Module 13- The Global Alcohol Strategy and regional plan of action Part One- Alcohol Policy and Public Health This module describes the policy response to alcohol-related problems at the regional and global levels. Here we describe the World Health Organization’s global alcohol strategy and PAHO’s regional plan of action. We also describe how to develop an action plan to address the effects of harmful alcohol use. Module 13- The Global Alcohol Strategy and regional plan of action Pan American Health Organization

Learning Objectives Upon completion of this module you will be able to: Describe the development and adoption of the WHO global alcohol strategy Describe the regional plan of action on alcohol Upon completion of this module you will be able to describe the development and adoption of the WHO global alcohol strategy and the regional plan of action on alcohol. Pan American Health Organization

63rd World Health Assembly (17-21 May, 2010) Resolution WHA63.13 "Global strategy to reduce the harmful use of alcohol" In May, 2010, the 63rd session of the World Health Assembly met in Geneva, Switzerland to deliberate on the world’s most pressing health issues. As part of their deliberations, the 193 United Nations Member States adopted a Global Strategy to Reduce the Harmful Use of Alcohol. The strategy gives guidance to both Member States and to the World Health Organization on ways to reduce the harmful effects of alcohol. In the debate at the Assembly, delegates pointed to the global aspects of the problem and requested that alcohol problems receive a higher priority at the WHO. The main issues identified in the debate were the increasing binge drinking among young people worldwide, and the expanding influence of alcohol marketing and advertising. Pan American Health Organization

WHO Global Strategy (2010) Collaboration between the WHO Secretariat and Member States All important stake-holders were consulted, including the alcohol industry and NGO’s Unique consensus among WHO’s 193 Member States on ways to tackle harmful use of alcohol The Global Strategy was developed through a long collaboration between the WHO Secretariat and Member States, including PAHO. All important stakeholders were consulted, including the alcohol industry and the major nongovernmental organizations. The Strategy represents a unique consensus among WHO’s 193 Member States on ways to tackle harmful use of alcohol. Pan American Health Organization

WHO Strategy Objectives Raise global awareness and increase commitment by governments to act Strengthen the knowledge base Increase technical support to Member States and enhance their capacity to respond Strengthen partnerships and coordination Improve systems for monitoring, surveillance and information dissemination The WHO Global Strategy has five objectives: (1) raise global awareness of the health, social and economic problems caused by alcohol, and increase commitment by governments to address the harmful use of alcohol; (2) strengthen the knowledge base on the magnitude of alcohol problems and the determinants of alcohol-related harm, as well as research on effective interventions to reduce and prevent such harm; (3) increase technical support to Member States and enhance their capacity to respond to the harmful use of alcohol and associated health conditions; (4) strengthen partnerships and provide better coordination among stakeholders. In addition, Member States should mobilize the resources required for concerted action to prevent the harmful use of alcohol; (5) improve systems for monitoring and surveillance at different levels, and more effective dissemination of information for advocacy, policy development and evaluation purposes. Pan American Health Organization

10 Target Policy Areas 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 The WHO Strategy’s policy options and interventions are grouped into 10 target areas, which were identified during the consultation process. These areas should be seen as supportive and complementary: (1) Provide leadership, raise awareness and stimulate strong political will and commitment (2) Strengthen the ability of health services to respond to alcohol-related problems, not only by means of clinical response but also through advocacy. (3) Mobilize communities mobilized for action to reduce problems and support victims (4) Strengthen drink–driving policies and countermeasures, using deterrence approaches as well as measures to create a healthy driving environment (5) Regulate the public and commercial availability of alcohol (6) Reducing the impact of marketing of alcoholic beverages, especially the influence of marketing on youth (7) Promote pricing policies to reduce underage drinking and to halt progression towards drinking large volumes of alcohol and/or episodes of heavy drinking, and to influence consumers’ preferences (8) Support harm reduction approaches to reduce the negative consequences of drinking and alcohol intoxication (9) Reduce the public health impact of illegal and informal alcohol through quality control, inspection and taxation (10) Conduct monitoring and surveillance of trends in alcohol use and alcohol-related problems. Pan American Health Organization

Regional Plan of Action for Reducing Harmful Use of Alcohol Implement global strategy Technical cooperation on 10 policy areas Regional network for alcohol and public health The regional plan of action in the Americas includes aspects of the global strategy as well as the creation of the Pan American Network for Alcohol and Public Health, also known as PANNAPH. Pan American Health Organization

Regional Plan Strategic Areas Development and implementation of national public health policies, plans, laws, and resource allocation Strengthen public health measures among high-risk groups: homeless, prisoners, sex workers, children and adolescents, and pregnant women Alcohol-related policies as part of general health policies, plans and laws The following strategic areas should be covered in any action plan. Strategic Area 1: Development and implementation of national public health policies, plans, laws, and resource allocation. Strengthen public health measures among high-risk groups: homeless, prisoners, sex workers, children and adolescents, and pregnant women. Alcohol -related policies as part of general health policies, plans and laws. Pan American Health Organization

