The Global Strategy FINAL - who.int · WHO Library Cataloguing-in-Publication Data Global strategy...

Global strategy to reduce the harmful

use of alcohol

alcohol

alcohol

ContactManagement of Substance AbuseDepartment of Mental Health and Substance Abuse20, Avenue Appia1211 Geneva 27SwitzerlandTel: + 41 22 791 21 11Email: [email protected]/substance_abuse

The harmful use of alcohol is

the third leading risk factor

for premature deaths and

disabilities in the world. It is

estimated that 2.5 million people

worldwide died of alcohol-

related causes in 2004, including

320 000 young people between

15 and 29 years of age.

ISBN 978 92 4 159993 1

EXIT THE MAZE OFHARMFUL SUBSTANCE USEFOR BETTER GLOBAL HEALTH


use of alcohol

WHO Library Cataloguing-in-Publication Data

Global strategy to reduce the harmful use of alcohol.

1.Alcohol drinking - adverse effects. 2.Social control - methods. 3.Alcoholism - prevention and control. 4.Public policy. I.World Health Organization.

ISBN 978 92 4 159993 1 (NLM classification: WM 274)

© World Health Organization 2010

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Printed in Italy.

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1. Foreword 3

2. Theglobalstrategytoreducetheharmfuluseofalcohol 5 Settingthescene 5 Challengesandopportunities 6 Aimsandobjectives 8 Guidingprinciples 9 Nationalpoliciesandmeasures 9 Policyoptionsandinterventions 11 Globalaction:keyrolesandcomponents 19 Implementingthestrategy 23

3. ResolutionoftheSixty-thirdWorldHealthAssembly(May2010) WHA63.13Globalstrategytoreducetheharmfuluseofalcohol 27

Annexes 29I. ReportbytheSecretariattotheSixty-thirdWorldHealthAssembly (May2010) 29II. Evidencefortheeffectivenessandcost-effectivenessofinterventions toreduceharmfuluseofalcohol 31III. ResolutionoftheSixty-firstWorldHealthAssembly(May2008) WHA61.4Strategiestoreducetheharmfuluseofalcohol 34IV. ResolutionoftheFifty-eighthWorldHealthAssembly(May2005) WHA58.26Public-healthproblemscausedbyharmfuluseofalcohol 36

TABLE OF CONTENTS

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Theharmfuluseofalcoholcausesanestimated2.5milliondeathseveryyear,ofwhichasignificantproportionoccurintheyoung.Alcoholuseisthethirdleadingriskfactorforpoorhealthglobally.Awidevarietyofalcohol-relatedproblemscanhavedevastatingimpactsonindividualsandtheirfamiliesandcanseriouslyaffect

communitylife.Theharmfuluseofalcoholisoneofthefourmostcommonmodifiableandpreventableriskfactorsformajornoncommunicablediseases(NCDs).Thereisalsoemergingevidencethattheharmfuluseofalcoholcontributestothehealthburdencausedbycommunicablediseasessuchas,forexample,tuberculosisandHIV/AIDS.

Reducing theharmfuluseofalcoholbyeffectivepolicymeasuresandbyprovidingarelevantinfrastructuretosuccessfullyimplementthosemeasuresismuchmorethanapublichealthissue.Indeed,itisadevelopmentissue,sincethelevelofriskassociatedwiththeharmfuluseofalcoholindevelopingcountriesismuchhigherthanthatinhigh-incomecountrieswherepeopleareincreasinglyprotectedbycomprehensivelawsandinterventions–andbymechanismstoensurethattheseareimplemented.

Theglobalstrategytoreducetheharmfuluseofalcohol,endorsedbytheSixty-thirdWorldHealthAssemblyinMay2010,recognizesthecloselinksbetweentheharmfuluseofalcoholandsocioeconomicdevelopment.ItrepresentsthecommitmentbytheMemberStatesoftheWorldHealthOrganizationtosustainedactionatall levels.ItalsobuildsonseveralWHOglobalandregionalstrategicinitiatives,includingtheactionplanfortheglobalstrategyforthepreventionandcontrolofnoncommunicablediseaseswhichwasendorsedbytheWorldHealthAssemblyin2008.

Indeed, WHO is witnessing how public health policy-makers in developing countriesandeconomiesintransitionareincreasinglychallengedtoformulateeffectivestrategiestoaddressthepublichealthproblemscausedbytheharmfuluseofalcohol.Workablesolutions exist and the global strategy provides a portfolio of policy options andinterventionsthatshouldbeconsideredforimplementationineachcountryasintegralpartsofnationalpolicy,aswellaswithinbroaderdevelopmentframeworks.Theglobalstrategyalsosetspriorityareasforglobalactionthatisintendedtopromote,supportandcomplementrelevantactionsatlocal,nationalandregionallevels.HonouringthespiritoftheParisDeclarationonAidEffectiveness,WHOcallsoninternationaldevelopmentpartnerstorespondfavourablytorequestsfromdevelopingcountriesfortechnicalsupportin implementingandadaptingthesepolicyoptionsaccordingtonationalprioritiesandcontexts.

TheconsensusreachedontheglobalstrategyanditsendorsementbytheWorldHealthAssemblyistheoutcomeofclosecollaborationbetweenWHOMemberStatesandtheWHOsecretariat.Theprocessthatledtothedevelopmentoftheglobalstrategyincludedconsultationswithotherstakeholders,suchascivilsocietygroupsandeconomicoperators.Similarly,theimplementationoftheglobalstrategywillrequireactivecollaborationwithMemberStates,withappropriateengagementof internationaldevelopmentpartners,civilsociety,theprivatesector,aswellaspublichealthandresearchinstitutions.Aswe

FOREWORD

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GLOBAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL

moveforward,WHOwillcontinuetoinvolverelevantstakeholdersineffortstoachievethestrategygoalsandobjectives.

Iamconfidentthatbyworkingtogethertowardstheobjectivesoftheglobalstrategy,wecanreducethenegativehealthandsocialconsequencesoftheharmfuluseofalcoholandmakeourcommunitieshealthier,saferandmorepleasantplacesinwhichtolive,workandspendourleisuretime.

DrAlaAlwanAssistantDirector-GeneralNoncommunicableDiseasesandMentalHealthWorldHealthOrganization


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THE GLOBAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL1

Setting the scene1. Theharmfuluseofalcohol2hasaseriouseffectonpublichealthandisconsidered

tobeoneofthemainriskfactorsforpoorhealthglobally.Inthecontextofthisdraftstrategy,theconceptoftheharmfuluseofalcohol3isbroadandencompassesthedrinkingthatcausesdetrimentalhealthandsocialconsequencesforthedrinker,thepeoplearoundthedrinkerandsocietyatlarge,aswellasthepatternsofdrinkingthatareassociatedwithincreasedriskofadversehealthoutcomes.Theharmfuluseofalcoholcompromisesbothindividualandsocialdevelopment.Itcanruinthelivesofindividuals,devastatefamilies,anddamagethefabricofcommunities.

2. Theharmfuluseofalcoholisasignificantcontributortotheglobalburdenofdiseaseandislistedasthethirdleadingriskfactorforprematuredeathsanddisabilitiesintheworld.4Itisestimatedthat2.5millionpeopleworldwidediedofalcohol-relatedcausesin2004,including320000youngpeoplebetween15and29yearsofage.Harmfuluseofalcoholwasresponsiblefor3.8%ofalldeathsintheworldin2004and4.5%oftheglobalburdenofdiseaseasmeasuredindisability-adjustedlifeyearslost,evenwhenconsiderationisgiventothemodestprotectiveeffects,especiallyoncoronaryheartdisease,oflowconsumptionofalcoholforsomepeopleaged40yearsorolder.

3. Harmfuldrinkingisamajoravoidableriskfactorforneuropsychiatricdisordersandothernoncommunicablediseasessuchascardiovasculardiseases,cirrhosisoftheliverandvariouscancers.Forsomediseasesthereisnoevidenceofathresholdeffectintherelationshipbetweentheriskandlevelofalcoholconsumption.Theharmfuluse of alcohol is also associated with several infectious diseases like HIV/AIDS,tuberculosisandpneumonia.Asignificantproportionofthediseaseburdenattributabletoharmfuldrinkingarisesfromunintentionalandintentionalinjuries,includingthoseduetoroadtrafficcrashesandviolence,andsuicides.Fatal injuriesattributabletoalcoholconsumptiontendtooccurinrelativelyyoungpeople.

4. Thedegreeofriskforharmfuluseofalcoholvarieswithage,sexandotherbiologicalcharacteristicsoftheconsumeraswellaswiththesettingandcontextinwhichthedrinkingtakesplace.Somevulnerableorat-riskgroupsandindividualshaveincreased

1 See resolution WHA63.13 (page 27).

2 An alcoholic beverage is a liquid that contains ethanol (ethyl alcohol, commonly called “alcohol”) and is intended for drinking. In most countries with a legal definition of “alcoholic beverage” a threshold for content of ethanol by volume in a beverage is set at ≥ 0.5% or 1.0%. The predominant categories of alcoholic beverages are beers, wines and spirits.

3 The word “harmful” in this strategy refers only to public-health effects of alcohol consumption, without prejudice to religious beliefs and cultural norms in any way.

4 See document A60/14 Add.1 for a global assessment of public-health problems caused by harmful use of alcohol, and Global Health Risks: Mortality and burden of disease attributable to selected major risk factors. Geneva, World Health Organization, 2009.

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susceptibility to the toxic, psychoactive and dependence-producing properties ofethanol.Atthesametimelowriskpatternsofalcoholconsumptionattheindividuallevelmaynotbeassociatedwithoccurrenceorsignificantlyincreasedprobabilityofnegativehealthandsocialconsequences.

5. Asubstantialscientificknowledgebaseexistsforpolicy-makersontheeffectivenessandcost-effectivenessofstrategiesandinterventionstopreventandreducealcohol-relatedharm.1Althoughmuchoftheevidencecomesfromhigh-incomecountries,theresultsofmeta-analysesandreviewsoftheavailableevidence2providesufficientknowledgetoinformpolicyrecommendationsintermsofcomparativeeffectivenessandcost-effectivenessofselectedpolicymeasures.Withbetterawareness,thereareincreasedresponsesatnational,regionalandgloballevels.However,thesepolicyresponsesareoftenfragmentedanddonotalwayscorrespondtothemagnitudeoftheimpactonhealthandsocialdevelopment.

Challenges and opportunities6. Thepresentcommitmenttoreducingtheharmfuluseofalcoholprovidesagreat

opportunityforimprovinghealthandsocialwell-beingandforreducingtheexistingalcohol-attributablediseaseburden.However,thereareconsiderablechallengesthathavetobetakenintoaccountinglobalornationalinitiativesorprogrammes.Theseincludethefollowing:

(a) Increasingglobalactionandinternationalcooperation.Thecurrentrelevanthealth,culturalandmarkettrendsworldwidemeanthatharmfuluseofalcoholwill continue tobeaglobalhealth issue.These trendsshouldbe recognizedandappropriateresponsesimplementedatalllevels.Inthisrespect,thereisaneedforglobalguidanceandincreasedinternationalcollaborationtosupportandcomplementregionalandnationalactions.

