WHO GLOBAL ALCOHOL STRATEGY . . WHO GLOBAL ALCOHOL STRATEGY Maristela G. Monteiro, M.D., Ph.D. Senior Advisor on Alcohol and Substance Abuse

World Health Assembly resolutions addressing alcohol-related public health problems 1979: Development of the WHO Programme on alcohol related problems 1983: Alcohol consumption and related problems 1986: Prevention of mental, neurological and psychosocial problems 1989: Prevention and control of drug and alcohol abuse 2002: Mental health 2004: Health promotion and healthy lifestyles 2005 (58th WHA): Public health problems caused by harmful use of alcohol

Process leading to the resolution of alcohol at the World Health Assembly 2008 WHA58 (May 2005): Resolution "Public health problems caused by harmful use of alcohol". WHA60 (May 2007): Report of the Secretariat on strategies to reduce harmful use of alcohol with global assessment of public health problems caused by harmful use of alcohol and discussions on the draft resolution. Resolution on a global strategy for lack of consensus- consultation process put in place. Informal consultation (December 2007) with Member States on strategies on reduce harmful use of alcohol – 9 policy areas for action identified. EB122 (January 2008): Considered a report from the Secretariat and the draft resolution calling for a global strategy to reduce the harmful use of alcohol.

Sixty-First World Health Assembly (2008) resolution "Strategies to reduce the harmful use of alcohol" After noting that they had not reached a consensus last year, delegates adopted a resolution calling upon WHO to produce a draft global strategy to reduce the harmful use of alcohol.

Context of a process towards a global strategy to reduce harmful use of alcohol WHA58 resolution "Public health problems caused by harmful use of alcohol" WHA61.4 resolution "Strategies to reduce the harmful use of alcohol" Action Plan for the Global strategy on noncommunicable diseases World Health Report 2002 2003 2002 2007 2013 2006 2010 2005 2008 WHO Expert Committee on Problems Related to Alcohol Consumption Global strategy on harmful use of alcohol Development of regional strategies in WPRO, SEARO (existing in EURO) Global Survey on Alcohol and Health and ATLAS survey on PTR for SUD FCTC

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 Slide 4 The global strategy and WHA resolution 63.13 build on several WHO global and regional strategic initiatives and represents the commitment by WHO Member States to sustained action at all levels. The consensus reached on the global strategy and its endorsement by the World Health Assembly was the outcome of close collaboration between WHO Member States and the WHO Secretariat. The process of developing the global strategy gave our Member States the opportunity to participate in all stages of the development, including technical consultations at the regional level in which many of you participated, and to share best practices in reducing the harmful use of alcohol. As part of the implementation of resolution WHA61.4, the WHO secretariat has also conducted a broad and inclusive consultation process with different stakeholders on ways they can contribute to reduce harmful use of alcohol. This consultation process involved a web based hearing, round table meetings with economic operators and with NGOs and a consultation with other UN agencies and intergovernmental organizations. The outcomes of these consultations was taken into consideration in the development of the strategy. The strong participation of the regional offices in the entire process of preparing a draft global strategy to reduce harmful use of alcohol has been pivotal for building consensus and for securing a coherent approach with existing regional initiatives on alcohol. Continued strong involvement of the regional offices is needed, as well as of WHO country offices, to secure good implementation of the global strategy at all levels. And I acknowledge and welcome significant contribution, including financial contribution, of all WHO regional offices in preparation of this meeting.

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 Slide 5 The purpose of the global strategy is to support and complement public health policies in Member States. The strategy contains a set of principles that should guide the development and implementation of policies; it sets priority areas for global action, recommends target areas for national action and gives a strong mandate to WHO to strengthen action at all levels.

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 Slide 6 Ladies and gentlemen The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health. In October 2006 a WHO Expert Committee on Problems Related to Alcohol Consumption reviewed scientific and empirical evidence of effectiveness of different policy options, and provided technical recommendations on policies and interventions to reduce alcohol-related harm. Later today you will also listen to a presentation from Professor Thomas Babor, who has been one of the lead authors to the book Alcohol: No Ordinary Commodity, that summarize the current knowledge on scientific evidence of effectiveness of different policy options. Effective and cost-effective policy measures and interventions to reduce the harmful use of alcohol exist, and can be implemented and enforced as appropriate according to national contexts.

