1. Monitoring of Alcoholic Beverages Consumption in Thailand Gun Chernrungroj M.D., M.P.H., Ph.D. Non-communicable Disease Information Center, Department of Disease Control, Ministry of Public Health, Thailand

2. Background Alcohol use is embedded in Thai Societies Alcohol use is embedded in Thai Societies In 2004, about 20.8 Thai used alcoholic beverages. In 2004, about 20.8 Thai used alcoholic beverages. Constraints on production and trade and on consumption of alcohol have been weakened. Constraints on production and trade and on consumption of alcohol have been weakened. Alcohol has become one of the most important risk to health. Alcohol has become one of the most important risk to health.

3. Public Health and Social Problems Caused by Harmful Use of Alcohol Domestic violence Domestic violence Unintentional injuries Unintentional injuries Damage nearly every organs in the body Damage nearly every organs in the body and cause more than 60 diseases and conditions Alcohol dependence Alcohol dependence Liver cirrhosis Liver cirrhosis Injuries Injuries

4. Burden of alcohol in Thailand The most recent burden of disease study in 2542 Disability-adjusted life year (DALY) The most recent burden of disease study in 2542 Disability-adjusted life year (DALY) Death from alcohol = 17,000 deaths (4%) Death from alcohol = 17,000 deaths (4%) Death and Disability = 540,000 year (5.8%) (global = 4%) (developed countries = 9.2%) Death and Disability = 540,000 year (5.8%) (global = 4%) (developed countries = 9.2%) Alcohol is the second most risk factors that causes death and disability in Thai population Alcohol is the second most risk factors that causes death and disability in Thai population

5. Burden of alcohol in Thailand Estimated economic lost by alcohol in 2546 13,007 – 33652 million baht Estimated economic lost by alcohol in 2546 13,007 – 33652 million baht 0.22 – 0.56 of gross domestic product (GDP) 0.22 – 0.56 of gross domestic product (GDP)

6. Why monitoring Alcohol use? Quantitative estimate magnitude of health problems caused by alcohol. Quantitative estimate magnitude of health problems caused by alcohol. Detection of changes of population consumption. Detection of changes of population consumption. Documentation of the distribution and spread of alcohol consumption. Documentation of the distribution and spread of alcohol consumption. Evaluation of control and prevention measures. Evaluation of control and prevention measures.

7. Characteristic of a monitoring (surveillance) system ResearchSurveillance Information Health Policies & Programs influence evaluate

8. Research What is the health problem caused by alcoholic beverages? What is the health problem caused by alcoholic beverages? What is the risk of getting the diseases by alcohol consumption? What is the risk of getting the diseases by alcohol consumption? How to prevent new drinker? How to prevent new drinker? What is the most effective measure to prevent and control alcohol consumption? What is the most effective measure to prevent and control alcohol consumption?

9. Surveillance or Monitoring What is the size of the problem of alcohol consumption in population? What is the size of the problem of alcohol consumption in population? Morbidity Morbidity Current drinker Current drinker What is the burden of alcohol consumption to the population? What is the burden of alcohol consumption to the population?

10. Existing Program and Policies Do the existing programs and policies can reduce the burden from use of alcohol? Do the existing programs and policies can reduce the burden from use of alcohol? How do we know? How do we know?

11. Framework of Indicators for Alcohol Monitoring Production Production Amount of production (Department of excise) Amount of production (Department of excise) Local production Local production Number of alcohol manufacture Number of alcohol manufacture Individual Consumption Individual Consumption Population (survey) Population (survey) Qualitative Qualitative Abstainer Abstainer Current drinker Current drinker Quantitative Quantitative Average amount of drink Average amount of drink

12. Sources of Data Burden of Alcohol consumption (Multiple sources) Burden of Alcohol consumption (Multiple sources) Morbidity from harmful use of alcohol Morbidity from harmful use of alcohol Tax revenue from the Department of Excise Tax revenue from the Department of Excise Number of alcohol manufacturers Number of alcohol manufacturers National Survey National Survey National Statistical Office National Statistical Office Ministry of Public Health Ministry of Public Health National Health Examination Survey National Health Examination Survey Behavior Risk Factor Surveillance System Behavior Risk Factor Surveillance System

13. Situation of Production and Sell of Alcohol 2543 government stop monopolized alcohol production 2543 government stop monopolized alcohol production In 2547 In 2547 66 manufacturers (company) 66 manufacturers (company) 5943 groups of Distilled alcohol home and cottage industry 5943 groups of Distilled alcohol home and cottage industry 1960 groups of Fermented home and cottage industry 1960 groups of Fermented home and cottage industry

