Reducing the Harm caused by Alcohol: A co-ordinated European Response

Royal College of Physicians Conference, 13 November 2007, London.

Over one hundred and thirty participants from more than twelve countries attended this conference, organised by the Royal College Of Commissions, in the context of the EU funded Building Capacity project. The conference invited UK and European medical professions to share latest evidence and experience and to produce a Conference Charter for a co-ordinated response to reduce the harm caused by alcohol to Europe.

http://www.rcplondon.ac.uk/event/details.aspx?e=937

The UK Alcohol Health Alliance was also launched in tandem to the conference; the alliance chaired by Professor Ian Gilmore, brings together some twenty organisations, including medical bodies, patient representatives and alcohol health campaigners, aiming to reduce the damage to health caused by alcohol misuse.(http://www.rcplondon.ac.uk/alcoholalliance/ )

The conference included a variety of speakers and themes:

Robert Madelin, Director General of DG Sanco, European Commission, gave an overview of the ‘Alcohol and Health Forum', a multistakeholder platform brining together stakeholders pledging to take action to reduce alcohol related harm. The European Alcohol and Health Forum is the most important tool on European level to tackle with alcohol related problems in the following areas: under age drinking, information on effects of harmful drinking, responsible drinking/ promoting behavioural changes, consumer information and commercial communications.

Dr Vladimir Poznyac, from the Head Quarters of the World Health Organization (Geneva) presented global developments in the field of alcohol policy on the global level. He also stressed the important role of the physicians in prevention and treatment of alcohol related diseases and alcohol dependency.

Professor Jurgen Rehm, from University of Toronto and Centre for Addiction and Mental Health, highlighted the burden caused by alcohol. He stressed the relation between amount of alcohol and the risk of different diseases. The main alcohol-attributable causes of premature death in Europe are intentional and unintentional injuries, liver cirrhoses, cardiovascular diseases, cancer. Alcohol is a major risk factor for premature mortality and morbidity in the EU. The risk is higher for men than for women. There are also regional differences in Europe. The alcohol-attributable deaths and burden of disease are higher in the Central and Eastern European countries than in the EU 15[1]. In the end alcohol-attributable health harm is only one part of overall harm by alcohol.

Professor Sir Michael Marmot, University College London presented effective alcohol policy measures that can be taken reduce alcohol related harm, focusing his explanations on the developments in the United Kingdom. The fall in the relative price of alcohol, the increasing availability and the increased promotion of alcoholic beverages by the drinks industry are the main reasons for the increase of alcohol related harm in the UK. He is in favour with the adopted EU strategy to reduce alcohol related harm. Finally he stressed the necessity of a Framework Convention on alcohol, which could be a parallel to the Framework Convention for Tobacco Control.

Dr Peter Anderson, Consultant in Public Health, highlighted the impact of alcohol advertising on alcohol consumption among young people. His presentation was mainly based on the results of the EU funded ELSA project. He presented different studies which show that the influence of alcohol on young people's drinking patterns, and emphasises that statutory regulations are more effective than self-regulation. He underlined this demand on statutory regulations with current examples of alcohol advertising, which infringed self-regulation codes of the advertising industry itself. An example of good practice is the French ‘loi Evin' in France which bans all alcohol advertising on television.

Dr Richard Yoast from the Office of Alcohol, Tobacco and Other Drug Abuse Prevention, American Medical Association described the structure of the health system and situation of prevention in the USA. There are gaps in the system for identification of early symptoms of alcohol problems. Physicians play a key role in the medical care system in both the prevention and treatment of alcohol related harm, but this has to be supported by education, effective concepts, advocacy etc. An overall strategy based upon concrete action is needed.

Dr Antoni Gual, from the Neurosciences Institute, Clinical Hospital University of Barcelona, discussed the differences between North and South Europe with regard to alcohol consumption an alcohol related harm and emphasised that these differences are gradually evening out; these trends can be attributed to globalization and global marketing strategies by the alcohol industry. He highlighted the need for a common European alcohol policy.

Dr Ann Hope, from Trinity College, Dublin focused her presentation on alcohol and young people, as binge drinking has become a common drinking pattern among young people across Europe. She stressed that most violence among young people is related to heavy alcohol use, and that measures to reduce alcohol consumption among young people are insufficient across Europe. The Alcohol strategy is focussed on reducing alcohol consumption among young people, but restrictions on alcohol advertising are overlooked. She called for the implementation of effective and evidence based measures aimed at reducing alcohol consumption and heavy alcohol use.

Three speakers then addressed the question ‘What can the medical profession do?'. Professor Vivienne Nathanson (British Medical Association), Professor Joe Barry (Irish Medical Organisation) and Dr Vladimiy Poznyak (WHO) gave statements about the importance of the involvement of medical professionals in alcohol policy, and emphasised that cooperation with relevant government bodies is necessary for in order to formulate, and implement effective alcohol policies. Building coalition building with other relevant organisations can support this process. There are examples of lobbying by the Irish Medical Organisation on drinking and driving the Government introduced mandatory alcohol testing in July 2006, as a result of a lengthy campaign. The WHO representative emphasised that medical professions play an important role of different levels and should be visible in the field of alcohol prevention by sending clear public health oriented messages with regard to alcohol consumption.

Participants were then invited to discuss and endorse the Conference Charter, which included the following headings:

The price of alcohol should be increased
There should be enough treatment and help available to those who need it
There should be greater regulation of the drinks industry
The medical profession should be more active in helping reduce the impact of alcohol on health and society

The Charter is available at:

http://www.rcplondon.ac.uk/news/EU/ConferenceCharter.pdf

The conference was a good example that the collaboration and the exchange between Alcohol Policy experts as well as Public Health experts and medical professionals are necessary. Although medical professionals are mainly focused on treatment, the discussions showed the relevance of alcohol policy issues, and direct impact these may have in their ongoing work focused on reducing alcohol related harm. It is necessary for them to agree upon public messages regarding the negative impact of alcohol consumption. A common strategy is needed for both parties to work in effective partnership and gain political influence.

For more information check the website of the Royal College of Physicians

http://www.rcplondon.ac.uk/news/EU/ConferenceCharter.pdf

[1] Austria, Belgium, Denmark, France, Finland, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the United Kingdom