Alcohol

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The Minister of Health, Honorable Atupele Muluzi waves high the newly launched National Alcohol Policy for Malawi
Malawi launches the National Alcohol Policy on 18 August 2017
Malawi
Alcohol drinks

    Overview

    The African Region is faced with a growing burden of harmful alcohol consumption and its disastrous effects. There is no other consumer product as widely available as alcohol that accounts for as much premature death and disability.

    There are two main characteristics that describe alcohol consumption patterns in the Region: a high level of alcohol abstention in some countries and high volume consumption with severe health and social consequences in others.

    Alcohol use has immediate and long-term effects that increase the risks associated with numerous health conditions. Alcohol is a leading cause of risky sexual behaviours such as unprotected sex, sex with multiple partners, and produces an increased risk of sexual assault. These behaviours can result in unintended pregnancies and sexually transmitted infections (STIs) such as human papillomavirus (HPV) and HIV.

    In the Region, HPV is a significant threat and is the leading cause of cervical cancer. Alcohol is also known to increase cancer of the liver, breast, colon, oesophagus, throat and mouth.

    Heart attacks, strokes and high blood pressure – all significant health conditions in the Region – can develop from the harmful use of alcohol. Alcoholic hepatitis and scarring of the liver are also devastating outcomes of alcohol use.

    Additional Information

    Monitoring Alcohol Marketing in Africa MAMPA Project

     

     

    Factsheet

    Key Facts

    • Worldwide, 3.3 million deaths every year result from harmful use of alcohol,2 this represent 5.9 % of all deaths.
    • The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.
    • Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability- adjusted life years (DALYs).3
    • Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25 % of the total deaths are alcohol-attributable.
    • There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable conditions as well as injuries.
    • The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS.
    • Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large.
    Drinking alcohol during pregnancy is harmful to the unborn child

    Alcohol impacts people and societies in different ways and is determined by the volume of alcohol consumed, the pattern of drinking, and, on rare occasions, the quality of alcohol consumed. Alcohol is a psychoactive substance and its harmful use is known to have dependence-producing properties and cause more than 200 diseases among drinkers as well as devastating effects to innocent victims such as unborn children.

    Drinking alcohol during pregnancy can lead to miscarriage, preterm birth, still birth, spontaneous abortion, and contribute to a range of disabilities known as foetal alcohol spectrum disorders (FASD). FASD is an umbrella term referring to an array of conditions involving impairments of the growth and development of the central nervous system caused by alcohol intake during pregnancy.

    At the most severe end of this spectrum is foetal alcohol syndrome (FAS), a leading preventable cause of mental impairment in many countries. This is part of the evidence supporting mandatory health warning labels on alcoholic beverage containers, including information for all pregnant women on the impact of alcohol on the foetus or unborn baby.

    FAS-related impairment is severe, permanent and associated with substantial health care costs. There is no cure for FAS and treatment is focused on managing learning difficulties, behavioural problems, language, delayed social or motor skills, impaired memory and attention deficits.

    In order to support countries address the harmful use of alcohol in the African Region, WHO has produced a strategy aimed at contributing to the prevention and reduction of harmful use of alcohol in the African Region. Implementation of this strategy will provide a clear understanding of the adverse health effects of alcohol and allow it to be placed high in national health, social and development agendas.

    “There are no reliable FASD prevalence figures in the African Region but a government-led strategy including legislation, regulation, protection of human rights, mobilization of communities, and education of the public is needed. Strategic information, surveillance and research will counter the harmful use of alcohol and improve the health sector response to ensure universal health coverage reaches all individuals equitably,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.

    Many relevant decision-making authorities need to be involved in the formulation and implementation of alcohol policies, such as ministries of health and other governmental bodies, including taxation agencies.

    “Successful implementation of a national action plan requires sustained political commitment and legislation towards the reduction of harmful use of alcohol, effective coordination, sustainable funding and appropriate engagement of subnational governments as well as civil society and other relevant authorities and stakeholders,” said Dr Andrea Bruni, Alcohol and Substance Abuse Technical Officer at the WHO Regional Office for Africa.

    WHO is prepared and committed to continue to monitor, report and disseminate the best available knowledge on alcohol consumption, alcohol-related harm, and policy responses at all levels. These are key to monitoring progress in implementing the global strategy and regional action plans to reduce the harmful use of alcohol.

