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Evaluation and Monitoring Ofaction Onalcohol Evaluation and monitoring ofaction onalcohol WHO Regional Publications European Series No. 59 Publication Series of the European Alcohol Action Plan Evaluation and monitoring of action on alcohol, by Peter Anderson and Juhani Lehto. Approaches to alcohol control policy, by Juhani Lehto. The economics of alcohol policy, by Juhani Lehto. Alcohol and the media, by Marjatta Montonen. Community and municipal action on alcohol, by Bruce Ritson. Alcohol and primary health care, by Peter Anderson. Treatment approaches to alcohol problems, by Nick Heather. Young people and alcohol, drugs and tobacco, by Kellie Anderson. Alcohol and the workplace, by Marion Henderson, Graeme Hutcheson and John Davies. The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of over 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 850 million people liv- ing in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of Russia. The European programme of WHO therefore concentrates both on the problems associated with industrial and post -industrial soci- ety and on those faced by the emerging democracies of central and eastern Europe and the former Soviet Union. In its strategy for attaining the goal of health for all the Regional Office is arranging its activities in three main areas: lifestyles conducive to health, a healthy environment, and appropriate services for prevention, treatment and care. The European Region is characterized by the large number of languages spoken by its peoples, and the resulting difficulties in disseminating information to all who may need it. Applications for rights of translation of Regional Office books are there- fore most welcome. World Health Organization Regional Office for Europe Copenhagen -i;valuation and monitoring of actionon alcohol Targets, indicators and monitoring and reporting systems for action on alcohol by Peter Anderson Alcohol, Drugs and Tobacco Unit WHO Regional Office for Europe and Juhani Lehto National Research and Development Centre for Welfare and Health, Helsinki, Finland WHO Regional Publications, European Series, No. 59 Text editing by Mary Stewart Burgher WHO Library Cataloguing in Publication Data Anderson, Peter Evaluation and monitoring of action on alcohol : targets, indicators and monitoring and reporting systems for action on alcohol / by Peter Anderson and Juhani Lehto (WHO regional publications. European series ; No. 59) 1.Alcoholism - prevention and control 2.Health policy 3.Health plan implementation 4.Evaluation studies 5.Europe I.Lehto, Juhani II.Title III.Series ISBN 92 890 1323 0 (LC Classification: HV 5082) ISSN 0378 -2255 The Regional Office for Europe of the World Health Organization welcomes requests permission or translate its publications, in part or in full. Applica- tions and enquiries should be addressed to the Office of Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK -2100 Copenhagen0,Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. ©World Health Organization 1995 Publications of the World Health Organization enjoy copyright protection in accord- ance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publica- tion do not imply the expression of any opinion whatsoever on the part of the Secre- tariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its fron- tiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omis- sions excepted, the names of proprietary products are distinguished by initial capital letters. The views expressed in this publication are those of the authors and do not nec- essarily represent the decisions or the stated policy of the World Health Organization. PRINTED IN FINLAND Contents Page Introduction 1. Targets for health for all 3 Target 17 4 The nature of targets 5 Setting targets 5 2. Potential targets related to alcohol 8 Alcohol use 8 Health status 13 Social and economic factors 17 Policy objectives 21 3. Targets and indicators for action at the European level 30 Minimum set of targets and indicators 31 Additional targets and indicators 39 European summaries on alcohol, drugs and tobacco 44 4. Targets and indicators for action at the national level 46 Alcohol use indicators 46 Health status indicators 48 Social and economic indicators 50 Alcohol policy indicators 52 Attitudes to alcohol and alcohol control policies 55 Evaluation and monitoring at the national level 56 5. Targets and indicators for action at the local level 59 Availability of data 60 Mapping data at the sublocal level 61 Daily experience of local people and professionals 62 Potential targets 62 6. Conclusion 64 References 66 Annex 1. Targets for health for all 72 Annex 2. Alcohol consumption surveys 78 iii Targets for health for all Introduction The health policy for the WHO European Region, as expressed in 38 targets, lists the improvements in health that are needed to secure health for all Europeans by the year 2000 (1). Target 17 addresses alcohol consumption. Alcohol is of particular concern for the Region because of the high level of its production, global trade and consumption and the extent of associated problems (2). The Region faces a complex future, with a trend towards political liberalization and the attendant difficul- ties of evaluating and predicting changes in the central and eastern countries. In this context, alcohol should be viewed as a special com- modity, because of its dependence- producing properties and the severity of the problems associated with its use. Most of these prob- lems, if not all, can be prevented. The European Alcohol Action Plan was prepared to support the attainment of target 17 through work for significant reductions in the harmful consumption of alcohol in all Member States (3). The Action Plan proposes a comprehensive public health policy on alcohol at the European, national and local levels. Such policies would combine control measures with action by the community, the health services and other sectors, including social welfare, education and criminal justice. The Plan advocates both measures to reduce overall levels of alcohol consumption (a population -based approach) and specific measures aimedatriskbehaviour(ahigh -riskapproach).In September 1992, the WHO Regional Committee for Europe strongly endorsed the Action Plan as a positive set of guidelines for Member States to follow. 1 Evaluation and monitoring of action on alcohol One of the ideas underpinning the targets for health for all is that effective public health policy needs clear objectives and targets, and that the attainment of or progress towards the targets should be monitored and evaluated. The monitoring and evaluation should give feedback to political decision -makers, administrators and everyone who is responsible for the implementation of the policy. These people need the information to develop, update or restructure the policy and its components, as well as to assess the ways in whichitis implemented. One of the first priorities for work under the European Alcohol Action Plan is thus to clarify objectives, set targets, agree on indica- tors and create monitoring and evaluation systems at the international, national and local levels. This publication, the first in a series of nine, is based on the experiences of WHO and many countries in develop- ing their knowledge bases on alcohol consumption, related problems and social responses. A WHO working group discussed the first draft in Copenhagen in September 1992. This publication presents proposals for "subtargets" of target 17, and for indicators and data sources for use in monitoring and evalua- tion. The information that is or may be available varies considerably between countries, so monitoring and evaluation systems cannot be identical. Nevertheless, the Region as a whole and its Member States would benefit if as many countries as possible used at least a mini- mum number of indicators that have been proved to be the most eas- ily available and best to reflect the overall attainment of the targets. Such indicators are also required for international comparison and evaluation. This publication contains six chapters. The first discusses the 38 targets of the health policy for Europe, which the Member States of the WHO European Region have adopted. The second chapter discusses potential targets and indicators
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