Reducing harmful use of alcohol:
from global strategy to action
Dag Rekve
Management of Substance Abuse
Department of Mental Health and Substance Abuse
WHO Headquarters
WHO governing structure
 UN specialized health agency
 194 Member States
 The World Health Assembly
 Executive Board
 6 Regional Committees
 Consensus driven
 Mostly non-binding
Global Status Report on Alcohol and
Health (WHO, 2011)
 Continues series of the global status reports
on alcohol and health from WHO
 Based on the data from the Global Information
System on Alcohol and Health (GISAH) and
the Global Burden of Disease study
 Contains country profiles for WHO Member
States
 Launched in Geneva on 11.02.2011 at the
Global meeting of the WHO national
counterparts to reduce the harmful use of
alcohol
 Highly commended in the public health
category in the British Medical Association
(BMA) Book competition 2012
Alcohol consumption
in the world (WHO, 2011)
 Estimated ~2.5 billion people consuming alcoholic
beverages
– on average 6.1 litres of pure alcohol per capita of adult (15+)
population, including 1.8 litres (28.6%) of "unrecorded" alcohol
 Estimated ~ 45% of the world adult population has never
consumed alcohol
– Men – 35%
– Women – 55%
 In addition, 13.1% of men and 12.5% of women have not
consumed alcohol during the past year
Source of data: WHO Global Information System on Alcohol and Health (GISAH)
Total adult per capita consumption (world)
Lifetime prevalence of abstention (world)
Patterns of drinking
Risks and consequences
1. Impact on the individual drinker
2. Impact on people other than the
drinker
3. Impact on overall health burden
4. Impact on social and economic
development
Disease burden attributable to alcohol
consumption worldwide (WHO, 2011)
 In 2004 estimated 2.5 million people died worldwide of
alcohol-related causes which accounted for 3.8% of
global mortality in all age groups
– 6.1% in men
– 1.1% in women
– 320 000 young people between 15 and 29 years old
 4.6% of all DALYs lost worldwide due to harmful use of
alcohol
– 7.1% in men
– 1.4% in women
Too big alcohol-attributable disease
burden by any measure (WHO, 2009)
Global distribution of
alcohol-attributable deaths and DALYs
Deaths
DALYs
DALYs attributed to 10 leading risk factors for the
age group 15 to 59 years old in the world
(WHO, 2009)
Alcohol use
Unsafe sex
Tobacco use
High blood glucose
Occupational risks
High blood pressure
Overweight and obesity
High cholesterol
Physical inactivity
Iron deficiency
-
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
60,000,000
70,000,000
Distribution of alcohol-attributable male
deaths (of all male deaths)
Effective prevention policy measures
exist
 Regulating and restricting availability of
alcoholic beverages;
 Reducing demand through taxation and
pricing mechanisms;
 Regulating the marketing of alcoholic
beverages (in particular to younger
people);
 Enacting appropriate drink-driving policies;
 Raising awareness and support for
effective policies.
 Implementing screening programmes and
brief interventions for hazardous and
harmful use of alcohol.
Global strategy to reduce
the harmful use of alcohol
 Developed through a long and
intense collaboration between
the WHO Secretariat and
Member States.
 Incorporates, when relevant
and appropriate, the outcomes
of consultations with
stakeholders, including the
industry and NGOs.
 Represents a unique
consensus among WHO 194
Member States on ways to
tackle harmful use of alcohol at
all levels.
Definition of "harmful use of alcohol" in
the WHO global strategy
 Drinking that causes detrimental health and social
consequences for
– the drinker
– people around the drinker and
– society at large.
 Patterns of drinking that are associated with
increased risk of adverse health outcomes
("hazardous use")
– Level and pattern of alcohol consumption
• Heavy episodic drinking
WHO Global strategy to reduce the
harmful use of alcohol: five objectives
(a)
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;
(b)
strengthened knowledge base on the magnitude and determinants of alcoholrelated harm and on effective interventions to reduce and prevent such harm;
(c)
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;
(d)
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;
(e)
improved systems for monitoring and surveillance at different levels, and more
