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O R G A N I S A T I O N M O N D I A L E D E L A
W O R L D H E A L T H O R G A N I Z A T I O N
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E B 7 5 / l N F . D O Ce/ 7 11 D e c e m b e r 1984
EXECUTIVE BOARD Seventy-fifth Session Provisional agenda item 7•2
A L C O H O L CONSUMPTION AND A L C O H O L - R E L A T E D PROBLEMS
This d o c u m e n t is submitted t o the Board to provide information on the steps that h a v e been taken to intensify WHO* s programme on
alcohol-related problems in r e s p o n s e to resolution W H A 3 6 . 1 2 .
I . INTRODUCTION
1. Recent decades h a v e witnessed considerable increases in alcohol consumption and in alcohol-related problems in countries in all regions of the w o r l d . In the WHO E u r o p e a n R e g i o n , the number of countries with an annual per capita intake of m o r e than 10 litres of pure alcohol increased from three in 1950 to 18 by 1 9 7 9 . C o u n t r i e s in the WHO W e s t e r n Pacific Region report sharp increases in alcohol-related health d a m a g e , in alcohol-related c r i m e s , and in alcohol-related accidents d u r i n g the 1 9 7 0 s . ^ Similar reports h a v e emerged from countries in other WHO r e g i o n s , including those with long traditions of abstinence from alcohol• Although some countries in W e s t e r n Europe and North A m e r i c a are now reporting a levelling off and even a modest decline in alcohol c o n s u m p t i o n , the global trend is still that of continuing g r o w t h , with p a r t i c u l a r l y sharp increases in c o m m e r c i a l l y produced alcoholic beverages in some d e v e l o p i n g countries in A f r i c a , Latin A m e r i c a and the W e s t e r n Pacific Because of the positive association which generally exists b e t w e e n trends in consumption and trends in alcohol-related p r o b l e m s , this increase is likely to h a v e enormous public health implications.
2 . T h e World Health Assembly has responded to this serious s i t u a t i o n . In May 1979 the Thirty-second World Health Assembly recognized "that problems related to a l c o h o l , and particularly to its excessive c o n s u m p t i o n , rank among the w o r l d1 s m a j o r public health
problems" (resolution W H A 3 2 . 4 0 ) . The T e c h n i c a l D i s c u s s i o n s at the T h i r t y - f i f t h World H e a l t h Assembly three years later, on "Alcohol c o n s u m p t i o n and alcohol-related problems:
development of national policies and p r o g r a m m e s " , brought together participants from m o r e than 100 c o u n t r i e s . The results of their d i s c u s s i o n s were echoed in r e s o l u t i o n W H A 3 6 . 1 2 ^ at the Thirty-sixth World Health A s s e m b l y (May 1983).
3 . This information document summarizes the steps which h a v e b e e n taken w i t h i n the M e n t a l Health programme to implement paragraph 4(1) of that r e s o l u t i o n , which requests the
Director-General :
(1) to continue and intensify W H O1s programme on alcohol-related problems as an
integral part of the strategy for health for all through a primary h e a l t h care a p p r o a c h , as envisaged in the Seventh G e n e r a l P r o g r a m m e of W o r k , a n d , in accordance with
resolution W H A 3 2 . 4 0 .
(a) to strengthen further W H O1s capacity to respond to requests from Member States to support their efforts in dealing with alcohol-related problems；
(b) to carry out studies on factors affecting alcohol consumption patterns and on measures to influence these patterns；
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(c) to promote further joint consideration by the organizations of the United Nations system and nongovernmental organizations of the problems associated with alcohol and their alleviation;
(d) to seek additional funds from relevant United Nations bodies as well as governmental and nongovernmental sources.
I I . WHO'S PROGRAMME
Focus on alcohol-related problems
4. During the period of the Sixth General Programme of Work (1978-1983), a major change occurred in WHO1s activities in the area of alcohol abuse. The concept of "alcoholism" was replaced with the much broader range of "alcohol-related problems'1 In consequence of this important shift in emphasis， a number of broad lines of action were started, which relied upon the active involvement of all WHO regions and reflected the growing concern of Member States throughout the world. The work in the European Region and in North America in
the alcohol policy area was of particular i m p o r t a n c e ,5,6,7 , 8 whi1st in the Western Pacific Region alarm at increasing alcohol consumption led to the adoption of a wide-ranging resolution (WPR/RC33.R15) by the Regional Committee in 1982.
