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Políticas Públicas em Alcohol Prof. Dr. Ronaldo Laranjeira Universidade Federal de São Paulo

Políticas Públicas em Alcohol Prof. Dr. Ronaldo Laranjeira Universidade Federal de São Paulo. Chosing effective strategies . Need for a systematic procedure to evaluate the evidence, compare alternativa interventions and assess the fbenefits to society of different approaches.

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Políticas Públicas em Alcohol Prof. Dr. Ronaldo Laranjeira Universidade Federal de São Paulo

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  1. Políticas Públicas em AlcoholProf. Dr. Ronaldo LaranjeiraUniversidade Federal de São Paulo

  2. Chosing effective strategies • Need for a systematic procedure to evaluate the evidence, compare alternativa interventions and assess the fbenefits to society of different approaches

  3. Proportion of alcohol consumers in WHO sub-regions

  4. Drinking Pattern Values for Selected WHO Regions

  5. 12 leading selected risk factors as causes of disease burden measured in DALYs Developed countries Developing countries High Mortality Low Mortality 1 Underweight Alcohol (6.2%) Tobacco (12.2%) 2 Unsafe sex Blood pressure Blood pressure 3 Unsafe water Tobacco (4.0%) Alcohol (9.2%) 4 Indoor smoke Underweight Cholesterol 5 Zinc deficiency Body mass index Body mass index 6 Iron deficiency Cholesterol Low fruit & veg intake 7 Vitamin A deficiency Low fruit & veg intake Physical inactivity 8 Blood pressure Indoor smoke - solid fuels Illicit drugs (1.8%) 9 Tobacco (2.0%) Iron deficiency Unsafe sex 10 Cholesterol Unsafe water Iron deficiency 11 Alcohol Unsafe sex Lead exposure 12 Low fruit & veg intake Lead exposure Child sexual abuse

  6. World Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s)

  7. World Disease burden (DALYs) in 2000 attributable to selected leading risk factors Number of Disability-Adjusted Life Years (000s)

  8. World Disease burden (DALYs) in 2000 attributable to Addictive Substances related Risks Number of Disability-Adjusted Life Years (000s)

  9. World Deaths in 2000 attributable to Addictive Substances related Risks Number of deaths (000s)

  10. World Deaths in 2000 attributable to Addictive Substances related Risks Number of deaths (000s)

  11. WHO Regions Deaths in 2000 attributable to selected leading risk factors Number of deaths (000s)

  12. WHO Regions Disease burden (DALYs) in 2000 attributable to selected leading risk factors Number of Disability-Adjusted Life Years (000s)

  13. Burden of disease attributable to addictive substances related risks: ALCOHOL (% DALYs in each subregion) Proportion of DALYs attributable to selected risk factor <0.5% 0.5-0.9% 1-1.9% 2-3.9% 4-7.9% 8-15.9%

  14. Burden of disease attributable to addictive substances related risks: TOBACCO (% DALYs in each subregion) Proportion of DALYs attributable to selected risk factor <0.5% 0.5-0.9% 1-1.9% 2-3.9% 4-7.9% 8-15.9%

  15. Burden of disease attributable to addictive substances related risks: ILLICIT DRUGS (% DALYs in each subregion) Proportion of DALYs attributable to selected risk factor <0.5% 0.5-0.9% 1-1.9% 2-3.9%

  16. Conclusions • The burden of licit and illicit drug problems is increasingly evident. • From a public health perspective tobacco and alcohol use carry much higher burdens that illicit drug use. • Alcohol and drug polices need to address the relative harms of these substances. • In the management of psychoactive substance problems (prevention and treatment) more attention should be paid to epidemiologic evidence and developments in neuroscience.

  17. WHO’s Comparative Risk Assessment Collaborating Group • 27 groups: • Core, metholodology, etc. Group • 26 risk factor groups • Alcohol group: • J Rehm, R Room, M Monteiro, G Gmel, K Graham, N Rehn, C T Sempos, U Frick, D Jernigan

  18. Patterns of drinking • Countries assigned hazardous drinking scores, a numeric indicator of hazard per litre of alcohol consumed • Information drawn from research literature supplemented by key informant questionnaires • Applied to two areas: injuries and CHD.

  19. Dimensions of patterns of drinking • High usual quantity of alcohol per occasion • Festive drinking common – at fiestas or community celebrations • Proportion of drinking occasions when drinkers get drunk • Low proportion of drinkers who drink daily or nearly daily • Less common to drink with meals • Common to drink in public places

  20. Pattern of drinking 2000(based on CRA) Patterns ofdrinking 1.00 to 2.00 2.00 to 2.50 2.50 to 3.00 3.00 to 4.00

  21. Aspects of alcohol used in estimating alcohol attributable fraction (AAF) for different conditions Volume of drinking Drinking pattern hazard score (predominance of intoxication) Prior alcohol dependence Alcohol- attributable conditions* Physical diseases (except CHD) Coronary heart disease Injuries Depression *AAF = 1 by definition