effective dissemination and application of information for advocacy, policy
development and evaluation purposes.
What actions are needed to reduce
the harmful use of alcohol?
Global, regional and national actions on:
–
–
–
–
levels of alcohol consumption
patterns of alcohol consumption
contexts of alcohol consumption
wider social determinants of health
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.
The content of the strategy
The global strategy:
– complements and supports public
health policies in Member States;
– gives guidance for action at all
levels;
– sets priority areas for global
action;
– contains a portfolio of policy
options and measures that could
be considered for implementation
and adjusted as appropriate at the
national level
National policies and measures
 Member States have a primary responsibility for formulating,
implementing, monitoring and evaluating public policies to reduce
the harmful use of alcohol. Such policies require a wide range of
public health-oriented strategies for prevention and treatment.
 All countries will benefit from having a national strategy and
appropriate legal frameworks to reduce harmful use of alcohol,
regardless of the level of resources in the country.
 Sustained political commitment, effective coordination, sustainable
funding and appropriate engagement of subnational governments
as well as from civil society and economic operators are essential
for success.
 Health ministries have a crucial role in bringing together the other
ministries and stakeholders needed for effective policy design and
implementation.
Regional initiatives
following the global strategy
 Regional office for Africa
– Reduction of the harmful use of alcohol:
A strategy for the WHO African Region
 Regional office for the Americas/PAHO
– Plan of Action to Reduce the Harmful Use of Alcohol
 Regional office for Europe
– European action plan to reduce
the harmful use of alcohol 2012–2020
Priority areas for global action
Public health advocacy and partnership
Technical support and capacity building
Production and dissemination of
knowledge
Resource mobilization
Recommended ten target areas for policy
measures and interventions
1.
Leadership, awareness
and commitment
2.
Health services'
response
3.
Community action
4.
Drink-driving policies
and countermeasures
5.
Availability of alcohol
6.
Marketing of alcoholic
beverages
7.
Pricing policies
8.
Reducing the negative
consequences of drinking
and alcohol intoxication
9.
Reducing the public health
impact of illicit alcohol and
informally produced alcohol
10. Monitoring and surveillance
Implementation mechanisms for the Global strategy
to reduce harmful use of alcohol
Global level
Global network
of
WHO counterparts
Chairs of
the global
network
Task force on Public
health advocacy and
partnership
Chairs of
regional
networks
WHO
Secretariat
Task force on
Technical support
and capacity
building
WHO
Secretariat
Chairs of
task forces
Coordinating council
Task force on
Production and
dissemination of
knowledge
International
partners and
other
stakeholders
Task force on
Resource
mobilization
Chairs of
working
groups
Technical working
group(s) on selected
target areas for national
action
WHO global counterparts network
first meeting 8-11 February 2011
Advocacy, partnerships and
resource mobilization
 Support for the Global network of WHO national counterparts and
collaborative implementation (WHO Secretariat- MS) mechanisms (task
forces and the working groups)
– Meetings of the Coordinating Council (2012, 2013)
– Second meeting of the Global network (2013)
 Co-hosting Global Alcohol Policy Conference (Thailand, 13-15 February
2012)
 Implementation/action plan elaborated in collaboration with MS, published
and disseminated
 Interagency UN task force on implementation of the global strategy (2012)
 Meeting of interested parties (2012)
Global Alcohol Policy Conference
co-hosted by WHO
Bangkok, Thailand, 13-15 February 2012,
 1216 participants from more
than 50 countries
 Participants of the
Conference adopted the
Declaration calling on
intergovernmental agencies,
NGO networks,
governments, academia,
civil society, professional
organizations, communities,
and individuals, at all levels
to take action
The UN Political Declaration on
Prevention and Control of NCDs (2011)
Tobacco use
Unhealthy diets
Physical
inactivity
Harmful use of
alcohol
Cardiovascular
diseases




