Global Status report on Alcohol reviewd by Helena Conibear
This 400 page report released by the World Health Organisation
(WHO), is ambitious indeed,claiming that it is the first time
that a comprehensive 'global surveillance' of alcohol consumption,
production, regulation and its health effects has been compiled.WHO
admit data collection and the lack of standardised methodologies
makes accuracy difficult, but it is a relatively comprehensive
study The opening paragraph of the report sets a negative tone
'Alcohol related deaths and disability account for even greater
costs to life and longevity than those caused by tobacco use'
( according to a study by Murray and Lopez) sponsored by themselves),
but apart from this attention grabbing introduction the report
makes for interesting, and largely balanced reading.
Global burden of disease
The study by Murray and Lopez of 1996, cited in the introduction,
lists physical inactivity (1.9 million deaths)malnutrition (5.8
million deaths) hypertension (2.9 million deaths) and tobacco
(3 million) as some of the worst offenders for the global burden
of disease. Alcohol is held responsible for .7 million deaths
world wide by the study, below risk from occupation(1.1 million)
and unsafe sex (1 million).
Patterns of consumption reveal interesting trends, WHO estimates
that the heaviest 10% drinkers account for 50% of a nations consumption.Slovenia,
Korea and Luxembourg and the Czech Republic are the heaviest drinking
nations at approximately 14litres of pure alcohol per capita over
15 years old, but these highs are well below the levels in France
for example in the 1970's at over 20 litres a head. The report
states that 'alcohol consumption has been rising unabatedly in
the under developed world', but this, it fails to point out, is
from a tiny base. Lesotho shows the biggest percentage change
- from nil to 1.2 litres per head, followed by China from 1 litre
to 5 and Thailand from 1.9 litres to 8.4 in the last 20 years.
The most worrying figures for mortality come from the former Soviet
Union where illicit production and the black market is rife. The
report shows that 50% of North Americans had not drunk in the
last month and only 16% of Britons drink 3 to 4 days a week.
Health Effects of alcohol consumption
Again the chapter starts with a strong negative' alcohol use is
related to a wide range of physical, mental and social harms'
, without quantifying 'use'. It goes further to espouse the discredited
Ledermann theory that the level of alcohol related problems is
proportionate to the level of use within a population. On reading
further however, after detailed listings of the diseases associated
with the misuse of alcohol,the chapter does state clearly that
' research has also found a decrease in all- case mortality among
certain light to moderate drinkers' although recent studies do
not find this effect they claim. The chapter concludes encouragingly
' the predominant expert judgement at the time of writing is that,
among populations at high risk of heart disease,drinking alcohol
in amounts between 5 and 20 g per day has some protective effect'.
On reviewing specific alcohol related diseases the highest levels
of cirrhosis and liver disease are found in Hungary and Romania
at 7 deaths per 10,000, against a Western European and US average
of .7. The chapter logically concludes that alcohol use has a
more protective effect in developed countries which suffered 40%
of alcohol related deaths, but 62% of the deaths averted by moderate
consumption. Central and Eastern Europe are highlighted as of
serious concern as alcohol is contributing to a decline in male
Benefits and costs of alcohol
Surprisingly this section opens with 'alcohol provides some benefits
to individuals and to Governments'. Benefits are listed as conviviality
and sociability as well as the protective effect. Revenue to Governments
is also listed as a benefit, contributing up to 23% of budgets.
Costs are cited as treating injuries and diseases, property loss,
law enforcement costs, loss of productivity and productive life
years.Some social costs are estimated, but the methodology is
admitted to be varied and difficult to quantify.
Alcohol Control Policies
These are listed and discussed rather than strong objectives put
forward. WHO advocate a comprehensive and global approach to solving
alcohol related problems.These ' alcohol control policies' should
include information and awareness programmes, treatment services
and 'preventative policies'. It criticises current education and
health promotion as ineffective in a largely unregulated advertising
sector as 'they compete with other persuasional messages in the
environment including ones intended to sell alcohol'. It suggests
the restriction of the production and sale of alcohol, such as
the number of outlets and the hours of sale. The success of partial
prohibition in several countries is detailed. Tax is cited as
'a potent tool of prevention policy' but can only be effective
if there is government control over the market, or illicit supply
makes misuse worse (former USSR cited). The regulation of promotional
activities and the sponsorship by alcohol of events is discussed
as are , finally, determent policies such as drink driving campaigns
and strong enforcement of BAC levels.
The report concludes' the evidence displayed on the pages is sufficient
to suggest that alcohol is a significant threat to world health'.
The bulk of the report however, makes for interesting reading
and draws on some interesting studies and statistics, both positive
For further information or a copy of the report, contact Dr Maristela
Monteiro, coordinator, Management of Substance dependence WHO
tel 41 22 791 4791.