(b) Ensuring intersectoralaction.Thediversityof alcohol-relatedproblemsandmeasures necessary to reduce alcohol-related harm points to the need forcomprehensiveactionacrossnumeroussectors.Policiestoreducetheharmfuluseofalcoholmustreachbeyondthehealthsector,andappropriatelyengagesuchsectorsasdevelopment,transport,justice,socialwelfare,fiscalpolicy,trade,agriculture,consumerpolicy,educationandemployment,aswellascivilsocietyandeconomicoperators.

(c) Accordingappropriateattention.Preventingandreducingharmfuluseofalcoholisoftengivenalowpriorityamongdecision-makersdespitecompellingevidenceof its serious public health effects. In addition, there is a clear discrepancybetweentheincreasingavailabilityandaffordabilityofalcoholbeveragesinmanydevelopingandlow-andmiddle-incomecountriesandthosecountries’capabilityandcapacity tomeettheadditionalpublichealthburdenthat follows.Unlessthisproblemisgiventheattentionitdeserves,thespreadofharmfuldrinkingpracticesandnormswillcontinue.

1 See document A60/14 for evidence-based strategies and interventions to reduce alcohol-related harm.

2 See, for example: WHO Technical Report Series, No. 944, 2007 and Evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol-related harm. Copenhagen, World Health Organization Regional Office for Europe, 2009.


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(d) Balancingdifferentinterests.Production,distribution,marketingandsalesofalcohol create employment and generate considerable income for economicoperators and tax revenue for governments at different levels. Public healthmeasurestoreduceharmfuluseofalcoholaresometimesjudgedtobeinconflictwithothergoals like freemarketsandconsumerchoiceandcanbeseenasharmingeconomicinterestsandreducinggovernmentrevenues.Policy-makersfacethechallengeofgivinganappropriateprioritytothepromotionandprotectionofpopulationhealthwhiletakingintoaccountothergoals,obligations,includinginternationallegalobligations,andinterests.Itshouldbenotedinthisrespectthatinternationaltradeagreementsgenerallyrecognizetherightofcountriestotakemeasurestoprotecthumanhealth,providedthatthesearenotappliedinamannerwhichwouldconstituteameansofunjustifiableorarbitrarydiscriminationordisguisedrestrictionstotrade.Inthisregard,national,regionalandinternationaleffortsshouldtakeintoaccounttheimpactofharmfuluseofalcohol.

(e) Focusingonequity.Population-wideratesofdrinkingofalcoholicbeveragesaremarkedlylowerinpoorersocietiesthaninwealthierones.However,foragivenamountofconsumption,poorerpopulationsmayexperiencedisproportionatelyhigher levels of alcohol-attributable harm. There is a great need to developand implement effective policies and programmes that reduce such socialdisparitiesbothinsideacountryandbetweencountries.Suchpoliciesarealsoneededinordertogenerateanddisseminatenewknowledgeaboutthecomplexrelationship between harmful consumption of alcohol and social and healthinequity, particularly among indigenous populations, minority or marginalizedgroupsandindevelopingcountries.

(f) Consideringthe“context”inrecommendingactions.Muchofthepublishedevidenceofeffectivenessofalcohol-relatedpolicyinterventionscomesfromhigh-incomecountries,andconcernshavebeenexpressedthattheireffectivenessdependsoncontextandmaynotbetransferrabletoothersettings.However,manyinterventionstoreduceharmfuluseofalcoholhavebeenimplementedinawidevarietyofculturesandsettings,andtheirresultsareoftenconsistentandinlinewiththeunderpinningtheoriesandevidencebaseaccumulatedinothersimilarpublichealthareas.Thefocusforthosedevelopingandimplementingpoliciesshouldbeonappropriatetailoringofeffectiveinterventionstoaccommodatelocalcontextsandonappropriatemonitoringandevaluationtoprovidefeedbackforfurtheraction.

(g) Strengtheninginformation.Systemsforcollecting,analysinganddisseminatingdataonalcoholconsumption,alcohol-relatedharmandpolicyresponseshavebeen developed by Member States, the WHO Secretariat, and some otherstakeholders.Therearestillsubstantialgapsinknowledgeanditisimportanttosharpenthefocusoninformationandknowledgeproductionanddisseminationfor further developments in this area, especially in developing and low- andmiddle-incomecountries.TheWHOGlobalInformationSystemonAlcoholandHealthandintegratedregionalinformationsystemsprovidethemeanstomonitorbetterprogressmadeinreducingharmfuluseofalcoholattheglobalandregionallevels.

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Aims and objectives7. Nationaland localeffortscanproducebetter resultswhentheyaresupportedby

regionalandglobalactionwithinagreedpolicyframes.ThusthepurposeoftheglobalstrategyistosupportandcomplementpublichealthpoliciesinMemberStates.

8. Thevisionbehind theglobalstrategy is improvedhealthandsocialoutcomes forindividuals, families and communities, with considerably reduced morbidity andmortalityduetoharmfuluseofalcoholandtheirensuingsocialconsequences.Itisenvisagedthattheglobalstrategywillpromoteandsupportlocal,regionalandglobalactionstopreventandreducetheharmfuluseofalcohol.

9. Theglobalstrategyaimstogiveguidanceforactionatalllevels;tosetpriorityareasforglobalaction;andtorecommendaportfolioofpolicyoptionsandmeasuresthatcouldbeconsideredforimplementationandadjustedasappropriateatthenationallevel,takingintoaccountnationalcircumstances,suchasreligiousandculturalcontexts,nationalpublichealthpriorities,aswellasresources,capacitiesandcapabilities.

10. Thestrategyhasfiveobjectives:

(a) raisedglobalawarenessofthemagnitudeandnatureofthehealth,socialandeconomicproblemscausedbyharmfuluseofalcohol,andincreasedcommitmentbygovernmentstoacttoaddresstheharmfuluseofalcohol;

(b) strengthenedknowledgebaseonthemagnitudeanddeterminantsofalcohol-relatedharmandoneffectiveinterventionstoreduceandpreventsuchharm;

(c) increasedtechnicalsupportto,andenhancedcapacityof,MemberStatesforpreventingtheharmfuluseofalcoholandmanagingalcohol-usedisordersandassociatedhealthconditions;

(d) strengthened partnerships and better coordination among stakeholders andincreasedmobilizationofresourcesrequiredforappropriateandconcertedactiontopreventtheharmfuluseofalcohol;

(e) improvedsystemsformonitoringandsurveillanceatdifferentlevels,andmoreeffective dissemination and application of information for advocacy, policydevelopmentandevaluationpurposes.

11. The harmful use of alcohol and its related public health problems are influencedbythegeneral levelofalcoholconsumption inapopulation,drinkingpatternsandlocalcontexts.Achievingthefiveobjectiveswillrequireglobal,regionalandnationalactionsonthelevels,patternsandcontextsofalcoholconsumptionandthewidersocialdeterminantsofhealth.Specialattentionneedstobegiventoreducingharmtopeopleotherthanthedrinkerandtopopulationsthatareatparticularriskfromharmfuluseofalcohol,suchaschildren,adolescents,womenofchild-bearingage,pregnantandbreastfeedingwomen,indigenouspeoplesandotherminoritygroupsorgroupswithlowsocioeconomicstatus.

AIMS AND OBJECTIVES


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Guiding principles12. Theprotectionofthehealthofthepopulationbypreventingandreducingtheharmful

use of alcohol is a public health priority. The following principles will guide thedevelopmentandimplementationofpoliciesatalllevels;theyreflectthemultifaceteddeterminantsofalcohol-relatedharmandtheconcertedmultisectoralactionsrequiredtoimplementeffectiveinterventions.

(a) Public policies and interventions to prevent and reduce alcohol-related harmshouldbeguidedandformulatedbypublichealthinterestsandbasedonclearpublichealthgoalsandthebestavailableevidence.

(b) Policies should be equitable and sensitive to national, religious and culturalcontexts.

(c) Allinvolvedpartieshavetheresponsibilitytoactinwaysthatdonotunderminetheimplementationofpublicpoliciesandinterventionstopreventandreduceharmfuluseofalcohol.

(d) Publichealthshouldbegivenproperdeferenceinrelationtocompetinginterestsandapproachesthatsupportthatdirectionshouldbepromoted.

(e) Protection of populations at high risk of alcohol-attributable harm and thoseexposedtotheeffectsofharmfuldrinkingbyothersshouldbeanintegralpartofpoliciesaddressingtheharmfuluseofalcohol.

(f) Individualsandfamiliesaffectedbytheharmfuluseofalcoholshouldhaveaccesstoaffordableandeffectivepreventionandcareservices.

(g) Children,teenagersandadultswhochoosenottodrinkalcoholbeverageshavethe right tobesupported in their non-drinkingbehaviour andprotected frompressurestodrink.

(h) Public policies and interventions to prevent and reduce alcohol-related harmshouldencompassallalcoholicbeveragesandsurrogatealcohol.1

National policies and measures13. Theharmfuluseofalcoholcanbereducedifeffectiveactionsaretakenbycountriesto

protecttheirpopulations.MemberStateshaveaprimaryresponsibilityforformulating,implementing,monitoringandevaluatingpublicpoliciestoreducetheharmfuluseofalcohol.Suchpoliciesrequireawiderangeofpublichealth-orientedstrategiesforpreventionandtreatment.Allcountrieswillbenefitfromhavinganationalstrategyandappropriatelegalframeworkstoreduceharmfuluseofalcohol,regardlessofthelevelofresourcesinthecountry.Dependingonthecharacteristicsofpolicyoptionsandnationalcircumstances,somepolicyoptionscanbeimplementedbynon-legalframeworkssuchasguidelinesorvoluntaryrestraints.Successfulimplementationof

1 In this strategy “surrogate alcohol” refers to liquids usually containing ethanol and not intended for consumption as beverages, that are consumed orally as substitutes for alcoholic beverages with the objective to producing intoxication or other effects associated with alcohol consumption.

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measuresshouldbeassistedbymonitoringimpactandcomplianceandestablishingandimposingsanctionsfornon-compliancewithadoptedlawsandregulations.

14.Sustained political commitment, effective coordination, sustainable funding andappropriateengagementofsubnationalgovernmentsaswellasfromcivilsocietyandeconomicoperatorsareessentialforsuccess.Manyrelevantdecision-makingauthorities should be involved in the formulation and implementation of alcoholpolicies,suchashealthministries, transportationauthoritiesor taxationagencies.Governmentsneedtoestablisheffectiveandpermanentcoordinationmachinery,suchasanationalalcoholcouncil,comprisingseniorrepresentativesofmanyministriesandotherpartners,inordertoensureacoherentapproachtoalcoholpoliciesandaproperbalancebetweenpolicygoalsinrelationtoharmfuluseofalcoholandotherpublicpolicygoals.

