Dangers de l'alcool : rapport complet de l'OMS

Description

Rapport de l'OMS de 2014 qui dit entre autre que l'alcool tue plus de 3 millions de personnes par an dans le monde.

Sujets

• Boisson alcoolisée
• Organisation mondiale de la santé
• Rapport

Informations

• Publié par: Fil_actu
• Publié le: 13 mai 2014
• Nombre de lectures: 32
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

Global status report on alcohol and health 2014

Global status report on alcohol and health 2014

WHO Library Cataloguing-in-Publication Data

Global status report on alcohol and health – 2014 ed.

1.Alcoholism - epidemiology. 2.Alcohol drinking - adverse effects. 3.Social control, Formal - methods. 4.Cost of illness. 5.Public policy. I.World Health Organization.

ISBN 978 92 4 156475 5 (Print) ISBN 978 92 4 069276 3 (PDF)

© World Health Organization 2014

(NLM classification: WM 274)

All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: [phone]; fax: [phone]; e-mail: [e-mail]).

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The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

Design and layout: L’IV Com Sàrl, Villars-sous-Yens, Switzerland.

Printed in Luxembourg.

CONTENTS

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Acknowledgements  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Abbreviations  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii 1 Alcoholand public health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Alcoholconsumption in its historical context  .. . . . . . . . . . . . . . . . . . . . . . . . 3 1.2 Pathwaysof alcoholrelated harm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4 1.2.1 Volumeof alcohol consumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.2.2 Patternof drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.2.3 Qualityof alcohol consumed  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.3Mechanisms of harm in an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.4Abstention  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.5Factors affecting alcohol consumption and alcoholrelated harm  . . . . . . . . 7 1.5.1 Age  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.5.2 Gender  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.5.3 Familialrisk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.5.4 Socioeconomicstatus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.5.5 Economicdevelopment  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.5.6 Cultureand context  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.5.7 Alcoholcontrol and regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.6Alcoholrelated harms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.6.1 Healthconsequences for drinkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 1.6.2 Socioeconomicconsequences for drinkers . . . . . . . . . . . . . . . . . . . . . 13 1.6.3 Harmsto other individuals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.6.4 Harmto society at large . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.7Action to reduce harmful use of alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18 1.7.1 Evidenceof effectiveness  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 1.7.2 Globalaction  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.7.3 Regionalaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1.7.4 Nationalpolicies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 1.8Monitoring  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2 Alcoholconsumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.1Levels of consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 2.1.1 Totalper capita consumption  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 2.1.2 Unrecordedalcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 2.1.3 Mostconsumed alcoholic beverages . . . . . . . . . . . . . . . . . . . . . . . . . . 31 2.2Patterns of drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2.2.1 Abstentionrates  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2.2.2 Heavyepisodic drinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 2.2.3 Patternsof drinking score . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.2.4 Factorsimpacting on alcohol consumption . . . . . . . . . . . . . . . . . . . . . 36

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2.3Trends and projections  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 2.3.1 Fiveyearchange in alcohol consumption  . . . . . . . . . . . . . . . . . . . . . . 41 2.3.2 Projectionsup to 2025 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 3 Healthconsequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 3.1Aggregate health effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 3.1.1 Alcoholattributablemortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 3.1.2 Alcoholattributableburden of disease and injury . . . . . . . . . . . . . . . . 50 3.1.3 Factorsimpacting on health consequences . . . . . . . . . . . . . . . . . . . . . 52 3.2Trends and projections  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4 Alcoholpolicy and interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.1Leadership, awareness and commitment . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.1.1 Writtennational alcohol policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 62 4.1.2Nationwide awarenessraising activities  . . . . . . . . . . . . . . . . . . . . . . . 63 4.2Health services’ response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 63 4.3Community action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.4Drink–driving countermeasures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.4.1 BAClimits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.4.2 Methodsused to ascertain driver BACs  . . . . . . . . . . . . . . . . . . . . . . . 69 4.5Regulating availability of alcohol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 4.5.1 Nationalcontrol of production and sale of alcohol . . . . . . . . . . . . . . . . 71 4.5.2 Restrictionson on/offpremise sales of alcoholic beverages . . . . . . . 72 4.5.3 Nationalminimum purchase or consumption age . . . . . . . . . . . . . . . . 74 4.5.4 Restrictionson drinking in public  .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4.5.5 Restrictionson purchase of alcohol at petrol stations . . . . . . . . . . . . . 75 4.6Marketing restrictions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 4.6.1 Regulationson alcohol advertising . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 4.6.2 Regulationon alcohol product placement  .. . . . . . . . . . . . . . . . . . . . . 78 4.6.3 Regulationon alcohol sales promotions . . . . . . . . . . . . . . . . . . . . . . . . 80 4.6.4 Methodsof detecting marketing infringements  . . . . . . . . . . . . . . . . . 80 4.7Pricing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 4.7.1 Excisetax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 4.8Reducing negative consequences of drinking  .. . . . . . . . . . . . . . . . . . . . . . 81 4.8.1 Responsiblebeverage services training . . . . . . . . . . . . . . . . . . . . . . . . 81 4.8.2 Labelson alcohol containers  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 4.9Addressing illicit and informal production . . . . . . . . . . . . . . . . . . . . . . . . . . 82 4.9.1 Inclusionof informal or illicit production in national alcohol policies . . 83 4.9.2 Methodsused to track illicit or informal alcohol  . . . . . . . . . . . . . . . . . 84 4.10 Monitoringand surveillance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 4.10.1 Nationalsurveys on alcohol consumption . . . . . . . . . . . . . . . . . . . . . . 84 4.10.2 Legaldefinition of an alcoholic beverage . . . . . . . . . . . . . . . . . . . . . . . 84 4.10.3 Nationalmonitoring systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 4.11Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Country profiles  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Appendix I – Alcohol consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 Appendix II – Health consequences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 Appendix III – Indicators related to alcohol policy and interventions . . . . . . . 321 Appendix IV – Data sources and methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365