14. Situation of alcohol consumption in population Indirect method Indirect method Total alcohol production/population Total alcohol production/population Underestimated Underestimated No data of local production, illegal brewing, smuggling and tourist alcohol. No data of local production, illegal brewing, smuggling and tourist alcohol. Not account for tourist (20 million/year) and migrant labor (approx 3 million) (mostly actively drink) Not account for tourist (20 million/year) and migrant labor (approx 3 million) (mostly actively drink) In 2543: over produced before stop monopolized market (in 2543 WHO & FAO reported: Thailand ranked No 5 in the world) In 2543: over produced before stop monopolized market (in 2543 WHO & FAO reported: Thailand ranked No 5 in the world)

15. Production of Liquor and Beer 2537-2547

16. ปริมาณยอดจำหน่ายสุราระหว่างปี 2530- 2540 ( ล้านลิตร ), ปริมาณสุรา เบียร์และแอลกอฮอล์ที่คนไทยที่อายุ 15 ปีขึ้นไปบริโภคต่อคนต่อปี ( ลิตรต่อ คนต่อปี )

18. Direct Direct Survey in population Survey in population Definition, questionnaire, and methodology of survey. Definition, questionnaire, and methodology of survey. Prevalence of current drinker, abstainer, binge drinker Prevalence of current drinker, abstainer, binge drinker Average amount and frequency of alcohol drinking (per week/ per year) Average amount and frequency of alcohol drinking (per week/ per year)

19. Survey related to Alcohol consumption in Thailand Survey of tobacco and alcohol consumption by National Statistical Office Survey of tobacco and alcohol consumption by National Statistical Office National Health Examination Survey by MOPH National Health Examination Survey by MOPH Behavior Risk Factor Surveillance System by MOPH Behavior Risk Factor Surveillance System by MOPH

20. Major indicators in Surveys Tobacco & Alcohol Sur NHEBRFSS Current drinker √√√ Binge drinker √√ Average drink/week √√ Drink and drive/ride √√

21. Definition Alcohol consumption Alcohol consumption Individual practices with respect to use of alcoholic beverages of all types including beer, wine, fortified wine, and distilled spirit. Individual practices with respect to use of alcoholic beverages of all types including beer, wine, fortified wine, and distilled spirit. Abstainer Abstainer absence of alcohol use as a lifelong practice absence of alcohol use as a lifelong practice

22. Quantities of Alcohol consumption Amount of Alcohol in different type of beverages Amount of Alcohol in different type of beverages Type Ethanol content (%) Type Ethanol content (%) Thai Beer5 - 6 (USA 3.5) Thai Beer5 - 6 (USA 3.5) Hard liquor 28 - 40 Hard liquor 28 - 40 Wine12 - 13 Wine12 - 13

23. Definition of alcohol use Abstainer Abstainer Current drinker Current drinker Ex-drinker Ex-drinker Binge drinker Binge drinker Average of consumption per week Average of consumption per week Standard Drink Standard Drink

24. Number of current drinker, age > 15. 2534 - 2547 (million)

25. Prevalence of Current Drinker, age > 15, 2534 - 2547

26. Morbidity caused by alcohol Reported cases of alcoholic liver disease Reported cases of alcoholic liver disease Other alcohol related diseases and injuries Other alcohol related diseases and injuries Multiple causes Multiple causes

27. Number of Alcoholic liver diseases 2539 - 2545

28. ร้อยละของการบาดเจ็บที่เกี่ยวข้องกับการใช้เครื่องดื่ม แอลกอฮอล์ จำแนกตามสาเหตุสำคัญ ปี 2543-2547 25432544254525462547 อุบัติเหตุการ ขนส่ง 32.833.6 33.238.6 อุบัติเหตุพลัดตก หกล้ม 8.18.99.29.59.6 การตั้งใจทำร้าย ตนเอง 20.620.920.822.821.3 การถูกทำร้าย 50.951.152.160.658.4 อุบัติเหตุแรง เชิงกลวัตถุ สิ่งของ 6.55.96.87.3

29. Summary of Situation Alcohol production and consumption are on the rise and very rapid in most recent years. Alcohol production and consumption are on the rise and very rapid in most recent years. Disease and Injuries related to alcohol consumption have been rising. Disease and Injuries related to alcohol consumption have been rising. Both number of drinkers and amount of alcohol are also increase. Both number of drinkers and amount of alcohol are also increase.

30. Future work for effective alcohol monitoring system Increase standard and method of alcohol production data collection. Increase standard and method of alcohol production data collection. National standard of definition of alcohol consumption and survey methodology. National standard of definition of alcohol consumption and survey methodology. Strengthening evidence for sound policy development. Strengthening evidence for sound policy development. More analysis for special groups of concern: who are affected the most? More analysis for special groups of concern: who are affected the most?