15.Healthministrieshaveacrucial role inbringing together theotherministriesandstakeholdersneededforeffectivepolicydesignand implementation.Theyshouldalsoensurethatplanningandprovisionofpreventionandtreatmentstrategiesandinterventionsarecoordinatedwiththoseforotherrelatedhealthconditionswithhighpublichealthpriority suchas illicitdruguse,mental illness, violenceand injuries,cardiovasculardiseases,cancer,tuberculosisandHIV/AIDS.

16. The policy options and interventions available for national action can be groupedinto 10 recommended target areas, which should be seen as supportive andcomplementarytoeachother.These10areasare:

(a) leadership,awarenessandcommitment

(b) healthservices’response

(c) communityaction

(d) drink-drivingpoliciesandcountermeasures

(e) availabilityofalcohol

(f) marketingofalcoholicbeverages

(g) pricingpolicies

(h) reducingthenegativeconsequencesofdrinkingandalcoholintoxication

(i) reducingthepublichealthimpactofillicitalcoholandinformallyproducedalcohol1

(j) monitoringandsurveillance.

17. ThepolicyoptionsandinterventionsproposedbelowforconsiderationbyMemberStatesforeachofthe10recommendedtargetareasarebasedoncurrentscientificknowledge,availableevidenceoneffectivenessandcost-effectiveness,experienceandgoodpractices.Notall thepolicyoptionsand interventionswillbeapplicable

1 Informally produced alcohol means alcoholic beverages produced at home or locally by fermentation and distillation of fruits, grains, vegetables and the like, and often within the context of local cultural practices and traditions. Examples of informally produced alcoholic beverages include sorghum beer, palm wine and spirits produced from sugarcane, grains or other commodities.


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or relevant for allMemberStatesandsomemaybebeyondavailable resources.Assuch,themeasuresshouldbeimplementedatthediscretionofeachMemberStatedependingonnational, religiousandculturalcontexts,nationalpublichealthpriorities,andavailableresources,andinaccordancewithconstitutionalprinciplesandinternationallegalobligations.Policymeasuresandinterventionsatthenationallevelwillbesupportedandcomplementedbyglobalandregionaleffortstoreducetheharmfuluseofalcohol.

Policy options and interventionsArea 1. Leadership, awareness and commitment

18.Sustainable action requires strong leadership and a solid base of awareness andpoliticalwillandcommitment.Thecommitmentsshouldideallybeexpressedthroughadequatelyfundedcomprehensiveandintersectoralnationalpoliciesthatclarifythecontributions,anddivisionofresponsibility,ofthedifferentpartners involved.Thepoliciesmustbebasedonavailableevidenceandtailoredto localcircumstances,withclearobjectives,strategiesandtargets.Thepolicyshouldbeaccompaniedbyaspecificactionplanandsupportedbyeffectiveandsustainableimplementationandevaluationmechanisms.Theappropriateengagementofcivilsocietyandeconomicoperatorsisessential.

19. Forthisareapolicyoptionsandinterventionsinclude:

(a) developingorstrengtheningexisting,comprehensivenationalandsubnationalstrategies,plansofactionandactivitiestoreducetheharmfuluseofalcohol;

(b) establishing or appointing a main institution or agency, as appropriate, to beresponsibleforfollowingupnationalpolicies,strategiesandplans;

(c) coordinating alcohol strategieswithwork in other relevant sectors, includingcooperationbetweendifferentlevelsofgovernments,andwithotherrelevanthealth-sectorstrategiesandplans;

(d) ensuring broad access to information and effective education and publicawareness programmes among all levels of society about the full range ofalcohol-relatedharmexperiencedinthecountryandtheneedfor,andexistenceof,effectivepreventivemeasures;

(e) raisingawarenessofharmtoothersandamongvulnerablegroupscausedbydrinking,avoidingstigmatizationandactivelydiscouragingdiscriminationagainstaffectedgroupsandindividuals.

Area 2. Health services’ response

20.Health services are central to tackling harm at the individual level among thosewith alcohol-use disorders and other health conditions caused by harmful use ofalcohol.Healthservicesshouldprovidepreventionandtreatment interventionstoindividualsandfamiliesatriskof,oraffectedby,alcohol-usedisordersandassociatedconditions.Anotherimportantroleofhealthservicesandhealthprofessionalsisto

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informsocietiesaboutthepublichealthandsocialconsequencesofharmfuluseofalcohol,supportcommunitiesintheireffortstoreducetheharmfuluseofalcohol,and to advocate effective societal responses. Health services should reach outto,mobilizeandinvolveabroadrangeofplayersoutsidethehealthsector.Healthservicesresponseshouldbesufficientlystrengthenedandfundedinawaythatiscommensuratewiththemagnitudeofthepublichealthproblemscausedbyharmfuluseofalcohol.


(a) increasingcapacityofhealthandsocialwelfaresystemstodeliverprevention,treatmentandcareforalcohol-useandalcohol-induceddisordersandco-morbidconditions,includingsupportandtreatmentforaffectedfamiliesandsupportformutualhelporself-helpactivitiesandprogrammes;

(b) supporting initiatives for screening and brief interventions for hazardous andharmfuldrinkingatprimaryhealthcareandothersettings;suchinitiativesshouldincludeearlyidentificationandmanagementofharmfuldrinkingamongpregnantwomenandwomenofchild-bearingage;

(c) improving capacity for prevention of, identification of, and interventions forindividualsand families livingwith fetal alcoholsyndromeandaspectrumofassociateddisorders;

(d) developmentandeffectivecoordinationofintegratedand/orlinkedprevention,treatment and care strategies and services for alcohol-use disorders and co-morbidconditions,includingdrug-usedisorders,depression,suicides,HIV/AIDSandtuberculosis;

(e) securing universal access to health including through enhancing availability,accessibility and affordability of treatment services for groups of lowsocioeconomicstatus;

(f) establishingandmaintainingasystemofregistrationandmonitoringofalcohol-attributablemorbidityandmortality,withregularreportingmechanisms;

(g) provisionofculturallysensitivehealthandsocialservicesasappropriate.

Area 3. Community action

22. The impactofharmfuluseofalcoholoncommunitiescantriggerandfoster localinitiatives and solutions to local problems. Communities can be supported andempoweredbygovernmentsandotherstakeholderstousetheirlocalknowledgeandexpertiseinadoptingeffectiveapproachestopreventandreducetheharmfuluseofalcoholbychangingcollectiveratherthanindividualbehaviourwhilebeingsensitivetoculturalnorms,beliefsandvaluesystems.


(a) supporting rapid assessments in order to identify gaps andpriority areas forinterventionsatthecommunitylevel;


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(b) facilitating increasedrecognitionofalcohol-relatedharmatthe local levelandpromoting appropriate effective and cost-effective responses to the localdeterminantsofharmfuluseofalcoholandrelatedproblems;

(c) strengtheningcapacityoflocalauthoritiestoencourageandcoordinateconcertedcommunityactionbysupportingandpromotingthedevelopmentofmunicipalpoliciestoreduceharmfuluseofalcohol,aswellastheircapacitytoenhancepartnerships and networks of community institutions and nongovernmentalorganizations;

(d) providing information about effective community-based interventions, andbuildingcapacityatcommunitylevelfortheirimplementation;

(e) mobilizingcommunitiestopreventthesellingofalcoholto,andconsumptionof alcohol by, under-age drinkers, and to develop and support alcohol-freeenvironments,especiallyforyouthandotherat-riskgroups;

(f) providingcommunitycareandsupportforaffectedindividualsandtheirfamilies;

(g) developingorsupportingcommunityprogrammesandpoliciesforsubpopulationsatparticularrisk,suchasyoungpeople,unemployedpersonsandindigenouspopulations,specificissuesliketheproductionanddistributionofillicitorinformal-alcoholbeveragesandeventsatcommunitylevelsuchassportingeventsandtownfestivals.

Area 4. Drink-driving policies and countermeasures

24.Driving under the influence of alcohol seriously affects a person’s judgment,coordinationandothermotorfunctions.Alcohol-impaireddrivingisasignificantpublichealthproblem that affectsboth thedrinkerand inmanycases innocentparties.Strongevidence-based interventionsexist for reducingdrink-driving.Strategies toreduceharmassociatedwithdrink-drivingshouldincludedeterrentmeasuresthataimtoreducethelikelihoodthatapersonwilldriveundertheinfluenceofalcohol,andmeasuresthatcreateasaferdrivingenvironmentinordertoreduceboththelikelihoodandseverityofharmassociatedwithalcohol-influencedcrashes.

25. In some countries, the number of traffic-related injuries involving intoxicatedpedestriansissubstantialandshouldbeahighpriorityforintervention.


(a) introducingandenforcinganupperlimitforbloodalcoholconcentration,withareducedlimitforprofessionaldriversandyoungornovicedrivers;

(b) promotingsobrietycheckpointsandrandombreath-testing;

(c) administrativesuspensionofdrivinglicences;

(d) graduatedlicensingfornovicedriverswithzero-tolerancefordrink-driving;

(e) usinganignitioninterlock,inspecificcontextswhereaffordable,toreducedrink-drivingincidents;

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(f) mandatory driver-education, counselling and, as appropriate, treatmentprogrammes;

(g) encouragingprovisionofalternativetransportation,includingpublictransportuntilaftertheclosingtimefordrinkingplaces;

(h) conductingpublicawarenessandinformationcampaignsinsupportofpolicyandinordertoincreasethegeneraldeterrenceeffect;

(i) runningcarefullyplanned,high-intensity,well-executedmassmediacampaignstargetedatspecificsituations,suchasholidayseasons,oraudiencessuchasyoungpeople.

Area 5. Availability of alcohol

27.Publichealthstrategiesthatseektoregulatethecommercialorpublicavailabilityofalcoholthroughlaws,policies,andprogrammesareimportantwaystoreducethegenerallevelofharmfuluseofalcohol.Suchstrategiesprovideessentialmeasurestopreventeasyaccesstoalcoholbyvulnerableandhigh-riskgroups.Commercialandpublicavailabilityofalcoholcanhaveareciprocalinfluenceonthesocialavailabilityofalcoholandthuscontributetochangingsocialandculturalnormsthatpromotesharmfuluseofalcohol.Thelevelofregulationontheavailabilityofalcoholwilldependonlocalcircumstances,includingsocial,culturalandeconomiccontextsaswellasexistingbindinginternationalobligations.Insomedevelopingandlow-andmiddle-incomecountries,informalmarketsarethemainsourceofalcoholandformalcontrolsonsaleneedtobecomplementedbyactionsaddressingillicitorinformallyproducedalcohol.Furthermore,restrictionsonavailabilitythataretoostrictmaypromotethedevelopmentof aparallel illicitmarket.Secondary supplyof alcohol, for examplefromparentsorfriends,needsalsotobetakenintoconsiderationinmeasuresontheavailabilityofalcohol.


