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Alcohol misuse needs a global response
Editorial
Alcohol misuse needs a global response
www.thelancet.com Vol 373 February 7, 2009
should avoid alcohol altogether. Similarly, in Australia the National Health and Medical Research Council will be issuing guidelines in late February, recommending that people under the age of 18 years should not consume any alcohol. Certainly, it is desirable to delay the onset age of drinking. US experience showed that raising the minimum legal drinking age to 21 years (with minimum enforcement) substantially reduced deaths from alcoholrelated causes. However, education and persuasion are the least effective intervention and so advice by itself in England and Australia will likely make little difference unless it is complemented by policies that focus on price, availability, and affordability at the population level. The UK is often cited as a country that (because of industry influence and the possible political unpopularity of having a drinking age limit) has had an absence of effective alcohol policies, preferring soft measures like education campaigns on issues such as underage drinking, rather than tackling the root of the problem. It is no surprise then that the UK has some of the worst indicators of alcoholrelated harm in young people in Europe. Patterns of global alcohol consumption are changing. The recent increase in consumption in low-income and middle-income countries in southeast Asia and the western Pacific regions are particularly worrying. And the alcohol industry is rapidly infiltrating the markets of Brazil, India, China, and Russia. Last week, news reports of the closure of 800 liquor stores in Rajasthan, India, to curb alcohol-related harm, together with the South African Government shutting down 30 000 illegal shabeens (drinking dens), show positive moves by governments to tackle the problem. Addressing the harms of alcohol as part of a globalhealth agenda is gathering momentum. WHO is in the midst of developing a strategy to reduce harmful use of alcohol in consultation and collaboration with member states. That work will be presented to the World Health Assembly in 2010. A Framework Convention on Alcohol Control (a legally binding international treaty) is under discussion. And a forthcoming Lancet Series on alcohol will explore the dimensions of an effective response required to tackle this global-health threat. But countries should not wait. They need to act now to develop comprehensive and effective policies to make a difference. ■ The Lancet
The printed journal includes an image merely for illustration Reuters
Around 2 billion people worldwide consume alcoholic beverages and over 76 million people have alcohol-use disorders. In most parts of the world the burden related to alcohol consumption in terms of morbidity, mortality, and disability is substantial. WHO estimates that the harmful use of alcohol causes about 2·3 million premature deaths per year worldwide (3·7% of global mortality) and is responsible for 4·4% of the global burden of disease. Although there are regional and national differences in levels, patterns, and context of drinking, current trends suggest availability and alcohol consumption will continue to rise. The health effects of alcohol are diverse. The highest alcohol-attributable burdens are neuropsychiatric disorders, which are described in a Seminar by Marc A Schuckit in The Lancet today. Alcohol use increases the risk of cardiovascular diseases and various cancers, as well as injuries and accidents. It increases the transmission of sexually transmitted diseases and HIV infection through association with unsafe sexual practices. The harmful effects of alcohol are associated with many adverse consequences such as crime, violence, unemployment, and workplace absenteeism. Rising levels of consumption are most pronounced in women and young people, with the latter more prone to heavy binge drinking. There is no doubt that tackling alcoholrelated harm is an urgent public-health imperative. To a large extent the burden attributable to alcohol is preventable and there are proven and effective strategies and interventions to reduce alcohol-related harm. The challenge is getting governments to implement effective alcohol policies in the face of strong industry opposition and widespread public sentiment that alcohol-related harm is a problem confined to a few very heavy drinkers. The Scandinavian countries have traditionally had some of the best-developed policies to control hazardous drinking: government monopolies on alcohol sales, higher taxes on high-alcohol beverages, restrictions on promotion and sale, and tough policies combatting drinking and driving. But these policies have been eroded as a result of deregulation imposed as a condition of European Union membership, and global pressures to allow free trade in all commodities, including alcohol. Last week, the UK Government released guidance recommending that young people up to the age of 15 years
A shebeen in KwaMashu, South Africa See Seminar page 492
For the WHO expert committee on problems related to alcohol consumption second report see http://www.who.int/substance_ abuse/expert_committee_ alcohol_trs944.pdf For the 5-point plan for alcohol-free childhood see http://www.dh.gov.uk/en/News/ Recentstories/DH_093912 For the BBC news report on Rajasthan see http://news.bbc. co.uk/1/hi/world/south_ asia/7856472.stm For the BBC news report on South Africa see http://news. bbc.co.uk/1/hi/world/south_ asia/7856472.stm