FOREWORD

am pleased to present the World Health Organization’s Global status report on alcohol and health 2014. WHO has published several reports in the past on this topic with the I reduce the harmful use of alcohol inStates after endorsement of the Global strategy to last one being published in 2011, but this report of 2014 has some unique features. First, it describes some progress made in alcohol policy development in WHO Member 2010. Second, this report provides a wealth of information on alcoholrelated indicators for the comprehensive global monitoring framework for the prevention and control of noncommunicable diseases (NCDs) adopted by the 66th World Health Assembly. The global monitoring framework was developed to fulfil the mandate given by the Political Declaration of the Highlevel Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases (NCDs) and includes the voluntary target of a 10% relative reduction in harmful use of alcohol by 2025 measured against a 2010 baseline. Thirdly, this report presents an overview of some of the mechanisms and pathways which underlie the impact of the harmful use of alcohol on public health.

The report highlights some progress achieved in WHO Member States in the development and implementation of alcohol policies according to the ten areas of action at the national level recommended by the Global strategy. This progress is uneven and there is no room for complacency given the enormous public health burden attributable to alcohol consumption. Globally, harmful use of alcohol causes approximately 3.3 million deaths every year (or 5.9% of all deaths), and 5.1% of the global burden of disease is attributable to alcohol consumption. We now have an extended knowledge of the causal relationship between alcohol consumption and more than 200 health conditions, including the new data on causal relationships between the harmful use of alcohol and the incidence and clinical outcomes of infectious diseases such as tuberculosis, HIV/AIDS and pneumonia. Considering that beyond health consequences, the harmful use of alcohol inflicts significant social and economic losses on individuals and society at large, the harmful use of alcohol continues to be a factor that has to be addressed to ensure sustained social and economic development throughout the world. In the light of a growing population worldwide and the predicted increase in alcohol consumption in the world, the alcohol attributable disease burden as well as the social and economic burden may increase further unless effective prevention policies and measures based on the best available evidence are implemented worldwide. And, importantly, we know that in countries with lower economic wealth the morbidity and mortality risks are higher per litre of pure alcohol consumed than in the higher income countries.

Following the endorsement of the Global strategy to reduce the harmful use of alcohol WHO has strengthened its actions and activities to prevent and reduce alcoholrelated harm at all levels. Several regions have developed and adopted regional strategies focusing on the target areas recommended in the global strategy. At the global level the WHO Secretariat has facilitated establishment of a global network of WHO national counterparts as well as a coordinating council to ensure effective collaboration with and between Member States. At the same time all the efforts and resources available at all levels are clearly not adequate to confront the enormous public health burden caused by the harmful use of alcohol, and further progress is needed at all levels and by all relevant actors to

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achieve the objectives of the Global alcohol strategy and the voluntary global target of at least a 10% relative reduction in the harmful use of alcohol by 2025. WHO is prepared and committed to continue to monitor, report and disseminate the best available knowledge on alcohol consumption, alcoholrelated harm and policy responses at all levels, which is key to monitoring progress in implementing the Global strategy and regional action plans. Accurate and uptodate information is vital for alcohol policy development, and I hope that you will find this report, which is largely based on the information submitted from Member States, useful in contributing to the public health objectives articulated in the Global strategy to reduce the harmful use of alcohol.

Oleg Chestnov Assistant DirectorGeneral Noncommunicable Diseases and Mental Health

ACKNOWLEDGEMENTS

he report was produced by the Management of Substance Abuse Unit (MSB) in the Department of Mental Health and Substance Abuse (MSD) of the World Health alc T harm and policy responses, and is linked to WHO’s work on the Globaloholrelated Organization (WHO), Geneva, Switzerland. The report was developed within the framework of WHO activities on global monitoring of alcohol consumption, Information System on Alcohol and Health (GISAH).