(a) establishing,operatingandenforcinganappropriatesystemtoregulateproduction,wholesalingandservingofalcoholicbeveragesthatplacesreasonablelimitationsonthedistributionofalcoholandtheoperationofalcoholoutletsinaccordancewithculturalnorms,bythefollowingpossiblemeasures:

(i) introducing,whereappropriate,alicensingsystemonretailsales,orpublichealthorientedgovernmentmonopolies;

(ii) regulatingthenumberandlocationofon-premiseandoff-premisealcoholoutlets;

(iii) regulatingdaysandhoursofretailsales;

(iv) regulatingmodesofretailsalesofalcohol;

(v) regulatingretailsalesincertainplacesorduringspecialevents;


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(b) establishing an appropriate minimum age for purchase or consumption ofalcoholicbeveragesandotherpoliciesinordertoraisebarriersagainstsalesto,andconsumptionofalcoholicbeveragesby,adolescents;

(c) adoptingpoliciestopreventsalestointoxicatedpersonsandthosebelowthelegalageandconsideringtheintroductionofmechanismsforplacingliabilityonsellersandserversinaccordancewithnationallegislations;

(d) settingpoliciesregardingdrinkinginpublicplacesoratofficialpublicagencies’activitiesandfunctions;

(e) adoptingpolicies to reduceandeliminate availability of illicit production, saleanddistributionofalcoholicbeveragesaswellastoregulateorcontrolinformalalcohol.

Area 6. Marketing1 of alcoholic beverages

29.Reducingtheimpactofmarketing,particularlyonyoungpeopleandadolescents,isanimportantconsiderationinreducingharmfuluseofalcohol.Alcoholismarketedthroughincreasinglysophisticatedadvertisingandpromotiontechniques,includinglinking alcohol brands to sports and cultural activities, sponsorships and productplacements,andnewmarketingtechniquessuchase-mails,SMSandpodcasting,social media and other communication techniques. The transmission of alcoholmarketingmessagesacrossnationalbordersandjurisdictionsonchannelssuchassatellitetelevisionandtheInternet,andsponsorshipofsportsandculturaleventsisemergingasaseriousconcerninsomecountries.

30. It is very difficult to target young adult consumers without exposing cohorts ofadolescentsunderthelegalagetothesamemarketing.Theexposureofchildrenandyoungpeopletoappealingmarketingisofparticularconcern,asisthetargetingofnewmarketsindevelopingandlow-andmiddle-incomecountrieswithacurrentlowprevalenceofalcoholconsumptionorhighabstinencerates.Boththecontentofalcoholmarketingandtheamountofexposureofyoungpeopletothatmarketingarecrucialissues.Aprecautionaryapproachtoprotectingyoungpeopleagainstthesemarketingtechniquesshouldbeconsidered.


(a) settingupregulatoryorco-regulatoryframeworks,preferablywithalegislativebasis,andsupportedwhenappropriatebyself-regulatorymeasures,foralcoholmarketingby:

(i) regulatingthecontentandthevolumeofmarketing;

(ii) regulatingdirectorindirectmarketingincertainorallmedia;

(iii) regulatingsponsorshipactivitiesthatpromotealcoholicbeverages;

1 Marketing could refer, as appropriate and in accordance with national legislation, to any form of commercial communication or message that is designed to increase, or has the effect of increasing, the recognition, appeal and/or consumption of particular products and services. It could comprise anything that acts to advertise or otherwise promote a product or service.

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(iv) restricting or banning promotions in connection with activities targetingyoungpeople;

(v) regulatingnewformsofalcoholmarketingtechniques,forinstancesocialmedia;

(b) developmentbypublicagenciesorindependentbodiesofeffectivesystemsofsurveillanceofmarketingofalcoholproducts;

(c) settingupeffectiveadministrativeanddeterrencesystemsforinfringementsonmarketingrestrictions.

Area 7. Pricing policies

32.Consumers, includingheavydrinkersandyoungpeople,aresensitive tochangesinthepriceofdrinks.Pricingpoliciescanbeusedtoreduceunderagedrinking,tohaltprogressiontowardsdrinkinglargevolumesofalcoholand/orepisodesofheavydrinking,andtoinfluenceconsumers’preferences.Increasingthepriceofalcoholicbeveragesisoneofthemosteffectiveinterventionstoreduceharmfuluseofalcohol.Akeyfactorforthesuccessofprice-relatedpoliciesinreducingharmfuluseofalcoholisaneffectiveandefficientsystemfortaxationmatchedbyadequatetaxcollectionandenforcement.

33. Factorssuchasconsumerpreferencesandchoice,changesinincome,alternativesourcesforalcohol in thecountryor inneighbouringcountries,andthepresenceor absence of other alcohol policy measures may influence the effectiveness ofthispolicyoption.Demandfordifferentbeveragesmaybeaffecteddifferently.Taxincreasescanhavedifferentimpactsonsales,dependingonhowtheyaffectthepricetotheconsumer.Theexistenceofasubstantialillicitmarketforalcoholcomplicatespolicy considerations on taxation in many countries. In such circumstances taxchangesmustbeaccompaniedbyefforts tobring the illicitand informalmarketsundereffectivegovernmentcontrol.Increasedtaxationcanalsomeetresistancefromconsumergroupsandeconomicoperators,andtaxationpolicywillbenefitfromthesupportofinformationandawareness-buildingmeasurestocountersuchresistance.


(a) establishingasystemforspecificdomestictaxationonalcoholaccompaniedbyaneffectiveenforcementsystem,whichmaytakeintoaccount,asappropriate,thealcoholiccontentofthebeverage;

(b) regularlyreviewingpricesinrelationtolevelofinflationandincome;

(c) banningorrestrictingtheuseofdirectandindirectpricepromotions,discountsales,salesbelowcostandflat ratesforunlimiteddrinkingorother typesofvolumesales;

(d) establishingminimumpricesforalcoholwhereapplicable;

(e) providingpriceincentivesfornon-alcoholicbeverages;

(f) reducingorstoppingsubsidiestoeconomicoperatorsintheareaofalcohol.


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Area 8. Reducing the negative consequences of drinking and alcohol intoxication

35. This target area includes policy options and interventions that focus directly onreducingtheharmfromalcoholintoxicationanddrinkingwithoutnecessarilyaffectingtheunderlyingalcoholconsumption.Currentevidenceandgoodpracticesfavourthecomplementaryuseofinterventionswithinabroaderstrategythatpreventsorreducesthe negative consequences of drinking and alcohol intoxication. In implementingtheseapproaches,managingthedrinkingenvironmentorinformingconsumers,theperceptionofendorsingorpromotingdrinkingshouldbeavoided.


(a) regulating the drinking context in order to minimize violence and disruptivebehaviour,includingservingalcoholinplasticcontainersorshatter-proofglassandmanagementofalcohol-relatedissuesatlarge-scalepublicevents;

(b) enforcinglawsagainstservingtointoxicationandlegalliabilityforconsequencesofharmresultingfromintoxicationcausedbytheservingofalcohol;

(c) enactingmanagementpoliciesrelatingtoresponsibleservingofbeverageonpremisesandtrainingstaffinrelevantsectorsinhowbettertoprevent,identifyandmanageintoxicatedandaggressivedrinkers;

(d) reducingthealcoholicstrengthinsidedifferentbeveragecategories;

(e) providingnecessarycareorshelterforseverelyintoxicatedpeople;

(f) providing consumer information about, and labelling alcoholic beverages toindicate,theharmrelatedtoalcohol.

Area 9. Reducing the public health impact of illicit alcohol and informally produced alcohol

37. Consumptionofillicitlyorinformallyproducedalcoholcouldhaveadditionalnegativehealthconsequencesduetoahigherethanolcontentandpotentialcontaminationwithtoxicsubstances,suchasmethanol.Itmayalsohampergovernments’abilitiestotaxandcontrollegallyproducedalcohol.Actionstoreducetheseadditionalnegativeeffectsshouldbetakenaccordingtotheprevalenceofillicitand/orinformalalcoholconsumptionand theassociatedharm.Goodscientific, technical and institutionalcapacity should be in place for the planning and implementation of appropriatenational,regionalandinternationalmeasures.Goodmarketknowledgeandinsightintothecompositionandproductionofinformalorillicitalcoholarealsoimportant,coupledwithanappropriate legislativeframeworkandactiveenforcement.Theseinterventionsshouldcomplement,notreplace,otherinterventionstoreduceharmfuluseofalcohol.

38.Productionandsaleofinformalalcoholareingrainedinmanyculturesandareofteninformallycontrolled.Thuscontrolmeasurescouldbedifferentforillicitalcoholandinformallyproducedalcohol andshouldbecombinedwithawareness raisingandcommunitymobilization.Effortstostimulatealternativesourcesofincomearealsoimportant.

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(a) good quality control with regard to production and distribution of alcoholicbeverages;

(b) regulatingsalesofinformallyproducedalcoholandbringingitintothetaxationsystem;

(c) anefficientcontrolandenforcementsystem,includingtaxstamps;

(d) developingorstrengtheningtrackingandtracingsystemsforillicitalcohol;

(e) ensuring necessary cooperation and exchange of relevant information oncombatingillicitalcoholamongauthoritiesatnationalandinternationallevels;

(f) issuingrelevantpublicwarningsaboutcontaminantsandotherhealththreatsfrominformalorillicitalcohol.

Area 10. Monitoring and surveillance

40.Datafrommonitoringandsurveillancecreatethebasisforthesuccessandappropriatedeliveryoftheotherninepolicyoptions.Local,nationalandinternationalmonitoringandsurveillanceareneededinordertomonitorthemagnitudeandtrendsofalcohol-relatedharms,tostrengthenadvocacy,toformulatepoliciesandtoassessimpactof interventions. Monitoring should also capture the profile of people accessingservicesandthereasonwhypeoplemostaffectedarenotaccessingpreventionandtreatmentservices.Datamaybeavailableinothersectors,andgoodsystemsforcoordination,informationexchangeandcollaborationarenecessaryinordertocollectthepotentiallybroadrangeofinformationneededtohavecomprehensivemonitoringandsurveillance.

41.Developmentofsustainablenationalinformationsystemsusingindicators,definitionsanddata-collectionprocedurescompatiblewithWHO’sglobalandregionalinformationsystemsprovidesan importantbasisforeffectiveevaluationofnationaleffortstoreduceharmfuluseofalcoholandformonitoringtrendsatsubregional,regionalandgloballevels.Systematiccontinualcollection,collationandanalysisofdata,timelydisseminationofinformationandfeedbacktopolicy-makersandotherstakeholdersshouldbeanintegralpartofimplementationofanypolicyandinterventiontoreduceharmfuluseofalcohol.Collecting,analysinganddisseminatinginformationonharmfuluseofalcoholareresource-intensiveactivities.


