adopted, under its
Health Promotion Foundation Act, the use of additional 2% of "sin
tax" on tobacco and alcohol and the proceeds are used for health
promotion activities, including reducing alcohol consumption and related
problems.
Regulating the
physical availability of alcohol
22. Various
legislative measures have been/could be used for reducing alcohol
consumption, and thereby the harm from its use, by limiting the physical
availability of alcohol. There is evidence that limiting the availability of
alcohol influences the rates of alcohol-related injuries and other problems.
Minimum
legal purchasing or drinking age: Setting a minimum legal age limit for
purchase or drinking alcohol is a measure targeted at the youth by
restricting their access to alcohol. Evidence suggests that consumption of
alcohol is usually influenced by the age at which alcohol is legally
available (on or off license) and increasing legal age for
purchasing/drinking is one of the most effective interventions in reducing
alcohol-related problems and the consumption of alcohol by minors. The
minimum age limit in SEAR countries varies from 18 to 21 years, except India
where it is 25 years. Globally, the age limit varies from 15 to 21 years.
However, to achieve its goal, minimum purchasing/ drinking age laws need an
effective enforcement and surveillance mechanism.
Restrictions
on sales: There are a number of policy options to limit the sales of
alcohol to consumers, such as (a) restricting the number, density and
locations of sale outlets; (b) limiting hours and days of sale; and (c)
imposing some other restrictions on sale.
Studies have shown
that measures such as closing of sales outlets or restriction of sale at
certain time of the day/specific days like religious days or paydays,
restrictions on sale of high alcohol content beverages or rationing the
amount of alcohol sold to an individual, could reduce social and
health-related problems linked to alcohol use in the short- and long-term.
Restriction on serving and selling alcohol (such as not serving already
intoxicated customers) has shown to be effective only if enforced with
server/seller liability. Prohibition of public drinking at specific settings
such as educational institutions, public places (offices and factories),
recreational settings (parks and beaches, cinema halls, sports stadiums) and
fast-food restaurants could ensure a safe public environment and minimize or
avoid injuries and loss of public property and productivity.
Total
prohibition or ban on alcohol: Worldwide experiences shows that total
prohibition on the production, sales, and consumption of alcohol usually does
not succeed, unless firmly rooted in the local culture or strong religious
convictions of the majority of the population. Although there is some
evidence that total prohibition of alcohol does reduce consumption and
alcohol-related problems, it could also promote organized crime and
corruption through cross-border smuggling and brewing of illicit liquor.
Measures against drink-driving
23. Research
indicates that the risk and severity of road traffic injuries increases with
drink-driving. This suggests that driving under the influence of alcohol,
even when the Blood Alcohol Concentration (BAC) is within the legal limit,
has a higher risk particularly for new and young drivers.
24. Effective
countermeasures include: (1) setting legal BAC at appropriate level, and if
possible, lowering the legal BAC level; (2) active surveillance system for
drink-driving; (3) swift punishment(s) including license suspension; and 4)
measures for high-risk groups, such as setting a specific lower level of
legal limit of BAC among new and young drivers and commercial drivers (“zero
tolerance”). It has been shown in research studies that regular and
comprehensive Random Breath Testing (RBT) is more effective than setting
fixed sobriety checkpoints.
Regulating
alcohol production and distribution
25. Legislative
control of production, marketing and sale of alcohol could take two positions
from (a) total control of production and/or sales (state monopoly) on one
side to (b) absolutely no control (total liberalization) on the other
extreme. Studies of the effects of privatizing alcohol retail sale monopolies
have shown that there was some increase in the levels of alcohol consumption
and alcohol-related problems, due in part to the increase in number of
outlets and hours of sales, that increased with privatization measures based
on profit motives. From a public health perspective, it is the retail level
which is important for controlling individual consumption while
monopolization of production or wholesale distribution may facilitate revenue
collection and effective control of the market.
26. Trade
and Commerce sectors regard "alcohol" as a "commercial
good" to be traded freely across countries like any other commodity.
Investment in production and sale of alcohol is seen as a service or an
investment within the arrangement of multilateral trade agreements.
Therefore, concerted efforts are needed to create awareness at national and
international levels that alcohol should be considered as special item that could
lead to adverse social and health consequences that go beyond economic gains
and free trade agreements. Furthermore, consideration should be given to the
formulation of special initiatives for select items (including alcohol) of
crucial public health importance.
Advertising restrictions
27. Alcohol
advertising has the potential of promoting changes in attitudes and social
values, including publicizing the desirability of social drinking to its
viewers, which all encourage a higher consumption of alcohol and weaken the
social climate towards effective alcohol control policy. In countries where
advertising in the media is not totally banned, there is frequent portrayal
of alcohol in media materials, particularly in magazines, newspapers and
television, especially of internationally branded beverages. The mainstream
of these portrayals suggests alcohol use as a harmless pursuit, showing
solidarity, friendship and masculinity, while neglecting any negative
consequences.
