^ ^ ^ WORLD HEALTH ORGANIZATION
ORGANISATION MONDIALE DE LA SANTÉ
E X E C U T I V E B O A R D S i x t y - t h i r d S e s s i o n
P r o v i s i o n a l a g e n d a i t e m 2 3
A L C O H O L - R E L A T E D P R O B L E M S : T H E N E E D T O D E V E L O P F U R T H E R T H E W H O
ЕВ6З/2З
2 7 N o v e m b e r 1 9 7 8
in
S ，‘ З ÙEC. , M Cf)
I N D E X E D
LlB^Z
I N I T I A T I V E R e p o r t b y t h e D i r e c t o r - G e n e r a l
T h i s p a p e r h a s b e e n p r e p a r e d i n r e s p o n s e t o r e s o l u t i o n W H A 2 8 . 8 1 . I t c o n t e n d s t h a t t h e s i t u a t i o n w i t h r e s p e c t t o a l c o h o l - r e l a t e d p r o b l e m s
t h r o u g h o u t t h e w o r l d is s u c h a s to r e q u i r e m a j o r a n d u r g e n t a c t i o n o n t h e p a r t o f W H O .
T h e e v i d e n c e o f i n c r e a s i n g d a m a g e in a l a r g e n u m b e r o f d e v e l o p i n g c o u n t r i e s s u g g e s t s t h a t a l c o h o l - r e l a t e d p r o b l e m s c o n s t i t u t e a n i m p o r t a n t o b s t a c l e t o t h e i r s o c i o e c o n o m i c d e v e l o p m e n t a n d , in a d d i t i o n , a r e l i k e l y t o o v e r w h e l m t h e i r h e a l t h r e s o u r c e s u n l e s s a p p r o p r i a t e m e a s u r e s a r e t a k e n . A t t h e s a m e t i m e t h e r e a r e c u r r e n t l y a v a i l a b l e t e c h n i q u e s o f p r e v e n t i o n a n d t r e a t m e n t w h i c h , i f w i d e l y a n d c o n s i s t e n t l y a p p l i e d , c o u l d a l l e v i a t e t h i s d a m a g e . W H O h a s t h e r e s p o n s i b i l i t y o f p r o v i d i n g l e a d e r s h i p in t h e a d v o c a c y o f t h e s e t e c h n i q u e s a n d t h e i r m o r e p e r v a s i v e i m p l e m e n t a t i o n .
A n o u t l i n e o f n a t i o n a l a n d i n t e r n a t i o n a l r e s p o n s e s t o a l c o h o l - r e l a t e d p r o b l e m s i s g i v e n , a n d a d r a f t r e s o l u t i o n is s u b m i t t e d f o r t h e E x e c u t i v e B o a r d1 s c o n s i d e r a t i o n .
C O N T E N T S
P a g e
I . W H Y C H O O S E T H I S M O M E N T ? 2 1 . T h e p r o b l e m g o e s b e y o n d t h e t r a d i t i o n a l c o n c e p t o f " a l c o h o l i s m " 2
2 . A l c o h o l p r o b l e m s ate g r e a t l y o n t h e i n c r e a s e i n m a n y p a r t s o f t h e w o r l d • • • • 2
3 . D e v e l o p i n g c o u n t r i e s a r e p a r t i c u l a r l y v u l n e r a b l e 3 4 . P o s s i b i l i t i e s f o r e f f e c t i v e i n t e r v e n t i o n a r e n o w a v a i l a b l e 4
I I . F R O M A W A R E N E S S T O A C T I O N : A N O U T L I N E O F A R E S P O N S E 6
5 . G e n e r a l c o n s i d e r a t i o n s 6 6 . C o m p o n e n t s o f a c o u n t r y r e s p o n s e t o a l c o h o l - r e l a t e d p r o b l e m s 7
7 . C o m p o n e n t s o f a n i n t e r n a t i o n a l r e s p o n s e t o a l c o h o l - r e l a t e d p r o b l e m s 8
8 . C o n c l u s i o n s 9 I I I . D R A F T R E S O L U T I O N 9
A N N E X : C o n s t i t u t i o n a l b a s i s f o r W H O a c t i o n a n d c u r r e n t i n t e r n a t i o n a l a c t i v i t i e s
c o n c e r n i n g a l c o h o l - r e l a t e d p r o b l e m s 11
EB63/23 p a g e 2
I . W H Y C H O O S E T H I S M D M E N T ?
T h e r e a r e p e r s u a s i v e r e a s o n s f o r c o n t e n d i n g t h a t t h e r e i s a p r e s s i n g n e e d f o r f u r t h e r a c t i o n o n d r i n k i n g p r o b l e m s . 1
1 . T h e p r o b l e m g o e s b e y o n d t h e t r a d i t i o n a l c o n c e p t o f " a l c o h o l i s m "
1 . 1 A l c o h o l i s m , d e f i n e d a s a d v a n c e d p h y s i c a l d e p e n d e n c e o n a l c o h o l , w h i l e p r e v a l e n t a n d i t s e l f a m a t t e r f o r s e r i o u s c o n c e r n , c o n s t i t u t e s o n l y a s m a l l p a r t o f t h e t o t a l o f a l c o h o l - r e l a t e d p r o b l e m s . W h a t m u s t n o w b e r e c o g n i z e d i s t h a t t h e e x c e s s i v e u s e o f a l c o h o l l e a d s t o a h o s t o f p r o b l e m s o f e x t r a o r d i n a r y a n d s u b t l e p e r v a s i v e n e s s . I f t h e r o l e o f a l c o h o l i n
t h e s e p r o b l e m a r e a s i s n e g l e c t e d , i n t e r v e n t i o n s , b o t h a t a p e r s o n a l a n d p u b l i c h e a l t h l e v e l , w i l l b e c o s t l y a n d i n e f f e c t i v e . A l c o h o l p r o g r a m m e s a r e t h e r e f o r e n o t t o b e s e e n a s v y i n g w i t h o t h e r h e a l t h p r o g r a m m e s f o r p r i o r i t y , b u t a s b e i n g i n e v i t a b l y l i n k e d w i t h o t h e r h e a l t h
e n d e a v o u r s .
1 . 2 T h e r e i s a n a c k n o w l e d g e d a s s o c i a t i o n b e t w e e n a l c o h o l a n d c r i m e , p a r t i c u l a r l y c r i m e s o f v i o l e n c e . S o m e c o u n t r i e s r e p o r t t h a t 5 0 % o f t h e i r c r i m e i s a l c o h o l - r e l a t e d . I n a d d i t i o n t o i t s c o n t r i b u t i o n t o t r a f f i c a c c i d e n t s , e x c e s s i v e d r i n k i n g i s r e l a t e d t o m a n y h o m e a n d i n d u s t r i a l a c c i d e n t s . I n d u s t r i a l a b s e n t e e i s m a n d l o w p r o d u c t i v i t y a t w o r k h a v e a l s o b e e n s h o w n t o b e r e l a t e d t o e x c e s s i v e d r i n k i n g .
