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Global strategy toreduce the harmfuluse of alcohol


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Global strategy toreduce the harmfuluse of alcohol


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WHO Library Cataloguing-in-Publication Data

Global strategy to reduce the harmul use o alcohol.

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

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

World Health Organization 2010

All rights reserved. Publications o the World Health Organization can be obtained rom WHO Press, World Health Organization, 20 Avenue Appia,1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; ax: +41 22 791 4857; e-mail: [email protected]). Requests or permission to reproduceor translate WHO publications whether or sale or or noncommercial distribution should be addressed to WHO Press, at the above address(ax: +41 22 791 4806; e-mail: [email protected]).

The designations employed and the presentation o the material in this publication do not imply the expression o any opinion whatsoever onthe part o the World Health Organization concerning the legal status o any country, territory, city or area or o its authorities, or concerning thedelimitation o its rontiers or boundaries. Dotted lines on maps represent approximate border lines or which there may not yet be ull agreement.

The mention o specic companies or o certain manuacturers products does not imply that they are endorsed or recommended by the WorldHealth Organization in preerence to others o a similar nature that are not mentioned. Errors and omissions excepted, the names o proprietaryproducts are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to veriy the inormation contained in this publication. However, thepublished material is being distributed without warranty o any kind, either expressed or implied. The responsibility or the interpretation and useo the material lies with the reader. In no event shall the World Health Organization be liable or damages arising rom its use.

Design and layout: LIV Com Srl, Le Mont-sur-Lausanne, Switzerland.

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 29

I. ReportbytheSecretariattotheSixty-thirdWorldHealthAssembly

(May2010) 29

II. Evidencefortheeffectivenessandcost-effectivenessofinterventions

toreduceharmfuluseofalcohol 31

III. ResolutionoftheSixty-rstWorldHealthAssembly(May2008)

WHA61.4Strategiestoreducetheharmfuluseofalcohol 34

IV. ResolutionoftheFifty-eighthWorldHealthAssembly(May2005)

WHA58.26Public-healthproblemscausedbyharmfuluseofalcohol 36

TABLE OF CONTENTS


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GLOBAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL

moveforward,WHOwillcontinuetoinvolverelevantstakeholdersineffortstoachieve

thestrategygoalsandobjectives.

Iamcondentthatbyworkingtogethertowardstheobjectivesoftheglobalstrategy,we

canreducethenegativehealthandsocialconsequencesoftheharmfuluseofalcohol

andmakeourcommunitieshealthier,saferandmorepleasantplacesinwhichtolive,

workandspendourleisuretime.

DrAlaAlwan

AssistantDirector-General

NoncommunicableDiseasesandMentalHealth

WorldHealthOrganization


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THE GLOBAL STRATEGY TO REDUCE THEHARMFUL USE OF ALCOHOL1

Setting the scene

1. Theharmfuluseofalcohol2hasaseriouseffectonpublichealthandisconsidered

tobeoneofthemainriskfactorsforpoorhealthglobally.Inthecontextofthisdraft

strategy,theconceptoftheharmfuluseofalcohol 3isbroadandencompassesthedrinkingthatcausesdetrimentalhealthandsocialconsequencesforthedrinker,the

peoplearoundthedrinkerandsocietyatlarge,aswellasthepatternsofdrinkingthat

areassociatedwithincreasedriskofadversehealthoutcomes.Theharmfuluseof

alcoholcompromisesbothindividualandsocialdevelopment.Itcanruinthelivesof

individuals,devastatefamilies,anddamagethefabricofcommunities.

2. Theharmfuluseofalcoholisasignicantcontributortotheglobalburdenofdisease

andislistedasthethirdleadingriskfactorforprematuredeathsanddisabilitiesinthe

world.4Itisestimatedthat2.5millionpeopleworldwidediedofalcohol-relatedcauses

in2004,including320000youngpeoplebetween15and29yearsofage.Harmful

useofalcoholwasresponsiblefor3.8%ofalldeathsintheworldin2004and4.5%

oftheglobalburdenofdiseaseasmeasuredindisability-adjustedlifeyearslost,even

whenconsiderationisgiventothemodestprotectiveeffects,especiallyoncoronary

heartdisease,oflowconsumptionofalcoholforsomepeopleaged40yearsorolder.

3. Harmfuldrinkingisamajoravoidableriskfactorforneuropsychiatricdisordersand

othernoncommunicablediseasessuchascardiovasculardiseases,cirrhosisofthe

liverandvariouscancers.Forsomediseasesthereisnoevidenceofathresholdeffect

intherelationshipbetweentheriskandlevelofalcoholconsumption.Theharmful

useof alcoholis also associatedwith several infectiousdiseases likeHIV/AIDS,

tuberculosisandpneumonia.Asignicantproportionofthediseaseburdenattributable

toharmfuldrinkingarisesfromunintentionalandintentionalinjuries,includingthose

duetoroadtrafccrashesandviolence,andsuicides.Fatalinjuriesattributabletoalcoholconsumptiontendtooccurinrelativelyyoungpeople.

4. Thedegreeofriskforharmfuluseofalcoholvarieswithage,sexandotherbiological

characteristicsoftheconsumeraswellaswiththesettingandcontextinwhichthe

drinkingtakesplace.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 alegal denition of alcoholic beverage a threshold for content of ethanol by volume in a beverage is set at 0.5% or 1.0%. The predominant categoriesof 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 normsin 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 andburden of disease attributable to selected major risk factors. Geneva, World Health O rganization, 2009.


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susceptibilityto the toxic,psychoactiveand dependence-producingproperties of

ethanol.Atthesametimelowriskpatternsofalcoholconsumptionattheindividual

levelmaynotbeassociatedwithoccurrenceorsignicantlyincreasedprobabilityof

negativehealthandsocialconsequences.

5. Asubstantialscienticknowledgebaseexistsforpolicy-makersontheeffectiveness

andcost-effectivenessofstrategiesandinterventionstopreventandreducealcohol-

relatedharm.1Althoughmuchoftheevidencecomesfromhigh-incomecountries,

theresultsofmeta-analysesandreviewsoftheavailableevidence 2providesufcient

knowledgetoinformpolicyrecommendationsintermsofcomparativeeffectiveness

andcost-effectivenessofselectedpolicymeasures.Withbetterawareness,there

areincreasedresponsesatnational,regionalandgloballevels.However,thesepolicy

responsesareoftenfragmentedanddonotalwayscorrespondtothemagnitudeof

theimpactonhealthandsocialdevelopment.

Challenges and opportunities6. Thepresentcommitmenttoreducingtheharmfuluseofalcoholprovidesagreat

opportunityforimprovinghealthandsocialwell-beingandforreducingtheexisting

alcohol-attributablediseaseburden.However,thereareconsiderablechallengesthat

havetobetakenintoaccountinglobalornationalinitiativesorprogrammes.These

includethefollowing:

(a) Increasingglobalactionandinternationalcooperation.Thecurrentrelevant

health,culturalandmarkettrendsworldwidemeanthatharmfuluseofalcohol

willcontinuetobea globalhealth issue.Thesetrendsshouldberecognized

andappropriateresponsesimplementedatalllevels.Inthisrespect,thereisa

needforglobalguidanceandincreasedinternationalcollaborationtosupportand

complementregionalandnationalactions.

(b) Ensuringintersectoralaction. Thediversityofalcohol-relatedproblemsand

measuresnecessaryto reduce alcohol-relatedharmpoints to theneedfor

comprehensiveactionacrossnumeroussectors.Policiestoreducetheharmful

useofalcoholmustreachbeyondthehealthsector,andappropriatelyengage

suchsectorsasdevelopment,transport,justice,socialwelfare,scalpolicy,trade,

agriculture,consumerpolicy,educationandemployment,aswellascivilsociety

andeconomicoperators.

(c) Accordingappropriateattention. Preventingandreducingharmfuluseofalcoholisoftengivenalowpriorityamongdecision-makersdespitecompellingevidence

of itsseriouspublichealtheffects.In addition, there isacleardiscrepancy

betweentheincreasingavailabilityandaffordabilityofalcoholbeveragesinmany

developingandlow-andmiddle-incomecountriesandthosecountriescapability

andcapacitytomeettheadditionalpublichealthburdenthatfollows.Unless

thisproblemisgiventheattentionitdeserves,thespreadofharmfuldrinking

practicesandnormswillcontinue.

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 Ofce for Europe, 2009.


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(d) Balancingdifferentinterests.Production,distribution,marketingandsalesof

alcohol createemploymentandgenerateconsiderableincome foreconomic

operatorsand tax revenueforgovernments atdifferentlevels.Publichealth

measurestoreduceharmfuluseofalcoholaresometimesjudgedtobeinconict

withothergoals likefreemarketsandconsumerchoiceandcanbeseenas

harmingeconomicinterestsandreducinggovernmentrevenues.Policy-makers

facethechallengeofgivinganappropriateprioritytothepromotionandprotection

ofpopulationhealthwhiletakingintoaccountothergoals,obligations,including

internationallegalobligations,andinterests.Itshouldbenotedinthisrespect

thatinternationaltradeagreementsgenerallyrecognizetherightofcountriesto

takemeasurestoprotecthumanhealth,providedthatthesearenotappliedina

mannerwhichwouldconstituteameansofunjustiableorarbitrarydiscrimination

ordisguisedrestrictionstotrade.Inthisregard,national,regionalandinternational

effortsshouldtakeintoaccounttheimpactofharmfuluseofalcohol.

(e) Focusingonequity.Population-wideratesofdrinkingofalcoholicbeveragesare

markedlylowerinpoorersocietiesthaninwealthierones.However,foragivenamountofconsumption,poorerpopulationsmayexperiencedisproportionately

higher levelsofalcohol-attributable harm.There isagreat needto develop

and implementeffectivepoliciesandprogrammesthat reducesuch social

disparitiesbothinsideacountryandbetweencountries.Suchpoliciesarealso

neededinordertogenerateanddisseminatenewknowledgeaboutthecomplex

relationshipbetweenharmfulconsumptionof alcoholand socialandhealth

inequity,particularlyamongindigenouspopulations,minority ormarginalized

groupsandindevelopingcountries.