5. Information from 80 countries on the prevention of alcohol-related problems was collated by WHO and published^ and an Expert Committee on Problems related to Alcohol Consumption held ДО in a d d i t i o n , WHO carried out a large collaborative study in measuring and
improving coramunity responses to alcohol-related problems in Mexico, Scotland and Z a m b i a .1 2
Current programme strategy
6 . In an effort to respond to the challenges contained in resolution WHA36.12, activities h a v e been concentrated on major priority a r e a s . These areas were selected as a result of a careful assessment of expressions of needs by countries and after consultation with WHO regional o f f i c e s . Significant developments in each of these areas are highlighted b e l o w .
Advocacy of the public health interest
7. Activities in the advocacy area were intended to strengthen WHO* s capacity to respond to requests from Member States (resolution WHA36.12, paragraph 4 ( 1 ) ( a ) ) . Four specific lines of work have been developed,
8. Firstly, it was recognized that the prevention of alcohol-related problems is one
essential part of the promotion of h e a l t h . A major new programme initiative is now beginning with an international workshop which will develop guidelines for the assessment of health promotion approaches to the reduction of alcohol problems. Four developing countries from different regions are participating in this activity, which will lead to the development and testing of specific approaches to the prevention of alcohol-related public health problems, with special emphasis on the needs of developing countries. M e a n w h i l e , in the European R e g i o n , work in prevention has focused particularly on vulnerable and high-risk g r o u p s , beginning with a review of different approaches to the prevention of alcohol problems in young people•
9. The second line of work seeks to promote cooperation with the media. An international meeting on alcohol and health held in Geneva in November 1983^^ identified promising
advocacy a p p r o a c h e s . This meeting involved media practitioners and communication
scientists. Their recommendations, which are now being implemented, include the preparation of press kits of basic information on physical diseases caused by alcohol, on alcohol
dependence and on alcohol and the family. A review document has also been prepared on the impact of TV on the mental health of adults and children which uses alcohol as a case study•
10. A third important target audience for advocacy is the scientific community. Through the encouragement of research in alcohol, and in particular through the proposals of a 1984 task force on the prevention of alcohol-related problems in adolescence. vigorous attempts are being made to stimulate increasing interest in this area of w o r k . Another good example
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of the use of advocacy within the scientific community is the stimulation of work on biological risk factors for alcohol d e p e n d e n c e , which relies upon long-term international collaborative e f f o r t , involving several centres•
11. A review was undertaken of the various documents on alcohol production, consumption and related health problems issued or drafted by the Organization during the past few years•
This review revealed that the information available has been insufficiently exploited for advocacy purposes• A series of publications and documents are now being prepared• These include several reports on trends in alcohol production and trade, with discussions of their public health implications and suggestions for future w o r k S h o r t articles in World
Health Statistics Q u a r t e r l y , the WHO Chronicle and World Health Forum will also deal with this topic• Other publications and documents, bringing together the results of work on alcohol policies ’ ’ and on community response to alcohol p r o b l e m s ,⑶ will be issued in early 1985.
National alcohol policies
12• Activities in the area of alcohol policy are in response to the need to understand which measures can influence alcohol consumption patterns (resolution WHA36.12 paragraph 4 ( 1 ) ( b ) ) . Following a comprehensive review of the world literature, a basic document has been prepared on policy options for d e c i s i o n - m a k e r s J l It draws upon previous and current work
undertaken in all WHO regions, particularly Europe, where consistent attention to this topic led to a major Symposium on Alcohol Control Experiences in 1 9 8 3 .1 7 The draft of the
document has been extensively circulated for comment to scientists and decision-makers throughout the world• It distinguishes between those policy measures for which there is now sufficient objective evidence of effectiveness, those for which the evidence is m i x e d , and those for which there is widespread popular support but little objective information.
