APN symposium 17 October 2012 Stockholm, Sweden Dr Lars Møller Programme Manager World Health Organization Regional Office for Europe

Source:  WHO  (2009)  The  global  burden  of  disease:  2004  update.  

Burden of NCD in Europe

Burden of disease by broad cause group and region, 2004

NCD

Best buys package population-based approaches •  Smoke-free environments •  Warning about the dangers of tobacco use •  Bans on tobacco advertising •  Raising taxes on tobacco •  Raising taxes on alcohol •  Restricting access to retail alcohol •  Bans on alcohol advertising •  Reducing salt intake and salt content of food •  Replacing trans-fat in food with polyunsaturated fat •  Promoting public awareness about diet and physical activity

• Adult  alcohol  per  capita   consumpEon  (10%   relaEve  reducEon)   • Fat  intake  (15%  rel.  red.)   • Low  fruit  and  vegetable   intake   • Overweight/obesity   • Insufficient  physical   acEvity  (10%  rel.  red.)   • Raised  blood  glucose   • Raised  blood  pressure   (25%  rel.  red.)   • Raised  total  cholesterol   (20%  rel.  red.  of  prev.  of   high  cholesterol)   • Salt/sodium  intake.  (30%   rel.  red.)   • Tobacco  smoking.  (30%   rel.  red.)  

Health  systems  response  

Exposures  

Outcomes  

• Mortality  between  ages   30  –  70  due  to  CVD,   cancer,  diabetes,  or  CRD   (25%  relaEve  reducEon)  

•  Access  to  palliaEve   care   •  Availability  of  basic   diagnosEcs  and   medicines   •  Cervical  cancer   screening   •  MulEdrug  therapy  for   CVD  risk  reducEon   •  Policies  to  eliminate   trans  fats   •  Policies  to  reduce   markeEng  of  foods  to   children   •  VaccinaEon  against   infecEous  cancers  

*  All  indicators  should  be  disaggregated  by  gender,  age,  socioeconomic  posiEon,  &  other  relevant  straEfiers  

Per capital alcohol consumption, 2005

Recorded alcohol consumption in the EU (in litres pure alcohol per capita 15+) – stable but high (more than twice the world average) 12 10 8

Total Beer

6

Wine Spirtis

4

Other 2 0 1998

2000

2002

2004

2006

2008

2010

Recorded adult (15+ years) per capita consumption (in litres of pure alcohol) 16,00

Litres of pure alcohol

14,00 12,00 10,00

Denmark Sweden Norway Finland

8,00

Iceland

6,00

WHO EURO

4,00 2,00 0,00

Regional differences

The Pareto principle 1/5 of consumers consume 4/5 of any product

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Moderate drinkers Hazardous drinkers Harmful drinkers

% population

% alcohol consumed

Three-quarters of the alcohol sold is drunk by hazardous/harmful drinkers

Alcohol-attributable disease and injury (green mainly protective) Chronic disease: Cancer: Mouth & oropharyngeal cancer, esophageal cancer, liver cancer, female breast cancer Neuropsychiatric diseases: Alcohol use disorders, unipolar major depression, primary epilepsy Diabetes Cardiovascular diseases: Hypertensive diseases, ischemic heart disease, ischemic stroke, hemorrhagic stroke Gastrointestinal diseases: Liver cirrhosis Conditions arising during perinatal period: Low birth weight, FAS

Alcohol-attributable disease and injury (green mainly protective) Injury: Unintentional injury: Motor vehicle accidents, drownings, falls, poisonings, other unintentional injuries Intentional injury: Self-inflicted injuries, homicide, other intentional injuries

High exposure, high burden of mortality and disease •  For men between ages of 15 and 64, 1 in 7 deaths in 2004 were caused by alcohol (clearly premature deaths given the life expectancy in Europe) •  For women of the same age category, 1 in 13 deaths in 2004 were caused by alcohol

Regional variation of alcohol-attributable deaths to all deaths, 2004, 15-64 year olds

Proportion of deaths for major disease categories attributable to alcohol

European Alcohol Action Plan 1992–1999

European Alcohol Action Plan 2000–2005

Sixty-third World Health Assembly, 17–21 May 2010 Endorsed the global strategy to reduce the harmful use of alcohol. World Health Assembly resolution WHA63.13

European action plan to reduce the harmful use of alcohol (EAAP) 2012–2020 – 10 action areas • 

Leadership, awareness and commitment, as sustainable intersectoral action requires strong leadership and a solid base of awareness and political will

• 

Health services’ response, as these services are central to tackling health conditions in individuals caused by harmful alcohol use

• 

Community action, as governments and other stakeholders can support and empower communities in adopting effective approaches to prevent and reduce harmful alcohol use

• 

Policies and countermeasures on drink–driving, as it is extremely dangerous to drivers, passengers and other people using the roads

• 

Availability of alcohol, as public health policies to regulate commercial or public availability have proved to be very effective in reducing the general level of harmful use and drinking among minors

EAAP 2012–2020 – 10 action areas • 

Marketing of alcoholic beverages, as systems are needed to protect people, particularly children and young people, from advanced advertising and promotion techniques

• 

Pricing policies, as most consumers, particularly heavy drinkers and young people, are sensitive to changes in the prices of alcohol products

• 

Reducing the negative consequences of drinking and alcohol intoxication, in order to minimize violence, intoxication and harm to intoxicated people

• 

Reducing the public health impact of illicit and informally produced alcohol, as its consumption could have additional negative health consequences due to its higher ethanol content and potential contamination with toxic substances

• 

Monitoring and surveillance, as relevant data create the basis for the appropriate delivery and success of responses

European status report on alcohol and health 2010

Plans for 2012 – 2013 • 

Publication with European action plan including two new annexes on indicators and a check list for policy makers

• 

Publication on alcohol and prisoners

• 

Status report on alcohol in the European Union 2013, May 2013

• 

Status report on alcohol in the WHO European Region including country profiles – early 2014

• 

Update of Alcohol information system on alcohol and health

• 

Country work: Croatia, Moldova, Montenegro, Kazakhstan, Czech republic, Hungary, Serbia, Slovakia

• 

Meetings with WHO National counterparts on alcohol policy

Thank you! Contact details: [email protected] Website: http://www.euro.who.int/alcohol European information system on alcohol and health: http://who.int/gho/eisah