о
1 . 3 I n m a n y d e v e l o p i n g c o u n t r i e s t h e d i v e r s i o n o f f a m i l y i n c o m e t o a p a r e n t1 s e x c e s s i v e d r i n k i n g m a y s e r i o u s l y c o n t r i b u t e t o s e c o n d a r y p o v e r t y a n d t h e m a l n u t r i t i o n o f c h i l d r e n . E x c e s s i v e d r i n k i n g c o n t r i b u t e s t o t h e p r e v a l e n c e o f c i r r h o s i s , p a n c r e a t i t i s , c e r t a i n f o r m s o f h e a r t d i s e a s e a n d c a n c e r . I t s i g n i f i c a n t l y l o w e r s r e s i s t a n c e t o i n f e c t i o n , i s a s s o c i a t e d w i t h t u b e r c u l o s i s , a n d e x a c e r b a t e s t h e c o n s e q u e n c e s o f h e p a t i t i s w h e r e t h a t c o n d i t i o n is e n d e m i c . E x c e s s i v e d r i n k i n g b y p r e g n a n t w o m e n h a s b e e n s h o w n t o b e a s s o c i a t e d w i t h
d e v e l o p m e n t a l r e t a r d a t i o n i n t h e i r p r o g e n y . E x c e s s i v e d r i n k i n g m a y l e a d t o d e p e n d e n c e , b r a i n d a m a g e , h a l l u c i n a t o r y s t a t e s , a n d o t h e r s e v e r e m e n t a l d i s o r d e r s . P e o p l e w i t h s e r i o u s
d r i n k i n g p r o b l e m s h a v e a s u i c i d e r a t e o f u p t o 8 0 t i m e s t h a t o f t h e g e n e r a l p o p u l a t i o n .
1 . 4 I f t h e m e d i c a l , p s y c h i a t r i c a n d s o c i a l c o s t s o f d r i n k i n g a r e a l l p u t t o g e t h e r , t h e t o t a l i m p a c t i n m a n y c o u n t r i e s m u s t n o w b e r e c o g n i z e d a s o n e o f m a j o r p r o p o r t i o n s . F o r e x a m p l e , c a l c u l a t i o n s s u g g e s t t h a t t h e a n n u a l c o s t m a y b e o f t h e o r d e r o f U S $ 2 5 t h o u s a n d m i l l i o n i n t h e U n i t e d S t a t e s o f A m e r i c a a n d A u s t . $ 1 . 1 t h o u s a n d m i l l i o n i n A u s t r a l i a .
1 . 5 T h e r e i s n o r e a s o n t o b e l i e v e t h a t s u c h m a s s i v e c o s t s a r e c o n f i n e d t o d e v e l o p e d c o u n t r i e s . O n t h e c o n t r a r y , i t a p p e a r s t h a t d e v e l o p i n g c o u n t r i e s m a y b e p a r t i c u l a r l y v u l n e r a b l e t o a l c o h o l - r e l a t e d p r o b l e m s .
2 . A l c o h o l p r o b l e m s a r e g r e a t l y o n t h e i n c r e a s e i n m a n y p a r t s o f t h e w o r l d
2 . 1 T h e e x t e n t a n d s e r i o u s n e s s o f d r i n k i n g p r o b l e m s i n t h e d e v e l o p i n g c o u n t r i e s a r e o n l y n o w b e g i n n i n g t o b e r e a l i z e d . U n l e s s a c t i o n i s t a k e n w i t h r e s p e c t t o t h e s e p r o b l e m s t h e y w i l l c o n s t i t u t e a s e r i o u s o b s t a c l e t o t h e s o c i o e c o n o m i c d e v e l o p m e n t o f t h e s e c o u n t r i e s a n d a s e v e r e b u r d e n o n t h e i r a v a i l a b l e s e r v i c e s .
2 . 2 T h e o c c a s i o n f o r a l a r m i s n o t m e r e l y a n e n d e m i c o f l a r g e p r o p o r t i o n , a l t h o u g h t h e l o n g - e s t a b l i s h e d s c a l e a n d t o l e r a n c e o f a l c o h o l p r o b l e m s i n m a n y p a r t s o f t h e w o r l d s h o u l d i n f a c t b e c a u s e f o r c o n s i d e r a b l e a n x i e t y ; w h a t is p r o f o u n d l y d i s t u r b i n g i s t h a t t h e w o r l d p i c t u r e i s
f a r f r o m s t a t i c .
T h e b a s i s , i n t e r m s o f r e s o l u t i o n s a d o p t e d a n d W H O1 s p r o g r a m m e i n t h i s a r e a , i s g i v e n in t h e A n n e x .
2
T h e b a s e s f o r t h e s e a n d o t h e r a s s e r t i o n s m a d e i n t h i s p a p e r a r e p r o v i d e d in t h e
b a c k g r o u n d d o c u m e n t e n t i t l e d " A l c o h o l p r o b l e m s i n d e v e l o p i n g c o u n t r i e s " , G e n e v a , 1 9 7 8， c o p i e s o f w h i c h a r e a v a i l a b l e t o m e m b e r s o f t h e E x e c u t i v e B o a r d . 、” ， _
EB63/23 page 3 2 . 3 T h e d e t a i l e d e v i d e n c e t o s u p p o r t t h i s c o n t e n t i o n i s t o b e f o u n d i n a n u m b e r o f r e p o r t s；^ w h i l e i t w o u l d b e i n a p p r o p r i a t e t o r e h e a r s e a l l t h a t e v i d e n c e i n d e t a i l h e r e , i t m a y b e
u s e f u l t o g i v e a f e w i l l u s t r a t i v e e x a m p l e s o f t h e m a g n i t u d e o f c h a n g e i n v o l v e d . A l t h o u g h t h e e v i d e n c e w h i c h c a n b e a s s e m b l e d i s i n e v i t a b l y i n c o m p l e t e , r e f l e c t i n g t h e i n a d e q u a c y o f
i n f o r m a t i o n s y s t e m s i n m a n y c o u n t r i e s , t h e r e p o r t s a v a i l a b l e r e v e a l a r e m a r k a b l e c o n s i s t e n c y .
2 . 4 H e a l t h f a c i l i t i e s a r e a m o n g t h o s e e x p e r i e n c i n g a n i n c r e a s i n g b u r d e n f r o m a l c o h o l - r e l a t e d h e a l t h p r o b l e m s . I n B r a z i l , f i r s t a d m i s s i o n s w i t h a d i a g n o s i s o f a l c o h o l i s m t r e b l e d b e t w e e n
1 9 6 0 a n d 1 9 7 0 . I n C h i l e 3 0 % o f t h e b u d g e t f o r m e d i c a l a n d p s y c h i a t r i c s e r v i c e s i s s p e n t o n m e d i c a l c a r e o f " a l c o h o l i s m " a n d i t s c o n s e q u e n c e s . I n Y u g o s l a v i a 5 0 % o f a l l m a l e a d m i s s i o n s
t o p s y c h i a t r i c h o s p i t a l s i n 1 9 7 2 h a d " a l c o h o l i s m " a s t h e i r f i r s t d i a g n o s i s - a s d i d b e t w e e n 2 5 % a n d 457o o f m a l e a d m i s s i o n s t o g e n e r a l m e d i c a l w a r d s i n F r a n c e . I n E n g l a n d a n d W a l e s t h e i n c r e a s e i n a d m i s s i o n s w i t h a r e l e v a n t p r i m a r y o r s e c o n d a r y d i a g n o s i s o f a l c o h o l i s m o r
a l c o h o l i c p s y c h o s i s w a s 2 0 - f o l d o v e r t h e l a s t 2 5 y e a r s .
2 . 5 T h e c o n t r i b u t i o n o f a l c o h o l i c c i r r h o s i s t o t o t a l c i r r h o s i s r a t e s i n S r i L a n k a r o s e f r o m 2 4 % i n 1 9 4 8 t o 5 5 % i n 1 9 6 8； c i r r h o s i s d e a t h r a t e s i n A n c h o r a g e ( A l a s k a ) i n c r e a s e d b y 1 4 2 % b e t w e e n 1 9 5 9 a n d 1 9 7 5 . I n m o s t c o u n t r i e s f o r w h i c h v a l i d d a t a c a n b e o b t a i n e d c i r r h o s i s n o w r a n k s a m o n g t h e f i v e l e a d i n g c a u s e s o f d e a t h f o r p e r s o n s b e t w e e n t h e a g e s o f 2 5 a n d 6 4 y e a r s .
