The World Health Organization (WHO) conducted a survey of academic and research institutions, Non-Governmental Organisations and industry representatives to express views and opinions on the problems related to alcohol consumption. IHRA was one of the hundreds of associations to submit as part of this survey. Also, the WHO have released long-awaited clinical protocols relating to Hepatitis.
The alcohol stakeholders survey was conducted to provide the WHO with more information about how alcohol related problems were perceived around the world. This is in response to a 2005 World Health Assembly resolution, which calls upon the WHO to draw up recommendations for effective alcohol harm reduction policies and interventions in time for the 2007 World Health Assembly. So far, the WHO has consulted key stakeholders through meetings with civil society groups, scientists and industry representatives and selected representatives (including IHRA) have also been invited to present their views to the WHO this month.
The survey asked groups to write up to 300 words on (1) the magnitude of health problems related to alcohol consumption, (2) effective interventions to reduce health problems related to alcohol consumption and (3) any additional comments. After consultations between the IHRA Executive Director, IHRA Executive Committee and IHRA Communications and Project Development Officer, the organisation’s response was as follows:
(1) As WHO is fully aware, there are numerous health problems associated with the consumption of alcohol, even though the majority of people consume alcohol in a responsible way. These can be broadly divided into chronic, longer-term health problems and acute, shorter-term harms and risks.
The long-term health problems related to alcohol consumption are many and they are generally the highest profile and costliest harms in terms of treatment, impact, morbidity and mortality. The treatment of these problems is a major burden for healthcare services and governments globally. The prevention of these harms is often targeted at the population-level (due to the associations between long-term health problems and per capita alcohol consumption), but certain sub-populations and patterns of drinking are at much higher risk of alcohol harm (such as binge-drinkers, young people, pregnant women, chronic drinkers, indigenous populations and the homeless). Prevention should be targeted to reflect this imbalance in risk.
The short-term health problems associated with alcohol consumption include accidents, falls, poisoning or overdose, violence and suicide. Generally, these receive less attention than long-term health problems (including in WHO literature) and are often not adequately measured. However, they are sufficiently costly (both in terms of lives and healthcare resources) to warrant significant prevention interventions. Prevention measures should be targeted at vulnerable sub-populations, drinking behaviours and drinking contexts. These short-term health problems are more responsive to changes in drinking behaviour and are therefore good indicators of change.
Importantly, however, the harms that alcohol can cause go beyond medical problems and include a variety of problems related to social nuisance and public order. Prevention measures and policies (national and international) must also consider the social, community, economic and criminal impacts.
(2) For many decades, supply and demand reduction measures (such as taxation increases and restrictions in availability and licensing) have been promoted as the most effective response to alcohol-related problems. This is based on evidence that increases in per capita alcohol consumption are generally accompanied by increasing alcohol-related problems and vice versa. However, such measures are politically, economically or ideologically beyond the reach of many societies and nations across the world (especially in the developing world). They also fail to take in the importance of non-commercial alcohol. Further, focussing only on supply and demand can have the negative impact that it absolves people at a local level from engaging in action to reduce alcohol-related harms. Hence the national and local repose to alcohol needs to be significantly broader.
In recent years, the emphasis has changed slightly towards measures that attempt to modify hazardous drinking contexts, behaviours and patterns (often alongside measures that attempt to reduce per capita consumption). This “harm reduction” approach involves targeting interventions at specific groups within the general population (such as binge drinkers or pregnant women) or targeted at certain drinking contexts (high risk drinking venues) or high-risk behaviours. There is a growing body of evidence in support of interventions at the local, city level.
Local alcohol harm reduction measures must include all local stakeholders and be cross-sectoral in order to foster enthusiasm and a proactive culture. It is then essential to quickly assess the local situation – who drinks, where, when, why and at what cost? The alcohol field needs to develop capacity to undertake local “rapid assessments” that can provide the evidence of need for a comprehensive package of interventions, such as server training, designated driver schemes, safer (shatterproof) glasses in bars, safer better designed drinking environments and the enforcement of existing licensing laws.
(3) Like many commodities, alcohol can be enjoyed and misused, benefiting as well as harming those who consume it. When attempting to reduce the health problems associated with alcohol consumption, it is essential to gain a full understanding of the patterns, environments and contexts of drinking. The harms of alcohol do not apply to entire populations in equal measure – there are groups at higher risks than others. Essentially, however, these harms are preventable. Long-term objectives are to change the culture of drinking: but in the short term there are practical measures that can be implemented to reduce the impact on individuals and communities.
Harm reduction is not a new concept in the alcohol field. The notion of ‘making the world a safe place for drunks’ in the 1960s was based on the recognition that, despite valiant attempts to eradicate public drunkenness, there would always be some individuals who would end up intoxicated in public. Prudence dictated the need to reduce the harm these individuals caused to themselves and their communities. Harm reduction approaches to alcohol complement supply and demand reduction measures. Harm reduction acts to provide more pragmatic, targeted and locally defined approaches to the extensive problems that alcohol can cause.
The submitted opinions and views will be gathered in a forthcoming WHO report on the health problems related to alcohol consumption. In 2007, the WHO will be asked to present to the World Health Assembly on the subject of evidence-based strategies and interventions to reduce alcohol-related harm.