13• It is hoped that the above document will be of use in a wide range of countries, and that opportunities will arise for working with countries to help test the impact of different approaches to policy development and implementation. In the meantime, intercountry and national workshops are being organized in a number of countries, particularly in the African R e g i o n . These workshops will bring together participants from other sectors as well as h e a l t h , and will serve as a stimulus to the development of local plans of action to reduce alcohol problems. An intercountry collaborative project has begun in the European Region, involving eight Member States in the promotion of studies of alcohol-related problems and responses to them at coiranunity level, as part of the development of more effective national programmes.
14. In support of work on national alcohol policies, efforts are also being made to promote the development of sound national and international data bases on alcohol-related problems.
The lack of adequate statistical informat ion in this area has been repeatedly deplored in Health Assembly resolutions. Following detailed planning, it has now been established that collaborating centres are especially well placed to play a lead ing role in developing
activities in this a r e a . With support from the Regional Office for the Americas, the Alcoholism and Drug Addiction Research Foundation (Toronto, Canada) and the National
Institute on Alcohol Abuse and Alcoholism (Washington, DC) are bringing together groups of scientists from a range of countries to work on the improvement of the measurement of the role of alcohol in casualty statistics.
15. This activity is taking place within the context of continuing work on the development of better indicators of mental health problems and on the improvement of the assessment of physical damage caused by alcohol consumption. As part of its efforts to monitor progress towards health for a l l , the Regional Office for Europe is developing a list of indicators, which include those relevant to alcohol and drug targets for that Region,
Development of techniques for identification, prevent ion arid management in primary health care settings
1 6 . Work in this area has been developed through a number of specific projects, also
designed to strengthen W H O1s capacity to respond to requests from Member States (resolution WHA36.12, paragraph 4 ( 1 ) ( a ) ) . Simple procedures for the early detect ion of alcohol problems in primary health care settings have been d e v e l o p e d . Various exist ing methods were compared,
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in o r d e r to d e t e r m i n e w h i c h items s h o u l d e v e n t u a l l y be i n c l u d e d in a s c r e e n i n g i n s t r u m e n t , w h i c h w a s then tested in six c o u n t r i e s . A n u m b e r of r e p o r t s r e l a t i n g to this a c t i v i t y are b e i n g p r o d u c e d , and w i l l a p p e a r in the n e a r f u t u r e .
1 7 . T h e r e s u l t s of the e a r l y d e t e c t i o n p r o j e c t are b e i n g fed d i r e c t l y into w o r k o n the d e v e l o p m e n t and e v a l u a t i o n of m e a s u r e s to b e used for t r e a t m e n t and m a n a g e m e n t of a l c o h o l p r o b l e m s in the p r i m a r y h e a l t h c a r e s e t t i n g . The p r o j e c t on t r e a t m e n t e m p h a s i z e s the
d e v e l o p m e n t of e f f e c t i v e and s i m p l e l o w - c o s t m e t h o d s , d e s i g n e d to i n c r e a s e (a) the n u m b e r of p e o p l e w h o w i l l b e r e a c h e d , (b) the l i k e l i h o o d that h e a l t h s y s t e m s c a n i n c o r p o r a t e the
r e l e v a n t k n o w l e d g e , and (c) the l i k e l i h o o d that c o u n t r i e s c a n afford the c o s t . C e n t r e s in 10 c o u n t r i e s are n o w i m p l e m e n t i n g the p i l o t p h a s e • A s i m p l e a d v i c e s e s s i o n is b e i n g c o m p a r e d w i t h a c o u n s e l l i n g s e s s i o n and a s e l f - h e l p m a n u a l , in o r d e r to test t h e i r r e l a t i v e
e f f e c t i v e n e s s in r e d u c i n g c o n s u m p t i o n a n d / o r a l c o h o l - r e l a t e d p r o b l e m s . A n i m p o r t a n t c o n t r i b u t i o n to this w o r k h a s b e e n the d e v e l o p m e n t of a p r i m a r y h e a l t h c a r e m a n u a l o n
r e s p o n d ing to a l c o h o l and d r u g p r o b l e m s , w h i c h is a l s o b e i n g i n d e p e n d e n t l y tested in a n u m b e r of d i f f e r e n t s e t t i n g s .
