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 Impact on the individual drinker  Impact on people other than the drinker Impact on overall health burden Impact on social and economic development 9 9

World Health Organization Disease burden attributable to alcohol consumption worldwide (WHO, 2011) 19 April 2017 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

DALYs attributed to 10 leading risk factors for the age group 15 to 59 years old in the world (WHO, 2009)

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 World Health Organization Definition of "harmful use of alcohol" in the WHO global strategy 19 April 2017 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 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.

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 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

Technical support and capacity building Implementation mechanisms 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 Chairs 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

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 This is just to remind ourselves that the focus of the GS and the HLM and its political declaration is on the four groups of NCDs that constitute around 80%of NCD deaths and that share the same risk factors and therefore also the same strategies

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). Direct technical support in selected countries.

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.

Developing a global monitoring framework and targets for NCDs Realizing the commitments included in the UN Political Declaration on NCDs: Developing a global monitoring framework and targets for NCDs

Political Declaration What WHO is doing High-level Meeting 113 Member States 34 Presidents and Prime-Ministers 3 Vice-Presidents and Deputy Prime-Ministers 51 Ministers of Foreign Affairs and Health 11 Heads of UN Agencies 100s of NGOs Political Declaration Establish multisectoral national plans by 2013 Integrate NCDs into health-planning processes and the national development agenda Promote multisectoral action through health-in-all policies and whole-of-government approaches Build national capacity Increase domestic resources What WHO is doing 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 UN High-level Meeting on NCDs (New York, 19-20 September 2011) World Health Assembly in May 2012: Decided to adopt a global target of a 25% reduction in premature mortality from noncommunicable diseases by 2025

Political Declaration on NCDs 61. Call upon WHO, with the full participation of Member States, informed by their national situations, through its existing structures, and in collaboration with United Nations agencies, funds and programmes, and other relevant regional and international organizations, as appropriate, building on continuing efforts to develop before the end of 2012, a comprehensive global monitoring framework, including a set of indicators, capable of application across regional and country settings, including through multisectoral approaches, to monitor trends and to assess progress made in the implementation of national strategies and plans on NCDs.

Political Declaration on NCDs 62. Call upon WHO, in collaboration with Member States through the governing bodies of WHO, and in collaboration with United Nations agencies, and other relevant regional and international organizations, as appropriate, building on the work already under way, to prepare recommendations for a set of voluntary global targets for the prevention and control of NCDs, before the end of 2012. 63. Consider the development of national targets and indicators based on national situations, building on guidance provided by WHO, to focus on efforts to address the impacts of non-communicable diseases and their risk factors and determinants.

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/