2 . 6 R o a d a c c i d e n t s d a t a g i v e f u r t h e r i n d i c a t i o n o f t h e e x t e n t o f t h e p r o b l e m . O v e r t h e y e a r s 1 9 6 5 - 1 9 7 5 r o a d a c c i d e n t r a t e s i n K u w a i t h a v e t r i p l e d , w i t h a l c o h o l v e r y c l e a r l y i m p l i c a t e d , w h i l e a s t u d y o f a u t o p s i e s i n Z a m b i a r e v e a l e d t h a t 2 7 % o f r o a d a c c i d e n t v i c t i m s h a d e t h a n o l l e v e l s a b o v e 0 . 8 g p e r 1 0 0 0 g b l o o d , a n d i n t w o - t h i r d s o f t h e s e c a s e s t h e l e v e l w a s a b o v e 2 . 0 g . T r a f f i c a c c i d e n t s a r e t h e f i f t h l e a d i n g c a u s e o f d e a t h i n V e n e z u e l a , w i t h a l c o h o l b e i n g i m p l i c a t e d i n 3 6 - 6 0 % o f c a s e s . I n A l a s k a 8 0 % o f a l l t r a f f i c f a t a l i t i e s i n v o l v e d h e a v y a l c o h o l i n t a k e .
2 . 7 S t u d i e s o f t h e r e l a t i o n s h i p b e t w e e n a l c o h o l a n d c r i m e s o f v i o l e n c e i m p l i c a t e a l c o h o l i n 1 3 - 5 0 % o f r a p e s , 2 4 - 7 2 % o f c a s e s o f a s s a u l t a n d 2 8 - 8 6 % o f c a s e s o f h o m i c i d e . A l c o h o l i c i n t o x i c a t i o n h a s b e e n f o u n d i n o n e n a t i o n w i d e s u r v e y t o b e a p r e c i p i t a t i n g f a c t o r i n 1 3 % o f c h i l d a b u s e c a s e s .
2 . 8 O n t h e b a s i s o f w h a t i s d e f i n i t e l y k n o w n o r m a y f a i r l y b e p r e s u m e d , i t w o u l d b e s a n g u i n e i n t h e e x t r e m e t o i g n o r e t h e w a r n i n g s o r t o p l e a d o n l y f o r m o r e r e s e a r c h . 3 . D e v e l o p i n g c o u n t r i e s a r e p a r t i c u l a r l y v u l n e r a b l e
3 . 1 W h i l e a l c o h o l p r o b l e m s h a v e t h e s a m e b a s i c t y p e s o f m e d i c a l , p s y c h i a t r i c a n d s o c i a l i m p a c t w h a t e v e r t h e c o u n t r y , e v i d e n c e n o w e m e r g i n g ^ s u g g e s t s t h a t c o u n t r i e s i n a s t a t e o f r a p i d s o c i o e c o n o m i c d e v e l o p m e n t m a y , i n a d d i t i o n , b e v u l n e r a b l e to c e r t a i n s p e c i a l t y p e s o f d a m a g e . T h e v e r y f a c t o f r a p i d d e v e l o p m e n t b r i n g s a b o u t s o c i o c u l t u r a l c h a n g e s w h i c h l o o s e n o l d f o r m s o f i n f o r m a l c o n t r o l o n t h e i n d i v i d u a l . N e w w e a l t h i s s u d d e n l y a v a i l a b l e , a n d t h e r e i s m o n e y t o s p e n d o n d r i n k . T h e r e a l c o s t o f a l c o h o l h a s g o n e d o w n i n m o s t p a r t s o f t h e w o r l d d e s p i t e i n c r e a s e d t a x a t i o n . I n d u s t r i a l t e c h n o l o g i e s o f l i q u o r p r o d u c t i o n a n d t h e a c t i v i t i e s o f m u l t i n a t i o n a l s s u p p l a n t t r a d i t i o n a l m e t h o d s o f b r e w i n g o r d i s t i l l i n g , a n d v a s t l y i n c r e a s e t h e s u p p l y .
3 . 2 W o r l d s t a t i s t i c s o f r e c o r d e d p r o d u c t i o n s h o w t h a t i n t h e y e a r s 1 9 6 0 - 1 9 7 2 t h e q u a n t i t i e s o f w i n e p r o d u c e d i n c r e a s e d b y 2 0 % , o f d i s t i l l e d b e v e r a g e s b y 6 0 % , a n d o f b e e r b y 8 0 % . In 2 5 c o u n t r i e s w i t h f a i r l y c o m p l e t e s t a t i s t i c s , a n n u a l p e r c a p i t a c o n s u m p t i o n o f a l c o h o l
T h e i n t e r n a t i o n a l r e v i e w o f p r e v e n t i o n o f a l c o h o l - r e l a t e d p r o b l e m s , w h i c h h a s s o f a r c o m p i l e d i n f o r m a t i o n c o l l e c t e d f r o m o v e r 7 0 c o u n t r i e s i n a l l W H O r e g i o n s； a n d t h e r e v i e w o f a l c o h o l p r o b l e m s i n d e v e l o p i n g c o u n t r i e s , r e f e r r e d t o i n t h e f o o t n o t e t o p a r a g r a p h 1 . 3 .
2
S e e s o u r c e s r e f e r r e d t o in t h e f o o t n o t e t o p a r a g r a p h s 1 . 3 a n d 2 . 3 , a n d p a r a g r a p h 2 . 4 o f t h e A n n e x .
E B 6 3 / 2 3 p a g e 4
i n c r e a s e d b y between 30% and over 5 0 0 % . In Nigeria the a m o u n t s of beer a v a i l a b l e from
r e c o r d e d p r o d u c t i o n and i m p o r t a t i o n rose from 106 to 448 m i l l i o n litres b e t w e e n 1970 and 1976，
w h i l e the importation of Scotch w h i s k y to V e n e z u e l a increased from 3.7 m i l l i o n litres in 1970 to 6 m i l l i o n litres in 1 9 7 5 , w i t h an estimated a d d i t i o n a l 1 - 1 0 m i l l i o n litres of spirits i m p o r t e d i l l e g a l l y each y e a r . Beer consumption increased b y 4 0 0 % in T a h i t i b e t w e e n 1958 and 1 9 7 1 , w h i l e w h i s k y c o n s u m p t i o n increased 2 6 - f o l d , w i t h p u b l i c drunkenness and traffic accidents a s s u m i n g serious p r o p o r t i o n s . In Hong Kong the rate of a l c o h o l c o n s u m p t i o n doubled b e t w e e n 1972 and 1 9 7 7 , with a p a r a l l e l increase in the incidence of liver c i r r h o s i s .
3.3 In m a n y countries individuals are subjected to n e w demands and stresses at a time when old forms of family and c o m m u n i t y support are d i m i n i s h i n g . D r i n k i n g o f t e n b e c o m e s a symbol of p r e s t i g e and s u c c e s s , as w e l l as being a ready t r a n q u i l l i z e r。 The c o n s e q u e n c e s can be u n d e r s t o o d p a r t l y in terms of the special v u l n e r a b i l i t y to a l c o h o l - r e l a t e d problems of p a r t i c u l a r groups w i t h i n these c o u n t r i e s . A c o m b i n a t i o n of circumstances m a k e s emergent p r o f e s s i o n a l and m a n a g e r i a l sectors of the p o p u l a t i o n one such group； as one i n f o r m a n t from A f r i c a p u t i t , the first g e n e r a t i o n of doctors in his c o u n t r y was w i p e d out b y a l c o h o l i s m .
