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Making South-East Asia SAFER from Alcohol-Related Harm

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Making South-East Asia SAFER from Alcohol-Related Harm Alcohol use is responsible for more than 1 in 20 deaths globally and in the WHO Making South-East Asia safer South-east Asia Region. It causes more deaths than those caused by tuberculosis, HIV/AIDS, and diabetes, each. Notably, more than one in every ve deaths from from alcohol related harm: tuberculosis is attributed to alcohol use. The societal costs of alcohol aecting the partners, children, families and communities of drinkers are estimated to be twice those Current status and way forward incurred by drinkers themselves. The per capita alcohol consumption has been increasing substantially in the South-East Asia Region since 2000. Bold policy actions and their eective implementation are required to reverse the trends in increasing per capita consumption. WHO launched “SAFER” – an action package prioritizing ve high-impact policy action domains. The paper provides the current status of implementation of SAFER policy action package in WHO South-East Asia Region. 9 789290 227274 Making South-East Asia SAFER from alcohol-related harm: current status and way forward Making South-East Asia SAFER from alcohol-related harm: Current status and way forward ISBN: 978 92 9022 727 4 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization.. Suggested citation. Making South-East Asia SAFER from alcohol-related harm: Current status and way forward. New Delhi: World Health Organization, Regional Office for South-East Asia; 2019. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in India Cover Painting: Miss Wikawee Rattanamanee, Bangkok, Thailand Contents List of figures, tables and boxes iv Abbreviations and acronyms vi Foreword by Regional Director vii Acknowledgments ix Executive summary x Harmful use of alcohol: A public health and developmental urgency 1 SAFER: alcohol control initiative 4 Implementation of SAFER in WHO SEA Region: a baseline assessment 5 S: Strengthen restrictions on alcohol availability 5 A: Advance and enforce drink-driving countermeasures 14 F: Facilitate access to screening, brief intervention and treatment 18 E: Enforce bans or comprehensive restrictions on advertising, sponsorship and promotions 21 R: Raise prices on alcohol through excise taxes and pricing policies 27 Monitoring and evaluation 36 The call for action 37 References 39 List of figures, tables and boxes Figures Fig. 1: Percentage of all deaths and DALYs in WHO South-East Asia Region attributed to alcohol among all ages, and among 15–49-years-old by sex, 2017 Fig. 2: Current and projected trends in total alcohol per capita consumption (APC) (15+ years) in Litters of pure alcohol in WHO South-East Asia Region Fig. 3: WHO SAFER action package Fig. 4: The overall physical availability restrictiveness score for alcoholic beverages in WHO SEA Region, 2016 Fig. 5: The overall score for stringency of drink-driving countermeasures on a scale of 1–5 in WHO South-East Asia Region, 2016 Fig. 6: Marketing restrictiveness index (scale of 1 to 5) for alcohol in WHO South-East Asia Region, 2016 Fig. 7: Overall pricing stringency score for policies enacted to raise the price of alcoholic beverages in WHO south-East Asia Region (2017) Fig. 8: SAFER policy content score on a scale of 1–100 for selected Member States of SEA Region iv Tables Table 1: Licensing requirements and government monopolies to regulate production, export– import, retail sales in WHO South-East Asia Region, 2016 Table 2: Off- and on-premise sale restrictions on sale of alcohol Table 3: Restrictions on alcohol use in public places in WHO South-East Asia Region, 2016 Table 4: Legal blood alcohol concentration limits and driver screening methods Table 5: Penalties for drink driving for first/repeated offence in WHO South-East Asia Region, 2016 Table 6: Coverage of health services response for detection and treatment of harmful and hazardous alcohol use in WHO SEA Region, 2014–2016 Table 7: Policy situation on alcohol marketing, advertising and sponsorship in WHO South-East Asia Region Table 8:Status of taxation on alcoholic beverages and other pricing policies in WHO South- East Asia Region, 2016 Boxes Box 1: Public health burden related to Alcohol in SEA Region Box 2: Alcohol consumption levels and pattern in SEA Region Box 3: Policy options and interventions for regulating availability of alcohol Making South-East Asia SAFER from alcohol-related harm: Current status and way forward Box 4: Government monopoly on both wholesale and retail distribution Box 5: Days of restricted/no alcohol sale in SEA Region Box 6: Restriction on h of sale Box 7: Physical availability restrictiveness score Box 8: Drink driving countermeasures score Box 9: Health services score Box 10: Policy options and interventions for marketing restrictions Box 11: Marketing restrictiveness score Box 12: Pricing stringency score to curb alcohol consumption Box 13: Policy response to reduce harmful use of alcohol in SEA Region: key points v Making South-East Asia SAFER from alcohol-related harm: Current status and way forward Abbreviations and acronyms AAF alcohol-attributable fraction AIDS acquired immune deficiency syndrome APC alcohol per capita consumption BAC blood alcohol concentration DALYs disability-adjusted life year GSHS global school-based student health survey HED heavy episodic drinking HIV human immunodeficiency virus I$ International dollar MDA minimum drinking age MPA minimum purchasing age NCD noncommunicable disease RBT random breath testing SDG Sustainable Development Goal SEA South-East Asia vi STEPS STEPwise approach to surveillance TB tuberculosis UT union territory WHO World Health Organization Making South-East Asia SAFER from alcohol-related harm: Current status and way forward Foreword by Regional Director The harmful use of alcohol has a direct – and very negative – impact on public health and development across the world. Every year it is estimated to cause 3.3 million deaths, equating to one in every 20, and accounts for more than 5% of the global disease burden. To counter the problem, in 2018 WHO, in collaboration with a range of development partners, launched the SAFER Initiative – an action-oriented technical package and roadmap that prioritizes five high-impact and cost-effective strategies including three ‘best buys’ to help Member States reduce alcohol’s damaging effect on health, the social fabric and economy. As the following report details, the WHO South-East Asia Region is harnessing the Initiative’s momentum, including by documenting the status of alcohol use in the Region and charting the way forward. In doing so, the report provides Region-specific policy insights pertaining to each of the Initiative’s five key strategies. There is a clear need for action. Across the Region, the harmful use of alcohol causes more than 650 000 deaths each year – more than those caused by each of tuberculosis, HIV/AIDS or diabetes. Notably, more than one in every five deaths from tuberculosis—the battle against which is one of the Region’s Flagship Priorities – are attributed to alcohol use. Increased consumption is of concern.
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