(f) Consideringthecontextinrecommendingactions.Muchofthepublished

evidenceofeffectivenessofalcohol-relatedpolicyinterventionscomesfromhigh-

incomecountries,andconcernshavebeenexpressedthattheireffectiveness

dependsoncontextandmaynotbe transferrabletoothersettings.However,

manyinterventionstoreduceharmfuluseofalcoholhavebeenimplementedina

widevarietyofculturesandsettings,andtheirresultsareoftenconsistentandin

linewiththeunderpinningtheoriesandevidencebaseaccumulatedinothersimilar

publichealthareas.Thefocusforthosedevelopingandimplementingpolicies

shouldbeonappropriatetailoringofeffectiveinterventionstoaccommodatelocal

contextsandonappropriatemonitoringandevaluationtoprovidefeedbackfor

furtheraction.

(g) Strengtheninginformation.Systemsforcollecting,analysinganddisseminating

dataonalcoholconsumption,alcohol-relatedharmandpolicyresponseshavebeendevelopedbyMemberStates, theWHOSecretariat, andsomeother

stakeholders.Therearestillsubstantialgapsinknowledgeanditisimportantto

sharpenthefocusoninformationandknowledgeproductionanddissemination

forfurther developments in this area,especially indevelopingandlow-and

middle-incomecountries.TheWHOGlobalInformationSystemonAlcoholand

Healthandintegratedregionalinformationsystemsprovidethemeanstomonitor

betterprogressmadeinreducingharmfuluseofalcoholattheglobalandregional

levels.


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Aims and objectives

7. Nationalandlocaleffortscanproducebetter resultswhentheyaresupportedby

regionalandglobalactionwithinagreedpolicyframes.Thusthepurposeoftheglobal

strategyistosupportandcomplementpublichealthpoliciesinMemberStates.

8. Thevisionbehindtheglobalstrategyis improvedhealthandsocialoutcomesfor

individuals, familiesand communities,withconsiderablyreducedmorbidityand

mortalityduetoharmfuluseofalcoholandtheirensuingsocialconsequences.Itis

envisagedthattheglobalstrategywillpromoteandsupportlocal,regionalandglobal

actionstopreventandreducetheharmfuluseofalcohol.

9. Theglobalstrategyaimstogiveguidanceforactionatalllevels;tosetpriorityareasfor

globalaction;andtorecommendaportfolioofpolicyoptionsandmeasuresthatcould

beconsideredforimplementationandadjustedasappropriateatthenationallevel,

takingintoaccountnationalcircumstances,suchasreligiousandculturalcontexts,nationalpublichealthpriorities,aswellasresources,capacitiesandcapabilities.

10. Thestrategyhasveobjectives:

(a) raisedglobalawarenessofthemagnitudeandnatureofthehealth,socialand

economicproblemscausedbyharmfuluseofalcohol,andincreasedcommitment

bygovernmentstoacttoaddresstheharmfuluseofalcohol;

(b) strengthenedknowledgebaseonthemagnitudeanddeterminantsofalcohol-

relatedharmandoneffectiveinterventionstoreduceandpreventsuchharm;

(c) increasedtechnicalsupportto,andenhancedcapacityof,MemberStatesfor

preventingtheharmfuluseofalcoholandmanagingalcohol-usedisordersand

associatedhealthconditions;

(d) strengthenedpartnershipsandbetter coordinationamongstakeholdersand

increasedmobilizationofresourcesrequiredforappropriateandconcertedaction

topreventtheharmfuluseofalcohol;

(e) improvedsystemsformonitoringandsurveillanceatdifferentlevels,andmore

effective disseminationandapplicationof information for advocacy, policy

developmentandevaluationpurposes.

11. Theharmfuluseofalcohol andits related publichealth problemsareinuenced

bythegenerallevelofalcoholconsumptioninapopulation,drinkingpatternsand

localcontexts.Achievingtheveobjectiveswillrequireglobal,regionalandnational

actionsonthelevels,patternsandcontextsofalcoholconsumptionandthewider

socialdeterminantsofhealth.Specialattentionneedstobegiventoreducingharm

topeopleotherthanthedrinkerandtopopulationsthatareatparticularriskfrom

harmfuluseofalcohol,suchaschildren,adolescents,womenofchild-bearingage,

pregnantandbreastfeedingwomen,indigenouspeoplesandotherminoritygroups

orgroupswithlowsocioeconomicstatus.

AIMS AND OBJECTIVES


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Guiding principles

12. Theprotectionofthehealthofthepopulationbypreventingandreducingtheharmful

useofalcohol isapublichealthpriority.Thefollowingprincipleswill guide the

developmentandimplementationofpoliciesatalllevels;theyreectthemultifaceted

determinantsofalcohol-relatedharmandtheconcertedmultisectoralactionsrequired

toimplementeffectiveinterventions.

(a) Public policiesandinterventionsto preventand reducealcohol-related harm

shouldbeguidedandformulatedbypublichealthinterestsandbasedonclear

publichealthgoalsandthebestavailableevidence.

(b) Policies should beequitableandsensitive tonational,religiousandcultural

contexts.

(c) Allinvolvedpartieshavetheresponsibilitytoactinwaysthatdonotunderminetheimplementationofpublicpoliciesandinterventionstopreventandreduce

harmfuluseofalcohol.

(d) Publichealthshouldbegivenproperdeferenceinrelationtocompetinginterests

andapproachesthatsupportthatdirectionshouldbepromoted.

(e) Protectionofpopulationsat high risk ofalcohol-attributable harmandthose

exposedtotheeffectsofharmfuldrinkingbyothersshouldbeanintegralpart

ofpoliciesaddressingtheharmfuluseofalcohol.

(f) Individualsandfamiliesaffectedbytheharmfuluseofalcoholshouldhaveaccess

toaffordableandeffectivepreventionandcareservices.

(g) Children,teenagersandadultswhochoosenottodrinkalcoholbeverageshave

the right tobe supportedin theirnon-drinkingbehaviour andprotectedfrom

pressurestodrink.

(h) Public policiesandinterventionsto preventand reducealcohol-related harm

shouldencompassallalcoholicbeveragesandsurrogatealcohol.1

National policies and measures13. Theharmfuluseofalcoholcanbereducedifeffectiveactionsaretakenbycountriesto

protecttheirpopulations.MemberStateshaveaprimaryresponsibilityforformulating,

implementing,monitoringandevaluatingpublicpoliciestoreducetheharmfuluse

ofalcohol.Suchpoliciesrequireawiderangeofpublichealth-orientedstrategiesfor

preventionandtreatment.Allcountrieswillbenetfromhavinganationalstrategy

andappropriatelegalframeworkstoreduceharmfuluseofalcohol,regardlessofthe

levelofresourcesinthecountry.Dependingonthecharacteristicsofpolicyoptions

andnationalcircumstances,somepolicyoptionscanbeimplementedbynon-legal

frameworkssuchasguidelinesorvoluntaryrestraints.Successfulimplementationof

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


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measuresshouldbeassistedbymonitoringimpactandcomplianceandestablishing

andimposingsanctionsfornon-compliancewithadoptedlawsandregulations.

14.Sustainedpolitical commitment,effectivecoordination,sustainable fundingand

appropriateengagementofsubnationalgovernmentsaswellasfromcivilsociety

andeconomicoperatorsareessentialforsuccess.Manyrelevantdecision-making

authoritiesshouldbe involved intheformulationand implementationofalcohol

policies,suchashealthministries,transportationauthoritiesortaxationagencies.

Governmentsneedtoestablisheffectiveandpermanentcoordinationmachinery,such

asanationalalcoholcouncil,comprisingseniorrepresentativesofmanyministries

andotherpartners,inordertoensureacoherentapproachtoalcoholpoliciesanda

properbalancebetweenpolicygoalsinrelationtoharmfuluseofalcoholandother

publicpolicygoals.

15.Healthministrieshaveacrucialrolein bringingtogethertheotherministriesand

stakeholdersneededforeffectivepolicydesignandimplementation.Theyshould

alsoensurethatplanningandprovisionofpreventionandtreatmentstrategiesandinterventionsarecoordinatedwiththoseforotherrelatedhealthconditionswithhigh

publichealthprioritysuchasillicitdruguse,mentalillness,violenceandinjuries,

cardiovasculardiseases,cancer,tuberculosisandHIV/AIDS.

16. Thepolicyoptionsandinterventionsavailable fornational actioncanbegrouped

into10 recommended target areas,which should beseenas supportiveand

complementarytoeachother.These10areasare:

(a) leadership,awarenessandcommitment

(b) healthservicesresponse

(c) communityaction

(d) drink-drivingpoliciesandcountermeasures

(e) availabilityofalcohol

(f) marketingofalcoholicbeverages

(g) pricingpolicies

(h) reducingthenegativeconsequencesofdrinkingandalcoholintoxication

(i) reducingthepublichealthimpactofillicitalcoholandinformallyproducedalcohol1

(j) monitoringandsurveillance.

17. ThepolicyoptionsandinterventionsproposedbelowforconsiderationbyMember

Statesforeachofthe10recommendedtargetareasarebasedoncurrentscientic

knowledge,availableevidenceoneffectivenessandcost-effectiveness,experience

andgoodpractices.Notallthepolicyoptionsandinterventionswillbeapplicable

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


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orrelevantforallMemberStatesandsomemaybebeyondavailable resources.

Assuch,themeasuresshouldbeimplementedatthediscretionofeachMember

Statedependingonnational,religiousandculturalcontexts,nationalpublichealth

priorities,andavailableresources,andinaccordancewithconstitutionalprinciples

andinternationallegalobligations.Policymeasuresandinterventionsatthenational

levelwillbesupportedandcomplementedbyglobalandregionaleffortstoreduce

theharmfuluseofalcohol.

Policy options and interventions

Area 1. Leadership, awareness and commitment

18.Sustainableaction requiresstrongleadershipandasolidbaseofawarenessand

politicalwillandcommitment.Thecommitmentsshouldideallybeexpressedthrough

adequatelyfundedcomprehensiveandintersectoralnationalpoliciesthatclarifythecontributions,anddivisionof responsibility,of thedifferentpartnersinvolved.The

policiesmustbebasedonavailableevidenceandtailoredtolocalcircumstances,

withclearobjectives,strategiesandtargets.Thepolicyshouldbeaccompaniedbya

specicactionplanandsupportedbyeffectiveandsustainableimplementationand

evaluationmechanisms.Theappropriateengagementofcivilsocietyandeconomic

operatorsisessential.

