Support for strong alcohol policies

Dr Margaret Chan
Director-General of the World Health Organization

Opening address at the Global Alcohol Policy Symposium
Istanbul, Turkey

26 April 2013

Excellencies, honourable ministers, distinguished delegates, colleagues in public health, ladies and gentlemen,

It is an honour, and a great pleasure, to participate in the opening ceremony for this Global Alcohol Policy Symposium. The large number of countries represented here today is a signal of the growing concern about the harmful use of alcohol, and growing determination to take action.

Health officials gave us a similar signal last year, when Thailand hosted a Global Alcohol Policy Conference. These events tell us that action at the policy level is needed.

They tell us that action is deeply desired by many governments, by many civil society organizations, and by the many millions of people around the world who have seen lives, families, careers, and communities devastated or destroyed by the harmful use of alcohol.

This includes the many people who have lost a relative or loved one following a drink-driving incident. Alcohol consumption can harm the user, but it can also harm the innocent.

Harmful drinking causes immense damage to health and societies and imposes a heavy burden on health systems and health budgets. It is a major risk factor, and it is a largely avoidable one.

Alcohol can be a killer. WHO estimates that the harmful use of alcohol is responsible for around 2.3 million deaths worldwide each year.

Alcohol can kill slowly, as it gradually contributes to diseases like cirrhosis of the liver, and cancers at several sites. Harmful drinking is also a major risk factor for cardiovascular diseases.

Alcohol can kill quickly, sometimes instantly, when it contributes to traffic crashes, injuries, violence, violent crime, and suicide.

Harmful drinking makes a significant contribution to ill health and disability. It is a major risk factor for a range of neuropsychiatric disorders, which increase the burden on health systems and societies even further.

Harmful drinking is linked to much more than an increased risk of chronic noncommunicable diseases. Through various mechanisms, harmful drinking increases the risk of infectious diseases, like pneumonia and tuberculosis, and has a negative impact on treatment outcomes, also for HIV/AIDS.

Alcohol consumption during pregnancy can cause permanent physical and mental damage to the child. Bluntly stated, alcohol is a teratogen for the developing fetus.

These risks, this tragic and costly human harm, is largely avoidable.

Reducing the risks requires population-wide measures. Introducing these measures requires high-level commitment, and it requires a great deal of courage.

Ladies and gentlemen,

The job we face is not an easy one. A societal problem, like harmful drinking, has multiple dimensions and contributing factors that extend well beyond the health sector. The health sector, acting alone, cannot implement an adequate range of effective alcohol policies.

Depending on the national context, efforts to protect populations from the harmful use of alcohol can require support from fiscal policies, trade policies, the judicial system, law enforcement, and government ministries responsible for youth, road safety, consumer affairs, and commerce.

On the positive side, all countries wishing to introduce or strengthen alcohol policies have a powerful instrument to assist them. This is the Global strategy to reduce the harmful use of alcohol, endorsed by WHO Member States in 2010.

The strategy sets out a menu of policy options and supporting interventions for reducing the harmful use of alcohol. Each country can draw upon this menu to craft effective and affordable policies that match distinct national problems and priorities, as expressed in distinct cultural and religious contexts.

The strategy was carefully developed during wide-ranging negotiations and consultations that lasted nearly three years. Its unanimous endorsement was a landmark for public health, WHO, and its Member States.

Policies and their supporting interventions are based on solid scientific knowledge, backed by evidence of effectiveness and cost-effectiveness, and supported by practical experiences within countries.

This diversified menu of options is organized around 10 recommended target areas for action. Actions range in nature from community action, to responses within health services, to a number of regulatory measures.

Regulatory measures are particularly effective in preventing deaths and injuries from drink-driving, constraining the availability of alcohol, and reducing the impact of marketing, especially on young people and adolescents. Ways of countering the problems of illicit alcohol and home-made brews are also included.

Increasing the price of alcoholic beverages is one of the most effective interventions to reduce the harmful use of alcohol. For this approach to be successful, countries need to have in place an effective and efficient system for taxation matched by adequate tax collection and enforcement.

Unfortunately, alcohol consumption is expanding rapidly in precisely those countries that lack the regulatory and other capacities needed to protect their populations from alcohol-related harm.

On the positive side, research tells us that strong alcohol policies work.

A reduction in the density of stores selling alcohol has been shown, over time, to reduce rates of child maltreatment and drink-driving. Having fewer outlets has also been linked to fewer traffic crashes and pedestrian injuries.

Restrictions on the times when alcohol is available also have an impact. In one city in Australia, late-night assaults declined by nearly 40% when closing hours for alcohol purchase were turned back modestly.

In a city in Brazil, with one of the highest murder rates in the country, the introduction of restrictions on alcohol availability was followed by a 44% decline in murders.

Price matters greatly. A recent systematic review suggests that doubling taxes on alcohol could reduce alcohol-related deaths by 35%, fatal traffic crashes by 11%, and the rates of sexually transmitted diseases by 6%.

Studies also show that taxes on alcohol can help prevent people from starting to drink. This approach is especially important in the many low- and middle-income countries that have high numbers of lifetime abstainers.

Ways to curtail the initiation of drinking become all the more important given the pressure to consume that comes with aggressive marketing of alcoholic beverages.

In short, national alcohol policies are needed, desired, entirely feasible, and highly effective.

Ladies and gentlemen,

The most important requirement for success, the item that heads that list of ten recommended target areas, is leadership, awareness, and commitment. Turkey has this leadership at the highest political level.

Prime Minister Erdogan is leading the initiative to reduce the harmful use of alcohol within Turkey. He is also the driving force behind this symposium.

The leadership he has shown in forging tough policies for tobacco control and road safety goes beyond safeguarding the health of the Turkish people. It is a model for other countries to follow, and it is a source of great encouragement.

Following a tobacco control law in 2008, smoking prevalence among Turkish adults has declined by an impressive 13%. This recent success is all the more remarkable given the historical importance of tobacco production to the Turkish economy.

I thank the Turkish government for using lessons from its own success to assist other countries in their tobacco control initiatives.

I am always thrilled when a head of state or head of government makes protecting the health of citizens a flagship item on the political agenda. My enthusiasm is fully justified. Some of the biggest threats to health in the 21st century need political solutions, and not just medical or technical ones.

Health all around the world is being profoundly shaped by the same powerful forces: demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles.

The health and medical professions can plead for lifestyle changes, tough tobacco legislation, strong alcohol policies, and healthy diets. We can diagnose patients, treat them (sometimes life-long), and issue the medical bills.

But we cannot reengineer social environments in ways that encourage healthy behaviours and protect populations from harm.

Improving the environment in which consumers make their choices is a political job, especially when public health interests clash with the interests of powerful economic operators, including the alcohol industry. As I said, it takes courage.

I thank Turkey, its Prime Minister, its Ministry of Health, and the Turkish Green Crescent Society for organizing and supporting this symposium. I am confident it will take us some more steps forward in our collective efforts to reduce the harmful use of alcohol.

Thank you.