Helsinki, August 29, 2011, BSPC ESC Alcohol Policy International perspective Mr.Bernt Bull, Chairman ASA EG, NDPHS

Main killers in the WHO European Region

Deaths in EURO due to selected risk factors in 2004

Global High Level Ministerial Conference on NCD

Per cent of global DALY

Alcohol consumption Two main dimensions affect health: ● Average of volume ● Patterns of drinking especially binge drinking Estimated deaths attributable to alcohol a year in Europe (2004). Estimated 17 mio years lost due to disability and death (DALY) a year in Europe (2004). In Europe, 6.5% of deaths and 11.4% of DALY’s were attributed to alcohol use. Globally 3.8% of deaths and 4.6% of DALY’s were attributed to alcohol use.

Causal model of alcohol consumption, intermediate mechanisms, and long-term consequences

Alcohol related disease and injury Chronic disease: ● Cancer: Mouth & oropharyngeal cancer, Esophageal cancer, Liver cancer, Female breast cancer, other neoplasms ● Neuropsychiatric diseases: Alcohol use disorders, unipolar major depression, epilepsy ● Diabetes ● Cardiovascular diseases: Hypertensive diseases, ischemic heart disease, stroke ● Gastrointestinal diseases: Liver cirrhosis ● Conditions arising during perinatal period: Low birth weight Injury: ● Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuries ● Intentional injury: Self-inflicted injuries, homicide, other intentional injuries

Absolute annual risk of death from alcohol-related diseases Source: Rehm et al (2010).

Total alcohol consumption in Europe (litres of pure alcohol)

Adult per capita consumption total (recorded and unrecorded) average

Adult per capita consumption total, average (drinkers only)

The impact of alcohol on societal health Based on the results of 21 European studies, the total tangible cost of alcohol to the European Union as it existed in 2003, was estimated to be €125 billion (range of estimates: €79–220 billion), This is equivalent to 1.3% of the gross domestic product (0.9–2.4%). Actual spending on alcohol-related problems accounts for €66 billion of this, while potential production not realized due to absenteeism, unemployment and premature mortality accounts for a further €59 billion

Alcohol policy – what works? Degree of evidence Evidence of action that reduces alcohol- related harm Evidence of action that does not reduce alcohol-related harm ConvincingAlcohol taxes Government monopolies for retail sale Restrictions on outlet density Restrictions on days and hours of sale Minimum purchase age Lower legal BAC levels for driving Random breath-testing Brief advice programmes Treatment for alcohol use disorders ProbableA minimum price per gram of alcohol Restrictions on the volume of commercial communications Enforcement of restrictions of sales to intoxicated and under-age people Lower taxes to manage cross-border trade Training of alcohol servers Designated driver campaigns Consumer labelling and warning messages Public education campaigns Limited- suggestive Suspension of driving licences Alcohol locks Workplace programmes Community-based programmes Campaigns funded by the alcohol industry

Objectives Building on the previous European Alcohol Action Plans, the five main objectives of the present Action Plan are aligned with those of the Global Strategy to: ● Raise awareness of the magnitude and nature of the health, social and economic burdens due to harmful use of alcohol, and to foster increased commitment by governments to act to address such burdens; ● Strengthen and disseminate the knowledge base on the size and determinants of alcohol-related harm and on effective interventions to reduce and prevent such harm; ● Increase technical support to, and enhance the capacity of, Member States for reducing the harm done by alcohol, and managing and treating alcohol-use disorders and associated health conditions; ● Strengthen partnerships and better coordination among stakeholders and increase mobilization of resources required for concerted action to reduce the harmful use of alcohol; and ● Improve systems for monitoring and surveillance at sub-national, national and European levels, and to ensure more effective dissemination and application of information for advocacy, policy development and evaluation.

Given the magnitude and the complexity of the problem, concerted efforts must be in place to support Countries in the challenges they face at the national level. International coordination and collaboration create the synergies that are needed and provide increased leverage for Countries to implement evidence-based Measures Raise Regional awareness of the magnitude and nature of the health, social and economic problems caused by harmful use of alcohol, and increased commitment by governments to act to address the harmful use of alcohol Sustainable action requires strong leadership and a solid base of awareness and political will and commitment To build political and community consensus about future directions in policy which target alcohol abuse and deals with its impact.