___________________________________________ High-Level Preparatory (HLP) Meeting for the Regional Committee WHO/SEARO, New Delhi, 29 June – 2 July 2009 Agenda item 5.6 SEA/HLP-Meet/5.6 9 June 2009 FOLLOW-UP ACTION ON PENDING ISSUES AND SELECTED REGIONAL COMMITTEE RESOLUTIONS/DECISIONS FOR THE LAST THREE YEARS: STRATEGIES TO REDUCE HARMFUL USE OF ALCOHOL The WHO Regional Committee for South-East Asia, vide resolution SEA/RC59/R8, requested the Regional Office to provide technical support to Member States in building and strengthening programmes on prevention of harm from alcohol use. The basis for the prevention of alcohol-related harm in the context of the South-East Asia Region should not only be disease prevention but reduction of poverty, disempowerment, violence, prevention of injuries and improvement of well-being and social capital. Programmes should address local patterns of alcohol consumption and attitudes of the communities. Another issue of concern is the consumption of alcohol among women, which is currently quite low, but is gradually increasing. Illicit alcohol production and consumption is also of concern in the Region. Legislation and policy measures alone cannot fully address the reduction of harm related to alcohol use in the Region. Thus, community empowerment programmes become important as a strategy to reduce harm from alcohol use in the community. Initiatives to reduce harm from alcohol use in the Region have to take into account all the above factors. A single solution to this problem does not exist in the context of the Region. Hence, care should be taken to ensure that interventions are tailored to the countries and communities they are addressed to. The strategies proposed by the Regional Office to reduce the harmful use of alcohol include: (a) Support to Member States for developing alcohol-related policy; (b) Regional contribution to the draft document “Towards a Global Strategy to Reduce Harmful Use of Alcohol”; and (c) Community action to reduce harm from alcohol use, based on evidence from the Region. The attached working paper is submitted to the High-Level Preparatory (HLP) Meeting for its review and recommendations. These recommendations will be submitted to the Sixty-second Session of the Regional Committee for its consideration.
SEA/HLP-Meet/5.6 Introduction 1. There is substantial evidence that alcohol use is a major determinant of ill-health and of economic and social disempowerment. Many governments worldwide, including the governments of Member States in the South-East Asia Region, consider harm from alcohol use in the community as a serious issue which needs addressing. 2. The WHO Regional Committee for South-East Asia, in its resolution (SEA/RC59/R8), requested the Regional Office to provide technical support to Member States in building and strengthening institutional capacities for developing information systems, policies, action plans, programmes, guidelines and monitoring and evaluation programmes on prevention of harm from alcohol use. 3. Alcohol use and its related harm depends on the socio-cultural milieu in which it is used. Policies, legislation, enforcement, cultural norms, alcohol industry activities, services available, level of empowerment of communities and individual perceptions are some of the factors that contribute to the initiation of use, continuation of use and behaviours that lead to harm from alcohol use. These diverse factors lead to many variations in behaviours, perceptions and responses related to use of alcohol, not only between countries, but also within countries. 4. There is a large body of information related to alcohol use, policies and interventions that has been developed internationally. Though such information is useful, it should not be assumed that transplanting measures found to be successful elsewhere, under completely different circumstances, will be effective in this Region. Largely, such research and information is from countries and regions that are economically developed with advanced infrastructure and services. In such situations, harm related to alcohol use is considered mainly an issue of health. In the South-East Asia Region, it is quite different. Alcohol is a significant contributor to poverty and impedes development, in addition to its adverse social, psychological and health impact. 5. Traditionally, information used for programme development has been mainly statistical data on the consumption rates and morbidity/mortality. Such information alone is insufficient to develop and implement effective programmes to reduce alcohol-related harm. Qualitative information covering the context and patterns of use, perceptions of communities, diverse agencies involved (often with conflicting interest) are more important and urgent at this juncture. In addition, initiatives already in place, current capacities and gaps that need filling should be considered. This is because alcohol- related programmes should not only be developed, strengthened and expedited, but also made relevant in the environments in which they will be implemented. Quantitative information relating to alcohol use is rare in most countries of the South-East Asia Region and relevant qualitative information is even more difficult to gather. It is in this context that the SEARO programme on reducing harm from alcohol use is being developed. SEA/HLP-Meet/5.6 Page 2 Issues on alcohol use relevant to WHO South-East Asia Region 6. The basis for the prevention of alcohol-related harm in the context of the South-East Asia Region should not only be disease prevention but reduction of poverty, disempowerment, violence (including domestic violence), prevention of injuries and improvement of well-being and social capital. Programmes should address local patterns of alcohol consumption (such as pay-day drinking), attitudes of some communities that consuming alcohol is a sign of “growing up” for boys, etc. Also, that people usually consume large quantities of alcohol at one time (binge drinking) when they drink, unlike western patterns of consumption, such as one glass of wine every day, needs to be addressed. Another issue of concern is the consumption of alcohol among women which is currently quite low, but gradually increasing. The success of voluntary restrictions in some communities (e.g. on religious grounds) needs to be studied. 7. Traditional western models of prevention of harm from alcohol use have not been very useful in countries of the Region due to the many local issues linked to alcohol use. 8. In addition, surveys including community assessments and field observations show that illicit alcohol production and consumption is also of concern in the Region. Illicit alcohol is now included under the category of “unrecorded” alcohol. Enforcement agencies are often overstretched by the limited resources available to them. Therefore, legislation and policy measures alone cannot fully address the reduction of harm related to alcohol use in the Region. Thus, community empowerment programmes become important as a strategy to reduce harm from alcohol use in the community. 