..Alcohol and Public Health in the Americas

Maristela G. Monteiro, M.D., Ph.D.Senior Advisor on Alcohol and Substance Abuse

AMERICAS 2004

Chart1

38575365.212911377701.911384611881689.288951148139.878937134342119.76493357752.924818

50770574.40038573145980.419235472166354.905856231542854.5515363510559383.13827641832280.12433952

7758826.8935695713101987.602517762555.52829474117341992.077926612065924.66612918392630.4323085

28699786.3567522218637.468554437364469.146627271182086.1067002720175780.31533724599254.32027853

5009668.065240525476201.189579674316651.1885646817121021.717872113447280.773203511855690.6786302

1930408.709526798837278.88619912792573.1437825117724569.584543112764475.242080112847725.6275753

AFRICA

THE AMERICAS

EASTERN MEDITERRANEAN

EUROPE

SOUTH-EAST ASIA

WESTERN PACIFIC

AFRO

38575365.21291

50770574.4003857

7758826.89356957

28699786.356752

5009668.06524052

1930408.70952679

16691708.159537

2906253.3428714

18056975.2815185

2258549.58487764

AFRICA

SEAR

34342119.7649

10559383.1382764

12065924.666129

20175780.3153372

13447280.7732035

12764475.2420801

12808968.634484

13326001.1019794

12491887.8589535

5132622.22787023

SOUTH-EAST ASIA

EMRO

11881689.28895

2166354.90585623

762555.528294741

7364469.14662727

4316651.18856468

2792573.14378251

7299286.505784

3880276.09910758

4239420.97437594

3230577.62975709

2612174.83215882

2296973.71984793

2534518.69382309

2914825.77962852

1688626.5748963

908338.54651239

1638122.5376222

2116524.2081996

1670863.3620588

512270.52480156

1637909.27932368

970621.27423087

EASTERN MEDITERRANEAN

world

90682768.9819

70017427.5396245

69423917.2007415

64240013.7142472

57226513.613089

56897031.19371

43841712.31883

41304910.6024463

41009243.6344767

35795832.0198964

WORLD (b)

WORLD

AMRO

13101987.602517

8837278.8861991

7879927.3123535

6165721.79612146

5476201.18957967

4348514.82804144

3594971.98767355

3145980.41923547

3109608.31197949

2472450.731125

THE AMERICAS

DALYs (000)

Sheet1

CauseWORLD (b)AFRICATHE AMERICASEASTERN MEDITERRANEANEUROPESOUTH-EAST ASIAWESTERN PACIFIC

Alcohol use69423917.20074157758826.8935695713101987.602517762555.52829474117341992.077926612065924.66612918392630.4323085

Tobacco use56897031.193711930408.709526798837278.88619912792573.1437825117724569.584543112764475.242080112847725.6275753

Overweight and obesity35795832.01989642258549.584877647879927.31235353230577.6297570911757955.88065815132622.227870235536199.38437887

High blood glucose41304910.60244632906253.34287146165721.796121463880276.099107587304453.7516022113326001.10197947722204.51076577

High blood pressure57226513.6130895009668.065240525476201.189579674316651.1885646817121021.717872113447280.773203511855690.6786302

Physical inactivity32099067.79596632289366.382718414348514.828041442612174.832158828264234.392098829010030.24160425574747.11934429

High cholesterol29723136.28255031070732.07336183594971.987673552296973.719847938974604.40742269856142.624029423929711.47021598

Unsafe sex70017427.539624550770574.40038573145980.419235472166354.905856231542854.5515363510559383.13827641832280.12433952

Illicit drug use13223277.30810711130717.1784263109608.311979492116524.20819962395116.600339732585208.259460111886102.74970226

Sub-optimal breastfeeding43841712.3188316691708.1595372472450.7311257299286.5057841262795.447007512808968.6344843306502.840889

Unsafe water, sanitation, hygiene64240013.714247228699786.3567522218637.468554437364469.146627271182086.1067002720175780.31533724599254.32027853

Occupational risks25668025.80675462507180.247996631942821.492096012534518.693823092543868.892845228074634.530140758065001.94985267

Low fruit and vegetable intake15973942.54432721031178.419624561704955.70885389908338.546512393624071.842801344864771.180147413840626.8463858

Underweight90682768.981938575365.212911377701.911384611881689.288951148139.878937134342119.76493357752.924818

Iron deficiency19733631.75170854709634.561734431069073.458003221688626.5748963947785.0035780457946005.351110773372506.80238294

Urban outdoor air pollution8747064.4828878881173.348512838884375.99320832970621.274230871455585.069464721911068.047045992644240.75042562

Unmet contraceptive need11501468.8144023644637.775698772734.22905651670863.3620588130978.366952114934214.68173348040.3989071

Child sexual abuse9017683.33949592602874.654496987753211.311488048512270.52480156798225.3848202324048322.39975532302779.06413324

Indoor smoke from solid fuels41009243.634476718056975.2815185734605.4191051984239420.97437594485429.26272755912491887.85895355000924.837788

Lead exposure8977416.826472461050147.67213925580436.3058933531637909.27932368133725.862866084043714.584286591531483.12196443

Vitamin A deficiency22099327.09120059322588.33939809343061.0248876842914825.77962852317823.1391861118548015.95511186653012.852987491

