Alcohol Prevention day Alcohol in Europe Peter Anderson, MD, MPH, PhD Rome 17 April 2008

1. Alcohol Prevention day Alcohol in Europe Peter Anderson, MD, MPH, PhD Rome 17 April 2008

2. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

3. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

4. Estimates for United Kingdom This is a graph that tells us what is the likelihood, when we die, that the cause of our death will be due to a disease caused by alcohol, related to how much we drink, on average, over our lives Risk per 1,000 Average daily consumption (grams pure alcohol) Source: Taylor & Rehm, based on Taylor et al., AJE, 2008; Rehm et al. IJMPR, 2008

5. So, this is a graph that tells us, when we die, what is the likelihood that the cause of our death is due to an injury caused by alcohol, But, since this risk is also affected by how often we drink, this graph is for when we drink every second day But, of course, the risk of death is not just about how much we drink on average, but also about how much we drink on an occasion Estimates for United Kingdom Risk per 1,000 Consumption per occasion (grams of pure alcohol) Source: Taylor & Rehm, based on Taylor et al., AJE, 2008; Rehm et al. IJMPR, 2008

6. The disease and injury risks are additive: For all of us (both men and women) who drink 4-5 glasses of wine on an occasion every second day over our lives, the risk that we will die from alcohol is about 10%

7. % Age (years) Proportion of European people who have had 5+ drinks on one occasion at least once a week during past 12 months by age Source: Eurobarometer 2007

8. 55-74 The risks for the middle aged are also shown in the UK, where alcohol-related deaths have more than doubled over the last 15 years 35-54 15-34 Source: Office for National Statistics, UK 2008

9. % Occupational group Proportion of European people of have had 5+ drinks on one occasion at least once a week during past 12 months by occupational group

10. The increase in alcohol-related deaths in the UK occur not only in the middle-aged, but also in the middle class. Death certificate mentions alcohol Death certificate states alcohol as underlying cause Source: Goldacre et al 2004

11. 0 10 20 30 40 50 60 % Proportion of European people of have had 5+ drinks on one occasion at least once a week during past 12 months by selected country Source: Eurobarometer 2007

12. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

13. As we know, adolescents are vulnerable to the effects of alcohol In fact, taxi drivers in London have increased hippocampal size Let, us look at the example of the hippocampus, a structure of the forebrain involved in memory and spatial navigation

14. Source: DeBellis et al 2000

15. 10% reduction Source: DeBellis et al 2000

16. Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

17. 3/19 Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

18. 3/19 1/9 Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

19. 3/19 0/19 1/9 Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

20. 3/19 0/19 2/12 1/9 Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

21. 6/59 3/19 0/19 2/12 1/9 Impact of school education: synthesis of 14 systematic reviews Source: Jones et al 2007

22. We undertook a systematic procedure to find and describe all studies that investigated the impact of media and advertising exposure on subsequent alcohol use We found 9 such studies, 8 of which were from the US and one from Belgium. All 9 studies found that the greater the exposure to media, alcohol advertisements, or promotional material, the greater the likelihood of starting to drink and the greater amount of alcohol consumed overall and on an occasion. No studies were found which did not show an impact Anderson, de Bruijn, Hastings et al (in preparation)

23. Californian study of the impact of exposure to alcohol advertisements on TV on alcohol use in 2,250 12 to 13 year old school children followed up for one year. At baseline, 16% reported drinking beer in the past month, 15% reported drinking wine in the past month, and 8% reported three-drink episodes in the past month. One year later, those who had watched 60% more alcohol advertisements on TV were 44% more likely to have used beer, 34% more likely to have ever used wine/liquor, and 26% more likely to have had 3 or more drinks on one occasion. Stacey et al (2004)

24. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

25. 2,000 homicides (4 in 10 of all murders) • 10,000 deaths of people other than the drink-driver from road traffic accidents (3 in 5 of all road traffic fatalities) • 16% of all child abuse / neglect • 5-9 million children living in families adversely affected by alcohol • 60,000 underweight births

