Alcohol Policy in the English speaking Caribbean (ESC): A Civil Society Perspective

1. Alcohol Policy in the English speaking Caribbean (ESC): A Civil Society Perspective Second Meeting of the Pan American Network on Alcohol and Public Health (PANNAPH) April 9-11, 2014 Cartagena, Colombia. Dr. RohanMaharaj on behalf of the Healthy Caribbean Coalition

2. Today's Presentation • Alcohol and Culture • The burden • Landmarks in tackling alcohol issues and NCDs in Caribbean • WHO Global Policy • Regional policy (2011) • Current happenings • Household Alcohol Survey (T&T) • The Way Forward for Civil Society in ESC

3. Review of alcohol policies in ESC: Methodology • Google search • Document review • Civil Society representatives throughout English speaking Caribbean • Contact with in-country organizations • Offices of the regional Chief Medical Officers • Ministry of Health (T&T) • Preliminary results of a national survey in Trinidad and Tobago

4. The Healthy Caribbean Coalition is a civil society alliance established to combat chronic diseases (NCDs) and their associated risk factors and conditions. MissionTo harness the power of civil society, in collaboration with government, private enterprise, academia, and international partners, as appropriate, in the development and implementation of plans for the prevention and management of chronic diseases among Caribbean people. http://www.healthycaribbean.org/about_us.html

5. FESTIVALS* ASSOCIATED WITH ALCOHOL USE IN TRINIDAD AND TOBAGO. Not including personal celebrations- birthdays, anniversaries, Christenings, Thanksgivings etc.

6. Burden • An estimated 5.4% of deaths in the Americas in 2002 were attributable to alcohol, compared to the world figure of 3.7% (46% higher than the global average). • Alcohol was responsible for nearly 10% of all Disability Adjusted Life Years (DALY) lost in the Region in 2002, compared to the global figure of 4.4%. • 20-50% of road traffic fatalities in the Region are alcohol related, and 50.5% of alcohol-attributable deaths in the Americas in 2002 were due to injuries and violence.

8. MAJOR ALCOHOL-RELATED HEALTH CONDITIONS CONTRIBUTING TO MORBIDITY AND MORTALITY • Cancers- head and neck cancers, colorectal cancers, liver cancer, female breast cancer • Neuropsychiatric conditions- alcohol dependence syndrome, alcohol abuse, depression • Type 2 Diabetes mellitus- protective and adverse effects • Cardiovascular effects-ischaemic heart disease, hypertensive disease, cerebro-vascular disease (protective and adverse effects for all cardiovascular conditions) • Gastrointestinal conditions- liver cirrhosis, pancreatitis • Infectious diseases- Tuberculosis, pneumonia • Maternal and perinatal conditions- Low birth weight, fetal alcohol syndrome • Acute toxic effects- alcohol poisoning • Accidents- road and other transport injuries, falls, drowning, burn injuries, occupational and machine injuries • Self-inflicted- suicide • Violent deaths- assault injuries

9. STEPS Surveys

10. Among those who drank alcohol in the last 30 days

11. Global School-based Student Health Survey (2003-10)

12. Landmarks in tackling alcohol issues in the Caribbean - 1 • 1999: The Caribbean Cooperation in Health Phase II identified the strengthening of alcohol prevention and control programmes as a priority issue in the context of prevention of mental health disorders • 2007: Declaration of POS acknowledges alcohol as a causal risk factor for NCDs* • 2010, Ministers of Health of Member States of WHO approved by consensus a global strategy to reduce alcohol-related problems • February 2011: WHO organized the first meeting between countries, to discuss mechanisms and priorities for implementing the global strategy. Pan-American Network on Alcohol and Public Health (PANNAPH), led by Mexico and vice-chaired by Brazil was formed • 2011: Member States of PAHO adopted a regional plan of action at the 51st Directing Council titled “Plan of Action to Reduce Harmful Use of Alcohol and promote a public health and human rights approach aimed at lowering the levels of per capita alcohol consumption in the population, as well as reducing alcohol related harm in the Americas and Caribbean”. *That public revenue derived from… alcohol ….should be employed….for preventing chronic NCDs, promoting health and supporting the work of the NCD Commissions

13. Landmarks in tackling alcohol issues in the Caribbean - 2 • 2011: United Nations High Level Meeting (UNHLM) on the Prevention and Control of Non-Communicable Disease (NCDs), September 19, 2011, identified alcohol as major NCD risk factor about which action needed to be taken. • 2013: WHA set as one its Global NCD targets the reduction by 10% of harmful use of alcohol by the year 2025. • 2012:the Government of Mexico hosted a PAHO led Meeting “Network on Alcohol and Public Health” in Mexico City. This was a multi-stakeholder meeting aimed at advancing the Global Strategy on Alcohol adopted by the 63rd WHA. • 2013: PAHO led Sub-Regional Meeting on Development of Alcohol Policy for English Speaking Caribbean Countries in Belize

