19.11.2012

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Alcohol and Chronic Disease

Dr Gauden Galea

Dr Lars MøllerWorld Health Organization, Regional Office for Europe

14 November 2012Bled, Slovenia

++ Breaking News ++ Global Monitoring Framework ++ Release 2012-11-09 18:30 ++

http://apps.who.int/gb/ncds/

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Raised blood pressure25%

Salt/sodium intake

30%

Tobacco30%

Physical inactivity

10%

Harmful use of alcohol10%

Medicines and technologies

80%

Drug therapy and counseling

50%

Premature mortality from NCDs25% reduction

Mortality and 

morbidity

Risk factors

National systemsresponse

Set of nine voluntary global targets

Diabetes /obesity

0%

Raised blood pressure25%

Salt/sodium intake

30%

Tobacco30%

Physical inactivity

10%

Harmful use of alcohol10%

Medicines and technologies

80%

Drug therapy and counseling

50%

Premature mortality from NCDs25% reduction

Mortality and 

morbidity

Risk factors

National systemsresponse

Set of nine voluntary global targets

Diabetes /obesity

0%

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Global monitoring framework, including 25 indicatorsM

ort

alit

yan

d M

orb

idit

y• Premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

• Cancer incidence, by type

Mo

rtal

ity

and

Mo

rbid

ity

• Premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

• Cancer incidence, by type

Global monitoring framework, including 25 indicators

Ris

k F

acto

rs Harmful use of alcohol (3)

Fat intake

Low fruit and vegetable intake

Overweight and obesity (2) 

Physical inactivity (2)

Raised blood glucose

Raised blood pressure

Raised total cholesterol

Salt/sodium intake

Tobacco (2)

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Mo

rtal

ity

and

Mo

rbid

ity

• Premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases

• Cancer incidence, by type

Ris

k F

acto

rs Harmful use of alcohol (3)

Fat intake

Low fruit and vegetable intake

Overweight and obesity (2) 

Physical inactivity (2)

Raised blood glucose

Raised blood pressure

Raised total cholesterol

Salt/sodium intake

Tobacco (2)

Global monitoring framework, including 25 indicators

Nat

ion

al s

yste

m r

esp

on

se Cervical cancer screening

Drug therapy and counseling to prevent heart attacks and strokes

Essential NCD medicines and technologies

Palliative care

Policies to eliminate partially hydrogenated vegetable oils from food supply

Policies to reduce marketing of foods to children

Vaccination against hepatitis B

Vaccination against human papillomavirus

Alcohol Indicators

• Alcohol per capita consumption

• Heavy episodic drinking

• Alcohol attributable morbidity and mortality

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Alcohol Indicators

• Alcohol per capita consumption (volume)

• Heavy episodic drinking (pattern)

• Alcohol attributable morbidity and mortality

Risk of alcohol-related disease (Volume)

Source: Australian Guidelines To Reduce Health Risks from Drinking Alcohol (2009)

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Risk of alcohol-related injury (Pattern)

Source: Australian Guidelines To Reduce Health Risks from Drinking Alcohol (2009)

Personal reflectionMake a note of two numbers

• What is an acceptable lifetime risk of death from alcohol use? 1:1,000,000? 1:1000?

Personal risk: 1 : ______

• What number of standard drinks per episode should I drink before my lifetime risk exceeds that acceptable level?

Number of std drinks: 1 : ______

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Lifetime risk of death from alcohol-related disease per 100 drinkers, by number of standard drinks per occasion, Australia 2002

Source: Australian Guidelines To Reduce Health Risks from Drinking Alcohol (2009)

Lifetime risk of death from alcohol-related injury per 100 male drinkers, by number of standard drinks per occasion and frequency of occasions

Source: Australian Guidelines To Reduce Health Risks from Drinking Alcohol (2009)

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White I R et al. BMJ 2002;325:191

©2002 by British Medical Journal Publishing Group

Cause specific relative risks by alcohol consumption.