19. Forthisareapolicyoptionsandinterventionsinclude:

(a) developingorstrengtheningexisting,comprehensivenationalandsubnational

strategies,plansofactionandactivitiestoreducetheharmfuluseofalcohol;

(b) establishing orappointingamain institutionoragency,asappropriate, tobe

responsibleforfollowingupnationalpolicies,strategiesandplans;

(c) coordinating alcoholstrategieswithwork inotherrelevantsectors, including

cooperationbetweendifferentlevelsofgovernments,andwithotherrelevant

health-sectorstrategiesandplans;

(d) ensuringbroadaccess toinformationand effectiveeducationandpublic

awarenessprogrammesamong alllevelsofsocietyabout thefull rangeof

alcohol-relatedharmexperiencedinthecountryandtheneedfor,andexistence

of,effectivepreventivemeasures;

(e) raisingawarenessofharmtoothersandamongvulnerablegroupscausedby

drinking,avoidingstigmatizationandactivelydiscouragingdiscriminationagainst

affectedgroupsandindividuals.

Area 2. Health services response

20.Healthservicesare central to tackling harmat the individuallevelamong those

withalcohol-usedisordersandotherhealthconditionscausedbyharmfuluseof

alcohol.Healthservicesshouldprovidepreventionandtreatmentinterventionsto

individualsandfamiliesatriskof,oraffectedby,alcohol-usedisordersandassociatedconditions.Anotherimportantroleofhealthservicesandhealthprofessionalsisto


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informsocietiesaboutthepublichealthandsocialconsequencesofharmfuluseof

alcohol,supportcommunitiesintheireffortstoreducetheharmfuluseofalcohol,

andtoadvocateeffectivesocietalresponses.Healthservicesshould reach out

to,mobilizeandinvolveabroadrangeofplayersoutsidethehealthsector.Health

servicesresponseshouldbesufcientlystrengthenedandfundedinawaythatis

commensuratewiththemagnitudeofthepublichealthproblemscausedbyharmful

useofalcohol.


(a) increasingcapacityofhealthandsocialwelfaresystemstodeliverprevention,

treatmentandcareforalcohol-useandalcohol-induceddisordersandco-morbid

conditions,includingsupportandtreatmentforaffectedfamiliesandsupportfor

mutualhelporself-helpactivitiesandprogrammes;

(b) supportinginitiatives forscreeningandbriefinterventionsforhazardousand

harmfuldrinkingatprimaryhealthcareandothersettings;suchinitiativesshouldincludeearlyidenticationandmanagementofharmfuldrinkingamongpregnant

womenandwomenofchild-bearingage;

(c) improvingcapacityforpreventionof, identicationof, and interventions for

individualsandfamilieslivingwithfetalalcoholsyndromeandaspectrumof

associateddisorders;

(d) developmentandeffectivecoordinationofintegratedand/orlinkedprevention,

treatmentandcarestrategiesandservices foralcohol-usedisordersandco-

morbidconditions,includingdrug-usedisorders,depression,suicides,HIV/AIDS

andtuberculosis;

(e) securinguniversal access tohealth including throughenhancing availability,

accessibility and affordability of treatment services for groups of low

socioeconomicstatus;

(f) establishingandmaintainingasystemofregistrationandmonitoringofalcohol-

attributablemorbidityandmortality,withregularreportingmechanisms;

(g) provisionofculturallysensitivehealthandsocialservicesasappropriate.

Area 3. Community action

22. Theimpactofharmfuluseofalcoholoncommunitiescantriggerandfosterlocal

initiativesand solutions to localproblems.Communitiescanbesupportedand

empoweredbygovernmentsandotherstakeholderstousetheirlocalknowledgeand

expertiseinadoptingeffectiveapproachestopreventandreducetheharmfuluseof

alcoholbychangingcollectiveratherthanindividualbehaviourwhilebeingsensitive

toculturalnorms,beliefsandvaluesystems.


(a) supporting rapidassessmentsin order toidentifygapsandpriorityareasfor

interventionsatthecommunitylevel;


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(b) facilitatingincreasedrecognitionofalcohol-relatedharmatthelocalleveland

promotingappropriateeffectiveand cost-effectiveresponses to the local

determinantsofharmfuluseofalcoholandrelatedproblems;

(c) strengtheningcapacityoflocalauthoritiestoencourageandcoordinateconcerted

communityactionbysupportingandpromotingthedevelopmentofmunicipal

policiestoreduceharmfuluseofalcohol,aswellastheircapacitytoenhance

partnershipsandnetworksof community institutionsandnongovernmental

organizations;

(d) providing informationabouteffective community-basedinterventions,and

buildingcapacityatcommunitylevelfortheirimplementation;

(e) mobilizingcommunitiestopreventthesellingofalcoholto,andconsumption

ofalcohol by,under-agedrinkers,and todevelopandsupportalcohol-free

environments,especiallyforyouthandotherat-riskgroups;

(f) providingcommunitycareandsupportforaffectedindividualsandtheirfamilies;

(g) developingorsupportingcommunityprogrammesandpoliciesforsubpopulations

atparticularrisk,suchasyoungpeople,unemployedpersonsandindigenous

populations,specicissuesliketheproductionanddistributionofillicitorinformal-

alcoholbeveragesandeventsatcommunitylevelsuchassportingeventsand

townfestivals.

Area 4. Drink-driving policies and countermeasures

24.Driving underthe influenceof alcohol seriouslyaffects a persons judgment,

coordinationandothermotorfunctions.Alcohol-impaireddrivingisasignicantpublic

healthproblemthataffectsboththedrinkerandinmanycasesinnocentparties.

Strongevidence-basedinterventionsexistforreducingdrink-driving.Strategiesto

reduceharmassociatedwithdrink-drivingshouldincludedeterrentmeasuresthat

aimtoreducethelikelihoodthatapersonwilldriveundertheinuenceofalcohol,

andmeasuresthatcreateasaferdrivingenvironmentinordertoreduceboththe

likelihoodandseverityofharmassociatedwithalcohol-inuencedcrashes.

25. In somecountries,the number of traffic-related injuries involving intoxicated

pedestriansissubstantialandshouldbeahighpriorityforintervention.


(a) introducingandenforcinganupperlimitforbloodalcoholconcentration,witha

reducedlimitforprofessionaldriversandyoungornovicedrivers;

(b) promotingsobrietycheckpointsandrandombreath-testing;

(c) administrativesuspensionofdrivinglicences;

(d) graduatedlicensingfornovicedriverswithzero-tolerancefordrink-driving;

(e) usinganignitioninterlock,inspeciccontextswhereaffordable,toreducedrink-drivingincidents;


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

programmes;

(g) encouragingprovisionofalternativetransportation,includingpublictransportuntil

aftertheclosingtimefordrinkingplaces;

(h) conductingpublicawarenessandinformationcampaignsinsupportofpolicyand

inordertoincreasethegeneraldeterrenceeffect;

(i) runningcarefullyplanned,high-intensity,well-executedmassmediacampaigns

targetedatspecicsituations,suchasholidayseasons,oraudiencessuchas

youngpeople.

Area 5. Availability of alcohol

27.Publichealthstrategiesthatseektoregulatethecommercialorpublicavailabilityof

alcoholthroughlaws,policies,andprogrammesare importantwaystoreducethegenerallevelofharmfuluseofalcohol.Suchstrategiesprovideessentialmeasures

topreventeasyaccesstoalcoholbyvulnerableandhigh-riskgroups.Commercialand

publicavailabilityofalcoholcanhaveareciprocalinuenceonthesocialavailability

ofalcoholandthuscontributetochangingsocialandculturalnormsthatpromotes

harmfuluseofalcohol.Thelevelofregulationontheavailabilityofalcoholwilldepend

onlocalcircumstances,includingsocial,culturalandeconomiccontextsaswellas

existingbindinginternationalobligations.Insomedevelopingandlow-andmiddle-

incomecountries,informalmarketsarethemainsourceofalcoholandformalcontrols

onsaleneedtobecomplementedbyactionsaddressingillicitorinformallyproduced

alcohol.Furthermore,restrictionsonavailabilitythataretoostrictmaypromotethe

developmentof aparallel illicitmarket.Secondarysupply ofalcohol, forexample

fromparentsorfriends,needsalsotobetakenintoconsiderationinmeasureson

theavailabilityofalcohol.


(a) establishing,operatingandenforcinganappropriatesystemtoregulateproduction,

wholesalingandservingofalcoholicbeveragesthatplacesreasonablelimitations

onthedistributionofalcoholandtheoperationofalcoholoutletsinaccordance

withculturalnorms,bythefollowingpossiblemeasures:

(i) introducing,whereappropriate,alicensingsystemonretailsales,orpublic

healthorientedgovernmentmonopolies;

(ii) regulatingthenumberandlocationofon-premiseandoff-premisealcohol

outlets;

(iii) regulatingdaysandhoursofretailsales;

(iv) regulatingmodesofretailsalesofalcohol;

(v) regulatingretailsalesincertainplacesorduringspecialevents;


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(b) establishingan appropriateminimumagefor purchase orconsumptionof

alcoholicbeveragesandotherpoliciesinordertoraisebarriersagainstsalesto,

andconsumptionofalcoholicbeveragesby,adolescents;

(c) adoptingpoliciestopreventsalestointoxicatedpersonsandthosebelowthe

legalageandconsideringtheintroductionofmechanismsforplacingliabilityon

sellersandserversinaccordancewithnationallegislations;

(d) settingpoliciesregardingdrinkinginpublicplacesoratofcialpublicagencies

activitiesandfunctions;

(e) adoptingpoliciesto reduceandeliminate availability ofillicitproduction,sale

anddistributionofalcoholicbeveragesaswellastoregulateorcontrolinformal

alcohol.

Area 6. Marketing1 of alcoholic beverages

29.Reducingtheimpactofmarketing,particularlyonyoungpeopleandadolescents,is

animportantconsiderationinreducingharmfuluseofalcohol.Alcoholismarketed

throughincreasinglysophisticatedadvertisingandpromotiontechniques,including

linkingalcoholbrandstosportsandculturalactivities, sponsorships andproduct

placements,andnewmarketingtechniquessuchase-mails,SMSandpodcasting,

socialmedia andothercommunication techniques.Thetransmissionof alcohol

marketingmessagesacrossnationalbordersandjurisdictionsonchannelssuchas

satellitetelevisionandtheInternet,andsponsorshipofsportsandculturaleventsis

emergingasaseriousconcerninsomecountries.

30. It isvery difcultto targetyoung adult consumerswithoutexposing cohortsof

adolescentsunderthelegalagetothesamemarketing.Theexposureofchildren

andyoungpeopletoappealingmarketingisofparticularconcern,asisthetargeting

ofnewmarketsindevelopingandlow-andmiddle-incomecountrieswithacurrent

lowprevalenceofalcoholconsumptionorhighabstinencerates.Boththecontent

ofalcoholmarketingandtheamountofexposureofyoungpeopletothatmarketing

arecrucialissues.Aprecautionaryapproachtoprotectingyoungpeopleagainstthese

marketingtechniquesshouldbeconsidered.