26. Pain and suffering €68bn Lost life €258bn Crime €12bn Value of suffering and loss of life due alcohol €270bn

27. Source: Streissguth et al 1994

31. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

32. Volume of consumption effectiveness trials Volume of consumption efficacy trials The reduction in drinking was similar in the normal clinical setting as in a research setting with greater resources This is called a forest plot, because it appears as a forest of lines. On average, drinkers reduced their consumption from 320g/week (32 drinks) to 280g/week (28 drinks) No treatment effect Treatment effect No treatment effect Treatment effect Kaner et al 2007

33. Proportion of heavy drinkers

34. Proportion of binge drinkers

35. Longer BI did not achieve significant extra benefits in terms of reduced drinking (a small extra reduction of 1.1 grams/week for every extra minute of counselling)

36. 6/59 Relative risk Alcohol consumption (g/day) Risk of ICU admission and hospital death after general surgery Source: Delgado Rodriguez et al 2003

37. Structure of presentation Alcohol causes a high level of harm Young people are vulnerable to alcohol Alcohol causes harm to people other than the drinker Help needs to be available for people with problems By focusing on their product, economic operators have the potential to reduce harm

38. Strength and Price: • economic operators can consider ways in which the strength and the price of the product can be managed to reduce the harm done by alcohol

39. Common organization in the market of wine: • From 01/08/2009, enrichment limits reduced; e.g., in zone A of Germany when unfavourable climatic conditions: • currently a wine with a natural alcohol content of 8% can be produced, and the alcohol content can be increased by 4.5% to 12.5% • under the new rules, the same wine cannot become more than 11.5% since only a maximum of 3.5% of enrichment will be possible

40. Illegally traded and illicit alcohol: Negative impact on producers and retailers Lower price, more harm Contamination from post-production handling No quality control Lost tax revenue to governments

41. Percentage of unrecorded consumption to total consumption: Older Member States: 11% Newer Member States: 38% Do not know distribution between: Legally traded Illegally traded

42. Illegally traded and illicit alcohol: Joint working in tracing and tracking illegal and illicit alcohol Tax stamps to trace products

43. Alcohol causes a high level of harm We continually need to remind people of the high level of harm that alcohol can cause through to old age: Community and municipal programmes need to be strengthened and implemented to raise awareness and support for alcohol policies Warning labels need to be added to alcohol containers Europe-wide to help establish a social understanding that alcohol is a special and hazardous commodity

44. Young people are vulnerable to alcohol We need to better protect young people: There needs to be much better regulation, enforcement and monitoring of alcohol marketing, which, not only deals with the content, but which substantially reduces the exposure of alcohol marketing to young people The rules relating to the marketing of alcoholic products should be approximated across Europe, noting the need to specify the extent to which alcohol marketing in certain categories of media and publications is allowed.

45. Alcohol causes harm to people other than the drinker There needs to be tougher action on reducing third party harm: The economic and physical availability of alcohol should be regulated, and limited to reduce third party harm, including the implementation of alcohol-free zones. In particular, a maximum BAC limit of 0.5 g/L eventually reduced to 0.2g/L, should be implemented Europe-wide with a lower limit of 0.0 g/L for novice drivers and drivers of public service and heavy goods vehicles.

46. Help needs to be available for people with problems There needs to be a considerable health systems investment in appropriate strategies to ensure the widespread availability and uptake of early identification and brief advice programmes in primary care settings, in cost effective treatment for alcohol use disorders, and in support for sufferers of third party harm. Making all health care settings, including hospitals alcohol-free would send an important health message.

47. By focussing on their product, economic operators have the potential to reduce harm Economic operators should consider ways in which the price and strength of their product can be managed to reduce harm, for example a commitment to support regulation for a minimum pricing structure Producers and retailers could commit to share intelligence and knowledge of illegally traded and illicit alcohol, together with a commitment to support Europe-wide tax stamps

48. Thank you for your attention!