Recorded alcohol consumption in the EU (in litrespure alcohol per capita 15+)– stable but high (more than twice the world average)

0

2

4

6

8

10

12

1998 2000 2002 2004 2006 2008 2010

Total

Beer

Wine

Spirtis

Other

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Regional differences

Lifetime abstainers in the EU, candidate countries, Norway and Switzerland, males (2009)

0

10

20

30

40

50

60

70

%

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Lifetime abstainers in the EU, candidate countries, Norway and Switzerland, females (2009)

0

10

20

30

40

50

60

70

80

90

100

%

THE 2011 ESPAD REPORT

Substance Use Among Students in 36 European Countries(European School Survey Project

on Alcohol and Other Drugs)

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Alcohol use during the past 30 days, males (2011)

0

10

20

30

40

50

60

70

80

90

%

Alcohol use during the past 30 days, females (2011)

0

10

20

30

40

50

60

70

80

%

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Being drunk during the past 30 days, males (2011)

0

5

10

15

20

25

30

35

40

%

Being drunk during the past 30 days, females (2011)

0

5

10

15

20

25

30

35

40

%

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Having had five or more drinks on one occasion during the past 30 days, males (2011)

0

10

20

30

40

50

60

70

%

Having had five or more drinks on one occasion during the past 30 days, females (2011)

0

10

20

30

40

50

60

%

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Regional variation of alcohol-attributable deaths to all deaths, 15-64 year olds

Proportion of alcohol-attributable deaths caused by harm to others, 2004, 15-64 years old

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Best buys packagepopulation-based approaches

• Smoke-free environments• Warning about the dangers of tobacco

use• Bans on tobacco advertising• Raising taxes on tobacco • Raising taxes on alcohol• Restricting access to retail alcohol• Bans on alcohol advertising• Reducing salt intake and salt content

of food• Replacing trans-fat in food with

polyunsaturated fat• Promoting public awareness about

diet and physical activity

European Alcohol Action Plans from 1992

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Sixty-third World Health Assembly, 17–21 May 2010

Endorsed the global strategy to reduce the harmful use of alcohol.

World Health Assembly resolution WHA63.13

European action plan to reduce the harmful useof alcohol (EAAP) 2012–2020 – 10 action areas

• Leadership, awareness and commitment, as sustainable intersectoralaction requires strong leadership and a solid base of awareness and political will

• Health services’ response, as these services are central to tackling health conditions in individuals caused by harmful alcohol use

• Community action, as governments and other stakeholders can support and empower communities in adopting effective approaches to prevent and reduce harmful alcohol use

• Policies and countermeasures on drink–driving, as it is extremely dangerous to drivers, passengers and other people using the roads

• Availability of alcohol, as public health policies to regulate commercial or public availability have proved to be very effective in reducing the general level of harmful use and drinking among minors

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EAAP 2012–2020 – 10 action areas

• Marketing of alcoholic beverages, as systems are needed to protect people, particularly children and young people, from advanced advertising and promotion techniques

• Pricing policies, as most consumers, particularly heavy drinkers and young people, are sensitive to changes in the prices of alcohol products

• Reducing the negative consequences of drinking and alcohol intoxication, in order to minimize violence, intoxication and harm to intoxicated people

• Reducing the public health impact of illicit and informally produced alcohol, as its consumption could have additional negative health consequences due to its higher ethanol content and potential contamination with toxic substances

• Monitoring and surveillance, as relevant data create the basis for the appropriate delivery and success of responses

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0 10 20 30

Availabiltyᵃ

Affordabilityᵃ

Illegal alcoholᵇ

Public awareness‐raising

Regulation of marketingᵃ

Drink‐driving policies

Harm reduction in environment

Advice and treatment

Community actionsᵃ

Workplacesᵃ

Monitoring and research

Number of countries

Stronger

Unchanged

Weaker

a Data missing from one country.b Data missing from two countries.

Changes in alcohol policy areas over the five years since 2006 (N=29)

Policy development at national level

0

5

10

15

20

25

30

Beer Wine Spirits

Number of countries

Beverage type

Inconclusive

Decrease

Stable

Increase

Trends in price of beer, wine and spirits relative to the consumer price index, previous five years (N=29), 2010

Price and tax measures

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Average price of 750 ml spirits (local brand) in Euro

0

5

10

15

20

25

30

35

40

45

50

Euro

Thank you!

Contact details: gga@euro.who.intlmo@euro.who.int

Website: http://www.euro.who.int/alcohol

European infosystem on alcohol and health: http://who.int/gho/eisah