(a) settingupregulatoryorco-regulatoryframeworks,preferablywithalegislative

basis,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 designedto increase, or has the effect of increasing, the recognition, appeal and/or consumption of particular products and services. It could comprise anythingthat acts to advertise or otherwise promote a product or service.


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(iv) restricting orbanningpromotions inconnectionwith activities targeting

youngpeople;

(v) regulatingnewformsofalcoholmarketingtechniques,forinstancesocial

media;

(b) developmentbypublicagenciesorindependentbodiesofeffectivesystemsof

surveillanceofmarketingofalcoholproducts;

(c) settingupeffectiveadministrativeanddeterrencesystemsforinfringementson

marketingrestrictions.

Area 7. Pricing policies

32.Consumers,includingheavydrinkersandyoungpeople,aresensitivetochanges

inthepriceofdrinks.Pricingpoliciescanbeusedtoreduceunderagedrinking,to

haltprogressiontowardsdrinkinglargevolumesofalcoholand/orepisodesofheavydrinking,andtoinuenceconsumerspreferences.Increasingthepriceofalcoholic

beveragesisoneofthemosteffectiveinterventionstoreduceharmfuluseofalcohol.

Akeyfactorforthesuccessofprice-relatedpoliciesinreducingharmfuluseofalcohol

isaneffectiveandefcientsystemfortaxationmatchedbyadequatetaxcollection

andenforcement.

33. Factorssuchasconsumerpreferencesandchoice,changesinincome,alternative

sourcesforalcoholinthecountryorinneighbouringcountries,andthepresence

orabsenceof otheralcoholpolicymeasuresmay inuence theeffectivenessof

thispolicyoption.Demandfordifferentbeveragesmaybeaffecteddifferently.Tax

increasescanhavedifferentimpactsonsales,dependingonhowtheyaffecttheprice

totheconsumer.Theexistenceofasubstantialillicitmarketforalcoholcomplicates

policy considerationson taxation inmanycountries. In suchcircumstancestax

changesmustbeaccompaniedbyeffortstobringtheillicitandinformalmarkets

undereffectivegovernmentcontrol.Increasedtaxationcanalsomeetresistancefrom

consumergroupsandeconomicoperators,andtaxationpolicywillbenetfromthe

supportofinformationandawareness-buildingmeasurestocountersuchresistance.


(a) establishingasystemforspecicdomestictaxationonalcoholaccompaniedby

aneffectiveenforcementsystem,whichmaytakeintoaccount,asappropriate,

thealcoholiccontentofthebeverage;

(b) regularlyreviewingpricesinrelationtolevelofinationandincome;

(c) banningorrestrictingtheuseofdirectandindirectpricepromotions,discount

sales,salesbelowcostandatratesforunlimiteddrinkingorothertypesof

volumesales;

(d) establishingminimumpricesforalcoholwhereapplicable;

(e) providingpriceincentivesfornon-alcoholicbeverages;

(f) reducingorstoppingsubsidiestoeconomicoperatorsintheareaofalcohol.


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

35. Thistargetareaincludespolicyoptionsandinterventionsthat focus directlyon

reducingtheharmfromalcoholintoxicationanddrinkingwithoutnecessarilyaffecting

theunderlyingalcoholconsumption.Currentevidenceandgoodpracticesfavourthe

complementaryuseofinterventionswithinabroaderstrategythatpreventsorreduces

thenegative consequencesofdrinking andalcohol intoxication.In implementing

theseapproaches,managingthedrinkingenvironmentorinformingconsumers,the

perceptionofendorsingorpromotingdrinkingshouldbeavoided.


(a) regulatingthedrinkingcontext inorder tominimizeviolenceanddisruptive

behaviour,includingservingalcoholinplasticcontainersorshatter-proofglass

andmanagementofalcohol-relatedissuesatlarge-scalepublicevents;

(b) enforcinglawsagainstservingtointoxicationandlegalliabilityforconsequencesofharmresultingfromintoxicationcausedbytheservingofalcohol;

(c) enactingmanagementpoliciesrelatingtoresponsibleservingofbeverageon

premisesandtrainingstaffinrelevantsectorsinhowbettertoprevent,identify

andmanageintoxicatedandaggressivedrinkers;

(d) reducingthealcoholicstrengthinsidedifferentbeveragecategories;

(e) providingnecessarycareorshelterforseverelyintoxicatedpeople;

(f) providing consumerinformation about, and labelling alcoholic beverages to

indicate,theharmrelatedtoalcohol.

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

produced alcohol

37. Consumptionofillicitlyorinformallyproducedalcoholcouldhaveadditionalnegative

healthconsequencesduetoahigherethanolcontentandpotentialcontamination

withtoxicsubstances,suchasmethanol.Itmayalsohampergovernmentsabilities

totaxandcontrollegallyproducedalcohol.Actionstoreducetheseadditionalnegative

effectsshouldbetakenaccordingtotheprevalenceofillicitand/orinformalalcohol

consumptionandtheassociatedharm.Goodscientic,technicalandinstitutional

capacityshouldbe inplace for theplanningand implementation ofappropriatenational,regionalandinternationalmeasures.Goodmarketknowledgeandinsight

intothecompositionandproductionofinformalorillicitalcoholarealsoimportant,

coupledwithanappropriatelegislativeframeworkandactiveenforcement.These

interventionsshouldcomplement,notreplace,otherinterventionstoreduceharmful

useofalcohol.

38.Productionandsaleofinformalalcoholareingrainedinmanyculturesandareoften

informallycontrolled.Thuscontrolmeasurescouldbedifferentforillicitalcoholand

informallyproducedalcoholandshouldbecombinedwithawarenessraisingand

communitymobilization.Effortstostimulatealternativesourcesofincomearealso

important.


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(a) goodquality controlwith regard toproductionand distributionof alcoholic

beverages;

(b) regulatingsalesofinformallyproducedalcoholandbringingitintothetaxation

system;

(c) anefcientcontrolandenforcementsystem,includingtaxstamps;

(d) developingorstrengtheningtrackingandtracingsystemsforillicitalcohol;

(e) ensuringnecessarycooperationandexchange ofrelevant informationon

combatingillicitalcoholamongauthoritiesatnationalandinternationallevels;

(f) issuingrelevantpublicwarningsaboutcontaminantsandotherhealththreats

frominformalorillicitalcohol.

Area 10. Monitoring and surveillance

40.Datafrommonitoringandsurveillancecreatethebasisforthesuccessandappropriate

deliveryoftheotherninepolicyoptions.Local,nationalandinternationalmonitoring

andsurveillanceareneededinordertomonitorthemagnitudeandtrendsofalcohol-

relatedharms,tostrengthenadvocacy,toformulatepoliciesandtoassessimpact

of interventions.Monitoringshouldalso capturethe proleofpeopleaccessing

servicesandthereasonwhypeoplemostaffectedarenotaccessingpreventionand

treatmentservices.Datamaybeavailableinothersectors,andgoodsystemsfor

coordination,informationexchangeandcollaborationarenecessaryinordertocollect

thepotentiallybroadrangeofinformationneededtohavecomprehensivemonitoring

andsurveillance.

41.Developmentofsustainablenationalinformationsystemsusingindicators,denitions

anddata-collectionprocedurescompatiblewithWHOsglobalandregionalinformation

systemsprovidesanimportantbasisforeffectiveevaluationofnationaleffortsto

reduceharmfuluseofalcoholandformonitoringtrendsatsubregional,regionaland

globallevels.Systematiccontinualcollection,collationandanalysisofdata,timely

disseminationofinformationandfeedbacktopolicy-makersandotherstakeholders

shouldbeanintegralpartofimplementationofanypolicyandinterventiontoreduce

harmfuluseofalcohol.Collecting,analysinganddisseminatinginformationonharmful

useofalcoholareresource-intensiveactivities.


(a) establishing effective frameworks formonitoringand surveillance activities

includingperiodicnationalsurveysonalcoholconsumptionandalcohol-related

harmandaplanforexchangeanddisseminationofinformation;

(b) establishingordesignatinganinstitutionorotherorganizationalentityresponsible

forcollecting,collating,analysinganddisseminatingavailabledata, including

publishingnationalreports;


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(c) deningandtrackingacommonsetofindicatorsofharmfuluseofalcoholand

ofpolicyresponsesandinterventionstopreventandreducesuchuse;

(d) creatingarepositoryofdataatthecountrylevelbasedoninternationallyagreed

indicatorsandreportingdataintheagreedformattoWHOandotherrelevant

internationalorganizations;

(e) developingevaluationmechanismswiththecollecteddatainordertodetermine

theimpactofpolicymeasures,interventionsandprogrammesputinplaceto

reducetheharmfuluseofalcohol.

Global action: key role and components

43.Giventhemagnitudeandthecomplexityoftheproblem,concertedglobalefforts

mustbeinplacetosupportMemberStatesinthechallengestheyfaceatthenationallevel.Internationalcoordinationandcollaborationcreatethesynergiesthatareneeded

andprovideincreasedleverageforMemberStatestoimplementevidence-based

measures.

44.WHO,incooperationwithotherorganizationsintheUnitedNationssystemandother

internationalpartnerswill:

(a) provideleadership;

(b) strengthenadvocacy;

(c) formulate,incollaborationwithMemberStates,evidence-basedpolicyoptions;

(d) promotenetworkingandexchangeofexperienceamongcountries;

(e) strengthenpartnershipsandresourcemobilization;

(f) coordinatemonitoringof alcohol-relatedharmandtheprogresscountriesare

makingtoaddressit.

45.ActionbyWHOand other internationalpartnersto support the implementation

oftheglobalstrategywillbetakenaccordingtotheirmandates.International

nongovernmentalorganizations,professionalassociations,researchinstitutionsandeconomicoperatorsintheareaofalcohol,allhaveimportantrolesinenhancingthe

globalaction,asfollows.

(a) Majorpartnerswithin theUnitedNations system andintergovernmental

organizationslikeILO,UNICEF,WTO,UNDP,UNFPA,UNAIDS,UnitedNations

OfceonDrugsandCrime,andtheWorldBankgroupwillbeurgedtoincrease

collaborationand cooperationto preventand reduceharmfuluseof alcohol,

especiallyindevelopingandlow-andmiddle-incomecountries.