14. WHO global strategy: 10 key areas of policy options and interventions at the national level • Leadership, awareness and commitment; • Health services' response; • Community action; • Drink-driving policies and countermeasures; • Availability of alcohol; • Marketing of alcoholic beverages; • Pricing policies; • Reducing the negative consequences of drinking and alcohol intoxication; • Reducing the public health impact of illicit alcohol and informally produced alcohol; • Monitoring and surveillance. http://www.who.int/substance_abuse/activities/gsrhua/en/

15. WHO global strategy: The 4 priority areas for global action are: • Public health advocacy and partnership; • Technical support and capacity building; • Production and dissemination of knowledge; • Resource mobilization. http://www.who.int/substance_abuse/activities/gsrhua/en/

16. Reducing risks and preventing disease: population-wide interventions A best buy is an intervention that is not only highly cost-effective but alsocheap, feasible and culturally acceptable to implement. • Increasing excise taxes on alcoholic beverages; • Regulating availability of alcoholic beverages, including minimum legal purchase age, restrictions on outlet density and on time of sale, and, where appropriate, governmental monopoly of retail sales; • Restricting exposure to marketing of alcoholic beverages through effective marketing regulations or comprehensive advertising bans; • Drink-driving countermeasures including random breath testing, sobriety check points and blood alcohol concentration (BAC) limits for drivers at 0.5 g/l, with reduced limits or zero tolerance for young drivers; • Treatment of alcohol use disorders and brief interventions for hazardous and harmful drinking. www.who.int/nmh/publications/ncd_report_chapter4.pdf‎

17. ALCOHOL POLICY: ESC (WHO, 2011) http://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/en/

18. Policy Characteristics #- risk of increasing black market forces

20. Opportunity for knowledge interventions

21. Current Alcohol Programmes in ESC organizations

22. Current Alcohol Programmes in ESC organizations

23. Household Alcohol Survey Trinidad and Tobago (HASTT), 2013 • Survey of 1695 HH to determine effect of alcohol on the psychological and social fabric of the HH • Respondents’ willingness to support in a national campaign to change alcohol regulations, advertisements and other policies.

24. How many bars or rumshops are there within walking distance of your home? 55.2% 87.1%

25. Bars, Rumshops and impact on Neighbourhoodsin Trinidad and Tobago

26. Which of the following changes regarding alcohol do you believe members of this HH will support in a national campaign?

27. Which of the following changes regarding alcohol do you believe members of this HH will support in a national campaign?

28. Gaps • DUI and driver’s license suspension • Advertisement • Follow up • *That public revenue derived from… alcohol ….should be employed….for preventing chronic NCDs, promoting health and supporting the work of the NCD Commissions • Belize meeting outcomes

29. Recommendations • Be cognizant of the historical failures of overzealousness. • Be conscious of the historical intertwining of our societies and alcohol production, trade and contribution to societal development.....

30. HCC Work Plan: In the short term • Short working session for members of English speaking Caribbean at the PANNAPH • Consolidate interest of 1st regional meeting (Belize). • Examine gaps identified- e.g. POS declaration • Establish working relationships with other CSOs, NGOs, FBOs, CBOs with interest in alcohol policy • Survey these organizations regarding priority areas (evidence-based) for possible intervention • Commission short public opinion polls as to feasibility of support for these priority areas

31. HCC Work Plan: In the short term to medium term • In recognition of CARICOM’s stated acknowledgement of alcohol as a risk factors for NCDs and CARICOM’s leadership on NCDs globally • Establish lines of communication with CARICOM, CMOs, and Heads of government at CARICOM meetings • Consider developing a regional alcohol policy • Establish lines of communication with members of government, government Ministers and governmental organizations, statutory bodies, and government Ministries • Explore feasibility of support for identified priority areas

32. HCC Work Plan: In the medium to long term • Work with governments to implement new rules, regulations or laws pertinent to priority areas. • Resume process

33. CARIBAPAN: Caribbean Alcohol Policy Advocacy Network • CARIBAPAN is an electronic platform for connecting individuals, civil society organisations (CSOs) and other related organisations working in the field of alcohol advocacy and prevention • Facilitate mutual learning • Strengthen individual and collective evidence-informed alcohol advocacy • Allow network of alcohol advocates to be better equipped to contribute significantly toward the development of Caribbean alcohol policy • Organisations with linkages to the alcohol industry are not as accepted as members of CARIBAPAN

34. CARIBAPAN: Caribbean Alcohol Policy Advocacy Network • Content of CARIBAPAN include: • Resources • Membership lists • Membership activities • Events calendar • Discussion Forums • Blogs • Polls • To join CARIBAPAN email maisha.hutton@healthycaribbean.org or contact the Healthy Caribbean Coalition Secretariat at tel: 246 435 7486

37. The Centre for Alcohol and Drug Abuse Prevention (CADA)

38. Acknowledgements • Alicia L. Wanklyn (Bermuda) • SonjetteRodrigues (St. Lucia) • Jacinta Bannis (Dominica) • Glynis Beaton (Guyana) • E Petrinella Edwards (St Kitts/ Nevis) • Pastor Kerry Omir Kerr (St. Vincent & Grenadines) • Pastor Victor Roach (Barbados)

39. If you produce cars, it does not mean you need to drive fast, and you still have speed limits; If you produce rum….