World Health Organization Alcohol and NCD 7 May 2018 Dr Vladimir Poznyak Coordinator, Management of Substance Abuse

World Health Organization 7 May 2018 Leading causes of attributable global mortality and burden of disease, 2004 Attributable Mortality Attributable DALYs % High blood pressure 12.8 Tobacco use 8.7 High blood glucose 5.8 Physical inactivity 5.5 Overweight and obesity 4.8 High cholesterol 4.5 Unsafe sex 4.0 Alcohol use 3.8 Childhood underweight 3.8 Indoor smoke from solid fuels 3.3 59 million total global deaths in 2004 % Childhood underweight 5.9 Unsafe sex 4.6 Alcohol use 4.5 Unsafe water, sanitation, hygiene 4.2 High blood pressure 3.7 Tobacco use 3.7 Suboptimal breastfeeding 2.9 High blood glucose 2.7 Indoor smoke from solid fuels 2.7 Overweight and obesity 2.3 1.5 billion total global DALYs in 2004

World Health Organization 7 May 2018 Percentage of disability-adjusted life years (DALYs) attributed to 19 leading risk factors, by country income level, 2004

Division by disease or injury of alcohol attributable deaths in the world for the year 2004

Alcohol attributable fractions (%) for DALYs of different diseases and injuries in the world in 2004

Dose-response relationship between alcohol consumption and the risk of coronary heart disease (Corrao et al, Preventive Medicine, 2004, 38, 5, 613-619)

PAF (%) for alcohol consumption as a risk factor to cancers worldwide (Danaei et al, Lancet, 2005; 366: 1784–93)

Odds Ratios for Esophageal Cancer at Different Amounts of Alcohol Consumption in Relation to the Flushing Response (Brooks et al, 2009, PLoS Med 6(3): e1000050)

Global burden of disease (DALYs in 000) attributable to alcohol in 2002 (WHO, 2007) Diseases and injuries … Cancer Neuropsychiatr. disorders Cardio-vascular diseases "Beneficial effects" for CVD "Beneficial effects" for diabetes mellitus Women 1460 3722 887 -1205 -86 Men 4593 19393 5711 -834 -225 Total 6054 23115 6598 -2309 -312 % of alcohol-attributable burden 9,0 34,3 9,8 93.3 6.7

Sixty-First World Health Assembly (2008) resolution "Strategies to reduce the harmful use of alcohol" Calling upon WHO to produce a draft global strategy to reduce the harmful use of alcohol.

Proposed policy options (WHO, 2008, 2009) World Health Organization Proposed policy options (WHO, 2008, 2009) 7 May 2018 An array of strategies and policy options can be implemented at various levels according to priorities, problems and needs Policies and strategies should address: Levels Patterns Context of alcohol consumption Combination of measures that could be recommended to Member States that target: Population at large Vulnerable groups such as young people and pregnant women Affected individuals Specific problems such as drink-driving and alcohol-related violence.

Target areas for policy options for Member States Leadership, awareness and commitment Health services' response Community action Drink-driving policies and countermeasures Availability of alcohol Marketing of alcoholic beverages Pricing policies Reducing the negative consequences of drinking and alcohol intoxication Reducing the public health impact of illicit alcohol and informally produced alcohol Monitoring and surveillance

Health services' response World Health Organization Health services' response 7 May 2018 Prevention, treatment and care for alcohol use disorders and co- morbid conditions Supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary care and other settings Development and effective coordination of integrated and/or linked prevention, treatment and care strategies and services for alcohol use disorders and co-morbid conditions … Establishing and maintaining a system of registration and monitoring of alcohol-attributable morbidity and mortality, wit hregular reporting mechanisms

Global action: key components Public health advocacy and partnership Technical support and capacity building Production and dissemination of knowledge Resource mobilization