Causative risk factors Strong links with NCDs Causative risk factors Tobacco use Unhealthy diets Physical inactivity Harmful use of alcohol Non-communicable diseases Heart disease and stroke  Diabetes Cancer Chronic lung disease Slide 7 As this pie chart shows, harmful drinking is a major avoidable risk factor for noncommunicable diseases, in particular cardiovascular diseases, cirrhosis of the liver and various cancers. Indeed, current evidence indicates that four types of noncommunicable diseases- cardiovascular diseases, cancers ,chronic respiratory diseases and diabetes - make the largest contribution to mortality in the majority of low-, middle and high-income countries and require concerted, coordinated action. These noncommunicable diseases are largely preventable by means of effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Indeed, tackling the global burden of NCDs is one of the major challenges for development in the 21st century. Global distribution of all alcohol-attributable deaths by disease or injury, 2004

5 STRATEGIC OBJECTIVES 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; Strengthened knowledge base on the magnitude and determinants of alcohol-related harm and on effective interventions to reduce and prevent such harm; 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; 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; Improved systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes.

Guiding principles Public health interest and evidence based Policies should be equitable and sensitive to national, religious and cultural contexts. All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions to prevent and reduce harmful use of alcohol. Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted. Protection of populations at high risk of alcohol-attributable harm and those exposed to the effects of harmful drinking by others should be an integral part of policies addressing the harmful use of alcohol. Individuals and families affected by the harmful use of alcohol should have access to affordable and effective prevention and care services. Children, teenagers and adults who choose not to drink alcohol beverages have the right to be supported in their non-drinking behavior and protected from pressures to drink. Public policies and interventions to prevent and reduce alcohol-related harm should encompass all alcoholic beverages and surrogate alcohol.

10 TARGET AREAS (a) leadership, awareness and commitment (b) health services’ response (c) community action (d) drink–driving policies and countermeasures (e) availability of alcohol (f) marketing of alcoholic beverages (g) pricing policies (h) reducing the negative consequences of drinking and alcohol intoxication (i) reducing the public health impact of illicit alcohol and informally produced alcohol1 (j) monitoring and surveillance.

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 resources available Slide 12 The process of developing the global strategy has given us valuable insight into what will be crucial factors in the success of the implementation of the strategy. Strong global and regional leadership guided by public health interests is required. Effective mechanisms for coordination and collaboration at all levels. The need to develop or update national policies and action plans is a first strategic element commonly identified for effective implementation of public health strategies at national level. The need for national institutional frameworks, intersectoral cooperation and effective surveillance and monitoring mechanisms are identified as basic requirements for effective policy implementation. Many of the solutions to addressing harmful use of alcohol lie outside the health sector. The ability of the health sector to reduce alcohol related problems therefore relies on building strong and durable partnerships with a range of other sectors and agencies. Appropriate engagement of relevant stakeholders is critical for successful implementation of the global strategy. It will require not only active collaboration with Member States, but also appropriate engagement of international development partners, non-governmental organizations, the private sector, as well as public health and research institutions. Successful implementation of the global strategy at the national, regional and global level will require substantial financial and technical resources, as well as firm political commitment from WHO Member States. Thus, effective implementation of the strategy will require highly concerted regional and global partnerships to mobilize and allocate resources.

Policy making Policy implementation Slide 14 The next four days will be crucial for the success of the implementation of the global strategy. There is no coincidence that this meeting takes place here in the Executive Board room of WHO. It was here in this room that central parts of the strategy was crafted out and key agreements reach on controversial issues. It is our hope and belief that you will carry on the spirit created in this room of a common understanding of the need to address the harmful use of alcohol as a global health threat, the willingness to overcome differing views and perspectives and the commitment to jointly take action to tackle this immense problem. I am confident that by working together towards the objectives of the global strategy, we can reduce the negative health and social consequences of the harmful use of alcohol and make our communities healthier, safer and more pleasant places in which to live, work and spend our leisure time. I wish you four days of fruitful discussions and deliberations and I look forward to hearing, on Friday, your recommendations for a the way ahead to translate the political guidance provided in the strategy into technical activities and actions to implement the global strategy and thus reduce the immense global burden from harmful use of alcohol. Thank you for your attention. Policy implementation

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