28. Studies
in developed countries have shown that advertising can influence consumer
choices, have a positive short-term impact on knowledge and awareness about
alcohol, but it has proved difficult to measure the exact effects of
advertising on demand for alcoholic beverages, in part because the effects
are likely to be cumulative and long-term. Recent literature suggests that
advertising and other marketing activities increase the overall demand and
influence teenagers and young adults towards higher consumption and harmful
drinking. Self regulation by the industry and mass media has been attempted
by developing codes of advertising as a preferred alternative for legal
advertising regulation. However, the effectiveness of voluntary codes is
likely to be limited.
29. Even
in places where alcohol advertising is banned, messages on alcohol use could
be conveyed to existing or potential consumers in a variety of ways. These
include: surrogate advertising – brand sharing of products including name and
logos, advertising at the point of sales, and sponsorship of events
particularly in teenager-friendly events such as sports, music and cultural
events. Thus an effective monitoring system is needed.
Promoting
community action
30. In
recent decades, community-level efforts to control harmful use of alcohol in
some countries were successful through enhanced partnerships and networks,
involving public agencies and NGOs. Community action is not in itself a
strategy, but rather a process of implementation of one or more policy
interventions at the community level. Recognition of harm from use of alcohol
within a community is an important step in organizing community-based
efforts.
31. Various
measures of community action include: (a) organizing awareness programmes to
deal with harm from alcohol use within the community, (b) monitoring
alcohol-related social and economic situations, (c) creating an atmosphere
for social control of harm from alcohol use by formulating community
sponsored rules and regulations, and (d) supporting measures including
community-based treatment and rehabilitation programmes.
32. There
have been several reports on community-based alcohol control actions
initiated by various women’s groups using different strategies. One effective
strategy has been restricting the availability of alcohol in specific
communities or townships by direct intervention.
33. A
large proportion of the formal and non-formal sectors' labour forces are
affected by harmful use of alcohol. The impact on the work force includes
absenteeism, work accidents, unemployment and poor productivity. Although it
is not mandatory for an employer to provide counseling and treatment for
alcohol-related problems, more and more employers are beginning to view
harmful use of alcohol as a social problem and its control as a corporate
responsibility.
Education and
persuasion
Mass media
campaigns
34. Mass
media has been used both by the alcohol industry to promote its products and
by governments to control harm from alcohol use. While mass media is a
popular means for attempting to control harm from alcohol use, evidence
suggests that complementary and reciprocal community actions pursued in
conjunction are more effective than media campaigns alone. In addition mass
media campaigns are expensive and could be countered by aggressive, well-funded
alcohol industry advertisements. Ingredients of an effective mass media
campaign are: well defined target group, undertaking formative research,
pre-test campaign materials, messages which build on existing knowledge,
messages which satisfy existing needs and motives, addressing knowledge and
beliefs which impede adoption of messages, guaranteed media plan for exposure
and long-term commitment for a campaign.
Educating
school children
35. Traditionally,
schools promote sporting activities and religious values, but more recently,
schools have started educating students on skills which they need to deal
with stressful life events, e.g. stress management and handling
peer-pressure. This strategy is termed as "Life-skills education".
Part of these skills is to stay away from habits such as smoking and drinking
alcohol. Such programmes include getting students to talk openly about the
subject of alcohol use, their attitudes, and environmental pressures on them
to drink alcohol and giving them information on the harmful effects of
alcohol. These programmes can go a long way in preventing the initiation of
alcohol use, particularly its harmful use.
Modifying
the drinking context
Provision of
alternative recreational facilities
36. In
many instances, the avenue for entertainment or recreation for adolescents
and blue-collar workers are taverns/public bars/restaurants, where alcohol is
liberally served together with food and other entertainment such as music,
TV, karaoke, dancing or billiards. Thus, initiatives in many countries
especially by city development authorities, to provide and encourage
alternate recreational places, and also organize leisure activities which involve
less or no drinking of alcohol could be helpful in reducing alcohol-related
problems. Job-creation and skill development programmes could also be useful
for adolescents, particularly those from the low socio-economic strata where
jobs are scarce and alcohol consumption rampant.
Public nuisance
and the responsibility while intoxicated
37. A
person charged for an offence can, and generally pleads not guilty with the
excuse of being under the influence of alcohol. The lawful position of
self-inflicted intoxication has been controversial. It seems that in
principle, legislation in most countries makes judgment for intoxicated
persons as if they were sober.
