Change through concrete Policies: The Case of EU Alcohol Policies and subsequent Healthcare Savings

December 05, 2016

Read the opinion-editorial by Helena Cortez-Pinto, Member of the UEG PAC and a Policy Councillor at the European Association for the Study of the Liver (EASL). 

According to World Health Organization (WHO) in the 2014 report [1], an estimated 3.3 million deaths, or 5.9 % of all deaths worldwide, were attributable to alcohol consumption in the year 2012, with about half a million due to liver cirrhosis.

Europe is the WHO region with the highest per capita alcohol consumption and the highest prevalence of heavy drinkers. In fact, in Europe the percentage of alcohol-attributable deaths is 13%, reflecting the higher consumption when compared with the other areas of the world.  The Global Burden of Disease Study 2010, recognizes alcohol as the fifth cause of disability-adjusted life years, affecting low, middle or high-income countries [2].

 

There is an extensive list of diseases to which alcohol consumption contributes, although in different percentages [1]. Some diseases, such as foetal alcohol syndrome or alcohol-use disorders, are exclusively attributable to alcohol, while others such as liver cirrhosis have an alcohol-attributable fraction of about 50%. Interestingly, many of the other alcohol-attributable diseases are gastroenterological, with an important percentage of digestive cancers, including liver cancer, but also pancreatic diseases such as pancreatitis or pancreatic cancer [1]. Furthermore, there is a very good correlation between the amount of pure alcohol consumed and the mortality from chronic liver disease in each country, with some exceptions that may be due to excess unrecorded alcohol consumption [3].

But how is the situation progressing?  In a very recent report from WHO we can observe that the WHO European region, as a whole, had a slight decline in alcohol consumption [4]. However, different trends were seen according to the region, with the Mediterranean area witnessing a decline in consumption, while central-eastern EU consumption remaining stable, and eastern and south-eastern part of the WHO European Region increasing their consumption over the past 25 years. As a result, EU eastern countries and UK had a marked increase in alcohol-related mortality rate, whilst countries of the Mediterranean area had a decrease. This is also reflected in the comparison of alcohol-attributable mortality between 1990 and 2014, where Eastern and – South Eastern regions registered the highest increase in all causes alcohol-related mortality [4].

Consequently, there is a need to implement measures that decrease excessive alcohol consumption and reduce associated elevated mortality and costs.One of the first questions that is usually raised, is why regulate? Regulation is needed, because alcohol is NOT a “normal” consumer product, and due to its addictive nature, implies specific regulations, as tobacco does. Furthermore, new trends of dangerous “drinking culture” have emerged, that have to be reversed. Also, policies based on individual responsibility, have mostly failed. Last, regulation costs nearly nothing, and can even increase the money revenue from taxes.

In 2011 the WHO published an action plan that was endorsed by 53 European Member States at the Regional Office for Europe [5]. Ten action areas were defined: 1) leadership, awareness and commitment – National plans, pricing policies; 2) health services’ response: brief advice interventions, 3) community and workplace action: reducing the negative consequences of drinking and alcohol intoxication; 4) driving policies and countermeasures – reducing the legal blood alcohol content (BAC) and enhance enforcement; 5) availability of alcohol - minimum purchase age no less that 18 years and reduction of the hours or days of sale, what was shown to lead to a clear reduction in drink-driving casualties and other alcohol-related harm [6]; 6) marketing of alcoholic beverages - regulating sponsorship activities that promote alcoholic beverages; and restricting or banning promotions in connection with young people; 7) pricing policies: increasing alcohol taxes, proportionally to their alcohol content; 8) reducing the negative consequences of drinking and alcohol intoxication; 9) reducing the public health impact of illicit alcohol and informally produced alcohol; 10) monitoring and surveillance.

From those measures, one that is fundamental is pricing/affordability, since it has been well demonstrated an inverse correlation between alcohol price and consumption. To decrease affordability, a specific measure was conceived, the minimum-unit pricing (MUP), setting a floor price for a unit of alcohol. This measure, although controversial, has shown to be very effective. For example, in British Columbia, it reduced 32% alcohol-related mortality one year after its implementation. This measure also has the advantage of being more effective for heavy consumers and for low-income groups, who are more in risk of the alcohol-related-harm [7].

Regarding advertising, we all aware that alcohol producers use a sophisticated advertising marketing in mainstream media, using sponsorships, and Internet media. The current revision of the Audiovisual Media Services Directive (AVMSD) is a great opportunity to decrease the exposition of Europe’s children and youth from health-harmful marketing.

So, we know what are the effective measures. What we need is political wish to implement them.

 

 

References

  1. WHO. GLOBAL STATUS REPORT on noncommunicable diseases 2014: WHO Library Cataloguing-in-Publication Data; 2014
  2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet 2012;380:2224-60.
  3. Sheron N. Alcohol and liver disease in Europe--Simple measures have the potential to prevent tens of thousands of premature deaths.J Hepatol 2016;64:957-67.
  4. Shield K, Rylett M, Rehm J. Public health successes and missed opportunities: Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014: WHO; 2016.
  5. WHO. European action plan to reduce the harmful use of alcohol 2012–2020; 2011.
  6. Anderson P, de Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies.Alcohol Alcohol 2009;44:229-43.
  7. Stockwell T, Auld MC, Zhao J, Martin G. Does minimum pricing reduce alcohol consumption? The experience of a Canadian province.Addiction 2012;107:912-20. 

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