Diabetes




Cancer




Chronic lung
disease

UN Political Declaration on Prevention and
Control of NCDs (2011)
 …underline the importance for MS to continue addressing
common risk factors for non-communicable diseases through the
implementation of the World Health Organization … Global
Strategy for the Prevention and Control of Non-communicable
Diseases as well as the Global Strategy on Diet, Physical Activity
and Health and the Global Strategy to Reduce the Harmful
Use of Alcohol;
 Promote the implementation of the WHO Global Strategy to
Reduce the Harmful Use of Alcohol…as well as raise
awareness of the problems caused by the harmful use of alcohol,
particularly among young people, and call upon WHO to intensify
efforts to assist Member States in this regard…
Building capacity for national action
This aim will be achieved through three
outputs:
 Development of technical tools for the
10 different areas for alcohol policy
development listed in the global alcohol
strategy
 Regional capacity building workshops
for training of national civil servants
(national counterparts on alcohol, NCD
focal points or other relevant
government officials).
B UILDING CAPACITY
FOR NATIONAL
ALCOHOL POLICIES
PROJECT PLAN, phase 1: Addressing the
harmful use of alcohol as a risk factor for
noncommunicable diseases (NCDs)
 Direct technical support in selected
countries.
Department of Mental Health and Substance Abuse
Draft 4/19/2012
Production and dissemination of
knowledge
 WHO Research initiative on Alcohol, Health and Development
– Global prevalence study on Fetal Alcohol Spectrum Disorder (FASD)
• To be implemented first in selected countries of Europe and Africa
– International study "Harm to others"
• To be implemented in selected countries of Asia, Africa, Americas and Europe
– Internataional research project on alcohol and infections diseases
• To be developed and implemented in HIV/AIDS and TB high prevalence countries of Africa and
Europe
 Supporting production and dissemination of new GBD/CRA estimates of
alcohol-attributable burden
– Meeting of the WHO Reference Group on Alcohol Epidemiology (2012-early 2013)
 Global Survey on Alcohol and Health 2012 – launched 24 January 2012
– Web-based (Datacol) data collection in collaboration with the regional offices
 Global Information System on Alcohol and Health
– Full integration with regional information systems on alcohol and health (2012)
– Preparation of the Global Status Report on Alcohol and Health (2013-2014)
E-health project on alcohol and health
Global Information System on
Alcohol and Health (GISAH)
http://www.who.int/gho/alcohol

There are over 200 indicators on GISAH.

Data can be exported as EXCEL files.

Definitions for each indicator are provided through a link to the
WHO Indicator and Measurement Registry (IMR). This allows
downloading of an Indicator booklet of GISAH indicators.

Indicators can be highlighted on the theme page including
interactive maps. Static maps are accessible in the Global
Health Observatory Map Gallery.

Country profiles can be downloaded from the theme page.
Realizing the commitments included in the UN Political Declaration on NCDs:
Developing a global monitoring framework and targets for NCDs
34 Presidents and PrimeMinisters
3 Vice-Presidents and
Deputy Prime-Ministers
51 Ministers of Foreign
Affairs and Health
11 Heads of UN Agencies
100s of NGOs
Establish multisectoral
national plans by 2013
Integrate NCDs into
health-planning processes
and the national
development agenda
Promote multisectoral
action through health-inall policies and whole-ofgovernment approaches
Build national capacity
Increase domestic
resources
What WHO is doing
113 Member States
Political Declaration
High-level Meeting
UN High-level Meeting on NCDs
(New York, 19-20 September 2011)
Develop a global
monitoring framework
and targets
Develop a global
implementation plan
2013-2020
Provide technical support
to developing countries
Identify options for
partnerships
Coordinate work with
other UN Agencies
Measure results
World Health Assembly in May 2012:
Decided to adopt a global target of a 25% reduction in premature mortality from
noncommunicable diseases by 2025
Draft indicators and targets on alcohol
 Indicator: Total (recorded and unrecorded) adult
(persons aged 15+ years) per capita consumption
(APC) of pure litres of alcohol within the calendar
year.
 Target: 10 per cent relative reduction in total APC.
 Suggested alternatives:
– Indicators of pattern of drinking (e.g. heavy episodic drinking)
– Indicators of alcohol-related harm (e.g. prevalence/incidence of
alcohol psychoses or alcohol liver cirrhosis)
– Policy-related process indicators
Key professes and milestones in developing global
monitoring framework with indicators and targets
 Informal consultations organized by the WHO
Secretariat (2012, ongoing)
 National consultation processes
 Discussion at the Regional committees in all six WHO
regions
 Formal consultation with Member States at WHO HQ,
Geneva, 5-7 November 2012
 Executive Board Meeting (January 2013) and 66th
WHA (May 2013)
Development of the WHO Global Mental
Health Action Plan
 Mandated by the 65th World Health Assembly resolution
adopted in May 2012
 In the process of development in intense consultations
with Member States and other stakeholders, also at the
regional level
 Mental health conditions include alcohol use disorders
 To be submitted to the 66th World Health Assembly
through the Executive Board (January 2013)
Conclusions
 Harmful use of alcohol should be a continuing concern
at local, national, regional and global levels with
political and professional attention and allocation of
resource in line with the magnitude of the problem.
 The global strategy represents a unique opportunity
historically for sustainable actions to reduce the
harmful use of alcohol.
Thank you for your attention
Further information at:
http://www.who.int/substance_abuse/