This impact on highly trained and key p e r s o n n e l represents a devastating loss for a country w h e r e such resources are scant a n d v i t a l to n a t i o n a l d e v e l o p m e n t . There is no doubt that these problems a r e a l s o h i g h l y p r e v a l e n t in u r b a n areas w h e r e rural dwellers h a v e m i g r a t e d and have been caught up in a way of life different from a n y t h i n g they had e x p e r i e n c e d b e f o r e : young p e o p l e , a l i e n a t e d from traditional v a l u e s , are often at p a r t i c u l a r r i s k , and also w o m e n , w h o m a y b e exposed for the first time to the p o s s i b i l i t y of d r i n k i n g , p r e v i o u s l y forbidden by- c u l t u r a l t r a d i t i o n .
3.4 E x c e s s i v e drinking also has a special impact in communities w h e r e n u t r i t i o n a l standards are at b e s t m a r g i n a l . This is a p p a r e n t n o t only in terms of p h y s i c a l d a m a g e , but also in the frequency w i t h w h i c h organic psychoses are p r e c i p i t a t e d in such c i r c u m s t a n c e s . Toxic s u b s t a n c e s present in certain h o m e - p r o d u c e d a l c o h o l i c b e v e r a g e s m a y add to these d a n g e r s . 3.5 The lack of a d e q u a t e p o l i c i n g and the erosion of informal social controls in situations c h a r a c t e r i z e d by transitoriness and a n o n y m i t y are factors that contribute to an a s s o c i a t i o n between crime and e x c e s s i v e d r i n k i n g . The diversion of scant h e a l t h c a r e resources to deal w i t h a l c o h o l - r e l a t e d problems - traffic accidents or injuries from drunken brawls burdening
c a s u a l t y departments and o p e r a t i n g t h e a t r e s , cirrhosis patients occupying b e d s , delirium tremens demanding e m e r g e n c y care - m a y put a serious strain on m e d i c a l services that are a l r e a d y o v e r b u r d e n e d .
4 . P o s s i b i l i t i e s for e f f e c t i v e intervention are now a v a i l a b l e
It would be of little p r o f i t if all that could be done was to describe the growing a w a r e n e s s of the range and c o m p l e x i t y of a l c o h o l - r e l a t e d p r o b l e m s , and to delineate the evidence for the increasing extent of these p r o b l e m s , and the seriousness of their impact on d e v e l o p i n g countries in p a r t i c u l a r . No m a t t e r how serious or extensive a h e a l t h p r o b l e m m i g h t b e , these aspects alone do not dictate the n e c e s s i t y for W H O initiative u n l e s s it can at
the same time be demonstrated that a p p r o p r i a t e technology exists for the p r e v e n t i o n and treatment of these p r o b l e m s .
4.1 The p o s s i b i l i t y of p r e v e n t i o n
4 . 1 . 1 E v i d e n c e a c c u m u l a t e d over recent years points to an e s t a b l i s h e d and c l o s e relationship between a c o u n t r y1 s per capita a l c o h o l consumption and its experience of a l c o h o l - r e l a t e d p r o b l e m s . W h i l e this m i g h t seem to be no m o r e than the scientific s u b s t a n t i a t i o n of common-
sense e x p e r i e n c e , it runs counter to traditional thinking that has seen a l c o h o l i s m as
something innate in the i n d i v i d u a l rather than as a p r o b l e m related to the d e g r e e of exposure to d r i n k i n g . It is also an a s s o c i a t i o n that indicates the p o s s i b i l i t y of p r e v e n t i o n , since it suggests that any reduction in per capita consumption w i l l be attended b y a significant d e c r e a s e in a l c o h o l - r e l a t e d p r o b l e m s .
EB63/23 page 5 4.1.2 This relationship is dramatically demonstrated by m o r t a l i t y statistics collected in France in the years 1907 to 1956. These reveal a rapid decline in cirrhosis m o r t a l i t y rates at times of severe restriction on the availability of alcoholic beverages during the two world w a r s , and an equally rapid increase when alcohol again became available: for France as a whole the decline in cirrhosis m o r t a l i t y among m i d d l e - a g e d males was of the order of 50%，
w h i l e in P a r i s , where there was less possibility of circumventing the rationing s y s t e m , the decline was m o r e than 8 0 % .
4.1.3 In the many countries where alcohol is an accepted substance and prohibition is neither acceptable nor feasible, it is desirable that the level of a l c o h o l consumption be controlled in a m a n n e r compatible with health interests, rather than that the m a t t e r b e left to uncontrolled m a r k e t forces. Among the interventions that have been found to be effective in reducing or at least stabilizing c o n s u m p t i o n , the following m a y be listed: increasing the price of alcohol in relation to disposable income； quota regulations on production; control of importation; and restrictions on the number of sales outlets. In countries in which alcohol is not widely available and prohibition is culturally a c c e p t a b l e , even this solution m a y be feasible.
4.1.4 These interventions w i l l clearly have economic consequences, and their application will require the political determination to give greater priority than in the p a s t to the health consequences of alcohol consumption.
4.1.5 It is of immense importance that it be recognized that these measures m u s t be taken in the context of community education and planning in the broadest sense. To deal w i t h the problems associated with the excessive u s e of a l c o h o l , functional alternatives to excessive drinking will have to be found. Those responsible for the provision of amenities and education therefore have a vital role to p l a y .
4.1.6 To discuss the possibilities of prevention of alcohol problems as if they w e r e Utopian would be to ignore a mass of evidence concerning etiological aspects and a set of levers which are potentially available to influence problem rates. W h a t is needed is the political will to use these levers.
4.2 The possibility of effective and low-cost treatment
4.2.1 I f , on the evidence amassed to d a t e , prevention is a distinct p o s s i b i l i t y , so is the treatment of secondary complications of alcohol u s e . There are a number of physical
complications of excessive drinking (for e x a m p l e , delirium tremens, acute i n t o x i c a t i o n , and peripheral neuritis) for which simple and inexpensive remedies are a v a i l a b l e . W h i l e it is not suggested that these techniques resolve the problems related to excessive d r i n k i n g , they offer the possibility of preventing serious disability and m a y even save lives.
4.2.2 There are also a number of indicators of problem drinking w h i c h , if identified as such, allow effective intervention, provided that the necessary legal sanctions e x i s t . Recidivism has been shown to be reduced if traffic offenders are required to attend a series of lectures and consultations as part of their sentence. A b s e n t e e i s m , declining
productivity and wastage can be reduced if firms m a k e attendance at occupationally-linked rehabilitation services a condition of continued employment.
4,2.3 Of greatest significance, p e r h a p s , is the evidence that simple a d v i c e , if given by a credible source, can be as effective as prolonged and intensive therapy in reducing the problems associated with drinking. The possibility of dealing with problems related to alcohol use thus comes within the province of different types of health w o r k e r s , including those involved in providing primary health c a r e , w h o , if trained to discern such problems arid skilled in persuasive communication, can be effective in their reduction. It has been
demonstrated that the skills involved in recognizing and managing a variety of diseases can be brought within the competence of primary health care workers through the use of decision matrices and diagnostic flow charts； the skills involved in diagnosing alcohol-related conditions m i g h t similarly be cultivated.