9. Initiatives to reduce harm from alcohol use in the Region have to take into account all the above factors. A “one-size-fits-all” solution to this problem does not exist in the context of the Region. Hence, care should be taken to ensure that interventions are tailored to the countries and communities they are addressed to. If this does not happen, the effectiveness and the efficiency of interventions are likely to suffer. Therefore, it is imperative that the policy makers, programme planners in government and other agencies responsible for reducing alcohol-related harm at country level have relevant information to design and implement effective programmes. Strategies to reduce harmful use of alcohol 10. The Mental Health and Substance Abuse Unit of the WHO Regional Office for South-East Asia has undertaken many activities to assist Member States in developing strategies to reduce harmful use of alcohol. Support to Member States for developing alcohol-related policy 11. As requested by the Government of India during the Sixty-first session of the Regional Committee and supported by governments of some other Member States, SEARO hosted an intercountry consultation entitled: “Intercountry Consultation on the Possibility of Developing a Framework Convention on Control of Harm from Alcohol Use”, 5-6 January 2009 in New Delhi. SEA/HLP-Meet/5.6 Page 3 12. The delegates discussed the need for an international convention on control of alcohol. Such an instrument was needed to address cross-border issues such as trade liberalization, foreign direct investment, global marketing and transnational advertising (e.g. through the internet). The meeting reached consensus that the name of such an agreement should be “Framework Convention on Alcohol Control (FCAC)”. This would include a wide range of activities which can lead to “control” of alcohol resulting in reducing harm from alcohol use. It was pointed out that “control” did not mean “ban”. 13. The delegates agreed that Member States in the South-East Asia Region should take this issue forward at the appropriate time and forum such as the WHO Executive Board and the World Health Assembly. Regional Contribution to the draft document “Towards a Global Strategy to Reduce Harmful Use of Alcohol” 14. World Health Assembly Resolution (WHA 61.4) entitled: “Strategies to reduce the harmful use of alcohol” requested WHO to prepare a draft global strategy to reduce harmful use of alcohol and to submit it to the Sixty-third World Health Assembly in 2010 through the Executive Board. The Management of Substance Abuse unit at WHO HQ in collaboration with the regional offices has developed an extensive process of consultation in developing the draft global strategy. It includes an open web-based consultation to which any one can contribute, round-table meetings with economic operators, NGOs, health professionals and intergovernmental organizations. It includes regional meetings in all six Regions in which Member States can contribute their perspective towards the content of the draft global strategy. 15. A WHO South-East Asia “Regional Technical Consultation on Global Strategy to Reduce Harmful Use of Alcohol” was held in Nonthaburi, Thailand, from 24-26 February 2009 and was co- sponsored by the Government of Thailand. Some of important issues raised by Member States included the consumption of home brew and illicit alcohol, the contribution of alcohol to poverty, linkage of alcohol to violence within families, pay-day drinking and binge drinking. The delegates also pointed out that alcohol use was culturally accepted in many communities, thus, total prohibition of alcohol should not be considered. Another important issue discussed was the effectiveness of community action in reducing harm from alcohol use which has been successfully implemented in some communities in the Region. 16. The delegates also discussed that understanding and awareness of alcohol-related harm and the wide spectrum of harm from alcohol use were not fully recognized. Delegates discussed that harmful use of alcohol (e.g. “binge” drinking) was only one of the means of harm from alcohol use in the broad spectrum of harm from alcohol use. The lack of national policies, legislation and programmes and the poor implementation of existing policies and legislation related to alcohol were cited as challenges by most delegates. The delegates emphasized that although there may be a global strategy, the autonomy of Member States towards accepting and implementing the policy must be respected. They also noted with concern that the aggressive marketing of alcohol particularly to adolescents by transnational alcohol companies was promoting alcohol use among the youth. The meeting concluded with broad support towards developing a draft global strategy on prevention of harmful use of alcohol. All delegates expressed the desire to see a draft of the policy before it was submitted to the WHO Executive Board in 2010. SEA/HLP-Meet/5.6 Page 4 Community action as a strategy to reduce harm from alcohol use based on evidence from the Region 17. The MHS unit in the Regional office has compiled and analysed community-based data on alcohol use from six Member States. Community-based surveys on the use and harm from alcohol use were conducted in three countries (Myanmar, Nepal and Sri Lanka). These sample survey data and information from national surveys of three other countries (India, Indonesia, and Thailand) were analysed. 18. The next step has been designing programmes to reduce harm from alcohol use through community action. These programmes have been developed in consultation with experts from Member States where the programmes will be implemented and were designed based on the findings of data compiled from six countries. Some of the areas for community action include interventions for young people (e.g. convincing them that the alcohol industry is manipulating them to drink alcohol), addressing the context of alcohol use (e.g. use on special occasions such as funerals), addressing pay-day drinking, addressing anti-social behaviour and violence related to alcohol (e.g. by removing social acceptance of violent behaviour when intoxicated) and addressing the manufacture and distribution of illicit alcohol at the community level. 19. The final step of programme development, which is currently in progress, will be the implementation and evaluation of these programmes. Such programmes will be implemented as pilot projects at five sites in India (supported by the Government of India), two sites in Sri Lanka (funded from extra-budgetary country funds) and two sites in Thailand (supported by ThaiHealth). The results will be available by the end of the year 2010. Based on the evaluation of these pilot projects, the SEARO programme on reducing harm from alcohol use will be taken forward. *****