(a) establishing effective frameworks for monitoring and surveillance activitiesincludingperiodicnationalsurveysonalcoholconsumptionandalcohol-relatedharmandaplanforexchangeanddisseminationofinformation;

(b) establishingordesignatinganinstitutionorotherorganizationalentityresponsiblefor collecting, collating, analysing and disseminating available data, includingpublishingnationalreports;


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(c) definingandtrackingacommonsetofindicatorsofharmfuluseofalcoholandofpolicyresponsesandinterventionstopreventandreducesuchuse;

(d) creatingarepositoryofdataatthecountrylevelbasedoninternationallyagreedindicatorsandreportingdataintheagreedformattoWHOandotherrelevantinternationalorganizations;

(e) developingevaluationmechanismswiththecollecteddatainordertodeterminetheimpactofpolicymeasures,interventionsandprogrammesputinplacetoreducetheharmfuluseofalcohol.

Global action: key role and components43.Giventhemagnitudeandthecomplexityoftheproblem,concertedglobalefforts

mustbeinplacetosupportMemberStatesinthechallengestheyfaceatthenationallevel.Internationalcoordinationandcollaborationcreatethesynergiesthatareneededandprovide increased leverage forMemberStates to implementevidence-basedmeasures.

44.WHO,incooperationwithotherorganizationsintheUnitedNationssystemandotherinternationalpartnerswill:

(a) provideleadership;

(b) strengthenadvocacy;

(c) formulate,incollaborationwithMemberStates,evidence-basedpolicyoptions;

(d) promotenetworkingandexchangeofexperienceamongcountries;

(e) strengthenpartnershipsandresourcemobilization;

(f) coordinatemonitoringofalcohol-relatedharmand theprogresscountriesaremakingtoaddressit.

45.Action by WHO and other international partners to support the implementationof the global strategy will be taken according to their mandates. Internationalnongovernmentalorganizations,professionalassociations,researchinstitutionsandeconomicoperatorsintheareaofalcohol,allhaveimportantrolesinenhancingtheglobalaction,asfollows.

(a) Major partners within the United Nations system and intergovernmentalorganizationslikeILO,UNICEF,WTO,UNDP,UNFPA,UNAIDS,UnitedNationsOfficeonDrugsandCrime,andtheWorldBankgroupwillbeurgedtoincreasecollaboration and cooperation to prevent and reduce harmful use of alcohol,especiallyindevelopingandlow-andmiddle-incomecountries.

(b) Civilsocietyhasanimportantroleinwarningabouttheimpactofharmfuluseofalcoholon individuals, familiesandcommunitiesand inbringingadditionalcommitmentandresourcesforreducingalcohol-relatedharm.Nongovernmental

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organizationsareespeciallyencouragedtoformwidenetworksandactiongroupstosupporttheimplementationoftheglobalstrategy.

(c) Researchinstitutionsandprofessionalassociationsplayapivotalroleingeneratingadditionalevidenceforactionanddisseminatingthistohealthprofessionalsandthe wider community. WHO collaborating centres have an important role insupportingtheimplementationandevaluationoftheglobalstrategy.

(d) Economicoperatorsinalcoholproductionandtradeareimportantplayersintheirroleasdevelopers,producers,distributors,marketersandsellersofalcoholicbeverages.Theyareespeciallyencouragedtoconsidereffectivewaystopreventand reduce harmful use of alcohol within their core roles mentioned above,includingself-regulatoryactionsand initiatives.Theycouldalsocontributebymakingavailabledataonsalesandconsumptionofalcoholbeverages.

(e) Themediaplayanincreasinglyimportantrole,notonlyasaconveyerofnewsandinformationbutalsoasachannelforcommercialcommunications,andwillbeencouragedtosupporttheintentionsandactivitiesoftheglobalstrategy.

Public health advocacy and partnership

46. Internationalpublichealthadvocacyandpartnershipareneeded forstrengthenedcommitmentandabilitiesofthegovernmentsandallrelevantpartiesatalllevelsforreducingharmfuluseofalcoholworldwide.

47.WHOiscommittedtoraisingawarenessofthepublichealthproblemscausedbyharmfuluseofalcoholandof thesteps thatcanbe taken topreventand reducesuchuseinordertosavelivesandreducesuffering.WHOwillengagewithotherinternational intergovernmental organizations and, as appropriate, internationalbodiesrepresentingkeystakeholders,toensurethatrelevantactorscancontributetoreducingtheharmfuluseofalcohol.

48. TheSecretariatwillprovidesupporttoMemberStatesby:

(a) raisingtheawarenessof themagnitudeofpublichealthproblemscausedbyharmfuluseofalcoholandadvocatingforappropriateactionatalllevelstopreventandreducesuchproblems;

(b) advocatingthatattentionisgiventoaddressingtheharmfuluseofalcoholintheagendasofrelevantinternationalandintergovernmentalorganizationsinordertosupportpolicycoherencebetweenhealthandothersectorsatregionalandgloballevels;

(c) promotingandfacilitatinginternationalcoordination,collaboration,partnershipsandinformationexchangetoensuretheneededsynergiesandconcertedactionsofallrelevantparties;

(d) ensuringconsistency,scientificsoundnessandclarityofkeymessagesaboutpreventingandreducingharmfuluseofalcohol;

(e) promotingintercountrynetworkingandexchangeofexperiences;


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(f) facilitatinginternationalnetworkinginordertotacklespecificandsimilarproblems(forexample,specificproblemsamongindigenousorotherminoritygroupsorchangingyouthdrinkingcultures);

(g) advocating appropriate consideration by parties in international, regional andbilateraltradenegotiationstotheneedandtheabilityofnationalandsubnationalgovernmentstoregulatealcoholdistribution,salesandmarketing,andthustomanagealcohol-relatedhealthandsocialcosts;

(h) ensuring that the WHO Secretariat has processes in place to work withnongovernmental organizations and other civil society groups, taking intoconsiderationanyconflictsofinterestthatsomenongovernmentalorganizationsmayhave;

(i) continuingitsdialoguewiththeprivatesectoronhowtheybestcancontributetothereductionofalcohol-relatedharm.Appropriateconsiderationwillbegiventothecommercialinterestsinvolvedandtheirpossibleconflictwithpublichealthobjectives.

Technical support and capacity building

49.ManyMemberStatesneedincreasedcapacityandcapabilitytocreate,enforceandsustain the necessary policy and legal frames and implementation mechanisms.Globalactionwill supportnationalaction through thedevelopmentofsustainablemechanismsandtheprovisionofthenecessarynormativeguidanceandtechnicaltoolsforeffectivetechnicalsupportandcapacitybuilding,withparticularfocusondevelopingandlow-andmiddle-incomecountries.Suchactionsmustbeinaccordancewith the national contexts, needs and priorities. Development of the necessaryinfrastructureforeffectivepolicyresponses incountrieswithhigheror increasingalcohol-attributableburdenisanimportantprerequisiteforattainingbroaderpublichealthanddevelopmentalobjectives.

50.WHOiscommittedtocooperatewithotherrelevantactorsatregionalandgloballevelsinordertoprovidetechnicalguidanceandsupportforstrengtheninginstitutionalcapacitytorespondtopublichealthproblemscausedbyharmfuluseofalcohol.WHOwill especially focusonsupport andbuildingcapacity indevelopingand low-andmiddle-incomecountries.


(a) documenting and disseminating good models of health-service responses toalcohol-relatedproblems;

(b) documenting and disseminating best practices and models of responses toalcohol-relatedproblemsindifferentsectors;

(c) drawingonexpertiseinotherareaslikeroadsafety,taxationandjusticewithpublichealthexpertiseinordertodesigneffectivemodelstopreventandreducealcohol-relatedharm;

(d) providing normative guidance on effective and cost-effective prevention andtreatmentinterventionsindifferentsettings;

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(e) developingandstrengtheningglobal,regionalandintercountrynetworksinordertohelpinsharingbestpracticesandfacilitatingcapacitybuilding;

(f) responding to Member States’ requests for support of their efforts to buildthe capacity to understand the implications of international trade and tradeagreementsforhealth.

Production and dissemination of knowledge

52. Importantareasforglobalactionwillbemonitoringtrendsinalcoholconsumption,alcohol-attributableharmandthesocietalresponses,analysingthisinformationandfacilitatingtimelydissemination.Availableknowledgeonthemagnitudeofharmfuluseofalcohol,andeffectivenessandcost-effectivenessofpreventiveandtreatmentinterventionsshouldbefurtherconsolidatedandexpandedsystematicallyatthegloballevel,especiallyinformationonepidemiologyofalcoholuseandalcohol-relatedharm,impactofharmfuluseofalcoholoneconomicandsocialdevelopmentandthespreadofinfectiousdiseasesindevelopingandlow-andmiddle-incomecountries.

53. TheGlobalInformationSystemonAlcoholandHealthanditsregionalcomponentsweredevelopedbyWHOfordynamicpresentationofthedataonlevelsandpatternsofalcoholconsumption,alcohol-attributablehealthandsocialconsequencesandpolicyresponsesatalllevels.Improvingtheglobalandregionaldataonalcoholandhealthrequiresdevelopmentofnationalmonitoringsystems,regularreportingofdatabydesignatedfocalpointstoWHOandstrengtheningtherelevantsurveillanceactivities.

54.WHOiscommittedtoworkingwiththerelevantpartnerstoshapetheinternationalresearchagendaonalcoholandhealth,buildcapacityforresearchandpromoteandsupportinternationalresearchnetworksandprojectstogenerateanddisseminatedatatoinformpolicyandprogrammedevelopment.


(a) providinganinternationalclearinghouseforinformationoneffectiveandcost-effectiveinterventionstoreduceharmfuluseofalcoholincludingpromotingandfacilitatingexchangeofinformationabouteffectivetreatmentservices;

(b) strengthening the Global Information System on Alcohol and Health and thecomparativeriskassessmentofthealcohol-attributablediseaseburden;

(c) developing or refining appropriate data-collection mechanisms, based oncomparabledataandagreedindicatorsanddefinitions,inordertofacilitatedatacollection,collation,analysisanddisseminationattheglobal,regionalandnationallevels;

(d) facilitating regional andglobal networks to support andcomplementnationalefforts,withafocusonknowledgeproductionandinformationexchange;

(e) continuingitscollaborationwithinternationalnetworksofscientistsandhealthexpertstopromoteresearchonvariousaspectsofharmfuluseofalcohol;

(f) facilitating comparative effectiveness studies of different policy measuresimplementedindifferentculturalanddevelopmentalcontexts;


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(g) facilitatingoperationalresearchtoexpandeffectiveinterventionsandresearchontherelationshipbetweenharmfuluseofalcoholandsocialandhealthinequities.

Resource mobilization

56. Themagnitudeofalcohol-attributablediseaseandsocialburdenisinsharpcontradictionwith the resourcesavailableatall levels to reduceharmfuluseofalcohol.Globaldevelopmentinitiativesmusttakeintoaccountthatdevelopingandlow-andmiddle-incomecountriesneedtechnicalsupport–throughaidandexpertise–toestablishandstrengthennationalpoliciesandplansforthepreventionofharmfuluseofalcoholand develop appropriate infrastructures, including those in health-care systems.Developmentagenciescouldconsiderreducingharmfuluseofalcoholasapriorityareaindevelopingandlow-andmiddle-incomecountrieswithahighburdenofdiseaseattributable to harmful use of alcohol. Official development assistance providesopportunitiestobuildsustainableinstitutionalcapacityinthisareaindevelopingandlow- and middle-income countries, as do mechanisms for collaboration betweendevelopingcountries.Inthatregard,MemberStatesareurgedtosupporteachotherintheimplementationoftheglobalstrategythroughinternationalcooperationandfinancialassistanceincludingofficialdevelopmentassistancefordevelopingcountries.