E B 6 3 / 2 3 p a g e 6
4.2.4 The fact that seemingly simple interventions can be as effective as m o r e intensive treatment regimes m e a n s that effective treatment of a l c o h o l - r e l a t e d problems can be u n d e r t a k e n in countries lacking specialized m e d i c a l s e r v i c e s . It also suggests that it is not the e x c l u s i v e p r o v i n c e of the h e a l t h s e r v i c e s , and that other credible persons can exercise a b e n e f i c i a l i n f l u e n c e . T r a d i t i o n a l healers and acknowledged community leaders become
p o t e n t i a l therapeutic allies if their influence is tempered b y a knowledge of the ways in which a l c o h o l - r e l a t e d problems m a n i f e s t themselves.
4.2.5 The fact that effective treatment inevitably m e a n s involving o t h e r s , apart from the i n d i v i d u a l c o n c e r n e d , emphasizes the importance of community p a r t i c i p a t i o n , and suggests that m e a n s m i g h t be f o u n d , even in countries with scarce m e d i c a l r e s o u r c e s , of responding to
a l c o h o l - r e l a t e d p r o b l e m s . The p r o v e n efficacy of self-help groups in the amelioration of a l c o h o l - r e l a t e d problems is of special relevance in this c o n n e x i o n .
4 . 2 . 6 It is c o n t e n d e d , t h e r e f o r e , not only that the means are available for m i n i m i z i n g the risk of problems o c c u r r i n g , but also that in those instances w h e r e problems are displayed there are simple and effective m e a n s of dealing with them - m e a n s that are available to d e v e l o p i n g as w e l l as to developed c o u n t r i e s .
II. FROM A W A R E N E S S TO A C T I O N : AN OUTLINE OF A RESPONSE 5 . G e n e r a l c o n s i d e r a t i o n s
W h i l e it w o u l d b e false to p r e t e n d that "easy solutions" can be found, an analysis of the e x p e r i e n c e reported by a number of countries suggests some general p r i n c i p l e s .
5.1 Responses to a l c o h o l - r e l a t e d problems m u s t be culturally sensitive. A l c o h o l - r e l a t e d problems a r e deeply e m b e d d e d in c o u n t r i e s1 cultural and social c i r c u m s t a n c e s , and drinking itself is regulated by a host of formal and informal c o n t r o l s . These c o n s i d e r a t i o n s , and the economic and p o l i t i c a l investment in beverage a l c o h o l , m e a n that the response to alcohol-
related problems m u s t conform to the s o c i a l , c u l t u r a l , and economic context - perhaps to an even g r e a t e r extent than is the case for other p r o b l e m s .
5.2 R e s p o n s e s to a l c o h o l - r e l a t e d problems m u s t be planned with consideration for their wider social and economic i m p l i c a t i o n s . A l c o h o l - r e l a t e d problems cross all ordinary boundaries of social concern； this p a p e r has already referred to factors as diverse as the foetal alcohol s y n d r o m e , secondary p o v e r t y , c i r r h o s i s , car c r a s h e s , c r i m i n a l i t y , and the influence of rapid s o c i o e c o n o m i c c h a n g e . The a p p r o p r i a t e response systems m u s t therefore have a similarly wide o r g a n i z a t i o n a l b a s e , and rest on p o l i t i c a l commitment so as to be able to integrate the efforts of m a n y s e c t o r s , including those relevant to dependence on other drugs.
5.3 Existing technologies m u s t be applied i m m e d i a t e l y , and new ones developed. The p r o g r a m m e s envisaged h e r e a r e not only concerned with the application of existing
t e c h n o l o g i e s , but should lead to the development of better technologies. "Technologies" means m a t t e r s as diverse as the design of methods for better treatment of the individual at the p r i m a r y level of care； the formulation of p o l i t i c a l and economic arguments that win support for p r e v e n t i v e measures； the development of research m e t h o d s that can help in the
implementation of p o l i c y - o r i e n t e d epidemiological and evaluation studies； and the preparation of curricula for the training of p e r s o n n e l .
5.4 Intercountry and interregional cooperation is i m p e r a t i v e . A s m a n y of the resources for training and the development of technologies are at present in short supply, especially in developing c o u n t r i e s , there is an imperative need to foster intercountry and interregional c o o p e r a t i o n . S u b s u m e d h e r e are such possibilities as developing joint training p r o g r a m m e s , the adoption of comparable information s y s t e m s , the exchange of information with respect to the effects of p a r t i c u l a r p o l i c i e s , and the standardization of tariff regulations. Alcohol- related problems p r o v i d e prime examples of the need for intercountry cooperation and the p o o l i n g of r e s o u r c e s .
EB63/23 page 7 5.5 T h e n e e d for evaluation and m o n i t o r i n g of country e x p e r i e n c e s . W h i l e there is a need to resist the temptation to face difficult problems by resorting to endless discussions and
r e v i e w , it is clear that the evaluation of programmes and techniques is e s s e n t i a l . A p p r o p r i a t e m e a n s for this p u r p o s e need to b e further d e v e l o p e d .
6 . Components of a country response to a l c o h o l - r e l a t e d problems
6.1 It w i l l be clear from w h a t has been said above that country responses to alcohol-related problems m u s t be incorporated into n a t i o n a l programmes w h i c h include not only general m e n t a l h e a l t h components but also consideration of such diverse m a t t e r s as traffic regulations and tariff l e v e l s . A r e s p o n s e w h i c h is integrated with other relevant sectors of p l a n n i n g , including those concerned w i t h dependence on other d r u g s , is regarded as an absolute p r e r e q u i s i t e for an effective response to alcohol-related p r o b l e m s .
6.2 Beyond this assertion of a general p r i n c i p l e , it is assumed that a country response will include the following four components : a concern for developing manpower； the provision of an o r g a n i z a t i o n a l structure； the collection of a p p r o p r i a t e information; and the
establishment of the n e c e s s a r y legislative framework for effective a c t i o n .
6.3 The d e v e l o p m e n t of the n e c e s s a r y m a n p o w e r . There is a n e e d , p a r t i c u l a r l y in developing c o u n t r i e s , to train and support different types of health workers so that they can recognize and deal w i t h the w i d e range of drinking problems that occur in nonspecific situations. There is also a n e e d to educate other p e r s o n n e l w h o , while they m a y have no direct responsibility for h e a l t h , a r e in a position to identify incipient alcohol problems (e.g. the p o l i c e , foremen, e l d e r s , and community w o r k e r s ) . A l t h o u g h m o s t of the care w i l l be given by nonspecialized s t a f f , it w i l l be n e c e s s a r y to develop specialized training because of the leadership and support required by g e n e r a l h e a l t h and social service staff and the need to develop n e w technologies a p p r o p r i a t e to particular c o u n t r i e s .
6.4 The p r o v i s i o n of an organizational structure. Two essential components of any
o r g a n i z a t i o n a l structure w i l l be the provision of treatment for people with drinking problems and the establishment of intersectoral lines of c o m m u n i c a t i o n . In a d d i t i o n , the provision of treatment calls for the identification and rationalization of existing services and lines of r e f e r r a l . The success of m e n t a l health coordinating groups in a number of countries suggests that they m a y be a m e c h a n i s m for ensuring intersectoral r e p r e s e n t a t i o n .
6.5 T h e collection of appropriate information. Effective planning and the m o n i t o r i n g of programmes w i l l be hampered if data on the key aspects of alcohol use and alcohol problem rates are not a v a i l a b l e . W h i l e action cannot await the setting-up of comprehensive data collection s y s t e m s , a component of any national response m u s t be the collection of data relevant to the objectives of the p r o g r a m m e . A n o t h e r component w i l l be the dissemination of information about "safe levels" of drinking and the design of persuasive health education m e s s a g e s .