Early
intervention and treatment services
Role of the
family
38. Harmful
consumption of alcohol by even one member of the family can adversely affect
the whole family. In the strong social network prevalent in Member States,
the role of the family becomes crucial. Family members have a significant
role in prevention of alcohol-related problems, especially the role of
parents in encouraging abstention, promoting alcohol-free activities,
conveying appropriate messages with regard to consumption and problems and
monitoring any negative situation.
39. The
first step is recognizing when alcohol consumption is reaching harmful levels
and facilitating interventions aimed at reducing alcohol use. For persons
with alcohol-use disorders, the next step is to obtain appropriate professional
help. Family support to the person is needed not only to seek treatment, but
to persist with the treatment, which is sometimes unpleasant. Rehabilitation,
which includes a return to normal family responsibility and a position of
respect within the family, is essential. Careful observation to prevent a
relapse into abuse of alcohol is very important. Often, friends play a major
role in perpetuating practices relating to alcohol use. The family also has a
crucial role to play in keeping its members away from the influence of such
friends or relatives who could draw the person back into harmful use again.
Parents should set a good example to their children in alcohol use.
Expanding the
role of the health sector from recipient to proactive agents
40. The
traditional role of the health sector is to provide treatment and
rehabilitation services for alcohol abusers and treating medical
complications for physical and mental disorders (e.g. liver and other
gastro-intestinal diseases, mental disorders, etc.). In addition, an
important role of the health sector, which includes primary care physicians,
nurses, other professionals and community health workers, could be in
screening and early identification of people who abuse alcohol followed by
brief interventions, particularly at primary health care level. This is
particularly important considering that there is a WHO-developed technology
using the AUDIT (Alcohol Use Disorder Identification Test) to screen for
harmful alcohol consumption.
41. Evidence
suggests that type of service for treatment of alcohol use disorders makes little difference in long-term outcomes7 , and more sophisticated and high-cost services are not demonstrably more effective8 , 9. Overall, brief intervention,
particularly at primary health care level, is the most cost-effective among screening and treatment measures.10
Establishing
sustainable managerial mechanisms
Cooperation
between stakeholders
42. There
are varied opinions on prevention and control of harmful use of alcohol. Many
public agencies and sectoral ministries, e.g. interior or home affairs, civil
and criminal courts, industries, budget and revenue, agriculture, customs and
other law enforcement agencies, medical associations, alcohol manufacturers,
as well as consumers, civil society, and other NGOs are lobbying for their
own point of view. This often creates confusion and conflict of interest as
well as duplication, rather than a synergistic effort for working together
with a clear formulation and effective implementation of national alcohol
policy. Coordination and cooperation between various public agencies, civil
society and private enterprises is essential, if it is conducted on
commercial interest-free basis.
Establishment of a national alcohol control authority
or similar agency
43. Alcohol
and health issues related to it should be accorded high national priority. In
doing so, there is a need to have an authoritative body, commission or
committee, responsible for developing and updating a national public health
oriented alcohol control policy and programmes. This body could represent the
highest level of government administration (such as Council of Ministers,
Parliamentary Committee or the Parliament). There should be adequate funding
and secretariat support from the government. Financial support for such an
establishment could be through earmarked taxes or a special allocation.
Monitoring and evaluation
44. There
is a need for countries to work together in collaboration with WHO and
interested alliances to monitor national and regional situation on alcohol
consumption and related problems including social cost of alcohol
consumption, as well as develop a comprehensive set of indicators for the
purpose of monitoring and evaluation of various alcohol control policy
options and strategies for reducing public health problems caused by alcohol.
WHO has already developed an international guide for Member States and other stakeholders for monitoring alcohol consumption and related harm. 11
45. The
potential for adaptation and use of such indicators depends upon the
availability of information and the existence of national programmes. The
data from other sectors and sources such as industry, customs, trade and
commerce, revenue, police, transport, and national surveys, can be used in
mutually consistent and supportive ways to create a valuable national
information source. There is a need to have a national information clearing
house for alcohol-related information.
Promoting
national and regional networks/centres
46. National
and regional networks of public health, economic and social institutions,
public policy faculties and experts should address issues related to
non-communicable diseases and their risk factors including alcohol. This
would generate evidence-based information which would strengthen the
planning, implementation, monitoring and evaluation processes, and in the
adoption of policies and strategies for reducing public health problems from
harmful use of alcohol.
Key players
and their role
47. Most
Member countries have some form of an alcohol control policy, although it may
not be an exclusive formal policy dealing with alcohol. Most of these are
sectoral actions indicating the commitment for preventing and reducing
alcohol-related problems.
WHO needs to work closely with each Member
country to provide technical assistance to develop an effective, integrated
and comprehensive national alcohol control policy.