(b) Civilsocietyhasanimportantroleinwarningabouttheimpactofharmfuluse

ofalcoholonindividuals,familiesandcommunitiesandinbringingadditionalcommitmentandresourcesforreducingalcohol-relatedharm.Nongovernmental


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organizationsareespeciallyencouragedtoformwidenetworksandactiongroups

tosupporttheimplementationoftheglobalstrategy.

(c) Researchinstitutionsandprofessionalassociationsplayapivotalroleingenerating

additionalevidenceforactionanddisseminatingthistohealthprofessionalsand

thewidercommunity.WHOcollaboratingcentres have animportant role in

supportingtheimplementationandevaluationoftheglobalstrategy.

(d) Economicoperatorsinalcoholproductionandtradeareimportantplayersintheir

roleasdevelopers,producers,distributors,marketersandsellersofalcoholic

beverages.Theyareespeciallyencouragedtoconsidereffectivewaystoprevent

andreduceharmfuluseofalcoholwithintheircore rolesmentionedabove,

includingself-regulatoryactionsandinitiatives.Theycouldalsocontributeby

makingavailabledataonsalesandconsumptionofalcoholbeverages.

(e) Themediaplayanincreasinglyimportantrole,notonlyasaconveyerofnews

andinformationbutalsoasachannelforcommercialcommunications,andwillbeencouragedtosupporttheintentionsandactivitiesoftheglobalstrategy.

Public health advocacy and partnership

46.Internationalpublichealthadvocacyandpartnershipareneededforstrengthened

commitmentandabilitiesofthegovernmentsandallrelevantpartiesatalllevelsfor

reducingharmfuluseofalcoholworldwide.

47.WHOiscommittedtoraisingawarenessofthepublichealthproblemscausedby

harmfuluseofalcoholandof thestepsthatcanbetakentopreventandreduce

suchuseinordertosavelivesandreducesuffering.WHOwillengagewithother

international intergovernmentalorganizations and, asappropriate,international

bodiesrepresentingkeystakeholders,toensurethatrelevantactorscancontribute

toreducingtheharmfuluseofalcohol.

48. TheSecretariatwillprovidesupporttoMemberStatesby:

(a) raisingtheawarenessof themagnitudeofpublichealthproblemscausedby

harmfuluseofalcoholandadvocatingforappropriateactionatalllevelstoprevent

andreducesuchproblems;

(b) advocatingthatattentionisgiventoaddressingtheharmfuluseofalcoholinthe

agendasofrelevantinternationalandintergovernmentalorganizationsinordertosupportpolicycoherencebetweenhealthandothersectorsatregionaland

globallevels;

(c) promotingandfacilitatinginternationalcoordination,collaboration,partnerships

andinformationexchangetoensuretheneededsynergiesandconcertedactions

ofallrelevantparties;

(d) ensuringconsistency,scienticsoundnessandclarityofkeymessagesabout

preventingandreducingharmfuluseofalcohol;

(e) promotingintercountrynetworkingandexchangeofexperiences;


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(f) facilitatinginternationalnetworkinginordertotacklespecicandsimilarproblems

(forexample,specicproblemsamongindigenousorotherminoritygroupsor

changingyouthdrinkingcultures);

(g) advocatingappropriateconsiderationby partiesin international,regionaland

bilateraltradenegotiationstotheneedandtheabilityofnationalandsubnational

governmentstoregulatealcoholdistribution,salesandmarketing,andthusto

managealcohol-relatedhealthandsocialcosts;

(h) ensuring that theWHOSecretariat has processesin placeto workwith

nongovernmental organizationsand other civil societygroups, taking into

considerationanyconictsofinterestthatsomenongovernmentalorganizations

mayhave;

(i) continuingitsdialoguewiththeprivatesectoronhowtheybestcancontribute

tothereductionofalcohol-relatedharm.Appropriateconsiderationwillbegiven

tothecommercialinterestsinvolvedandtheirpossibleconictwithpublichealthobjectives.

Technical support and capacity building

49.ManyMemberStatesneedincreasedcapacityandcapabilitytocreate,enforceand

sustainthenecessarypolicyand legal framesand implementationmechanisms.

Globalactionwillsupportnationalactionthroughthedevelopmentofsustainable

mechanismsandtheprovisionofthenecessarynormativeguidanceandtechnical

toolsforeffectivetechnicalsupportandcapacitybuilding,withparticularfocuson

developingandlow-andmiddle-incomecountries.Suchactionsmustbeinaccordance

withthe nationalcontexts,needs andpriorities.Developmentof thenecessary

infrastructureforeffectivepolicyresponsesincountrieswithhigherorincreasing

alcohol-attributableburdenisanimportantprerequisiteforattainingbroaderpublic

healthanddevelopmentalobjectives.

50.WHOiscommittedtocooperatewithotherrelevantactorsatregionalandglobal

levelsinordertoprovidetechnicalguidanceandsupportforstrengtheninginstitutional

capacitytorespondtopublichealthproblemscausedbyharmfuluseofalcohol.WHO

willespeciallyfocusonsupportandbuildingcapacityindevelopingandlow-and

middle-incomecountries.


(a) documentinganddisseminatinggoodmodels ofhealth-service responsesto

alcohol-relatedproblems;

(b) documentinganddisseminatingbestpracticesandmodelsof responses to

alcohol-relatedproblemsindifferentsectors;

(c) drawingonexpertiseinotherareaslikeroadsafety,taxationandjusticewith

publichealthexpertiseinordertodesigneffectivemodelstopreventandreduce

alcohol-relatedharm;

(d) providingnormativeguidanceoneffectiveand cost-effective preventionandtreatmentinterventionsindifferentsettings;


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(e) developingandstrengtheningglobal,regionalandintercountrynetworksinorder

tohelpinsharingbestpracticesandfacilitatingcapacitybuilding;

(f) responding toMemberStates requests for supportoftheireffortstobuild

thecapacityto understand the implicationsof international trade andtrade

agreementsforhealth.

Production and dissemination of knowledge

52. Importantareasforglobalactionwillbemonitoringtrendsinalcoholconsumption,

alcohol-attributableharmandthesocietalresponses,analysingthisinformationand

facilitatingtimelydissemination.Availableknowledgeonthemagnitudeofharmful

useofalcohol,andeffectivenessandcost-effectivenessofpreventiveandtreatment

interventionsshouldbefurtherconsolidatedandexpandedsystematicallyattheglobal

level,especiallyinformationonepidemiologyofalcoholuseandalcohol-relatedharm,

impactofharmfuluseofalcoholoneconomicandsocialdevelopmentandthespread

ofinfectiousdiseasesindevelopingandlow-andmiddle-incomecountries.

53. TheGlobalInformationSystemonAlcoholandHealthanditsregionalcomponents

weredevelopedbyWHOfordynamicpresentationofthedataonlevelsandpatterns

ofalcoholconsumption,alcohol-attributablehealthandsocialconsequencesandpolicy

responsesatalllevels.Improvingtheglobalandregionaldataonalcoholandhealth

requiresdevelopmentofnationalmonitoringsystems,regularreportingofdataby

designatedfocalpointstoWHOandstrengtheningtherelevantsurveillanceactivities.

54.WHOiscommittedtoworkingwiththerelevantpartnerstoshapetheinternational

researchagendaonalcoholandhealth,buildcapacityforresearchandpromoteand

supportinternationalresearchnetworksandprojectstogenerateanddisseminate

datatoinformpolicyandprogrammedevelopment.


(a) providinganinternationalclearinghousefor informationoneffectiveandcost-

effectiveinterventionstoreduceharmfuluseofalcoholincludingpromotingand

facilitatingexchangeofinformationabouteffectivetreatmentservices;

(b) strengthening theGlobal InformationSystemonAlcoholandHealth and the

comparativeriskassessmentofthealcohol-attributablediseaseburden;

(c) developing orrefiningappropriate data-collectionmechanisms,basedoncomparabledataandagreedindicatorsanddenitions,inordertofacilitatedata

collection,collation,analysisanddisseminationattheglobal,regionalandnational

levels;

(d) facilitatingregionalandglobalnetworkstosupportandcomplementnational

efforts,withafocusonknowledgeproductionandinformationexchange;

(e) continuingitscollaborationwithinternationalnetworksofscientistsandhealth

expertstopromoteresearchonvariousaspectsofharmfuluseofalcohol;

(f) facilitating comparative effectiveness studiesof different policymeasuresimplementedindifferentculturalanddevelopmentalcontexts;


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(g) facilitatingoperationalresearchtoexpandeffectiveinterventionsandresearchon

therelationshipbetweenharmfuluseofalcoholandsocialandhealthinequities.

Resource mobilization

56. Themagnitudeofalcohol-attributablediseaseandsocialburdenisinsharpcontradiction

withtheresourcesavailableatalllevelstoreduceharmfuluseofalcohol.Global

developmentinitiativesmusttakeintoaccountthatdevelopingandlow-andmiddle-

incomecountriesneedtechnicalsupportthroughaidandexpertisetoestablish

andstrengthennationalpoliciesandplansforthepreventionofharmfuluseofalcohol

anddevelopappropriate infrastructures, including those inhealth-caresystems.

Developmentagenciescouldconsiderreducingharmfuluseofalcoholasapriority

areaindevelopingandlow-andmiddle-incomecountrieswithahighburdenofdisease

attributable toharmfuluseof alcohol.Ofcialdevelopmentassistanceprovides

opportunitiestobuildsustainableinstitutionalcapacityinthisareaindevelopingand

low-andmiddle-incomecountries,as domechanisms forcollaborationbetween

developingcountries.Inthatregard,MemberStatesareurgedtosupporteachotherintheimplementationoftheglobalstrategythroughinternationalcooperationand

nancialassistanceincludingofcialdevelopmentassistancefordevelopingcountries.

57.WHOiscommittedtoassistcountriesuponrequestinresourcemobilizationand

poolingofavailableresourcestosupportglobalandnationalactiontoreduceharmful

useofalcoholinidentiedpriorityareas.


(a) promotingexchangeofexperienceandgoodpracticeinnancingpoliciesand

interventionstoreduceharmfuluseofalcohol;

(b) exploringneworinnovativewaysandmeanstosecureadequatefundingfor

implementationoftheglobalstrategy;

(c) collaboratingwithinternationalpartners,intergovernmentalpartnersanddonors

tomobilizenecessaryresourcestosupportdevelopingandlow-andmiddle-

incomecountriesintheireffortstoreduceharmfuluseofalcohol.

