As future health professionals, we should be aware of the ways in which ongoing demographic and social change might shape the patterns of illness we see in our careers. Srimathy Vijajan discusses the WHO’s approach to global trends in alcohol consumption, now thought to be the fifth most important risk factor in the global burden of disease.

The World Health Organization’s 2002 World Health Report (1) marked alcohol consumption as a significant risk factor for global health. Estimates for 2002 suggest that at least 2.3 million people died worldwide as a result of alcohol-related causes, accounting for 3.7% of global mortality that year. (2)Alcohol is known to contribute to over sixty known health problems, including alcoholic liver disease, oesophageal cancer and epilepsy. (3) As well as the obvious health consequences of alcohol consumption, there are also substantial associated financial, social, and emotional outcomes. (4) For example, a report by the Directorate General of the European Commission responsible for Public Health indicated that alcohol attributable disease, injury and violence cost the health, welfare, employment and criminal justice sectors £84 billion each year. Furthermore, the intangible costs of suffering and lost life added a further £182 billion each year. (5)

Although alcohol-related issues have gained prominence with the turn of the century, the WHO’s interest in this topic dates back to a 1975 monograph, Alcohol Control Policies in Public Health Perspective. This bought widespread recognition of the need to develop policies in order to control alcohol related problems. Following this publication, an Expert Committee on Problems relating to Alcohol Consumption was set up at WHO in 1979. In 1983, the World Health Assembly passed a recommendation that countries design national alcohol policies emphasizing preventative measures.

Since then many countries have been busy implementing their own alcohol policies. Despite such widespread implementation of policies, the global burden of disease attributable to alcohol remains high with 76.3 million individuals diagnosed with alcohol use disorders, making it the leading risk factor for disease burden in low mortality developing countries and the third largest risk factor in developed countries. (4) As a result, there is increased support for the need to tackle such a public health concern at a more global level. According to the WHO, the effects of globalisation have made domestic policies ineffective in tackling alcohol related issues. (6)

The WHO has since demonstrated the high priority it places on alcohol with the adoption of the resolution: ‘Public-health problems caused by harmful use of alcohol’ at the 58^th World Health Assembly (WHA). This resolution requested the WHO, among many other things, to “collaborate with health professionals, nongovernmental organizations (NGOs) and other relevant stakeholders.” Since then, the WHO has been undergoing consultations with both commercial industries and NGOs regarding this vital issue. One can appreciate the need for such discussion and negotiation if a global policy to control alcohol-related problems is to be adopted, as there will no doubt be opposition, in particular from the industry itself.

After the WHA resolution, another WHO Expert Committee on Problems related to alcohol consumption was set up with its main objective being to “review a range of public health problems attributable to alcohol consumption, and to provide technical recommendations on effective policies and interventions to reduce alcohol related harm.” The Expert Committee met in Geneva in October 2006. In line with the intention to produce the WHO Technical Report Series, No. 944, 2007, they put together a provisional report, which detailed significant changes in patterns of alcohol consumption and its health and social consequences since the 1979 meeting, including:

• Increased rate of consumption in low and middle-income countries
• Degree of hazard associated with drinking is higher is poor countries
• Harmful drinking is more common among the poorer than the richer
• Abstinence or infrequent drinking are more prevalent in older age groups, and intoxication or heavy drinking episodes are more frequent among adolescents and young adults
• Tendency for an increase in patterns of risky drinking among European teenagers in recent years (7)

The last point is of particular importance to countries such as the UK, where figures produced by the NHS Information Centre in June 2007 showed that the number of alcohol related admissions among children under 16 had increased by more than a third from 3870 in 1995-6 to 5280 in 2005-6. (8) The above trends mean that many governments are re-thinking their current alcohol policies, and indeed are now in a position to seek further assistance from the WHO.

In June 2007 the Executive Board of the World Health Organization considered the provisional report and agenda. (2) After reviewing available evidence they emphasized the WHO’s role in coordinating a global response and the need for global action to reduce alcohol-related harm. Currently, we are still waiting for this global policy to be adopted by WHO. No matter what the outcome is for the policy, it is widely accepted that the rate of alcohol related health and social problems is growing. As future health professionals the responsibility falls to us to act in an appropriate manner, to set an example and educate the public about the consequences of excessive alcohol consumption. So next time you find yourself enjoying a drink at your local, spare a thought for the global burden of disease from alcohol, which is likely to contribute greatly to our future workload as health professionals.

Srimathy Vijayan
4^th Year Medical Student
University of East Anglia
Norwich
s.vijayan@uea.ac.uk

[1] World Health Organization. World Health Report 2002 (The). Reducing Risks to Health, Promoting Healthy Life. Nonserial Publication. World Health Organization 2002

[2] World Health Organization. Evidence-based strategies and interventions to reduces alcohol-related harm. Global assessment of public-health problems caused by harmful use of alcohol. Sixtieth World Health Assembly, Provisional agenda item 12.7 A60/14 Add.1. 2007

[3] Room R, Babor T, Rehm J. Alcohol and public Health. Lancet 2005 365:519-30

[4] World Health Organization. Department of Mental Health and Substance Abuse, Geneva. Global Status Report: Alcohol Policy. 2004

[5] Anderson P, Baumberg B. Alcohol in Europe: a public health perspective. London: Institute of Alcohol Studies, 2006.

[6] D.H. Jernigan, et al. Towards a global alcohol policy: alcohol, public health and the role of WHO. Bulletin of the World Health Organization. 2000;78 (4)

[7] Who Expert Committee On Problems Related To Alcohol Consumption, Second report (provisional). WHO technical report series; no. 944. World Health Organization 2007

[8] Cole A, Kietowicz Z. BMA calls for action on “epidemic” of alcohol related problems. BMJ 2007;334:1343

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This entry was posted on Tuesday, October 16th, 2007 at 4:57 pm and is filed under Non-Communicable Diseases, Alcohol, Articles. You can follow any responses to this entry through the RSS 2.0 feed. You can trackback from your own site.