6.6 The establishment of the n e c e s s a r y legislative sanctions. M a n y of the suggested interventions for prevention and treatment (for e x a m p l e , the raising of the real cost of a l c o h o l , the enforcement of regulations regarding blood alcohol levels, the detention of traffic offenders found to be intoxicated at the time of the o f f e n c e , the regulation of tariff barriers) require legislative sanction. Moreover they require sanctions that are enforceable and are in fact e n f o r c e d . A n essential aspect of any country r e s p o n s e , therefore, is the p o l i t i c a l determination to p r o m o t e and adhere to policies that are bound to be controversial and that w i l l n e e d to contend with powerful interest g r o u p s . Some of the policies to be recommended from a health point of view will inevitably have implications for the alcohol i n d u s t r y , w h i c h p r o b a b l y sees alcohol as a commodity to be sold in as large quantities as possible at prices low enough to ensure an expanding m a r k e t .
EB63/23 p a g e 8
7 . Components of an international response to alcohol-related problems
7。1 A n y international response will be effective only in so far as it s u p p o r t s , and is based on information concerning country r e s p o n s e s . A c t i v i t i e s at the two levels are therefore c o m p l e m e n t a r y .
7•2 Facilitating n a t i o n a l m a n p o w e r development
7.2.1 It has already been emphasized that it will be n e c e s s a r y to p o o l resources because of their s c a r c i t y , p a r t i c u l a r l y in developing c o u n t r i e s . A component of the international response m i g h t be the development of intercountry training programmes and the establishment of regional resource c e n t r e s . The development of common treatment guidelines together with m e a n s for identifying people with drinking problems which are amenable to simple explanation and incorporation into the training programmes of a variety of health w o r k e r s are activities to be included under this h e a d i n g .
7•3 Development and trans fer of information concerning appropriate technologies
7.3.1 There is a need both to develop n e w technologies and to ensure the trans fer of such technologies between countries. International criteria for reporting n a t i o n a l alcohol- related problems are among the technologies to be d e v e l o p e d . Manuals m i g h t also be drafted describing the m e t h o d o l o g y of surveys of d r i n k i n g , the assessment of attitudes related to d r i n k i n g , and the community response to drinking after the m o d e l provided by the current WHO p r o j e c t on community responses to alcohol-related problems (see p a r a g r a p h 2#2 of the A n n e x )#
7.3.2 The international review and evaluation of preventive m e a s u r e s currently being carried out by WHO demonstrates the advantages of collating different c o u n t r i e s ' experiences with v a r i o u s p r e v e n t i v e and treatment m e a s u r e s and m a k i n g such experience available on a continuing
b a s i s .
7•4 Consideration of health implications of international trade in alcohol
7.4.1 W h i l e legislation relevant to alcohol-related problems will remain the prerogative of individual c o u n t r i e s , there is a need to examine existing trade relations between countries from the point of view of their health implications. It has already been observed that the p r o d u c t i o n of alcohol has m o v e d rapidly from a v i l l a g e to a n a t i o n a l basis and in some cases
to a m u l t i n a t i o n a l basis； the consequences have been a m a r k e d increase in the amount of alcohol c o n s u m e d , and a need to m o n i t o r the effects on h e a l t h .
7.4.2 The fact that different t a r i f f s are applied to alcohol by different countries contributes to illicit importation； consideration should be given to the advantages of rationalizing tariff systems.
7.4.3 The desire to harmonize regulations governing the hours of sale in different countries has almost invariably led to a liberalization of these hours and a p r o l i f e r a t i o n of outlets.
S o m e e c o n o m i c c o m m u n i t i e s , i n r e q u i r i n g the harmonization of trade a g r e e m e n t s , have promoted a freer movement of goods between c o u n t r i e s , including in some cases the freer m o v e m e n t of alcohol. The analysis o f t h e s e t r e n d s a n d their possible regulation is a necessary component of any international r e s p o n s e .
7.4.4 The review of international statistics on alcoholic beverages carried out by the Finnish Foundation for A l c o h o l Studies in collaboration with the W H O Regional O f f i c e for Europe provides a basis for further inquiry regarding the import, export and consumption of a l c o h o l . There is also a need to develop methods of estimating the extent of illicit alcohol production and home p r o d u c t i o n .
EB63/23 p a g e 9 7.5 A n a l y s i s of economic consequences of reduced consumption
7.5.1 A n y proposal to reduce c o n s u m p t i o n , if s u c c e s s f u l , w i l l have considerable economic consequences in those countries in which a significant p r o p o r t i o n of the w o r k force is
employed in alcohol-related i n d u s t r i e s , or w h e r e considerable revenue is earned on the sale or export of a l c o h o l . It w i l l be important to analyse those consequences if interventions of the kind recommended are c o n t e m p l a t e d .
8 . Conclusions
8.1 It has been argued in this paper that alcohol-related problems m a n i f e s t themselves in a variety of w a y s . A l c o h o l is implicated in problem areas as diverse as traffic accidents and secondary p o v e r t y . The excessive u s e of a l c o h o l contributes to the prevalence of some h e a l t h problems and exacerbates the effects of o t h e r s . T h e evidence available to W H O shows that alcohol-related problems a r e increasing rapidly in m o s t countries and that developing countries m a y be p a r t i c u l a r l y v u l n e r a b l e to their effects. A t the same t i m e , there is evidence that
effective interventions are available to prevent and m a n a g e m a n y of these p r o b l e m s .
8.2 Such i n t e r v e n t i o n s , if they are to s u c c e e d , m u s t be culturally s e n s i t i v e . They should be integrated into country health programmes and m u s t relate to the several sectors involved at both country and international levels. In the latter respect W H O has a role to play in facilitating joint action by the United N a t i o n s , the specialized agencies and interested nongovernmental o r g a n i z a t i o n s .
8.3 Resolutions adopted by the Executive B o a r d , the Regional Committees and W o r l d H e a l t h Assemblies demonstrate that Member States desire a m o r e intensive effort in this a r e a , and current national and international activities demonstrate the p o s s i b i l i t y of such a c t i o n . 8.4 A n outline of actions to strengthen n a t i o n a l and international responses to alcohol- related problems has been p r o p o s e d , and the advice of the E x e c u t i v e Board is sought on the implementation of these r e s p o n s e s .