1 8 . E f f o r t s in this a r e a are s u p p l e m e n t e d b y a d e s c r i p t i v e s u r v e y of the r o l e of g e n e r a l m e d i c a l p r a c t i t i o n e r s in the m a n a g e m e n t of a l c o h o l - r e l a t e d p r o b l e m s in a r a n g e of d e v e l o p i n g and d e v e l o p e d c o u n t r i e s . ” R e p o r t s b a s e d o n studies from 14 c e n t r e s in 12 c o u n t r i e s h a v e b e e n p r e p a r e d in o r d e r to a c h i e v e a b e t t e r u n d e r s t a n d i n g of the c u r r e n t p r a c t i c e and the
future p o t e n t i a l of p r i m a r y h e a l t h c a r e w o r k e r s in i d e n t i f i c a t i o n , t r e a t m e n t and 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 p r o b l e m s •
1 9 . W o r k h a s started in the E u r o p e a n R e g i o n on the d e v e l o p m e n t of m o d e l p r o g r a m m e s for t r e a t m e n t and r e h a b i l i t a t i o n , i n c l u d i n g e v a l u a t i o n m e t h o d o l o g y and p r o g r a m m e i m p l e m e n t a t i o n , b u i l d i n g on the e x p e r i e n c e s of s e v e r a l M e m b e r S t a t e s • T h e r e s p e c t i v e r o l e s of d i f f e r e n t s e c t o r s and s e r v i c e s , i n c l u d i n g lay g r o u p s , c o m m u n i t y n e t w o r k s and n o n - h e a l t h s e c t o r s , are a l s o b e i n g a n a l y s e d .
2 0 . M e a n w h i l e , in c o l l a b o r a t i o n w i t h the I n t e r n a t i o n a l L a b o u r O r g a n i s a t i o n (ILO) and the I n t e r n a t i o n a l C o u n c i l on A l c o h o l and A d d i c t i o n s , W H O p r e p a r e d six r e g i o n a l r e v i e w s of a l c o h o l - r e l a t e d p r o b l e m s in the e m p l o y m e n t s e t t i n g and the r e s p o n s e s w h i c h are c u r r e n t l y o f f e r e d to t h e m . The R e g i o n a l O f f i c e for the A m e r i c a s h a s b e e n e s p e c i a l l y a c t i v e in s t i m u l a t i n g p o l i c i e s and p r o g r a m m e s on a l c o h o l and d r u g p r o b l e m s in e m p l o y m e n t s e t t i n g s • M e a n w h i l e , s p e c i f i c p r o p o s a l s h a v e b e e n d e v e l o p e d for p o s s i b l e j o i n t a c t i o n by ILO and W H O ,
f o c u s i n g on p r e v e n t ive m e a s u r e s a p p r o p r i a t e for e m p l o y m e n t s e t t i n g s .