The local community (especially elected
officials and senior administrators) are crucial for taking effective action,
especially promoting awareness and legislative control, which are vital for
public health.
Health care professionals and public health
institutions are not only responsible for the provision of public education
and case management, but also in helping the implementation of effective
policy responses and also in mobilizing and lobbying for a change in society.
Various organized civil society groups at
local, national, international level, including their networks should work
together and can also play an advocacy role as well as function as a
monitoring watchdog to provide vital checks and balances by highlighting best
practices or policies to reduce public health problems caused by alcohol use.
The alcohol industry, trade and commerce and
associated businesses also have the primary responsibility in ensuring that
their practices in production, sales and marketing of their products meet the
highest possible standard of business ethics and fully comply with
established rules and regulations.
WHO
initiatives
48. The
Regional Office has recently documented regional experience in a publication
entitled “Public health problems caused by harmful use of alcohol in
South-East Asia Region: Gaining Less or Losing More?” This document reviews
the currently available information on the supply, demand and use of alcohol
in the population. Some suggestions are also provided on what can be done to
prevent harm from alcohol use in the community. It supplements the WHO Global
Report on Alcohol by adding region-specific information.
49. Another
document – "Alcohol Control Policies in the South-East Asia Region:
Selected Issues" has been developed. It is intended to inform policy
makers about the status of existing alcohol control policies in the Region
and to provide a baseline for monitoring progress in prevention of harm from
alcohol use. It could also serve as an advocacy tool for identifying existing
gaps and raising awareness about the need for additional alcohol control policies.
50. A
comprehensive study on the “Burden and Socio-Economic Impact of Alcohol Use –
The Bangalore Study”, has been carried out by interviewing almost 29,000
individuals from rural, town, slum and urban areas in Bangalore, India,
in 2005 showed the distinct effects and impacts of alcohol use among the
studied population.
51. A
self-learning material for community volunteers on prevention of harm from
alcohol use entitled: “Reducing Harm from Use of Alcohol – Community
Responses”, has been developed and tested. It contains simple instructions
which can be used by a motivated community activist to initiate programmes
within his/her community for prevention of harm from alcohol use.
52. A
life skill-based programme on adolescent mental health promotion has been developed,
consisting of eight modules on different aspects of relevance to adolescents.
It also includes one module on prevention of harm from alcohol use. All these
modules have been successfully tested in India,
Indonesia and Thailand.
53. An
advocacy material for adolescents entitled, “Facts on alcohol use and abuse:
What you should know”, provides adolescents with brief and clear information
on harm from alcohol use and abuse. This document has been extensively tested
in India.
The information is based on extensive feed back received from adolescents.
They are currently being implemented in Bhutan
and India.
54. Interactive
CD-based material for adolescents on prevention of harm from alcohol is being
prepared. A software development company in India will convert some of the
materials developed by WHO into an interactive programme on prevention of
harm from alcohol use.
Proposed
actions
55. Member
countries should consider appropriate participation of stakeholders not
having any conflict of interest in order to develop comprehensive national
alcohol control policies, action plans and programmes for reducing public
health problems caused by alcohol use.
56. There
is also a need to establish and/or strengthen appropriate national and, where
needed, sub-national mechanism(s) for effective planning, implementation,
monitoring and evaluation of national programmes with adequate institutional
capacity and funding.
57. WHO
should support Member States, in building and strengthening institutional
capacities for developing information systems, policies, action plans,
programmes and guidelines, and for monitoring/ evaluating the programmes.
58. WHO
should pursue appropriate partnership mechanism to facilitate stakeholders'
consultations and forums at national, intercountry and regional levels for
effective planning, implementation, monitoring and evaluation of national
programme, with adequate funding.
Conclusion
59. Many
countries of the Region which had low levels of consumption of alcohol until
recently are moving towards higher levels of consumption, particularly among
the youth and young adults. The impact of increasing incomes, globalization
and rapid trade liberalization has accelerated this movement. It is well
established that an increase in alcohol consumption by a community or a
nation could lead to a higher proportion of persons with alcohol-related health
and social problems, which is a public health issue. Harmful use of alcohol
has a significantly adverse impact on the lives of affected persons, their
families and communities, most notably in social, economic and health
aspects. The social impact and the burden on the nation are also substantial.
As such, there is a need to focus on the prevention and control of harmful
use of alcohol in countries of the Region from the perspectives of both
health promotion as well as socio-economic development.
60. The
history of measures for alcohol control and scientific evidence also point to
the need for pragmatic policy options and interventions rather than extreme
positions like total prohibition. A public health approach that takes into
account the trends of alcohol use is more likely to be effective.
|