III. DRAFT RESOLUTION
The Executive Board m a y w i s h to consider the following draft resolution:
Development of WHO programme on alcohol-related problems The Executive Board
RECOMMENDS to the Thirty-second W o r l d Health A s s e m b l y the adoption of the following resolution:
The Thirty-second W o r l d Health A s s e m b l y ,
Recognizing that alcohol-related problems rank among the world's m a j o r p u b l i c health concerns；
Recalling resolutions W H A 2 8 . 8 1 , W H A 2 8 . 8 4 and W H A 2 9 . 2 1 c o n c e r n i n g , r e s p e c t i v e l y , health statistics related to a l c o h o l , p s y c h o s o c i a l factors and h e a l t h , and .the
promotion of m e n t a l h e a l t h ;
Appreciating the w o r k already carried out by the Organization on alcohol- related problems；
Noting the discussions of the Executive Board concerning the need to develop further the W H O programme on alcohol-related problems；
1. URGES M e m b e r States to u n d e r t a k e m e a s u r e s to deal w i t h alcohol-related p r o b l e m s , including the d e v e l o p m e n t of n e c e s s a r y m a n p o w e r , the provision of treatment w i t h i n the context of g e n e r a l h e a l t h s e r v i c e s , the collection of appropriate information concerning a l c o h o l consumption and alcohol-related p r o b l e m s , and the establishment of legislative sanctions and m e a s u r e s enabling effective action to be taken；
2 . REQUESTS the D i r e c t o r - G e n e r a l :
(1) to strengthen W H O1 s capacity to respond to the problems associated with the excessive u s e of alcohol；
(2) to e n c o u r a g e greater intercountry collaboration w i t h respect to the p r e v e n t i o n and treatment of alcohol-related problems by developing joint training programmes； reviewing existing trade practices and agreements
relating to alcohol； establishing international criteria for reporting alcohol- related problems and levels of alcohol production； and ensuring the exchange of experience regarding particular p r e v e n t i v e measures；
(3) to p r o m o t e joint consideration by the organizations of the United Nat ions system of the problems associated w i t h the excessive use of alcohol and their a l l e v i a t i o n , and specifically to invite the U n i t e d Nations Statistical O f f i c e , I L O , FAO and UNESCO to collaborate w i t h WHO in this w o r k ;
(4) to seek a d d i t i o n a l funds from the U n i t e d N a t i o n s , particularly from the o r g a n i z a t i o n s concerned w i t h drug d e p e n d e n c e , and from governmental and n o n g o v e r n m e n t a l sources；
(5) to report on these m a t t e r s to future W o r l d Health Assemblies as a p p r o p r i a t e .
ЕВ63/23 page 11 ANNEX
CONSTITUTIONAL BASIS FOR WHO АСТ1Ш AND CURRENT INTERNATIONAL ACTIVITIES CONCERNING ALCOHOL-RELATED PROBLEMS
1. Resolutions adopted by the World Health Assembly, the Executive Board and Regional Committees
1.1 The immediate precedent for introducing a discussion of alcohol-related problems at the sixty-third session of the Executive Board is provided by the Health Assembly's resolution W H A 2 8 . 8 1 , in which the Director-General is requested "to direct special attention in the
future programme of W H O to the extent and seriousness of the individual, public health and social problems associated with the current use of alcohol in many countries of the world and the trend toward higher levels of consumption.1 1
1.2 There h a v e , however, been earlier resolutions adopted by the Health Assembly or the Executive Board calling for action in this field. As early as the First World Health Assembly it was resolved that the Executive Board be asked to establish an Expert Committee on Habit- Forming Drugs, later referred to as the Expert Committee on Drugs Liable to Produce Addiction.
Resolution EB8.R45 noted the report of the Alcoholism Sub-Committee of the Expert Committee on Mental Health and requested the Director-General" to cooperate in any programme concerned with the social and legislative aspects of the problem of alcoholism . . . R e s o l u t i o n WHA27.28 concerned itself particularly with health education with respect to, among other things, drug dependence and alcoholism, while resolution WHA27.59 recognized that the use of alcohol and other psychoactive drugs contributed significantly to the heavy toll taken by road traffic accidents.
1.3 Regional conmittees have indicated their concern with the problem not only by
acknowledging the relevance of resolutions passed by the Health Assembly but also by initiating resolutions of their own. The Region of the Americas has accepted a number of resolutions in this area (CSP 17/36, CSP 1 9 / 3 9 and CE 10¡22) and implemented them in a series of projects.
Countries in the South-East Asia Region recognized the need to address mental health problems, including alcoholism and drug dependence, by developing strategies for intervention based on the relationship between social action and mental health (resolution SEA/RC28/19)•
1.4 Countries in the Western Pacific Region have specifically acknowledged the importan ce of alcohol-related problems. Resolution WPR/RC26.R11 recognized that alcohol consumption and drug dependence remain a major cause of concern in the Region, while resolution WPR/RC25.R3 urged the inclusion of alcoholism in the expanded regional drug dependence programme and requested that
studies on the epidemiology of drug dependence and alcoholism be pursued and training programmes be supported. Resolution WPR/RC26.R11 urged governments to initiate and intensify programmes of education, legislation, treatment and rehabilitation and to maintain effective monitoring systems, developing and improving action programmes to combat drug dependence and alcoholism.
Resolution WPr/rC27.R5 was particularly explicit, requesting the Regional Director to cooperate with Member States in giving full attention to the seriousness of alcohol-related problems within the context of overall health programming.
1.5 Alcohol-related problems have been known to be prevalent in a number of developed countries for some considerable time. It is not surprising therefore that the European Region's long-term mental health programme has given such prominence to alcoholism and drug dependence and that activities in this sphere constituted an important pert of the programme during the period 1971-1976, This emphasis was in accordance with wishes expressed at the twentieth session of the Regional Committee. In discussing the second progress report on the long-term programme, almost all the speakers at the twenty-second session emphasized the importance of developing Regional Office activities in the field of drug dependence and
alcoholism. At its twenty-third session, in proposing an extension of the long-term programme for the years 1976-1980, the Regional Committee put forward a programme on alcohol and drug dependence including three specific proposals: (i) epidemiological studies of alcoholism and drug dependence； (ii) assessment of the influence of social and psychological factors on the incidence and prevalence of alcoholism; and (iii) provision of services for those afflicted with alcohol-related problems and drug dependence.
E B 6 3 / 2 3 p a g e 12 A n n e x
2 . C u r r e n t W H O a c t i v i t i e s
2.1 A n u m b e r of W H O' S c u r r e n t a c t i v i t i e s are r e l e v a n t to the e x p e c t a t i o n s e x p r e s s e d in r e s o l u t i o n W H A 2 8 . 8 1 . Some of the m o r e r e c e n t of these a c t i v i t i e s a r e d e s c r i b e d in the f o l l o w i n g p a r a g r a p h s , w h i c h do n o t in any w a y r e p r e s e n t an e x h a u s t i v e a c c o u n t .
2.2 A study of c o m m u n i t y r e s p o n s e s to a l c o h o l - r e l a t e d p r o b l e m s aims at s t i m u l a t i n g c o u n t r i e s to m a k e c a r e f u l a s s e s s m e n t of the n a t u r e and extent of the p r o b l e m s r e l a t e d to a l c o h o l
c o n s u m p t i o n at n a t i o n a l and local l e v e l s , to e x a m i n e how such p r o b l e m s are b e i n g dealt w i t h at p r e s e n t , and to d e v e l o p plans for a m o r e e f f e c t i v e r e s p o n s e w i t h i n the l i m i t a t i o n of a v a i l a b l e r e s o u r c e s . I n i t i a l l y c o l l a b o r a t i o n w a s a r r a n g e d , t h r o u g h g o v e r n m e n t s , w i t h r e s e a r c h teams in t h r e e c o u n t r i e s w i t h v e r y d i f f e r e n t s o c i o e c o n o m i c c o n d i t i o n s : M e x i c o , the U n i t e d K i n g d o m ( S c o t l a n d ) and Z a m b i a . The studies are b e i n g c a r r i e d out in b o t h u r b a n and r u r a l c o m m u n i t i e s . It is e x p e c t e d that the r e s e a r c h i n s t r u m e n t s d e v e l o p e d for such a r a n g e of s e t t i n g s and the e x p e r i e n c e a c q u i r e d w i l l be of v a l u e to a v a r i e t y of c o m m u n i t i e s and c o u n t r i e s w i s h i n g to carry out s i m i l a r studies as a b a s i s for the d e v e l o p m e n t of p r o g r a m m e s .