2 1 . A r e v i e w of the world l i t e r a t u r e o n the p r e v e n t i o n and m a n a g e m e n t of a l c o h o l p r o b l e m s in the family s e t t i n g w i l l b e a v a i l a b l e in 1 9 8 5 . It w i l l be used to d e t e r m i n e ways in w h i c h W H O c a n best a p p r o a c h this c o m p l e x field and b e c o m e u s e f u l l y i n v o l v e d • T h i s r e m a i n s a topic w i t h g r e a t p o t e n t i a l for d e v e l o p m e n t , and is a l r e a d y an i m p o r t a n t e m p h a s i s w i t h i n both the
a d v o c a c y and t r e a t m e n t a r e a s • I n t e r n a t i o n a l c o o r d i n a t i o n
2 2 . In o r d e r to r e s p o n d to r e s o l u t i o n W H A 3 6 . 1 2 , p a r a g r a p h 4 ( 1 ) ( c ) , the i n t e r e s t and
i n v o l v e m e n t of o t h e r s p e c i a l i s t b o d i e s w i t h i n the U n i t e d N a t i o n s s y s t e m h a s b e e n s t i m u l a t e d t h r o u g h s p e c i f i c p r o j e c t s , for e x a m p l e the c o l l a b o r a t i o n w i t h ILO on a l c o h o l p r o b l e m s in e m p l o y m e n t s e t t i n g s . At the same t i m e , b o t h U N E S C O and U N I C E F h a v e b e e n involved in
a c t i v i t i e s w i t h i n the a d v o c a c y area and f u r t h e r o p p o r t u n i t i e s for c o l l a b o r a t i o n are e n v i s a g e d as these a c t i v i t i e s d e v e l o p •
2 3 . In v i e w of the c r u c i a l r o l e of n o n g o v e r n m e n t a l o r g a n i z a t i o n s , a m e e t i n g was o r g a n i z e d in M a y 1984 of all o r g a n i z a t i o n s that had a n i n t e r e s t in WHO* s a l c o h o l p r o g r a m m e . A v e r y w i d e r a n g e of n o n g o v e r n m e n t a l o r g a n i z a t i o n s sent r e p r e s e n t a t i v e s to this m e e t i n g and a joint p l a n of w o r k , i n c l u d i n g r e g u l a r c o n t a c t and i n v o l v e m e n t in the p r o g r a m m e , h a s e m e r g e d . As a r e s u l t of r e g u l a r m e e t i n g s of i n t e r g o v e r n m e n t a l and n o n g o v e r n m e n t a l o r g a n i z a t i o n s in the E u r o p e a n R e g i o n , c l o s e c o l l a b o r a t i v e l i n k s h a v e b e e n e s t a b l i s h e d w i t h the C o u n c i l of E u r o p e for the d e v e l o p m e n t of p i l o t p r o j e c t s on e d u c a t i o n for h e a l t h to p r e v e n t d e p e n d e n c e .
2 4 . L i n k s with such o r g a n i z a t i o n s a r e c o m p l e m e n t a r y to e x i s t i n g p l a n s of w o r k w i t h W H O c o l l a b o r a t i n g c e n t r e s in b o t h d e v e l o p e d and d e v e l o p i n g c o u n t r i e s . T h e n e t w o r k of
c o l l a b o r a t i n g c e n t r e s a c t i v e in t r a i n i n g , t e a c h i n g and r e s e a r c h on a l c o h o l - r e l a t e d p r o b l e m s is a l r e a d y an i n t e g r a l part of the p r o g r a m m e . It is a n t i c i p a t e d that this n e t w o r k w i l l be e x p a n d e d to m e e t future n e e d s b o t h in the r e g i o n s and g l o b a l l y .
E B 7 5 / I N F . D O C . / 1 0 p a g e 5
O r g a n i z a t i o n and m a n a g e m e n t
2 5 . T h e W H O a l c o h o l p r o g r a m m e h a s the b e n e f i t of an a c t i v e and e n e r g e t i c a d v i s o r y g r o u p w h i c h r e v i e w s the g e n e r a l t h r u s t of the w o r k at g l o b a l l e v e l as w e l l as c o m m e n t i n g in d e t a i l o n s p e c i f i c a s p e c t s of i t . T h i s a d v i s o r y g r o u p , w h i c h i n c l u d e s m e m b e r s of the E x e c u t i v e B o a r d , p r o v i d e s r e g u l a r c r i t i c a l a s s e s s m e n t of the p r o g r a m m e w i t h i n the c o n t e x t of the b r o a d e r h e a l t h c o n c e r n s of the O r g a n i z a t i o n ,
2 6 . A l t h o u g h the r e g u l a r b u d g e t a l l o c a t i o n for the g l o b a l a l c o h o l p r o g r a m m e is r e l a t i v e l y m o d e s t , the sum of U S ¿ 200 0 0 0 h a s b e e n m a d e a v a i l a b l e d u r i n g the b i e n n i u m 1 9 8 4 - 1 9 8 5 f r o m the D i r e c t o r - G e n e r a l1 s D e v e l o p m e n t P r o g r a m m e I n r e s p o n s e to c o u n t r y n e e d s , the E u r o p e a n
R e g i o n h a s now e s t a b l i s h e d a s e p a r a t e and i d e n t i f i a b l e p r o g r a m m e o n 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 s t in o t h e r r e g i o n s a c t i v i t i e s o n a l c o h o l - and d r u g - r e l a t e d p r o b l e m s h a v e tended to b e u n d e r t a k e n t o g e t h e r .