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    For more information, please contact:

    Technical contact:

    Dr Andrea Bruni; Tel: +472 413 9122; Email: brunia [at] who.int

    Media contact:

    Dr Cory Couillard; Tel: + 472 413 9995; Email: couillardc [at] who.int

    Alcohol

    Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a large disease, social and economic burden in societies.

    Alcohol impacts people and societies in many ways and it is determined by the volume of alcohol consumed, the pattern of drinking, and, on rare occasions, the quality of alcohol consumed. In 2012, about 3.3 million deaths, or 5.9 % of all global deaths, were attributable to alcohol consumption.

    The harmful use of alcohol can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large.

    Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions.

    A significant proportion of the disease burden attributable to alcohol consumption arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides, and fatal alcohol-related injuries tend to occur in relatively younger age groups.

    The latest causal relationships are those between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications.

    Factors affecting alcohol consumption and alcohol-related harm

    A variety of factors have been identified at the individual and the societal level, which affect the levels and patterns of alcohol consumption and the magnitude of alcohol-related problems in populations.

    Environmental factors include economic development, culture, availability of alcohol, and the comprehensiveness and levels of implementation and enforcement of alcohol policies. For a given level or pattern of drinking, vulnerabilities within a society are likely to have similar differential effects as those between societies. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption.

    Conceptual causal model of alcohol consumption and health outcomes

    Figure 1: Conceptual causal model of alcohol consumption and health outcomes

    The impact of alcohol consumption on chronic and acute health outcomes in populations is largely determined by 2 separate but related dimensions of drinking:

    • the total volume of alcohol consumed, and
    • the pattern of drinking.

    The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication, and, on rare occasions, also the quality of alcohol consumed. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes in individuals.

    There are gender differences in alcohol-related mortality, morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcohol-attributable deaths among men amount to 7.6 % of all global deaths compared to 4.0 % of all deaths among women. Total alcohol per capita consumption in 2010 among male and female drinkers worldwide was on average 21.2 litres for males and 8.9 litres of pure alcohol for females.

    Ways to reduce the burden from harmful use of alcohol

    The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.

    Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost–effectiveness of the following strategies:

    • regulating the marketing of alcoholic beverages (in particular to younger people);
    • regulating and restricting availability of alcohol;
    • enacting appropriate drink-driving policies;
    • reducing demand through taxation and pricing mechanisms;
    • raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies;
    • providing accessible and affordable treatment for people with alcohol-use disorders; and
    • implementing screening and brief interventions programmes for hazardous and harmful drinking in health services.
    WHO response

    WHO aims to reduce the health burden caused by the harmful use of alcohol and, thereby, to save lives, prevent injuries and diseases and improve the well-being of individuals, communities and society at large.

    WHO emphasizes the development, implementation and evaluation of cost-effective interventions for harmful use of alcohol as well as creating, compiling and disseminating scientific information on alcohol use and dependence, and related health and social consequences.

    In 2010, the World Health Assembly approved a resolution endorsing a global strategy to reduce the harmful use of alcohol. The resolution urges countries to strengthen national responses to public health problems caused by the harmful use of alcohol.

    The global strategy to reduce the harmful use of alcohol represents a collective commitment by WHO Member States to reduce the global burden of disease caused by harmful use of alcohol. The strategy includes evidence-based policies and interventions that can protect health and save lives if adopted, implemented and enforced. The strategy also contains a set of principles to guide the development and implementation of policies; it sets priority areas for global action, recommends target areas for national action and gives a strong mandate to WHO to strengthen action at all levels.

    The policy options and interventions available for national action can be grouped into 10 recommended target areas, which are mutually supportive and complementary. The 10 areas are:

    • leadership, awareness and commitment
    • health services’ response
    • community action
    • drink–driving policies and countermeasures
    • availability of alcohol
    • marketing of alcoholic beverages
    • pricing policies
    • reducing the negative consequences of drinking and alcohol intoxication
    • reducing the public health impact of illicit alcohol and informally produced alcohol
    • monitoring and surveillance.

    The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels.

    Successful implementation of the strategy will require action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.