Implementing the strategy

59.SuccessfulimplementationofthestrategywillrequireconcertedactionbyMember

States,effectiveglobal governanceand appropriate engagementof allrelevant

stakeholders.Allactionslistedinthestrategyareproposedtosupporttheachievement

oftheveobjectives.

60.TheSecretariatwillreportregularlyontheglobalburdenofalcohol-relatedharm,

makeevidence-basedrecommendations,andadvocateactionatalllevelstoprevent

andreduceharmfuluseofalcohol.Itwillcollaboratewithotherintergovernmental

organizationsand,as appropriate, other internationalbodies representing key

stakeholders toensure thataction to reduce harmfuluseof alcohol receives

appropriatepriorityandresources.


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Links and interfaces with other strategies, plans and programmes

61. ThisglobalstrategybuildsuponregionalinitiativessuchastheFrameworkforalcohol

policyintheWHOEuropeanRegion(resolutionEUR/RC55/R1),theRegionalstrategy

toreducealcohol-relatedharmintheWesternPacicRegion(resolutionWPR/RC57.

R5),Alcohol consumptioncontrol policyoptions intheSouth-EastAsiaRegion

(resolutionSEA/RC59/R8), Publichealthproblemsofalcoholconsumption in the

EasternMediterraneanRegion(resolutionEM/RC53/R.5)andActionstoreducethe

harmfuluseofalcoholintheAfricanRegion(documentAFR/RC58/3).

62.Harmfuluseofalcoholisoneofthefourmainriskfactorshighlightedintheactionplan

fortheglobalstrategyforthepreventionandcontrolofnoncommunicablediseases

(resolutionWHA61.14).Thestrategytoreduceharmfuluseofalcoholbuildsonand

linkstotheotherriskfactorsfornoncommunicablediseasesandthedisease-specic

programmes,especiallythroughtheglobalstrategyondiet,physicalactivityandhealth

(resolutionWHA57.17),tobaccocontrol(resolutionWHA56.1),healthpromotionand

healthylifestyle(resolutionWHA57.16)andcancerpreventionandcontrol(resolutionWHA58.22).

63. Thestrategyalsolinksandaligns itselfwithother relatedactivities inWHO,

especiallytheMentalHealthGapActionProgramme,includingsuicideprevention

andmanagementofothersubstanceusedisordersaswellasprogrammaticactivities

onviolenceandhealth(resolutionWHA56.24),road safetyandhealth (resolution

WHA57.10),childandadolescenthealthanddevelopment(resolutionWHA56.21)

andreproductivehealth(resolutionWHA57.12).

64.Withemergingevidence,greaterattention isbeing givento the linksbetween

harmfuluseofalcoholandsomeinfectiousdiseasesandbetweenharmfuldrinking

anddevelopment.ThestrategyalsolinksinwithWHOsexistingprogammesonHIV/

AIDSandtuberculosisanditsworkonreducinghealthinequitiesthroughactionon

thesocialdeterminantsofhealth(resolutionWHA62.14)andachievingthehealth-

relateddevelopmentgoalsincludingthosecontainedintheUnitedNationsMillennium

Declaration(resolutionWHA58.30).

65. Theimplementationofaglobalstrategytoreduceharmfuluseofalcoholprovides

a supportive frameworkfor theWHO regionalofces toformulate, revisit and

implementregion-specicpoliciesand,togetherwiththecountryofces,provide

technicalsupporttoMemberStates.Emphasiswillalsobeputoncoordinationwithin

theSecretariatsothatallactionsrelevanttoharmfuluseofalcoholareinlinewith

thisstrategy.

Monitoring progress and reporting mechanisms

66. Formonitoringprogress,thestrategyrequiresappropriatemechanismsatdifferent

levelsforassessment,reportingandre-programming.Aframeworkwithanimpact-

focusedperspectiveisneededforassessingachievementofthestrategysobjectives.

67. WHOsGlobal SurveyonAlcoholandHealthandtheGlobal InformationSystem

onAlcoholandHealthwillbeimportantpartsofthereportingandmonitoring

mechanisms.Thedata-collectingtoolsofthelatterwillbeadjustedtoincludethe

relevantreportingontheprocessandoutcomesofimplementationofthestrategyatthenationallevel.


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68.Regularmeetingsofglobalandregionalnetworksofnationalcounterpartsoffera

mechanismfor technicaldiscussionof the implementationof theglobal strategy

atdifferentlevels.Inadditiontotakingstockoftheprocess,thesemeetingscould

includedetaileddiscussionsofpriorityareasandtopicsrelevanttoimplementation.

69.ReportingontheimplementationoftheglobalstrategytoMemberStateswilltake

placethroughregularreportstoWHOregionalcommitteesandtheHealthAssembly.

Informationaboutimplementationandprogressshouldalsobepresentedatregional

orinternationalforumsandappropriateintergovernmentalmeetings.


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TheSixty-thirdWorldHealthAssembly,1

Havingconsideredthereportonstrategiestoreducetheharmfuluseofalcohol1andthe

draftglobalstrategyannexedtherein;

RecallingresolutionsWHA58.26onpublic-healthproblemscausedbyharmfuluseofalcoholandWHA61.4onstrategiestoreducetheharmfuluseofalcohol;

1. ENDORSEStheglobalstrategytoreducetheharmfuluseofalcohol;

2. AFFIRMSthattheglobalstrategytoreducetheharmfuluseofalcoholaimsto

giveguidanceforactionatalllevelsandtosetpriorityareasforglobalaction,and

that itis aportfolioof policyoptionsandmeasuresthatcouldbe considered for

implementationandadjustedasappropriateatthenationallevel,takingintoaccount

nationalcircumstances,suchasreligiousandculturalcontexts,nationalpublichealth

priorities,aswellasresources,capacitiesandcapabilities;

3. URGESMemberStates:2

(1) toadoptandimplementtheglobalstrategytoreducetheharmfuluseofalcohol

asappropriateinordertocomplementandsupportpublichealthpoliciesin

MemberStatestoreducetheharmfuluseofalcohol,andtomobilizepolitical

willandnancialresourcesforthatpurpose;

(2) tocontinueimplementationof the resolutionsWHA61.4on thestrategies to

reduce theharmfuluseofalcoholandWHA58.26onpublic-healthproblems

causedbyharmfuluseofalcohol;

(3) toensurethatimplementationoftheglobalstrategytoreducetheharmfuluseofalcoholstrengthensthenationaleffortstoprotectat-riskpopulations,young

peopleandthoseaffectedbyharmfuldrinkingofothers;

(4) toensurethatimplementationoftheglobalstrategytoreducetheharmfuluse

ofalcoholisreectedinthenationalmonitoringsystemsandreportedregularly

toWHOsinformationsystemonalcoholandhealth;

1 Document A63/13.

2 And, where applicable, regional economic integration organizations.

RESOLUTIONOFTHESIXTY-THIRDWORLD

HEALTHASSEMBLY(MAY2010)

WHA63.13GLOBAL STRATEGY TO REDUCE THE

HARMFUL USE OF ALCOHOL


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4. REQUESTStheDirector-General:

(1) togivesufcientlyhighorganizationalpriority,andtoassureadequatenancial

andhumanresourcesatalllevels,tothepreventionandreductionofharmful

useofalcoholandimplementationoftheglobalstrategytoreducetheharmful

useofalcohol;

(2) tocollaboratewithandprovidesupporttoMemberStates,asappropriate,in

implementingthe global strategyto reduce theharmfuluseofalcoholand

strengtheningnationalresponsestopublichealthproblemscausedbytheharmful

useofalcohol;

(3) tomonitorprogressinimplementingtheglobalstrategytoreducetheharmful

useofalcoholandtoreportprogress,throughtheExecutiveBoard,totheSixty-

sixthWorldHealthAssembly.

(Eighth plenary meeting, 21 May 2010

Committee A, fourth report)


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ANNEXI

REPORTBYTHESECRETARIAT1TOTHESIXTY-

THIRDWORLDHEALTHASSEMBLY(MAY2010)

STRATEGIES TO REDUCE THE HARMFUL USE OFALCOHOL: DRAFT GLOBAL STRATEGY

1. InresolutionWHA61.4(Strategiestoreducetheharmfuluseofalcohol)theHealth

AssemblyrequestedtheDirector-GeneraltosubmittotheSixty-thirdWorldHealth

Assembly,throughtheExecutiveBoard,adraftglobalstrategytoreduceharmful

useofalcohol.TheHealthAssemblyurgedMemberStatestocollaboratewiththe

Secretariatindevelopingadraftglobalstrategy,andfurtherrequestedtheDirector-GeneraltocollaborateandconsultwithMemberStates,aswellastoconsultwith

intergovernmentalorganizations,healthprofessionals,nongovernmentalorganizations

andeconomicoperatorsonwaystheycouldcontributetoreducingharmfuluseof

alcohol.

2. TheSecretariathasdraftedastrategythroughaninclusiveandbroadcollaborative

processwithMemberStates.Indoingso,theSecretariattookintoconsideration

theoutcomesofconsultationswithotherstakeholdersonwaysinwhichtheycan

contribute toreducing theharmfuluseofalcohol.Thedraftstrategyisbasedon

existingbestpracticesandavailableevidenceofeffectivenessandcost-effectiveness

ofstrategiesandinterventionstoreducetheharmfuluseofalcohol;thisevidenceis

summarizedinAnnexll.

3. Theconsultativeprocessstartedwithapublic,web-basedhearingfrom3October

to15November2008,givingMemberStatesandotherstakeholdersanopportunity

tosubmitproposalsonwaystoreduceharmfuluseofalcohol.Twoseparateround-

tablediscussions,onewithnongovernmentalorganizationsandhealthprofessionals

andtheotherwitheconomicoperators,wereorganizedinGenevainNovember2008

inordertocollectviewsonwaysthesestakeholderscouldcontributetoreducing

harmfuluseofalcohol.Subsequently,aconsultationwithselectedintergovernmental

organizationswasheld(Geneva,8September2009).2

4. TheSecretariatbeganworkonadraftstrategybypreparingadiscussionpaperforfurtherconsultationswithMemberStates.Thatpaperwasformulatedonthebasisof

thedeliberationsofWHOsgoverningbodiesandseveralregionalcommitteesessions

aswellasthesimilaroutcomesofthosebodiespertainingtootherrelatedareassuch

asnoncommunicablediseases,mentalhealth,violenceandinjuryprevention,cancer,

familyandcommunityhealth,socialdeterminantsofhealth,HIV/AIDS,andtradeand

health.ItscontentwasalsoinuencedbytheoutcomesoftheSecretariatstechnical

activitiesonalcoholandhealth,includingtherelevantmeetingsoftechnicalexperts.