57.WHOiscommittedtoassistcountriesuponrequest in resourcemobilizationandpoolingofavailableresourcestosupportglobalandnationalactiontoreduceharmfuluseofalcoholinidentifiedpriorityareas.


(a) promotingexchangeofexperienceandgoodpracticeinfinancingpoliciesandinterventionstoreduceharmfuluseofalcohol;

(b) exploringnewor innovativewaysandmeanstosecureadequatefundingforimplementationoftheglobalstrategy;

(c) collaboratingwithinternationalpartners,intergovernmentalpartnersanddonorstomobilizenecessary resources tosupportdevelopingand low-andmiddle-incomecountriesintheireffortstoreduceharmfuluseofalcohol.

Implementing the strategy59.SuccessfulimplementationofthestrategywillrequireconcertedactionbyMember

States, effective global governance and appropriate engagement of all relevantstakeholders.Allactionslistedinthestrategyareproposedtosupporttheachievementofthefiveobjectives.

60. TheSecretariatwill report regularlyon theglobalburdenof alcohol-relatedharm,makeevidence-basedrecommendations,andadvocateactionatalllevelstopreventandreduceharmfuluseofalcohol.Itwillcollaboratewithotherintergovernmentalorganizations and, as appropriate, other international bodies representing keystakeholders to ensure that action to reduce harmful use of alcohol receivesappropriatepriorityandresources.

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Links and interfaces with other strategies, plans and programmes

61. ThisglobalstrategybuildsuponregionalinitiativessuchastheFrameworkforalcoholpolicyintheWHOEuropeanRegion(resolutionEUR/RC55/R1),theRegionalstrategytoreducealcohol-relatedharmintheWesternPacificRegion(resolutionWPR/RC57.R5), Alcohol consumption control – policy options in the South-East Asia Region(resolution SEA/RC59/R8), Public health problems of alcohol consumption in theEasternMediterraneanRegion(resolutionEM/RC53/R.5)andActionstoreducetheharmfuluseofalcoholintheAfricanRegion(documentAFR/RC58/3).

62.Harmfuluseofalcoholisoneofthefourmainriskfactorshighlightedintheactionplanfortheglobalstrategyforthepreventionandcontrolofnoncommunicablediseases(resolutionWHA61.14).Thestrategytoreduceharmfuluseofalcoholbuildsonandlinkstotheotherriskfactorsfornoncommunicablediseasesandthedisease-specificprogrammes,especiallythroughtheglobalstrategyondiet,physicalactivityandhealth(resolutionWHA57.17),tobaccocontrol(resolutionWHA56.1),healthpromotionandhealthylifestyle(resolutionWHA57.16)andcancerpreventionandcontrol(resolutionWHA58.22).

63. The strategy also links and aligns itself with other related activities in WHO,especiallytheMentalHealthGapActionProgramme, includingsuicidepreventionandmanagementofothersubstanceusedisordersaswellasprogrammaticactivitieson violenceandhealth (resolutionWHA56.24), road safety andhealth (resolutionWHA57.10),childandadolescenthealthanddevelopment (resolutionWHA56.21)andreproductivehealth(resolutionWHA57.12).

64.With emerging evidence, greater attention is being given to the links betweenharmfuluseofalcoholandsomeinfectiousdiseasesandbetweenharmfuldrinkinganddevelopment.ThestrategyalsolinksinwithWHO’sexistingprogammesonHIV/AIDSandtuberculosisanditsworkonreducinghealthinequitiesthroughactiononthesocialdeterminantsofhealth(resolutionWHA62.14)andachievingthehealth-relateddevelopmentgoalsincludingthosecontainedintheUnitedNationsMillenniumDeclaration(resolutionWHA58.30).

65. Theimplementationofaglobalstrategytoreduceharmfuluseofalcoholprovidesa supportive framework for the WHO regional offices to formulate, revisit andimplement region-specificpoliciesand, togetherwith thecountryoffices,providetechnicalsupporttoMemberStates.EmphasiswillalsobeputoncoordinationwithintheSecretariatsothatallactionsrelevanttoharmfuluseofalcoholareinlinewiththisstrategy.

Monitoring progress and reporting mechanisms

66. Formonitoringprogress,thestrategyrequiresappropriatemechanismsatdifferentlevelsforassessment,reportingandre-programming.Aframeworkwithanimpact-focusedperspectiveisneededforassessingachievementofthestrategy’sobjectives.

67. WHO’s Global Survey on Alcohol and Health and the Global Information Systemon Alcohol and Health will be important parts of the reporting and monitoringmechanisms.Thedata-collectingtoolsofthelatterwillbeadjustedtoincludetherelevantreportingontheprocessandoutcomesofimplementationofthestrategyatthenationallevel.


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68.Regularmeetingsofglobalandregionalnetworksofnationalcounterpartsofferamechanism for technical discussion of the implementation of the global strategyatdifferentlevels.Inadditiontotakingstockoftheprocess,thesemeetingscouldincludedetaileddiscussionsofpriorityareasandtopicsrelevanttoimplementation.

69.ReportingontheimplementationoftheglobalstrategytoMemberStateswilltakeplacethroughregularreportstoWHOregionalcommitteesandtheHealthAssembly.Informationaboutimplementationandprogressshouldalsobepresentedatregionalorinternationalforumsandappropriateintergovernmentalmeetings.

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TheSixty-thirdWorldHealthAssembly,1

Havingconsideredthereportonstrategiestoreducetheharmfuluseofalcohol1andthedraftglobalstrategyannexedtherein;

Recalling resolutionsWHA58.26onpublic-healthproblemscausedbyharmfuluseofalcoholandWHA61.4onstrategiestoreducetheharmfuluseofalcohol;

1. ENDORSEStheglobalstrategytoreducetheharmfuluseofalcohol;

2. AFFIRMS that the global strategy to reduce the harmful use of alcohol aims togiveguidanceforactionatalllevelsandtosetpriorityareasforglobalaction,andthat it is a portfolio of policyoptions andmeasures that couldbe considered forimplementationandadjustedasappropriateatthenationallevel,takingintoaccountnationalcircumstances,suchasreligiousandculturalcontexts,nationalpublichealthpriorities,aswellasresources,capacitiesandcapabilities;

3. URGESMemberStates:2

(1) toadoptandimplementtheglobalstrategytoreducetheharmfuluseofalcoholas appropriate in order to complement and support public health policies inMemberStatestoreducetheharmfuluseofalcohol,andtomobilizepoliticalwillandfinancialresourcesforthatpurpose;

(2) tocontinue implementationof the resolutionsWHA61.4on thestrategies toreduce theharmful useof alcohol andWHA58.26onpublic-healthproblemscausedbyharmfuluseofalcohol;

(3) toensurethatimplementationoftheglobalstrategytoreducetheharmfuluseofalcoholstrengthensthenationaleffortstoprotectat-riskpopulations,youngpeopleandthoseaffectedbyharmfuldrinkingofothers;

(4) toensurethatimplementationoftheglobalstrategytoreducetheharmfuluseofalcoholisreflectedinthenationalmonitoringsystemsandreportedregularlytoWHO’sinformationsystemonalcoholandhealth;

1 Document A63/13.

2 And, where applicable, regional economic integration organizations.

RESOLUTIONOFTHESIXTY-THIRDWORLDHEALTHASSEMBLY(MAY2010)WHA63.13GLOBAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL

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4. REQUESTStheDirector-General:

(1) togivesufficientlyhighorganizationalpriority,andtoassureadequatefinancialandhumanresourcesatall levels,tothepreventionandreductionofharmfuluseofalcoholandimplementationoftheglobalstrategytoreducetheharmfuluseofalcohol;

(2) tocollaboratewithandprovidesupport toMemberStates,asappropriate, inimplementing the global strategy to reduce the harmful use of alcohol andstrengtheningnationalresponsestopublichealthproblemscausedbytheharmfuluseofalcohol;

(3) tomonitorprogressinimplementingtheglobalstrategytoreducetheharmfuluseofalcoholandtoreportprogress,throughtheExecutiveBoard,totheSixty-sixthWorldHealthAssembly.

(Eighth plenary meeting, 21 May 2010 – Committee A, fourth report)


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ANNEXIREPORTBYTHESECRETARIAT1TOTHESIXTY-THIRDWORLDHEALTHASSEMBLY(MAY2010)STRATEGIES TO REDUCE THE HARMFUL USE OF ALCOHOL: DRAFT GLOBAL STRATEGY

1. InresolutionWHA61.4(Strategiestoreducetheharmfuluseofalcohol)theHealthAssemblyrequestedtheDirector-GeneraltosubmittotheSixty-thirdWorldHealthAssembly, throughtheExecutiveBoard,adraftglobalstrategytoreduceharmfuluseofalcohol.TheHealthAssemblyurgedMemberStatestocollaboratewiththeSecretariatindevelopingadraftglobalstrategy,andfurtherrequestedtheDirector-GeneraltocollaborateandconsultwithMemberStates,aswellastoconsultwithintergovernmentalorganizations,healthprofessionals,nongovernmentalorganizationsandeconomicoperatorsonwaystheycouldcontributetoreducingharmfuluseofalcohol.

2. TheSecretariathasdraftedastrategythroughaninclusiveandbroadcollaborativeprocesswithMemberStates. Indoingso, theSecretariat took intoconsiderationtheoutcomesofconsultationswithotherstakeholdersonwaysinwhichtheycancontribute to reducing theharmfuluseofalcohol.Thedraft strategy isbasedonexistingbestpracticesandavailableevidenceofeffectivenessandcost-effectivenessofstrategiesandinterventionstoreducetheharmfuluseofalcohol;thisevidenceissummarizedinAnnexll.

3. Theconsultativeprocessstartedwithapublic,web-basedhearingfrom3Octoberto15November2008,givingMemberStatesandotherstakeholdersanopportunitytosubmitproposalsonwaystoreduceharmfuluseofalcohol.Twoseparateround-tablediscussions,onewithnongovernmentalorganizationsandhealthprofessionalsandtheotherwitheconomicoperators,wereorganizedinGenevainNovember2008inordertocollectviewsonwaysthesestakeholderscouldcontributetoreducingharmfuluseofalcohol.Subsequently,aconsultationwithselectedintergovernmentalorganizationswasheld(Geneva,8September2009).2

4. TheSecretariatbeganworkonadraftstrategybypreparingadiscussionpaperforfurtherconsultationswithMemberStates.ThatpaperwasformulatedonthebasisofthedeliberationsofWHO’sgoverningbodiesandseveralregionalcommitteesessionsaswellasthesimilaroutcomesofthosebodiespertainingtootherrelatedareassuchasnoncommunicablediseases,mentalhealth,violenceandinjuryprevention,cancer,familyandcommunityhealth,socialdeterminantsofhealth,HIV/AIDS,andtradeandhealth.ItscontentwasalsoinfluencedbytheoutcomesoftheSecretariat’stechnicalactivitiesonalcoholandhealth,includingtherelevantmeetingsoftechnicalexperts.ThediscussionpaperwassenttotheMemberStatesandpostedontheWHOwebsite.