    Footnotes
    • Based on the Global status report on alcohol and health 2014.
    • The Global strategy refers only to public-health effects of alcohol consumption, without prejudice to religious beliefs and cultural norms in any way. The concept of “harmful use of alcohol” in this context is different from “harmful use of alcohol” as a diagnostic category in the ICD-10 Classification of Mental and Behavioural Disorders (WHO, 1992).
    • The disability-adjusted life year (DALY) extends the concept of potential years of life lost due to premature death to include equivalent years of "healthy" life lost by virtue of being in states of poor health or disability.
    Protecting unborn babies from alcohol-related harm

    Alcohol and drug abuse during pregnancy can harm babies. It can also cause miscarriage, preterm birth, and stillbirth. If an unborn baby is exposed to alcohol it can be affected for life. Fetal alcohol spectrum disorders (FASD) is the umbrella term for impairments of the growth and development of the brain and the central nervous system caused by drinking alcohol during pregnancy. Aboriginal women in Australia have shown how communities can take action to protect their women and babies from alcohol-related harm in pregnancy.

    The remote Fitzroy Valley in the Kimberly region of the north of Western Australia is renowned for its ancient reefs, huge boab trees, strong culture, and vivid art. The region is also home to about 4 500 Aboriginal people who are spread across 45 communities.

    As in many disadvantaged communities around the world, alcohol abuse was common half a decade ago. The high consumption of alcohol resulted in high numbers of alcohol-related deaths and suicides, and widespread violence and crime.

    Alcohol’s impact on the future

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    The most disturbing effect of the alcohol abuse, however, was the impact on future generations. In 2007, the Aboriginal communities in Kimberly recognized that many babies suffered from disorders associated with high rates of alcohol use during pregnancy. Signs of Fetal Alcohol Spectrum Disorders (FASD) may include physical deformities, mental retardation, learning disabilities, and behavioural problems with irreversible and lifelong effects on children’s development.

    The high numbers of babies exposed to alcohol in pregnancy triggered Aboriginal women to sound the alarm and take action to protect their communities from alcohol abuse and alcohol use in pregnancy.

    “FASD is a tragedy that somehow transcends other aspects of grief and trauma,” explains June Oscar, an Aboriginal leader and head of the Marninwarntikura Women’s Resource Centre in Fitzroy Crossing, the main town of Fitzroy Valley. “Here is innocent young life, the future of our people and all that goes with it – our culture, our language, deep knowledge of our creation and the laws of our country – being born into this world with brains and nervous systems that are so impaired that life for that person, from birth to death, is cruelly diminished.”

    Limiting alcohol

    Under June’s leadership, the Aboriginal communities successfully urged liquor licensing authorities to restrict the take-away sale of all alcoholic beverages but low strength beer in Fitzroy Crossing. After the restrictions were introduced domestic violence in the Aboriginal communities fell by 43% and alcohol-related presentations to hospital more than halved. The restrictions have since been extended indefinitely and taken up by some other rural communities.

    Partnership addressing Fetal Alcohol Spectrum Disorder

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    Maureen Carter from Nindilingarri Cultural Health Services joined June and other community leaders to establish a partnership with clinicians and researchers from the University of Sydney Medical School and George Institute for Global Health to diagnose, treat and prevent FASD. In 2009, they agreed to conduct the first population-based study of FASD prevalence in Australia, the Lililwan Project.

    The Lililwan Project looks at the scope of FASD and aims to provide each affected child with a personalized FASD management plan involving also their families, doctors and teachers. The project also educates the communities about the risks of drinking alcohol during pregnancy and about the challenges faced by children with FASD and their families. Multi-disciplinary teams of health workers travel and work together so that comprehensive care can be provided to children with FASD.

    “The Lililwan Project is an example of the power of collaboration – between Aboriginal and non-Aboriginal people, clinicians and researchers, governments and philanthropists – to tackle a difficult and sensitive problem and to make a difference to children and families“, says Professor Elizabeth Elliott, an Australian paediatrician and a Chief Investigator for the Lililwan Project. Prof Elliott was also a member of the group of experts convened by WHO to develop the "Guidelines for the identification and management of substance use and substance use disorders in pregnancy". These guidelines are aimed at preventing and managing alcohol and drug use during pregnancy and reducing the associated risks for unborn children worldwide.

    “Aboriginal people must take control. We can change what is happening in our communities,” emphasizes June Oscar. “When you read the next media piece of the suffering occurring in communities like ours, don’t think of us as victims. Rather, support us to be the architects of our future - a future in which every child has the right to be born healthy and to fulfil their potential.”