Regional Plan Strategic Areas cont. Promotion of universal prevention of alcohol misuse Promote evidence-based universal prevention models and best practices Support social and economic development of women and young people Strategic Area 2: Promotion of universal prevention of alcohol misuse. Promote evidence-based universal prevention models and best practices. Support social and economic development of women and young people. Pan American Health Organization

Regional Plan Strategic Areas cont. Promotion of early intervention in primary care settings Emphasize primary health care in an equitable and non-discriminative manner Delivery of specialized treatment, outreach and mutual help programs Provide tools for training the health work force Promote availability of medication Strategic Area 3: Promotion of early intervention in primary care settings. Emphasize primary health care in an equitable manner and free from discrimination. Delivery of specialized treatment, outreach, and mutual help programs. Provide tools for training the health work force. Promote availability of medication. Pan American Health Organization

Regional Plan Strategic Areas cont. Research, monitoring and evaluation Strategic Area 5: Strategic partnerships Strategic Area 4: Research, monitoring, and evaluation Strategic Area 5: Strategic Partnerships Pan American Health Organization

Regional Situation Lack of effective policies in most countries Powerful alcohol industry already influencing policy making and pressing to participate in the development of alcohol policies Lack of a strong voice from civil society pressing for effective policies The alcohol policy situation in the Latin American region can be described as follows: 1) there is a lack of effective policies in most countries, with no country serving as a model of best practice for other countries. 2) The alcohol industry is a powerful presence in alcohol policy making and has been pressing to participate in the development of alcohol policies at the regional, national and local levels. 3) There is a lack of a strong voice from civil society pressing for effective policies. Pan American Health Organization

Regional Situation, cont. Lack of technical capacity and financial resources Fear of economic impact of alcohol policies Culture of excessive drinking, resistance from the alcohol industry and lack of health systems able to respond to alcohol problems 4) There is a need for technical capacity and financial resources at all levels to support the dissemination of effective alcohol policies. 5) The economic impact of alcohol policies is feared, even though in most cases alcohol policies save lives and money. 6) Alcohol policy in Latin America is handicapped by a culture of excessive drinking, resistance from the alcohol industry and lack of health systems able to respond to alcohol problems. Pan American Health Organization

Regional Situation- Policy No country with a comprehensive policy to serve as a model to other countries Best practices do exist and need to be expanded and better documented, particularly in Latin America and the Caribbean Although there are no countries in the Americas with a comprehensive policy to serve as a model to other countries, best practices do exist and need to be expanded, particularly in Latin America and the Caribbean. Pan American Health Organization

Policy Examples Reducing hours and days of sale: Brazil, Peru, Colombia, USA, Canada Drink-driving countermeasures: Brazil, USA, Canada, Mexico Controlling advertising: Costa Rica Increasing prices and taxes: USA, Canada, Venezuela, Suriname Sales to minors: USA, Canada, Brazil (SP) Brief interventions in Primary Health Care: Mexico, Canada, USA, Chile, Brazil, Panama, Colombia, Dominican Republic Increased minimum drinking age: USA, Canada The following are examples of where progress is being made: Reducing hours and days of sale: Brazil, Peru, Colombia, USA, Canada; Drink-driving countermeasures: Brazil, USA, Canada, Mexico; Controlling advertising: Costa Rica; Increasing prices and taxes: USA, Canada, Venezuela, Suriname; Sales to minors: USA, Canada, Brazil (SP); Brief interventions in Primary Health Care: Mexico, Canada, USA, Chile, Brazil, Panama, Colombia, Dominican Republic; Increased minimum drinking age: USA, Canada Pan American Health Organization

Recent Developments Chile: National alcohol policy and alcohol screening in PHC Colombia: National alcohol policy development based on 10 target areas Ecuador: Treatment and care for alcohol problems Mexico: Revision of national law to better cover alcohol policies Panama: National plan to reduce alcohol problems Recent developments in a number of countries suggest that the WHO Global Strategy is beginning to be implemented. CHILE: national alcohol policy and alcohol screening in PHC; Colombia: national alcohol policy development based on 10 target areas; Ecuador: treatment and care for alcohol problems Mexico: revision of national law to better cover alcohol policies; Panama: national plan to reduce alcohol problems Pan American Health Organization

Recent Developments cont. Paraguay: National policy to reduce alcohol problems Peru: New law in Lima on reduced hours of sale Suriname: Increased import duties on liquors and wines/champagnes but not beer Venezuela: Increased taxes and prices on alcohol based on economic studies Paraguay: national policy to reduce alcohol problems; Peru: new law in Lima on reduced hours of sale; Suriname: increased import duties on liquors and wines/champagnes but not beer; Venezuela: increased taxes and prices on alcohol based on economic studies. Pan American Health Organization

These are examples of publications that are being disseminated by PAHO throughout the region in its efforts to promote evidence-based alcohol policy and to promote alcohol screening and brief intervention in primary health care. Pan American Health Organization

REFLECTION Looking at the regional plan of action, which actions at the national level would you prioritize for your country? Why? Pan American Health Organization