ThediscussionpaperwassenttotheMemberStatesandpostedontheWHOweb

site.

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 technicalconsultationswereheldbetweenFebruary andMay2009,

attendedbyparticipantsnominatedbygovernmentsof149MemberStates.Three

consultationswereheldin theWHORegionalOfcesforAfrica,Europeand the

EasternMediterranean.Thegovernmentsof Brazil, ThailandandNewZealand,

respectively, hosted theconsultations forMemberStates in theRegionof the

AmericasandtheSouth-EastAsiaandWesternPacicregions.Inalltheseregional

consultations,MemberStateswereinvitedtoprovidetheirviewsonthepossible

areasforglobalactionandcoordinationoutlinedinthediscussionpaper,andonhow

thestrategycouldbesttakeintoaccountnationalneedsandpriorities.Inaddition,

MemberStateswereencouragedto provide informationoncurrentnationaland

subregionalprocessesthatcouldcontributetothestrategydevelopmentprocess,

aswellasexamplesofbestpractices,withspecialemphasisonat-riskpopulations,

youngpeopleandthoseaffectedbytheharmfuldrinkingofothers.

6. Inpreparingaworkingdocumentfordevelopingadraftglobalstrategyto reduce

harmfuluseofalcohol theSecretariatbuilt onthe outcomesofthe regionalconsultationswithMemberStatesandtookintoconsiderationtheoutcomesofthe

previousconsultativeprocesswith all stakeholdersonways inwhichtheycould

contributetoreducingtheharmfuluseofalcohol.Theresultingdocumentprovided

backgroundinformationandsuggestedaims,objectivesandguidingprinciplesfora

globalstrategy,targetareasandasetofpolicymeasuresandinterventionsthatit

wasproposedMemberStatescouldimplementatthenationallevel.Theworking

documentwassenttoMemberStatesinAugust2009withaninvitationforwritten

feedbackonitscontent,andpostedontheWHOwebsite.TheSecretariatreceived

writtenfeedbackfrom40MemberStates.

7. TocontinuethecollaborationwithMemberStatesonthedraftstrategytheSecretariat

heldaninformalconsultationwithMemberStateson8October2009inGenevain

ordertodiscussthefeedbackontheworkingdocumentandtoofferanopportunity

forMemberStatestoprovidefurtherguidanceonnalizingadraftglobalstrategy.

Furthertakingintoaccounttheoutcomeofthatinformalconsultation,theSecretariat

nalizedadraftglobalstrategy.

8. InJanuary2010,at its126thsession,1theExecutiveBoardconsideredanearlier

versionofthisreportandthedraftstrategy.Duringthesession,discussionsonthe

draftglobalstrategywerealsoheldinanopen-endedinformalworkinggroup,co-

chairedbyCubaandSweden.Consensuswasreachedonarevisedtext.TheBoard

adoptedresolutionEB126.R11inwhich it recommendstheHealthAssembly to

endorsetheglobalstrategy.

Action by the Health Assembly

9. TheHealthAssemblyisinvitedtoadopttheresolutionrecommendedbytheExecutive

BoardcontainedinresolutionEB126.R11.

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


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1. Duringrecentyearsasubstantialbodyofknowledgehasaccumulatedonfeasibility,

effectiveness andcost-effectiveness ofdifferentpolicyoptions and interventions

aimedatreducingtheharmfuluseofalcohol.Mostoftheevidencecomesfromhigh-

incomecountries,butthenumberofstudiesinlow-andmiddle-incomecountriesis

steadilyincreasing.Thisannexbrieysummarizesthemainndingsofresearchthat

caninformpolicyandprogrammedevelopmenttopreventandreduceharmfuluseofalcohol.

2. Therearemany reasons for placingan emphasisoneducation and information,

includingthenotionthatapopulationshouldknowaboutandunderstandharmful

alcoholuseandassociatedhealthrisks,eventhoughtheevidencebaseindicates

thattheimpactofalcohol-educationprogrammesonharmfuluseofalcoholissmall.

Tobeeffective,educationaboutalcoholneedstogobeyondprovidinginformation

abouttherisksofharmfuluseofalcoholtopromotingtheavailabilityofeffective

interventionsandmobilizingpublicopinionandsupportforeffectivealcoholpolicies.

3. Theevidencefortheeffectivenessofearlyidenticationandbriefadviceforpersons

withhazardousandharmfulalcoholuseisextensiveandcomesfromalargenumber

ofsystematicreviewsfromavarietyofhealth-caresettingsindifferentcountries.

Thendingsshowthatmoreintensiveadviceappearstobenomoreeffectivethan

lessintensiveadvice.Cognitive-behaviouraltherapiesandpharmacologicaltherapies

dohaveapositiveeffectintreatmentofalcoholdependenceandrelatedproblems.

Considerationshouldalsobegiventointegratedtreatmentforco-morbidconditions,

suchasforhypertension,tuberculosisandHIV/AIDS,andtoself-helpgroups.

4. Animportantcomponentofcommunityactionprogrammes,whichhasbeenshownto

changeyoungpeoplesdrinkingbehaviourandonalcohol-relatedharmsuchastrafc

crashesandviolence,ismediaadvocacy.Anotherapproachtocommunityactionin

low-incomecountrieshasbeentoencouragecommunitiestomobilizepublicopiniontoaddresslocaldeterminantsofincreasedlevelsofharmfuluseofalcohol.

5. Strongevidencesupportstheconclusionthatasufcientlylowlimitforbloodalcohol

concentration(0.02%to0.05%)iseffectiveinreducingdrink-drivingcasualties.Both

intensiverandombreath-testing,wherebypoliceregularlystopdriversonarandom

basistochecktheirbloodalcoholconcentrations,andselectivebreath-testing,where

vehiclesarestoppedanddriverssuspectedofdrink-drivingarebreath-tested,reduce

alcohol-related injuriesandfatalities.There isevidence forsomeeffectiveness

ofsettinglowerlimitsforbloodalcoholconcentrations(includingazerolevel)for

youngornovicedrivers,administrativesuspensionofthedriverslicenceincaseofa

ANNEXII

EVIDENCE FOR THE EFFECTIVENESS AND COST-

EFFECTIVENESS OF INTERVENTIONS TO REDUCE

HARMFUL USE OF ALCOHOL


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bloodalcoholconcentrationabovethelimit,mandatorycounsellingortreatmentfor

alcohol-relatedconditionsandtheuseofanignitioninterlockforrepeatdrinkdrivers.

Consistentenforcementbypolicewithrandomorselectivebreath-testingfollowed

byeffectivesanctionsisessentialandshouldbesupportedbysustainedpublicity

andawarenesscampaigns.

6. Evidencefromarangeofsettingsdemonstratestheimportanceofalegalframework

forreducingthephysicalavailabilityofalcoholthatencompassesrestrictionsonboth

thesaleandservingofalcohol.Havingalicensingsystemforthesaleofalcoholallows

fortheopportunityforcontrol,sinceinfringementoflawscanbemetbyrevocation

ofthelicence.Implementationoflawsthatsetaminimumageforthepurchaseof

alcoholshowclearreductionsindrinking-drivingcasualtiesandotheralcohol-related

harm;themosteffectivemeansofenforcementisonsellers,whohaveabusiness

interestinretainingtherighttosellalcohol.Anincreaseddensityofalcoholoutlets

isassociatedwithincreasedlevelsofalcoholconsumptionamongyoungpeople,

increasedlevelsofassault,andotherharmsuchashomicide,childabuseandneglect,

self-inictedinjury,and,withlessconsistentevidence,roadtrafcinjuries.Reducingthehours ordaysof saleof alcoholicbeveragesleads to feweralcohol-related

problems,includinghomicidesandassaults.

7. Agrowingvolumeofevidencefromlongitudinalyouthstudiespointstoanimpactof

variousformsofalcoholmarketingoninitiationofyouthdrinkingandriskierpatterns

ofyouthdrinking.Someresultsremaincontested,inpartowingtomethodological

difculties.Tobeeffective,systemstoregulatemarketingneedsufcientincentives

tosucceed;ingeneral,regulatoryframeworksaremostactivewherepressurefrom

thegovernmentisgreatest,andcanonlyworkaslongasthereisprovisionforthird-

partyreviewofcomplaintsaboutviolations.Sanctionsandthethreatofsanctionsare

neededtoensurecompliance.

8. Themoreaffordablealcoholistheloweritsprice,orthemoredisposableincome

peoplehavethemoreitisconsumedandthegreaterthelevelofrelatedharm

inbothhigh-andlow-incomecountries.Modellingshowsthatsettingaminimum

priceperunitgramofalcoholreducesconsumptionandalcohol-relatedharm.Both

priceincreasesandsettingaminimumpriceareestimatedtohaveamuchgreater

impactondrinkerswhoconsumemorethanonthosewhoconsumeless.Natural

experimentsconsequenttoeconomictreatieshaveshownthat,asalcoholtaxesand

priceswereloweredtooffsetcross-bordertrade,sosales,alcoholconsumptionand

alcohol-relatedharmhaveusuallyincreased.

9. Someevidenceindicatesthatsafety-orienteddesignofthepremiseswherealcoholicbeveragesareservedandtheemploymentofsecuritystaff,inparttoreducepotential

violence,canreducealcohol-relatedharm.Eventhoughinterventionsmodifyingthe

behaviourofthoseservingalcoholappearineffective ontheirown,theymaybe

effectivewhenbackedupbyenforcementbypoliceorliquor-licenceinspectors.Harm-

reductionapproachcanbesupportedbystrongerpromotionofproductswithalower

alcoholconcentration,togetherwithmandatedhealthwarningsonalcohol-product

containers.Althoughsuchwarningsdonotleadtochangesindrinkingbehaviour,they

doimpactonintentionstochangedrinkingpatternsandremindconsumersaboutthe

risksassociatedwithalcoholconsumption.


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10.Goodscientic,technicalandinstitutionalcapacityshouldbeinplacefortheplanning

andimplementationofappropriatenational,regionalandinternationalmeasures.Good

marketknowledgeandinsightintothecompositionandproductionofinformalorillicit

alcoholarealsoimportant,coupledwithanappropriatelegislativeframeworkand

activeenforcement.Controlmeasuresshouldbecombinedwithawarenessraising

andcommunitymobilization.

