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).

Consumption Trends

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 life expectancy.

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 and negative.

For further information or a copy of the report, contact Dr Maristela Monteiro, coordinator, Management of Substance dependence WHO tel 41 22 791 4791.