Zinc deficiency15579955.1315328963547.028182318611.93457731638122.5376222174436.734578183927762.623177557474.2733952

Global climate change5403891.721016772028918.2673343281052.1190209054755869.65859078925932.03366742892319695.95275791192423.689645491

Unsafe health care injections6959598.57166232827368.03877088439525.5517727341937779.122580653261009.9565796182307819.749416992586096.15254131

Sheet1

0

0

0

0

0

0

0

0

0

0

EUROPE

Sheet2

1377701.9113846

3145980.41923547

13101987.602517

2218637.46855443

5476201.18957967

8837278.8861991

2472450.731125

6165721.79612146

734605.419105198

7879927.3123535

THE AMERICAS

Sheet3

0

0

0

0

0

0

0

0

0

0

WESTERN PACIFIC

0

0

0

0

0

0

0

0

0

0

WORLD (b)

Notes

List of countries in WHO RegionsRisk factor exposure measures - refer to (1) for more details and references

RegionMember StatesRisk factorExposure measure and units

African RegionAlgeriaChildhood and maternal undernutrition

AngolaUnderweightChildren < 1 standard deviation weight-for-age compared with the new WHO standards in 1SD increments; maternal body mass index

GBD 2004 IN THE AMERICAS9.2% OF ALL DALYS IN THE REGION WERE ATTRIBUTED TO ALCOHOL: 14.2% OF ALL DALYS AMONG MEN3.4% OF ALL DALYS AMONG WOMEN

AMERICAS B AND D HAD THE HIGHEST IMPACT16.7% OF ALL DALYS AMONG MEN3.4% OF ALL DALYS AMONG WOMEN

347,138 DEATHS FROM ALCOHOL, 5.6% OF THE TOTAL

Distribution of alcohol-attributable DALYs by disease group

Strong links with NCDsGlobal distribution of all alcohol-attributable deaths by disease or injury, 2004

ALCOHOL MARKETING - Ecuador

First Pan American Conference on Alcohol Public Policies 2005Brasilia Declaration Recommendations Preventing and reducing alcohol consumption related harms be considered a public health priority for action in all countries of the Americas

Regional and national strategies be developed, incorporating culturally-appropriate evidence based approaches to reduce alcohol related harm

Brasilia Declaration Recommendations Strategies be supported by improved information systems and further research

Creation of a regional network of national counterparts to work together

Implement and evaluate policies already known to be effective

Priority areas: heavy drinking occasions, overall alcohol consumption, women, indigenous peoples, youth, other vulnerable populations, violence, intentional and non-intentional injuries, underage drinking and alcohol use disorders

REGIONAL INITIATIVESMulticentric study on gender, alcohol, culture and harms (10 countries)PAHO-Valencia cooperation agreement on reducing alcohol problems in DOR, GUT, GUY, HON, NIC and PANINEBRIA Latina (http://www.inebria.net/Du14/pdf/boston_2011_brochure.pdf) Conference in Boston 21-23 September 2011Dissemination of informationRegional network of national counterparts (2011) and regional plan of action (2012)

Regional Situation- Policy No country with a comprehensive policy to serve as a model to other countries;

Best practices do exist and need to be expanded and better documented, particularly in Latin America and the Caribbean:

Reducing hours and days of sale: Brazil, Peru, Colombia, USA, CanadaReducing drink driving: Brazil, USA, Canada, MexicoControlling advertising: Costa RicaIncreasing prices and taxes: USA, Canada, VenezuelaSales to minors: USA, CanadaBrief interventions in Primary Health Care: Mexico, Canada, USA, Chile Minimum drinking age: USA, Canada

Global strategy to reduce the harmful use of alcohol (2010)Developed through a long and intense collaboration between the WHO Secretariat and Member States.All important stakeholders were consulted in the process, including the industry and NGOs.Represents a unique consensus among WHO 193 Member States on ways to tackle harmful use of alcohol at all levels.

10 TARGET POLICY AREAS(a) leadership, awareness and commitment(b) health services response(c) community action(d) drinkdriving policies and countermeasures(e) availability of alcohol(f) marketing of alcoholic beverages(g) pricing policies(h) reducing the negative consequences of drinking and alcohol intoxication(i) reducing the public health impact of illicit alcohol and informally produced alcohol(j) monitoring and surveillance.

ANOC2

950/dayPreventable deaths in the Americas

***Slide 7As this pie chart shows, harmful drinking is a major avoidable risk factor for noncommunicable diseases, in particular cardiovascular diseases, cirrhosis of the liver and various cancers. Indeed, current evidence indicates that four types of noncommunicable diseases- cardiovascular diseases, cancers ,chronic respiratory diseases and diabetes - make the largest contribution to mortality in the majority of low-, middle and high-income countries and require concerted, coordinated action. These noncommunicable diseases are largely preventable by means of effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. Indeed, tackling the global burden of NCDs is one of the major challenges for development in the 21st century. Consolidacion del mercadeo cervecero mundial, creando casi monopolios de produccion, distribucion y venta. Todavia, las estrategias de mercadeo son mucho mas agresivas en los paises en que ellos buscan la expansion del mercado, comparadas con los paises desarrollos y ya saturados. ****