11.AbibliographyofthemainsourcesofevidencewillbemadeavailableontheWHO

website.1

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


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The1Sixty-rstWorldHealthAssembly,

Havingconsideredthereportonstrategiestoreducetheharmfuluseofalcohol1andthe

furtherguidanceonstrategiesandpolicyelementoptionstherein;

ReafrmingresolutionsWHA32.40ondevelopmentoftheWHOprogrammeonalcohol-relatedproblems,WHA36.12onalcoholconsumptionand alcohol-relatedproblems,

developmentofnationalpoliciesandprogrammes,WHA42.20onpreventionandcontrol

ofdrugandalcoholabuseandWHA57.16onhealthpromotionandhealthylifestyles;

RecallingresolutionWHA58.26onpublic-healthproblemscausedbyharmfuluseofalcohol

anddecisionWHA60(10);

NotingthereportbytheSecretariatpresentedtotheSixtiethWorldHealthAssemblyon

evidence-basedstrategiesandinterventionstoreducealcohol-relatedharm,includingthe

addendumonaglobalassessmentofpublichealthproblemscausedbyharmfuluseof

alcohol;2

NotingthesecondreportoftheWHOExpertCommitteeonProblemsRelatedtoAlcohol

Consumption3andacknowledgingthateffectivestrategiesandinterventionsthattarget

thegeneralpopulation,vulnerablegroups,individualsandspecicproblemsareavailable

andshouldbeoptimallycombinedinordertoreducealcohol-relatedharm;

Mindfulthatsuchstrategiesandinterventionsmustbeimplementedinawaythattakes

intoaccountdifferentnational,religiousandculturalcontexts,includingnationalpublic

health problems,needsandpriorities,anddifferencesinMemberStates resources,

capacitiesandcapabilities;

Deeplyconcernedbytheextentofpublichealthproblemsassociatedwithharmfuluseofalcohol,includinginjuriesandviolence,andpossiblelinkstocertaincommunicable

diseases,therebyadding to thediseaseburden, inbothdevelopinganddeveloped

countries;

Mindfulthatinternationalcooperationinreducingpublichealthproblemscausedbythe

harmfuluseofalcoholisintensifying,andoftheneedtomobilizethenecessarysupport

atglobalandregionallevels,

1 Document A61/13.

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

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

ANNEXIII

RESOLUTIONOFTHESIXTY-FIRSTWORLD


WHA61.4 STRATEGIES TO REDUCE THE HARMFULUSE OF ALCOHOL


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1. URGESMemberStates:

(1) tocollaboratewiththeSecretariatindevelopingadraftglobalstrategyonharmful

useofalcoholbasedonallevidenceandbestpractices,inordertosupportand

complementpublichealthpoliciesinMemberStates,withspecialemphasison

anintegratedapproachtoprotectat-riskpopulations,youngpeopleandthose

affectedbyharmfuldrinkingofothers;

(2) todevelop, in interactionwith relevant stakeholders,national systems for

monitoringalcoholconsumption,itshealthandsocialconsequencesandthe

policyresponses,andtoreportregularlytoWHOsregionalandglobalinformation

systems;

(3) to consider strengthening national responses, asappropriateandwhere

necessary,topublichealthproblemscausedbyharmfuluseofalcohol,onthe

basisofevidenceoneffectivenessandcost-effectiveness ofstrategiesand

interventionstoreducealcohol-relatedharmgeneratedindifferentcontexts;


(1) toprepareadraftglobalstrategytoreduceharmfuluseofalcoholthatisbased

onallavailableevidenceandexistingbestpracticesandthataddressesrelevant

policyoptions, taking intoaccountdifferent national, religious andcultural

contexts, includingnationalpublichealthproblems,needsandpriorities,and

differencesinMemberStatesresources,capacitiesandcapabilities;

(2) toensurethatthedraftglobalstrategywillincludeasetofproposedmeasures

recommendedforStatestoimplementatthenationallevel,takingintoaccount

thenationalcircumstancesofeachcountry;

(3) toincludefulldetailsofongoingandemergingregional,subregionalandnational

processesasvitalcontributionstoaglobalstrategy;

(4) to collaborateandconsultwithMemberStates, aswell asconsultwith

intergovernmental organizations, health professionals, nongovernmental

organizationsandeconomicoperatorsonwaystheycouldcontributetoreducing

harmfuluseofalcohol;

(5) tosubmittotheSixty-thirdWorldHealthAssembly,throughtheExecutiveBoard,adraftglobalstrategytoreduceharmfuluseofalcohol.

(Eighth plenary meeting, 24 May 2008

Committee A, second report)


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TheFifty-eighthWorldHealthAssembly,

Havingconsideredthereportonpublichealthproblemscausedbyharmfuluseofalcohol;1

ReafrmingresolutionsWHA32.40ondevelopmentoftheWHOprogrammeonalcohol-

relatedproblems,WHA36.12onalcoholconsumptionand alcohol-relatedproblems:developmentofnationalpoliciesandprogrammes,WHA42.20onpreventionandcontrol

ofdrugandalcoholabuse,WHA55.10onmentalhealth:respondingtothecallforaction,

WHA57.10on roadsafetyandhealth,WHA57.16onhealth promotionand healthy

lifestyles,andWHA57.17ontheGlobalStrategyonDiet,PhysicalActivityandHealth;

RecallingThe world health report 2002,whichindicatedthat4%oftheburdenofdisease

and3.2%ofalldeathsgloballywereattributedtoalcohol,andthatalcoholwasthe

foremostrisktohealthinlow-mortalitydevelopingcountriesandthethirdindeveloped

countries;2

Recognizingthatthepatterns,contextandoveralllevelofalcoholconsumptioninuence

thehealthofthepopulationasawhole,andthatharmfuldrinkingisamongtheforemost

underlyingcausesof disease, injury, violence especiallydomestic violence against

womenandchildrendisability,socialproblemsandprematuredeaths,isassociatedwith

mentalill-health,hasaseriousimpactonhumanwelfareaffectingindividuals,families,

communitiesandsocietyasawhole,andcontributestosocialandhealthinequalities;

Emphasizingtheriskofharmduetoalcoholconsumption,particularlyin thecontextof

drivingavehicle,attheworkplace,andduringpregnancy;

Alarmedbytheextentofpublichealthproblemsassociatedwithharmfulconsumptionof

alcoholandthetrendsinhazardousdrinking,particularlyamongyoungpeople,inmany

MemberStates;

Recognizingthatintoxicationwithalcoholisassociatedwithhigh-riskbehaviours,including

theuseofotherpsychoactivesubstancesandunsafesex;

Concernedabouttheeconomiclosstosocietyresultingfromharmfulalcoholconsumption,

includingcoststothehealth,socialwelfareandcriminaljusticesystems,lostproductivity,

andreducedeconomicdevelopment;

Recognizing thethreatsposedto publichealthbythefactors thathavegivenrise to

increasingavailabilityandaccessibilityofalcoholicbeveragesinsomeMemberStates;

1 Document A58/18.

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

ANNEXIV

RESOLUTIONOFTHEFIFTY-EIGHTWORLD


WHA58.26 PUBLIC-HEALTH PROBLEMS CAUSEDBY HARMFUL USE OF ALCOHOL


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Notingthegrowingbodyofevidenceoftheeffectivenessofstrategiesandmeasures

aimedatreducingalcohol-relatedharm;

Mindfulthatindividualsshouldbeempoweredtomakepositive,life-changingdecisions

forthemselvesonmatterssuchasconsumptionofalcohol;

Takingdueconsideration of thereligiousandcultural sensitivities ofa considerable

numberofMemberStateswithregardtoconsumptionofalcohol,andemphasizingthat

useofthewordharmfulinthisresolutionrefersonlytopublic-healtheffectsofalcohol

consumption,withoutprejudicetoreligiousbeliefsandculturalnormsinanyway,

1. REQUESTSMemberStates:

(1) todevelop, implementandevaluateeffectivestrategiesandprogrammesfor

reducingthenegativehealthandsocialconsequencesofharmfuluseofalcohol;

(2) toencouragemobilizationandactiveandappropriateengagementofallconcerned

socialandeconomicgroups,includingscientic,professional,nongovernmental

andvoluntarybodies,theprivatesector,civilsocietyandindustryassociations,

inreducingharmfuluseofalcohol;

(3) tosupport theworkrequestedoftheDirector-General below, including, if

necessary,throughvoluntarycontributionsbyinterestedMemberStates;


(1) tostrengthentheSecretariatscapacitytoprovidesupporttoMemberStates

inmonitoringalcohol-relatedharmandtoreinforcethescienticandempirical

evidenceofeffectivenessofpolicies;

(2) toconsider intensifying international cooperation in reducing public-health

problemscausedbytheharmfuluseofalcohol,andtomobilizethenecessary

supportatglobalandregionallevels;

(3) toconsider alsoconducting further scientic studiespertaining todifferent

aspectsofpossibleimpactofalcoholconsumptiononpublichealth;

(4) toreporttotheSixtiethWorldHealthAssemblyonevidence-basedstrategiesand interventionsto reducealcohol-relatedharm,includingacomprehensive

assessmentofpublic-healthproblemscausedbyharmfuluseofalcohol

(5) todrawuprecommendationsforeffectivepoliciesandinterventionstoreduce

alcohol-relatedharm,andtodeveloptechnicaltoolsthatwillsupportMember

Statesinimplementingandevaluatingrecommendedstrategiesandprogrammes;

(6) to strengthen global and regional information systems through further

collectionandanalysisofdataonalcoholconsumptionanditshealthandsocial

consequences,providingtechnicalsupporttoMemberStatesandpromoting

researchwheresuchdataarenotavailable;


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(7) topromoteandsupportglobalandregionalactivitiesaimedatidentifyingand

managingalcohol-usedisordersinhealth-caresettingsandenhancingthecapacity

ofhealth-careprofessionalstoaddressproblemsoftheirpatientsassociatedwith

harmfulpatternsofalcoholconsumption;

(8) tocollaboratewithMemberStates,intergovernmentalorganizations,health

professionals,nongovernmentalorganizationsandotherrelevantstakeholders

topromotetheimplementationofeffectivepoliciesandprogrammestoreduce

harmfulalcoholconsumption;

(9) toorganizeopenconsultationswithrepresentativesoftheindustry,agricultureand

tradesectorsinordertolimitthehealthimpactofharmfulalcoholconsumption;

(10) toreportthroughtheExecutiveBoardtotheSixtiethWorldHealthAssemblyon

progressmadeinimplementationofthisresolution.

(Ninth plenary meeting, 25 May 2005

Committee B, fourth report)


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Contact

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 OF

HARMFUL SUBSTANCE USE

FOR BETTER GLOBAL HEALTH