2 7 . W i t h i n the last y e a r , a t t e m p t s to a t t r a c t e x t r a b u d g e t a r y f u n d i n g for the g l o b a l p r o g r a m m e in r e s p o n s e to r e s o l u t i o n W H A 3 6 , 1 2 , p a r a g r a p h 4 ( 1 ) ( d ) h a v e y i e l d e d s o m e p o s i t i v e r e s u l t s . A c o m m i t m e n t of c o n t i n u i n g s u p p o r t to the p r o g r a m m e h a s b e e n m a d e by the C o u n c i l of M i n i s t e r s of H e a l t h o f the A r a b C o u n t r i e s o f the G u l f Area； the N o r w e g i a n M i n i s t r y of
D e v e l o p m e n t C o o p e r a t i o n and the C h a r t e r M e d i c a l F o u n d a t i o n h a v e b o t h p r o v i d e d s u p p o r t for p a r t i c u l a r a c t i v i t i e s . In a d d i t i o n , the U n i t e d S t a t e s N a t i o n a l I n s t i t u t e o n A l c o h o l A b u s e and A l c o h o l i s m h a s s e c o n d e d a senior staff m e m b e r to W H O for 15 m o n t h s , and the H e a l t h
E d u c a t i o n C o u n c i l , U n i t e d K i n g d o m , h a s a g r e e d to second its a l c o h o l p r o g r a m m e m a n a g e r for o n e m o n t h each y e a r ,
I I I . C O N C L U S I O N S
2 8 . T h e a c t i v i t i e s h i g h l i g h t e d in this d o c u m e n t fall w i t h i n the w o r k of the M e n t a l H e a l t h p r o g r a m m e , w h i c h g i v e s c e n t r a l a t t e n t i o n to the p r e s e r v a t i o n and e n h a n c e m e n t of m e n t a l h e a l t h at all ages in the s p e c i f i c s o c i o c u l t u r e l s e t t i n g s of M e m b e r S t a t e s • It is w i t h i n this c o n t e x t that a c o m p r e h e n s i v e a p p r o a c h to the a l l e v i a t i o n of a l c o h o l - and d r u g - r e l a t e d p r o b l e m s is n o w b e i n g a c t i v e l y d e v e l o p e d .
2 9 . This b r i e f d e s c r i p t i o n d o e s less than j u s t i c e to the full r a n g e of a c t i v i t i e s c o n t a i n e d w i t h i n the c u r r e n t W H O a l c o h o l p r o g r a m m e . It h a s , of c o u r s e , b e e n i m p o s s i b l e to p r e s e n t the
full r a n g e of c o u n t r y and r e g i o n a l p r o g r a m m e s . It is h o p e d , h o w e v e r , that w h a t h a s b e e n p r e s e n t e d h e r e is s u f f i c i e n t to i l l u s t r a t e a c t i v i t i e s u n d e r t a k e n to d e v e l o p a c o h e r e n t r e s p o n s e to the p r i o r i t i e s a d v a n c e d in r e s o l u t i o n W H A 3 6 . 1 2 •
3 0 . It is p r o p o s e d that the a l c o h o l p r o g r a m m e should c o n t i n u e to d e v e l o p w i t h i n the m a j o r areas d e s c r i b e d a b o v e ; a d v o c a c y of the p u b l i c h e a l t h i n t e r e s t ; n a t i o n a l a l c o h o l policies；
d e v e l o p m e n t of t e c h n o l o g i e s for p r i m a r y h e a l t h c a r e settings； and i n t e r n a t i o n a l
c o o r d i n a t i o n . Such a p r o g r a m m e is c o n s i s t e n t w i t h the stated o b j e c t i v e s of W H O1s M e d i u m - T e r m M e n t a l H e a l t h P r o g r a m m e ” and w i t h the o v e r a l l aims of the S e v e n t h G e n e r a l P r o g r a m m e of W o r k • The intent ion is to b u i l d up a p r o g r a m m e w h i c h m a k e s the m o s t c o s t - e f f e c t i v e u s e of s c a r c e r e s o u r c e s , w h i c h w i l l a t t r a c t n a t i o n a l and i n t e r n a t i o n a l i n t e r e s t , and w h i c h w i l l c o n t r i b u t e s i g n i f i c a n t l y to the e f f o r t s of c o u n t r i e s to a c h i e v e the g o a l of h e a l t h for a l l .