  22. Alcohol-related disorders • Chronic disease: • Conditions arising during perinatal period*: low birth weight • Cancer*: lip & oropharyngeal cancer, esophageal cancer, liver cancer, laryngeal cancer, female breast cancer • Neuropsychiatric diseases: alcohol use disorders, unipolar major depression, epilepsy • Diabetes* • Cardiovascular diseases: hypertension, coronary heart disease, stroke • Gastrointestinal diseases*: liver cirrhosis • Injury: • Unintentional injury: motor vehicle accidents, drownings, falls, poisonings, other unintentional injuries • Intentional injury:self-inflicted injuries, homicide, other intentional injuries * AAF based on volume of drinking only

  23. Estimating AAFs • Alcohol-specific categories • Chronic health conditions • CHD • Depression • Injuries

  24. Alcohol-attributable mortality 0.35 to 1.00 1.00 to 4.00 4.00 to 6.00 6.00 to 8.00 8.00 to 20.00 Alcohol-related global burden of disease

  25. Leading risk factors for disease (WHR 2002) in emerging and established economies (% total DALYS)

  26. Disease conditions Males Females Total % of all alcohol-attributable deaths Global mortality burden (deaths in 1000s) attributable to alcohol by major disease categories - 2000 Conditions arising during the perinatal period 2 1 3 0% Malignant neoplasm 269 86 355 20% Neuro-psychiatric conditions 91 19 111 6% Cardiovascular diseases 392 -124 268 15% Other non-communicable diseases (diabetes, liver cirrhosis) 193 49 242 13% Unintentional injuries 484 92 577 32% Intentional injuries 206 42 248 14% Alcohol-related mortality burden all causes 1,638 166 1,804 100.0% All deaths 29,232 26,629 55,861 In comparison: estimate for 1990: 1.5% % of all deaths which are alcohol-attributable 5.6% 0.6% 3.2%

  27. Disease conditions Males Females Total % of all alcohol-attributable DALYs Global burden of disease (DALYs in 1000s) attributable to alcohol by major disease categories - 2000 Conditions arising during the perinatal period 68 55 123 0% Malignant neoplasm 3,180 1,021 4,201 7% Neuro-psychiatric conditions 18,090 3,814 21,904 38% Cardiovascular diseases 4,411 -428 3,983 7% Other non-communicable diseases (diabetes, liver cirrhosis) 3,695 860 4,555 8% Unintentional injuries 14,008 2,487 16,495 28% Intentional injuries 5,945 1,117 7,062 12% Alcohol-related disease burden all causes (DALYs) 49,397 8,926 58,323 100% All DALYs 755,176 689,993 1,445,169 In comparison: estimate for 1990: 3.5% % of all DALYs which are alcohol-attributable 6.5% 1.3% 4.0%

  28. Future • Increase in alcohol-related burden for two reasons: • The disease categories related to alcohol are relatively increasing: chronic disease, accidents and injuries • Alcohol consumption is increasing in the most populous parts of the world • Patterns are stable if not getting worse • If there are no interventions!!!

  29. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM Global Alcohol Policy

  30. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM • Declarations of interest • Used to be Regional Advisor for both alcohol and tobacco policy, WHO Regional Office for Europe • Scientist and policy advisor for Eurocare

  31. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM • Structure of presentation • Eurocare • The problem of alcohol • Some solutions for alcohol policy • Expectations of the WHO • What NGOs can bring

  32. Brief Description of Eurocare: • Eurocarewas formed in 1990 as an alliance of non-governmental organisations concerned with the impact of the European Union on alcohol policy in Member States • Starting with 9 member organisations in 1990, it now has 46 members from 12 EU States, 5 non EU States and 3 International Organisations with members in 26 European countries

  33. Brief Description of Eurocare: • Eurocarepromotes the implementation of evidence based alcohol policy and provides support to its member organizations • Key publications include: • Alcohol problems and the family, 1998 • The beverage alcohol industry’s social aspects organizations: A public health warning, 2002 • Drinking and driving in Europe, 2003

  34. Brief Description of Eurocare: • Eurocarewill be implementing a 3 year European Commission funded project (Alcohol Policy Network in the Context of a larger Europe: Bridging the Gap): • Creating an alcohol policy network in 27 European Member States and applicant countries, Norway and Switzerland • Preparing a report on alcohol in Europe • Preparing an advocacy training manual • Convening a European conference, Bridging the Gap, Warsaw, Poland, 16-19 June 2004 • Convening two summer advocacy schools, Slovenia 2005 and Catalonia 2006.

  35. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM

  36. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM These are net costs, accounting for heart disease They do not include social harms They do not include financial costs

  37. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM

  38. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM

  39. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM

  40. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM • At the community level: • Drinking and driving • Intoxication

  41. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM

  42. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM • Healthy Public Policy: • Taxation • Bans on advertising and marketing

  43. WORKING IN EUROPE FOR THE PREVENTION OF ALCOHOL RELATED HARM • Strengthening Community Action: • Drink driving • Educational and prevention programmes • Manage availability

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