1 Originally presented as document A63/13.

2 See the WHO web site for further information about the process of implementing resolution WHA61.4 and links to the various documents referred to in this report: http://www.who.int/substance_abuse/activities/globalstrategy/en/index.html.

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5. Six regional technical consultations were held between February and May 2009,attendedbyparticipantsnominatedbygovernmentsof149MemberStates.Threeconsultationswereheld in theWHORegionalOffices forAfrica,Europeand theEastern Mediterranean. The governments of Brazil, Thailand and New Zealand,respectively, hosted the consultations for Member States in the Region of theAmericasandtheSouth-EastAsiaandWesternPacificregions.Inalltheseregionalconsultations,MemberStateswereinvitedtoprovidetheirviewsonthepossibleareasforglobalactionandcoordinationoutlinedinthediscussionpaper,andonhowthestrategycouldbesttakeintoaccountnationalneedsandpriorities.Inaddition,Member States were encouraged to provide information on current national andsubregionalprocessesthatcouldcontributetothestrategydevelopmentprocess,aswellasexamplesofbestpractices,withspecialemphasisonat-riskpopulations,youngpeopleandthoseaffectedbytheharmfuldrinkingofothers.

6. Inpreparingaworkingdocument fordevelopingadraftglobalstrategy to reduceharmful use of alcohol the Secretariat built on the outcomes of the regionalconsultationswithMemberStatesandtookintoconsiderationtheoutcomesoftheprevious consultative process with all stakeholders on ways in which they couldcontributetoreducingtheharmfuluseofalcohol.Theresultingdocumentprovidedbackgroundinformationandsuggestedaims,objectivesandguidingprinciplesforaglobalstrategy,targetareasandasetofpolicymeasuresandinterventionsthatitwasproposedMemberStatescouldimplementatthenationallevel.TheworkingdocumentwassenttoMemberStatesinAugust2009withaninvitationforwrittenfeedbackonitscontent,andpostedontheWHOwebsite.TheSecretariatreceivedwrittenfeedbackfrom40MemberStates.

7. TocontinuethecollaborationwithMemberStatesonthedraftstrategytheSecretariatheldaninformalconsultationwithMemberStateson8October2009inGenevainordertodiscussthefeedbackontheworkingdocumentandtoofferanopportunityforMemberStatestoprovidefurtherguidanceonfinalizingadraftglobalstrategy.Furthertakingintoaccounttheoutcomeofthatinformalconsultation,theSecretariatfinalizedadraftglobalstrategy.

8. InJanuary2010,at its126thsession,1 theExecutiveBoardconsideredanearlierversionofthisreportandthedraftstrategy.Duringthesession,discussionsonthedraftglobalstrategywerealsoheldinanopen-endedinformalworkinggroup,co-chairedbyCubaandSweden.Consensuswasreachedonarevisedtext.TheBoardadopted resolution EB126.R11 in which it recommends the Health Assembly toendorsetheglobalstrategy.

Action by the Health Assembly9. TheHealthAssemblyisinvitedtoadopttheresolutionrecommendedbytheExecutive

BoardcontainedinresolutionEB126.R11.

1 See document EB126/2010/REC/2 , summary record of the eleventh meeting.


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1. Duringrecentyearsasubstantialbodyofknowledgehasaccumulatedonfeasibility,effectiveness and cost-effectiveness of different policy options and interventionsaimedatreducingtheharmfuluseofalcohol.Mostoftheevidencecomesfromhigh-incomecountries,butthenumberofstudiesinlow-andmiddle-incomecountriesissteadilyincreasing.Thisannexbrieflysummarizesthemainfindingsofresearchthatcaninformpolicyandprogrammedevelopmenttopreventandreduceharmfuluseofalcohol.

2. There are many reasons for placing an emphasis on education and information,includingthenotionthatapopulationshouldknowaboutandunderstandharmfulalcoholuseandassociatedhealthrisks,eventhoughtheevidencebase indicatesthattheimpactofalcohol-educationprogrammesonharmfuluseofalcoholissmall.Tobeeffective,educationaboutalcoholneedstogobeyondprovidinginformationabout therisksofharmfuluseofalcohol topromotingtheavailabilityofeffectiveinterventionsandmobilizingpublicopinionandsupportforeffectivealcoholpolicies.

3. Theevidencefortheeffectivenessofearlyidentificationandbriefadviceforpersonswithhazardousandharmfulalcoholuseisextensiveandcomesfromalargenumberofsystematicreviewsfromavarietyofhealth-caresettingsindifferentcountries.Thefindingsshowthatmoreintensiveadviceappearstobenomoreeffectivethanlessintensiveadvice.Cognitive-behaviouraltherapiesandpharmacologicaltherapiesdohaveapositiveeffectintreatmentofalcoholdependenceandrelatedproblems.Considerationshouldalsobegiventointegratedtreatmentforco-morbidconditions,suchasforhypertension,tuberculosisandHIV/AIDS,andtoself-helpgroups.

4. Animportantcomponentofcommunityactionprogrammes,whichhasbeenshowntochangeyoungpeople’sdrinkingbehaviourandonalcohol-relatedharmsuchastrafficcrashesandviolence,ismediaadvocacy.Anotherapproachtocommunityactioninlow-incomecountrieshasbeentoencouragecommunitiestomobilizepublicopiniontoaddresslocaldeterminantsofincreasedlevelsofharmfuluseofalcohol.

5. Strongevidencesupportstheconclusionthatasufficientlylowlimitforbloodalcoholconcentration(0.02%to0.05%)iseffectiveinreducingdrink-drivingcasualties.Bothintensiverandombreath-testing,wherebypoliceregularlystopdriversonarandombasistochecktheirbloodalcoholconcentrations,andselectivebreath-testing,wherevehiclesarestoppedanddriverssuspectedofdrink-drivingarebreath-tested,reducealcohol-related injuries and fatalities. There is evidence for some effectivenessofsetting lower limits forbloodalcoholconcentrations (includingazero level) foryoungornovicedrivers,administrativesuspensionofthedriver’slicenceincaseofa

ANNEXIIEVIDENCE FOR THE EFFECTIVENESS AND COST-EFFECTIVENESS OF INTERVENTIONS TO REDUCE HARMFUL USE OF ALCOHOL

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bloodalcoholconcentrationabovethelimit,mandatorycounsellingortreatmentforalcohol-relatedconditionsandtheuseofanignitioninterlockforrepeatdrinkdrivers.Consistentenforcementbypolicewithrandomorselectivebreath-testingfollowedbyeffectivesanctionsisessentialandshouldbesupportedbysustainedpublicityandawarenesscampaigns.

6. Evidencefromarangeofsettingsdemonstratestheimportanceofalegalframeworkforreducingthephysicalavailabilityofalcoholthatencompassesrestrictionsonboththesaleandservingofalcohol.Havingalicensingsystemforthesaleofalcoholallowsfortheopportunityforcontrol,sinceinfringementoflawscanbemetbyrevocationofthelicence.Implementationoflawsthatsetaminimumageforthepurchaseofalcoholshowclearreductionsindrinking-drivingcasualtiesandotheralcohol-relatedharm;themosteffectivemeansofenforcementisonsellers,whohaveabusinessinterestinretainingtherighttosellalcohol.Anincreaseddensityofalcoholoutletsisassociatedwith increased levelsofalcoholconsumptionamongyoungpeople,increasedlevelsofassault,andotherharmsuchashomicide,childabuseandneglect,self-inflictedinjury,and,withlessconsistentevidence,roadtrafficinjuries.Reducingthe hours or days of sale of alcoholic beverages leads to fewer alcohol-relatedproblems,includinghomicidesandassaults.

7. Agrowingvolumeofevidencefromlongitudinalyouthstudiespointstoanimpactofvariousformsofalcoholmarketingoninitiationofyouthdrinkingandriskierpatternsofyouthdrinking.Someresultsremaincontested,inpartowingtomethodologicaldifficulties.Tobeeffective,systemstoregulatemarketingneedsufficientincentivestosucceed;ingeneral,regulatoryframeworksaremostactivewherepressurefromthegovernmentisgreatest,andcanonlyworkaslongasthereisprovisionforthird-partyreviewofcomplaintsaboutviolations.Sanctionsandthethreatofsanctionsareneededtoensurecompliance.

8. Themoreaffordablealcoholis–theloweritsprice,orthemoredisposableincomepeoplehave– themore it isconsumedandthegreater the levelof relatedharminbothhigh-andlow-incomecountries.Modellingshowsthatsettingaminimumpriceperunitgramofalcoholreducesconsumptionandalcohol-relatedharm.Bothpriceincreasesandsettingaminimumpriceareestimatedtohaveamuchgreaterimpactondrinkerswhoconsumemorethanonthosewhoconsumeless.Naturalexperimentsconsequenttoeconomictreatieshaveshownthat,asalcoholtaxesandpriceswereloweredtooffsetcross-bordertrade,sosales,alcoholconsumptionandalcohol-relatedharmhaveusuallyincreased.

9. Someevidenceindicatesthatsafety-orienteddesignofthepremiseswherealcoholicbeveragesareservedandtheemploymentofsecuritystaff,inparttoreducepotentialviolence,canreducealcohol-relatedharm.Eventhoughinterventionsmodifyingthebehaviour of those serving alcohol appear ineffective on their own, they may beeffectivewhenbackedupbyenforcementbypoliceorliquor-licenceinspectors.Harm-reductionapproachcanbesupportedbystrongerpromotionofproductswithaloweralcoholconcentration,togetherwithmandatedhealthwarningsonalcohol-productcontainers.Althoughsuchwarningsdonotleadtochangesindrinkingbehaviour,theydoimpactonintentionstochangedrinkingpatternsandremindconsumersabouttherisksassociatedwithalcoholconsumption.


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10.Goodscientific,technicalandinstitutionalcapacityshouldbeinplacefortheplanningandimplementationofappropriatenational,regionalandinternationalmeasures.Goodmarketknowledgeandinsightintothecompositionandproductionofinformalorillicitalcoholarealso important,coupledwithanappropriate legislative frameworkandactiveenforcement.Controlmeasuresshouldbecombinedwithawarenessraisingandcommunitymobilization.

11.AbibliographyofthemainsourcesofevidencewillbemadeavailableontheWHOwebsite.1

1 http://www.who.int/substance_abuse/activities/globalstrategy/en/index.html (accessed 20 November 2009).

