5th NCD Seminar 6th September 2011 Lausanne, Switzerland The WHO global strategy to reduce the harmful use of alcohol in a national context Mr Dag Rekve Technical Officer Management of Substance Abuse Department of Mental Health and Substance Abuse World Health Organization

World Health Organization The WHO global strategy to reduce the harmful use of alcohol endorsed by the 63rd WHA resolution 12 September, 2018 12 September 2018 …the global strategy for reducing the harmful use of alcohol is a true breakthrough. This strategy gives you a large and flexible menu of evidence-based policy options for addressing a problem that damages health in rich and poor countries alike. The strategy sends a powerful message: countries are willing to work together to take a tough stand against the harmful use of alcohol. Dr Margaret Chan Director-General World Health Organization Closing speech at WHA63 2 2

Policy making Policy implementation

WHO governing structure UN specialized agency 193 Member States The World Health Assembly Executive Board HQ in Geneva 6 Regional Committees Consensus driven Mostly non-binding

WHO`s research strategy measuring the problem; understanding its cause(s); elaborating solutions; translating the solutions or evidence into policy, practice and products; and evaluating the effectiveness of solutions.

Too big burden to be neglected

Global distribution of alcohol-attributable deaths and DALYs

Different perspectives Percent of total Risk factor

Distribution of alcohol-attributable male deaths (of all male deaths)

Critical issues Alcohol exposure and incidence and clinical course of infectious diseases Alcohol exposure and harms to others including FAS/FASD Potential movements in abstention rates and changes in female drinking patterns The positive effects of alcohol consumption and possible implications for policy decisions

Effective counter measures exist Effective measures: regulating the marketing of alcoholic beverages, (in particular to younger people); regulating and restricting availability of alcohol; enacting appropriate drink-driving policies; reducing demand through taxation and pricing mechanisms; raising awareness and support for policies; providing accessible and affordable treatment for people with alcohol-use disorders; and implementing screening programmes and brief interventions for hazardous and harmful use of alcohol

Plus numerous regional resolutions, strategies and frameworks Important milestones October 2002: World Health Report 2002 May 2005: WHA58.26 May 2007: WHA60 May 2008: WHA61.4 May 2010: WHA63.13 Plus numerous regional resolutions, strategies and frameworks

The development of the strategy Stage I. Broad consultation process Web-based consultation Consultation with economic operators Consultation with NGOs and health professionals Consultation with UN agencies and IGOs Stage II. Draft strategy development Regional technical consultations with Member States (February – May 2009) in 6 WHO regions Draft development by the Secretariat in collaboration and consultation with Member States (May – October 2009) 126th session of the Executive Board WHA 63 ting.

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

WHO global strategy: 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 alcohol- related 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.

Achieving the objectives of the global strategy Requires 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

Global strategy: recommended ten target areas for policy measures and interventions 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

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

WHO global counterparts network 1. meeting 8-11 February 2011

The role of WHO national counterparts for implementation of the global strategy establish the working mechanisms and plans for the global network; elaborate priority areas and implementation plans for reducing the harmful use of alcohol at the global level; discuss priority areas and plans for implementing the global strategy at the regional level; discuss monitoring and reporting on the implementation of the global strategy at different levels;

Technical support and capacity building Implementation structures for the Global strategy to reduce harmful use of alcohol Global network of WHO counter-parts WHO Secretariat Global level Coordinating council Task force on Public health advocacy and partnership Chair of the global network Chairs of regional networks Chairs of task forces WHO Secretariat Chairs of working groups Task force on Technical support and capacity building Task force on Resource mobilization Task force on Production and dissemination of knowledge International partners and other stakeholders Technical working group(s) on selected target areas for national action

Challenges of Monitoring Unreliable or invalid data Incomparable data Establishing uniform definitions Need for historical data Resources

Framework for monitoring and evaluation

The implementation of the global strategy to reduce the harmful use of alcohol Strong global and regional leadership Effective mechanisms for coordination and collaboration between all levels Appropriate engagement of relevant stakeholders Sufficient recourses available

Issues to consider in policy formulation Replicability - can the intervention be implemented in different contexts and circumstances? Sustainability - are the required human, technical and financial resources such that the interventions can be continued for long enough to have the desired and lasting effect? Scalability - can the interventions be expanded to the scale required to be meaningful? Political feasibility - can the intervention be implemented in different political circumstances, e.g., with respect to timing, values, power structure, etc.? Economic feasibility - what are the required investments and are these reasonable? How can the finances be made available? What has to be given up by other sectors? Technical feasibility - are the tools required to make the intervention happen available or can they be made available?

Level of involvement Informing: To provide stakeholders with balanced and objective information to assist them in understanding the problem, alternatives, opportunities and/or solutions Consulting: To obtain feedback from stakeholders on analysis, alternatives and/or decisions Involving: To work directly with stakeholders throughout the process to ensure that public concerns and aspirations are consistently understood and considered Collaborating: To partner with stakeholders in each aspect of the decision including the development of alternatives and the identification of the preferred solution

WHO`s research strategy measuring the problem; understanding its cause(s); elaborating solutions; translating the solutions or evidence into policy, practice and products; and evaluating the effectiveness of solutions.

Thank you for your attention! Exit the maze of harmful use of alcohol for better global health Thank you for your attention! http://www.who.int/substance_abuse