R E F E R E N C E S
1• R e p o r t on R e g i o n a l W o r k s h o p on A l c o h o l - R e l a t e d P r o b l e m s , M a n i l a , P h i l i p p i n e s , 8 - 1 2 A u g u s t 1982 ( u n p u b l i s h e d W H O d o c u m e n t ( W P ) M N H / l C P / M N H / 0 0 4 ) , 1 9 8 4 .
2 • W a l s h , В. & G r a n t , M . Public h e a l t h i m p l i c a t i o n s of a l c o h o l p r o d u c t i o n and t r a d e . G e n e v a , W o r l d H e a l t h O r g a n i z a t i o n (WHO O f f s e t P u b l i c a t i o n ) (in p r e s s ) .
3 . D o c u m e n t W H A 3 6 / 1 9 8 3 / R E C / 1 , p . 9 .
4 . E d w a r d s , G . et a l . , e d . 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 > G e n e v a , W o r l d H e a l t h O r g a n i z a t i o n , 1977 (WHO O f f s e t P u b l i c a t i o n N o . 32).""“
5 . W o r l d H e a l t h O r g a n i z a t i o n . P u b l i c h e a l t h a s p e c t s of a l c o h o l and d r u g d e p e n d e n c e . R e p o r t of a W H O c o n f e r e n c e . C o p e n h a g e n , 1979 (EURO R e p o r t s and S t u d i e s , N o . 8 ) .
E B 7 5 / I N F . D O C . / 1 0 p a g e 6
6 . M a k e l a , К. et a l . A l c o h o l , s o c i e t y and the s t a t e : I • A c o m p a r a t i v e study of a l c o h o l c o n t r o l , T o r o n t o , A l c o h o l i s m and D r u g 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 , 1 9 8 1 .
7 . S i n g l e , E . et a l . A l c o h o l , s o c i e t y and the state； I I . T h e s o c i a l h i s t o r y of c o n t r o l p o l i c y in s e v e n c o u n t r i e s . T o r o n t o , A l c o h o l i s m and D r u g 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 , 1 9 8 1 .
8 . W a l s h , D . A l c o h o l - r e l a t e d m e d i c o s o c i a l p r o b l e m s and their p r e v e n t i o n . C o p e n h a g e n , W o r l d H e a l t h O r g a n i z a t i o n , 1982 ( P u b l i c H e a l t h in E u r o p e , N o . 1 7 ) .
9 . M o s e r , J . 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 p r o b l e m s . T o r o n t o , A l c o h o l i s m and D r u g 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 , 1 9 8 0 .
1 0 . W H O T e c h n i c a l R e p o r t S e r i e s , N o . 6 5 0 , 1 9 8 0 .
1 1 . R o o t m a n , I . & M o s e r , J . , e d • C o m m u n i t y r e s p o n s e to a l c o h o l - r e l a t e d p r o b l e m s , P h a s e I , F i n a l r e p o r t ( u n p u b l i s h e d W H O d o c u m e n t M N H / 8 3 . 1 7 ) , 1 9 8 3 .
1 2 . R o o t m a n , I . , e d . C o m m u n i t y r e s p o n s e to a l c o h o l - r e l a t e d p r o b l e m s , P h a s e I I , F i n a l r e p o r t ( u n p u b l i s h e d W H O d o c u m e n t M N H / 8 3 . 1 8 ) , 1 9 8 3 .