2.3 A c l o s e l y related p r o j e c t c o n c e r n s the p r e v e n t i o n of a l c o h o l - r e l a t e d d i s a b i l i t i e s . It seeks to i n v e s t i g a t e the n a t u r e of c u r r e n t m e a s u r e s , p o l i c i e s and p r o g r a m m e s aimed at p r e v e n t i n g , or r e d u c i n g , a l c o h o l - r e l a t e d p r o b l e m s , and to assess their i m p a c t . This is b e i n g d o n e through c o n s u l t a t i o n w i t h M e m b e r S t a t e s , through r e v i e w of the l i t e r a t u r e , and in c o n s u l t a t i o n w i t h e x p e r t s from a v a r i e t y of c o u n t r i e s . A r e v i e w of e x p e r i e n c e s in p r e v e n t i n g a l c o h o l - r e l a t e d p r o b l e m s w i l l b e p u b l i s h e d in m i d - 1 9 7 9 .
2.4 T h e r e s u l t s of a p r o j e c t c a r r i e d out in c o l l a b o r a t i o n w i t h the F i n n i s h F o u n d a t i o n for A l c o h o l S t u d i e s and the A d d i c t i o n R e s e a r c h F o u n d a t i o n of T o r o n t o m a k e a strong case for the c o n t e n t i o n that v a r i a t i o n s in the per capita a l c o h o l c o n s u m p t i o n of a p o p u l a t i o n bear d i r e c t l y on levels of a l c o h o l - r e l a t e d m o r t a l i t y and m o r b i d i t y , thus p r o v i d i n g e v i d e n c e c r u c i a l for p r e v e n t i v e p r o g r a m m e s • ^ This w o r k w a s f o l l o w e d u p by the c o m p i l a t i o n of those statistics on i n t e r n a t i o n a l p r o d u c t i o n , trade and c o n s u m p t i o n of a l c o h o l i c b e v e r a g e s that are considered e s s e n t i a l for the formulation of n a t i o n a l p u b l i e - h e a l t h - o r i e n t e d a l c o h o l p o l i c i e s . ^
2.5 R e s o l u t i o n W H A 2 8 . 8 1 , in addition to c a l l i n g attention to the extent and s e r i o u s n e s s of p r o b l e m s a s s o c i a t e d w i t h a l c o h o l , r e q u e s t s the D i r e c t o r - G e n e r a l "to take s t e p s , in c o o p e r a t i o n w i t h c o m p e t e n t i n t e r n a t i o n a l and n a t i o n a l o r g a n i z a t i o n s , ... to d e v e l o p c o m p a r a b l e information
systems on a l c o h o l c o n s u m p t i o n and other r e l e v a n t data n e e d e d for a p u b l i c - h e a 1 t h - o r i e n t e d a l c o h o l p o l i c y . " S e v e r a l important steps had in fact a l r e a d y been taken by W H O to p r o m o t e such w o r k . O n e example w a s the p r e p a r a t i o n of a r e v i e w of r e s p o n s e s to a l c o h o l - r e l a t e d p r o b l e m s in 33 c o u n t r i e s . ^
2.6 D i s c u s s i o n s h a v e also been held with the Finnish F o u n d a t i o n for A l c o h o l Studies r e g a r d i n g its offer to m a k e a v a i l a b l e to W H O the i n t e r n a t i o n a l s t a t i s t i c s it has c o l l e c t e d r e l a t i n g to the p r o d u c t i o n , trade and c o n s u m p t i o n of a l c o h o l . C o n s u l t a t i o n s h e l d w i t h the U n i t e d N a t i o n s S t a t i s t i c a l O f f i c e and r e l e v a n t U n i t e d N a t i o n s a g e n c i e s c o n f i r m that they w o u l d be w i l l i n g to m a k e a v a i l a b l e the data they h a v e c o l l e c t e d . The r e s p o n s i b i l i t y for c o l l a t i n g and
d i s s e m i n a t i n g this information w o u l d , h o w e v e r , b e W H O' S , and a d e q u a t e f u n d i n g w o u l d need to be found for this p u r p o s e .
B r u u n , K . et a l . (1975 ) A l c o h o l c o n t r o l p o l i c i e s in p u b l i c h e a l t h p e r s p e c t i v e，H e l s i n k i , F i n n i s h F o u n d a t i o n for A l c o h o l S t u d i e s , V o l . 2 5 .
2
F i n n i s h Foundation for A l c o h o l Studies and W H O R e g i o n a l O f f i c e for E u r o p e ( 1 9 7 7 )
I n t e r n a t i o n a l statistics on a l c o h o l i c beverages； production， trade and c o n s u m p t i o n , 1950-1972，
H e l s i n k i , F i n n i s h F o u n d a t i o n for A l c o h o l S t u d i e s , V o l . 2 7 . 3
M o s e r , J . ( 1 9 7 4 ) Problems and p r o g r a m m e s r e l a t e d to a l c o h o l and drug d e p e n d e n c e in 33 countries， G e n e v a , W H O O f f s e t P u b l . N o . 6.
EB63/23 page 13 Annex 2.7 N a t i o n a l statistics concerning m o r t a l i t y from a l c o h o l i s m and cirrhosis of the liver are already regularly collected and published by W H O . Attention has been focused in the past on m o r t a l i t y rather than on other health effects in relation to alcohol c o n s u m p t i o n . Within
the framework of a project on the m o n i t o r i n g of m e n t a l health n e e d s , h o w e v e r , m e t h o d s are being developed and tested for collecting patient-oriented statistical d a t a , including those concerning alcohol-related p r o b l e m s .
2.8 At the regional level there have been a number of activities over the y e a r s . The following are a few e x a m p l e s . In the European Region a study of the patterns of services for alcoholism and drug dependence has been carried out in eight countries.1 Participants from 22 countries attended a symposium on the planning and organization of services in 1975,^ and in August 1978 n e a r l y all countries of the Region w e r e represented at a conference on the public health aspects of alcoholism and drug d e p e n d e n c e , held in D u b r o v n i k , Y u g o s l a v i a . The European Region has global responsibility for programmes concerning traffic a c c i d e n t s , and has particularly considered the relevance of alcohol and other drugs to traffic a c c i d e n t s . In the Region of the Americas a training course on a l c o h o l i s m was held in 1973 in Costa Rica for health and social p e r s o n n e l from 12 Central and South American c o u n t r i e s , and studies have continued on the epidemiology of a l c o h o l i s m . An initial step was taken in the W e s t e r n Pacific Region with the circulation of a questionnaire in 1975 and the discussion of the replies at the twenty-seventh session of the R e g i o n a l C o m m i t t e e . ^ In Africa W H O collaborated in a workshop on drug addiction and alcoholism organized in N a i r o b i in 1974 by the Association of Psychiatrists in A f r i c a .
2.9 These activities have laid a firm basis for further w o r k in this area and demonstrated the commitment of countries to take seriously problems associated with the excessive u s e of a l c o h o l . They also confirm the existence of an international n e t w o r k of centres and collaborators w h o would be involved in the further development of W H O1s e f f o r t s .
O z a r i n , L. R . (1973) Existing patterns of services for alcoholism and drug d e p e n d e n c e ,
C o p e n h a g e n , EURO 5437 IV. ” ™1 —^“
2
W H O Regional Office for Europe (1976) Planning and organization of services for alcoholism and drug dependence (report on a s y m p o s i u m , A l b i , F r a n c e , 1975) C o p e n h a g e n , ICP/MNH 024 I V . ~
Document WPR/RC27/8 (Progress report by the R e g i o n a l D i r e c t o r ) .