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The1Sixty-firstWorldHealthAssembly,

Havingconsideredthereportonstrategiestoreducetheharmfuluseofalcohol1andthefurtherguidanceonstrategiesandpolicyelementoptionstherein;

ReaffirmingresolutionsWHA32.40ondevelopmentoftheWHOprogrammeonalcohol-related problems, WHA36.12 on alcohol consumption and alcohol-related problems,developmentofnationalpoliciesandprogrammes,WHA42.20onpreventionandcontrolofdrugandalcoholabuseandWHA57.16onhealthpromotionandhealthylifestyles;

RecallingresolutionWHA58.26onpublic-healthproblemscausedbyharmfuluseofalcoholanddecisionWHA60(10);

NotingthereportbytheSecretariatpresentedtotheSixtiethWorldHealthAssemblyonevidence-basedstrategiesandinterventionstoreducealcohol-relatedharm,includingtheaddendumonaglobalassessmentofpublichealthproblemscausedbyharmfuluseofalcohol;2

NotingthesecondreportoftheWHOExpertCommitteeonProblemsRelatedtoAlcoholConsumption3andacknowledgingthateffectivestrategiesandinterventionsthattargetthegeneralpopulation,vulnerablegroups,individualsandspecificproblemsareavailableandshouldbeoptimallycombinedinordertoreducealcohol-relatedharm;

Mindfulthatsuchstrategiesandinterventionsmustbeimplementedinawaythattakesintoaccountdifferentnational,religiousandculturalcontexts,includingnationalpublichealth problems, needs and priorities, and differences in Member States’ resources,capacitiesandcapabilities;

Deeplyconcernedbytheextentofpublichealthproblemsassociatedwithharmfuluseofalcohol, including injuriesandviolence,andpossible linkstocertaincommunicablediseases, thereby adding to the disease burden, in both developing and developedcountries;

Mindfulthatinternationalcooperationinreducingpublichealthproblemscausedbytheharmfuluseofalcoholisintensifying,andoftheneedtomobilizethenecessarysupportatglobalandregionallevels,

1 Document A61/13.

2 Documents A60/14 and A60/14 Add.1.

3 WHO Technical Report Series, No. 944, 2007.

ANNEXIIIRESOLUTIONOFTHESIXTY-FIRSTWORLDHEALTHASSEMBLY(MAY2008) WHA61.4 STRATEGIES TO REDUCE THE HARMFUL USE OF ALCOHOL


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1. URGESMemberStates:

(1) tocollaboratewiththeSecretariatindevelopingadraftglobalstrategyonharmfuluseofalcoholbasedonallevidenceandbestpractices,inordertosupportandcomplementpublichealthpoliciesinMemberStates,withspecialemphasisonanintegratedapproachtoprotectat-riskpopulations,youngpeopleandthoseaffectedbyharmfuldrinkingofothers;

(2) to develop, in interaction with relevant stakeholders, national systems formonitoringalcohol consumption, itshealth andsocial consequencesand thepolicyresponses,andtoreportregularlytoWHO’sregionalandglobalinformationsystems;

(3) to consider strengthening national responses, as appropriate and wherenecessary,topublichealthproblemscausedbyharmfuluseofalcohol,onthebasis of evidence on effectiveness and cost-effectiveness of strategies andinterventionstoreducealcohol-relatedharmgeneratedindifferentcontexts;


(1) toprepareadraftglobalstrategytoreduceharmfuluseofalcoholthatisbasedonallavailableevidenceandexistingbestpracticesandthataddressesrelevantpolicy options, taking into account different national, religious and culturalcontexts, includingnational publichealthproblems,needsandpriorities, anddifferencesinMemberStates’resources,capacitiesandcapabilities;

(2) toensurethatthedraftglobalstrategywillincludeasetofproposedmeasuresrecommendedforStatestoimplementatthenationallevel,takingintoaccountthenationalcircumstancesofeachcountry;

(3) toincludefulldetailsofongoingandemergingregional,subregionalandnationalprocessesasvitalcontributionstoaglobalstrategy;

(4) to collaborate and consult with Member States, as well as consult withintergovernmental organizations, health professionals, nongovernmentalorganizationsandeconomicoperatorsonwaystheycouldcontributetoreducingharmfuluseofalcohol;

(5) tosubmittotheSixty-thirdWorldHealthAssembly,throughtheExecutiveBoard,adraftglobalstrategytoreduceharmfuluseofalcohol.

(Eighth plenary meeting, 24 May 2008 –Committee A, second report)

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TheFifty-eighthWorldHealthAssembly,

Havingconsideredthereportonpublichealthproblemscausedbyharmfuluseofalcohol;1

ReaffirmingresolutionsWHA32.40ondevelopmentoftheWHOprogrammeonalcohol-related problems, WHA36.12 on alcohol consumption and alcohol-related problems:developmentofnationalpoliciesandprogrammes,WHA42.20onpreventionandcontrolofdrugandalcoholabuse,WHA55.10onmentalhealth:respondingtothecallforaction,WHA57.10 on road safety and health, WHA57.16 on health promotion and healthylifestyles,andWHA57.17ontheGlobalStrategyonDiet,PhysicalActivityandHealth;

RecallingThe world health report 2002,whichindicatedthat4%oftheburdenofdiseaseand 3.2% of all deaths globally were attributed to alcohol, and that alcohol was theforemostrisktohealthinlow-mortalitydevelopingcountriesandthethirdindevelopedcountries;2

Recognizingthatthepatterns,contextandoveralllevelofalcoholconsumptioninfluencethehealthofthepopulationasawhole,andthatharmfuldrinkingisamongtheforemostunderlying causes of disease, injury, violence – especially domestic violence againstwomenandchildren–disability,socialproblemsandprematuredeaths,isassociatedwithmentalill-health,hasaseriousimpactonhumanwelfareaffectingindividuals,families,communitiesandsocietyasawhole,andcontributestosocialandhealthinequalities;

Emphasizingtheriskofharmduetoalcoholconsumption,particularlyinthecontextofdrivingavehicle,attheworkplace,andduringpregnancy;

Alarmedbytheextentofpublichealthproblemsassociatedwithharmfulconsumptionofalcoholandthetrendsinhazardousdrinking,particularlyamongyoungpeople,inmanyMemberStates;

Recognizingthatintoxicationwithalcoholisassociatedwithhigh-riskbehaviours,includingtheuseofotherpsychoactivesubstancesandunsafesex;

Concernedabouttheeconomiclosstosocietyresultingfromharmfulalcoholconsumption,includingcoststothehealth,socialwelfareandcriminaljusticesystems,lostproductivity,andreducedeconomicdevelopment;

Recognizing the threatsposed topublichealthby the factors thathavegiven rise toincreasingavailabilityandaccessibilityofalcoholicbeveragesinsomeMemberStates;

1 Document A58/18.

2 The world health report 2002. Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.

ANNEXIVRESOLUTIONOFTHEFIFTY-EIGHTWORLDHEALTHASSEMBLY(MAY2005)WHA58.26 PUBLIC-HEALTH PROBLEMS CAUSED BY HARMFUL USE OF ALCOHOL


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Notingthegrowingbodyofevidenceoftheeffectivenessofstrategiesandmeasuresaimedatreducingalcohol-relatedharm;

Mindfulthatindividualsshouldbeempoweredtomakepositive,life-changingdecisionsforthemselvesonmatterssuchasconsumptionofalcohol;

Taking due consideration of the religious and cultural sensitivities of a considerablenumberofMemberStateswithregardtoconsumptionofalcohol,andemphasizingthatuseoftheword“harmful”inthisresolutionrefersonlytopublic-healtheffectsofalcoholconsumption,withoutprejudicetoreligiousbeliefsandculturalnormsinanyway,

1. REQUESTSMemberStates:

(1) todevelop, implementandevaluateeffectivestrategiesandprogrammesforreducingthenegativehealthandsocialconsequencesofharmfuluseofalcohol;

(2) toencouragemobilizationandactiveandappropriateengagementofallconcernedsocialandeconomicgroups,includingscientific,professional,nongovernmentalandvoluntarybodies,theprivatesector,civilsocietyandindustryassociations,inreducingharmfuluseofalcohol;

(3) to support the work requested of the Director-General below, including, ifnecessary,throughvoluntarycontributionsbyinterestedMemberStates;


(1) tostrengthentheSecretariat’scapacitytoprovidesupporttoMemberStatesinmonitoringalcohol-relatedharmandtoreinforcethescientificandempiricalevidenceofeffectivenessofpolicies;

(2) to consider intensifying international cooperation in reducing public-healthproblemscausedbytheharmfuluseofalcohol,andtomobilizethenecessarysupportatglobalandregionallevels;

(3) to consider also conducting further scientific studies pertaining to differentaspectsofpossibleimpactofalcoholconsumptiononpublichealth;

(4) toreporttotheSixtiethWorldHealthAssemblyonevidence-basedstrategiesand interventions to reduce alcohol-related harm, including a comprehensiveassessmentofpublic-healthproblemscausedbyharmfuluseofalcohol

(5) todrawuprecommendationsforeffectivepoliciesandinterventionstoreducealcohol-relatedharm,andtodeveloptechnicaltoolsthatwillsupportMemberStatesinimplementingandevaluatingrecommendedstrategiesandprogrammes;

(6) to strengthen global and regional information systems through furthercollectionandanalysisofdataonalcoholconsumptionanditshealthandsocialconsequences,providing technicalsupport toMemberStatesandpromotingresearchwheresuchdataarenotavailable;

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(7) topromoteandsupportglobalandregionalactivitiesaimedatidentifyingandmanagingalcohol-usedisordersinhealth-caresettingsandenhancingthecapacityofhealth-careprofessionalstoaddressproblemsoftheirpatientsassociatedwithharmfulpatternsofalcoholconsumption;

(8) to collaborate with Member States, intergovernmental organizations, healthprofessionals,nongovernmentalorganizationsandotherrelevantstakeholderstopromotetheimplementationofeffectivepoliciesandprogrammestoreduceharmfulalcoholconsumption;

(9) toorganizeopenconsultationswithrepresentativesoftheindustry,agricultureandtradesectorsinordertolimitthehealthimpactofharmfulalcoholconsumption;

(10) toreportthroughtheExecutiveBoardtotheSixtiethWorldHealthAssemblyonprogressmadeinimplementationofthisresolution.

(Ninth plenary meeting, 25 May 2005 –Committee B, fourth report)


use of alcohol

alcohol

alcoholContactManagement of Substance AbuseDepartment of Mental Health and Substance Abuse20, Avenue Appia1211 Geneva 27SwitzerlandTel: + 41 22 791 21 11Email: [email protected]/substance_abuse

The harmful use of alcohol is

the third leading risk factor

for premature deaths and

disabilities in the world. It is

estimated that 2.5 million people

worldwide died of alcohol-

related causes in 2004, including

320 000 young people between

15 and 29 years of age.

ISBN 978 92 4 159993 1

EXIT THE MAZE OFHARMFUL SUBSTANCE USEFOR BETTER GLOBAL HEALTH

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