13• G r a n t , M . 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 a m o n g s t y o u n g p e o p l e (unpublished E U R O d o c u m e n t I C P / A D A / 0 0 2 C s O l ) , 1 9 8 4 . •"“
1 4 . A l c o h o l and h e a l t h : r e p o r t o n i n f o r m a l c o n s u l t a t i o n , G e n e v a , 22-24 N o v e m b e r 1983 ( u n p u b l i s h e d W H O d o c u m e n t M N H / 8 3 . 3 2 ) , 1 9 8 3e
1 5 . L e a t h a r , D . T h e i m p a c t of T V o n t h e m e n t a l h e a l t h of a d u l t s and c h i l d r e n ( u n p u b l i s h e d W H O d o c u m e n t , b a c k g r o u n d p a p e r for S e m i n a r for T V P r o d u c e r s on H e a l t h I s s u e s C o v e r a g e , M o s c o w , 17-21 S e p t e m b e r 1 9 8 4 ) , 1 9 8 4 .
1 6 . A l c o h o l - r e l a t e d p r o b l e m s and t h e i r p r e v e n t i o n w i t h p a r t i c u l a r r e f e r e n c e ^ t o a d o l e s c e n c e . r e p o r t o f m e e t i n g of t a s k f o r c e , G e n e v a , 31 A u g u s t - 4 S e p t e m b e r 1984 (unptiblished W H O d o c u m e n t M N H / N A T / 8 4 . 1 ) , 1 9 8 4 .
1 7 . W o r l d H e a l t h O r g a n i z a t i o n . A l c o h o l p o l i c i e s . C o p e n h a g e n (WHO R e g i o n a l P u b l i c a t i o n s , E u r o p e a n S e r i e s , N o . 1 8 ) (in p r e s s ) •
1 8 • R e p o r t o n W o r k s h o p o n N a t i o n a l P o l i c y and P r o g r a m m e F o r m u l a t i o n for P r e v e n t i o n and C o n t r o l of A l c o h o l - R e l a t e d P r o b l e m s , A u c k l a n d , N e w Z e a l a n d , 5-9 N o v e m b e r 1 9 8 4 , M a n i l a (in p r e p a r a t i o n ) .
1 9 . M o s e r , J . A l c o h o l p o l i c i e s in n a t i o n a l h e a l t h and d e v e l o p m e n t p l a n n i n g : r e p o r t on the T e c h n i c a l D i s c u s s i o n s at the T h i r t y - f i f t h W o r l d H e a l t h A s s e m b l y . G e n e v a , World H e a l t h O r g a n i z a t i o n (WHO O f f s e t P u b l i c a t i o n ) (in p r e s s ) .
2 0 . R i t s o n , E . В. C o m m u n i t y r e s p o n s e to a l c o h o l - r e l a t e d p r o b l e m s : r e v i e w of an
i n t e r n a t i o n a l s t u d y , G e n e v a , W o r l d H e a l t h O r g a n i z a t i o n , 1985 (Public H e a l t h P a p e r s , N o . 8 1 ) .
2 1 . D e v e l o p i n g n a t i o n a l p o l i c i e s to p r e v e n t a l c o h o l - r e l a t e d p r o b l e m s (unpublished W H O d o c u m e n t M N H / P A D / 8 4 . 1 7 ) , 1 9 8 4 .
2 2 . T h e m a n a g e m e n t of a l c o h o l - r e l a t e d p r o b l e m s in g e n e r a l p r a c t i c e (unpublished W H O d o c u m e n t M N H / D A T / 8 4 . 7 ) • ‘ ~ 2 3 . A d v i s o r y G r o u p o n P r e v e n t i o n and C o n t r o l of A l c o h o l - R e l a t e d P r o b l e m s . r e p o r t of
m e e t i n g , G e n e v a , 2 3 - 2 5 M a y 1984 ( u n p u b l i s h e d W H O d o c u m e n t M N H / P A D / 8 4 . 5 ) , 1 9 8 4 . 2 4 . D o c u m e n t E B 7 3 / 1 9 8 4 / R E C / 1 , A n n e x 9 , p a r a g r a p h 2 . 2 .
2 5 . U n p u b l i s h e d W H O d o c u m e n t M N H / M T P / 8 3 . 1 9 .