433
Alcohol misuse needs a global response
www.thelancet.com Vol 373 February 7, 2009
should avoid alcohol altogether. Similarly, in Australia the National Health and Medical Research Council will be issuing guidelines in late February, recommending that people under the age of 18 years should not consume any alcohol. Certainly, it is desirable to delay the onset age of drinking. US experience showed that raising the minimum legal drinking age to 21 years (with minimum enforcement) substantially reduced deaths from alcoholrelated causes. However, education and persuasion are the least effective intervention and so advice by itself in England and Australia will likely make little difference unless it is complemented by policies that focus on price, availability, and affordability at the population level. The UK is often cited as a country that (because of industry influence and the possible political unpopularity of having a drinking age limit) has had an absence of effective alcohol policies, preferring soft measures like education campaigns on issues such as underage drinking, rather than tackling the root of the problem. It is no surprise then that the UK has some of the worst indicators of alcoholrelated harm in young people in Europe. Patterns of global alcohol consumption are changing. The recent increase in consumption in low-income and middle-income countries in southeast Asia and the western Pacific regions are particularly worrying. And the alcohol industry is rapidly infiltrating the markets of Brazil, India, China, and Russia. Last week, news reports of the closure of 800 liquor stores in Rajasthan, India, to curb alcohol-related harm, together with the South African Government shutting down 30 000 illegal shabeens (drinking dens), show positive moves by governments to tackle the problem. Addressing the harms of alcohol as part of a globalhealth agenda is gathering momentum. WHO is in the midst of developing a strategy to reduce harmful use of alcohol in consultation and collaboration with member states. That work will be presented to the World Health Assembly in 2010. A Framework Convention on Alcohol Control (a legally binding international treaty) is under discussion. And a forthcoming Lancet Series on alcohol will explore the dimensions of an effective response required to tackle this global-health threat. But countries should not wait. They need to act now to develop comprehensive and effective policies to make a difference. ■ The Lancet
The printed journal includes an image merely for illustration Reuters
Around 2 billion people worldwide consume alcoholic beverages and over 76 million people have alcohol-use disorders. In most parts of the world the burden related to alcohol consumption in terms of morbidity, mortality, and disability is substantial. WHO estimates that the harmful use of alcohol causes about 2·3 million premature deaths per year worldwide (3·7% of global mortality) and is responsible for 4·4% of the global burden of disease. Although there are regional and national differences in levels, patterns, and context of drinking, current trends suggest availability and alcohol consumption will continue to rise. The health effects of alcohol are diverse. The highest alcohol-attributable burdens are neuropsychiatric disorders, which are described in a Seminar by Marc A Schuckit in The Lancet today. Alcohol use increases the risk of cardiovascular diseases and various cancers, as well as injuries and accidents. It increases the transmission of sexually transmitted diseases and HIV infection through association with unsafe sexual practices. The harmful effects of alcohol are associated with many adverse consequences such as crime, violence, unemployment, and workplace absenteeism. Rising levels of consumption are most pronounced in women and young people, with the latter more prone to heavy binge drinking. There is no doubt that tackling alcoholrelated harm is an urgent public-health imperative. To a large extent the burden attributable to alcohol is preventable and there are proven and effective strategies and interventions to reduce alcohol-related harm. The challenge is getting governments to implement effective alcohol policies in the face of strong industry opposition and widespread public sentiment that alcohol-related harm is a problem confined to a few very heavy drinkers. The Scandinavian countries have traditionally had some of the best-developed policies to control hazardous drinking: government monopolies on alcohol sales, higher taxes on high-alcohol beverages, restrictions on promotion and sale, and tough policies combatting drinking and driving. But these policies have been eroded as a result of deregulation imposed as a condition of European Union membership, and global pressures to allow free trade in all commodities, including alcohol. Last week, the UK Government released guidance recommending that young people up to the age of 15 years
A shebeen in KwaMashu, South Africa See Seminar page 492
For the WHO expert committee on problems related to alcohol consumption second report see http://www.who.int/substance_ abuse/expert_committee_ alcohol_trs944.pdf For the 5-point plan for alcohol-free childhood see http://www.dh.gov.uk/en/News/ Recentstories/DH_093912 For the BBC news report on Rajasthan see http://news.bbc. co.uk/1/hi/world/south_ asia/7856472.stm For the BBC news report on South Africa see http://news. bbc.co.uk/1/hi/world/south_ asia/7856472.stm
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