Executive editors:Vladimir Poznyak and Dag Rekve.

Within the WHO Secretariat, Oleg Chestnov, Assistant DirectorGeneral, Noncommunicable Diseases and Mental Health, and Shekhar Saxena, Director, Department of Mental Health and Substance Abuse, provided vision, guidance, support and valuable contributions to this project.

The WHO staff involved in development and production of this report are: Alexandra Fleischmann, Vladimir Poznyak, Dag Rekve and Maria Renström of the WHO MSD/MSB unit at WHO Headquarters in Geneva. The report benefited from technical inputs from Nicolas Clark of WHO MSD/MSB. Linda Laatikainen provided a significant contribution to the production of the report during its final stages in her capacity as a consultant. Gretchen Stevens and Colin Mathers from the Department of Health Statistics and Information Systems, contributed to the estimates of alcoholattributable disease burden and provided technical input at all stages of the report’s development. Margie Peden from the Department of Violence and Injury Prevention provided technical input to the report at different stages of its development. Leanne Riley, Regina Guthold and Melanie Cowan from the Department of Prevention of Noncommunicable Diseases provided data from the WHOsupported surveys and technical input to the report. Florence Rusciano from the Department of Health Statistics and Information Systems created the maps used in the report.

Preparation of this report is a collaborative effort of the WHO Department of Mental Health and Substance Abuse, Management of Substance Abuse, with the Centre for Addiction and Mental Health (CAMH), Toronto, Canada. The contributions from Jürgen Rehm, Kevin Shield, Margaret Rylett (CAMH, Canada) as well as from Gerhard Gmel and Florian Labhart (Addiction Info, Switzerland) and David Jernigan and Marissa Esser (Johns Hopkins Bloomberg School of Public Health, USA) have been critical for development of this report.

The collection of data in the framework of the WHO Global Survey on Alcohol and Health and the development of this report were undertaken in collaboration with the six WHO regional offices and WHO country offices. Key contributors to the report in the WHO regional offices are: WHO African Region: Carina FerreiraBorges, Davison Munodawafa and Hudson Kubwalo WHO Region of the Americas: Maristela Monteiro, Jorge J. Rodriguez and Blake Andrea Smith

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WHO Eastern Mediterranean Region: Khalid Saeed WHO European Region: Lars Møller and Nina Blinkenberg WHO SouthEast Asia Region: Vijay Chandra and Nazneen Anwar WHO Western Pacific Region: Xiangdong Wang and Maribel Villanueva.

For their contributions to individual chapters and annexes we acknowledge the following: Executive summary:Linda Laatikainen and Maria Renström. Chapter 1:Laatikainen, Alexandra Fleischmann, Gerhard Gmel, David Jernigan, Linda Vladimir Poznyak, Jürgen Rehm, Dag Rekve, Maria Renström, Margaret Rylett. Chapter 2:Gerhard Gmel, Florian Labhart, Jürgen Rehm, Margaret Rylett, Kevin Shield. Chapter 3:Jürgen Rehm, Kevin Shield, Gretchen Stevens. Chapter 4:David Jernigan and Marissa Esser with contributions from Baigalmaa Dangaa (Mongolia), Melvyn Freeman (South Africa), Ivan Konorazov (Belarus), John Mayeya (Zambia) and Margaret Rylett. Country Profiles:Alexandra Fleischmann and Margaret Rylett with contributions from Gerhard Gmel, David Jernigan, Vladimir Poznyak, Jürgen Rehm and Dag Rekve. Appendices 1–3:Rylett and Alexandra Fleischmann with contribution from Margaret Gretchen Stevens. Appendix 4:Rylett with contributions from Alexandra Fleischmann, Jürgen Margaret Rehm and Gretchen Stevens.

This report would not have been possible without contributions of the WHO national counterparts for implementation of the Global strategy to reduce the harmful use of alcohol in WHO Member States who provided country level data and other relevant information regarding alcohol consumption, alcoholrelated harm and policy responses.

The report benefited from the input provided by the following peer reviewers: Chapter 1: SteveAllsop (Australia), Thomas Babor (USA), Maria Elena MedinaMora (Mexico), Neo Morojele (South Africa), Esa Österberg (Finland). Chapters 2 and 3:Guilherme Borges (Mexico), Wei Hao (China), Ralph Hingson (USA), Pia Mäkelä (Finland), Ingeborg Rossow (Norway). Chapter 4: BerntBull (Norway), Maris Jesse (Estonia), Isidore S. Obot (Nigeria), Esa Österberg (Finland), Charles Parry (South Africa).

Susan Kaplan (Switzerland) edited the report.

L’IV Com Sàrl (Switzerland) developed the graphic design and layout.

Administrative support was provided by Divina Maramba and Mary Dillon.

WHO interns who contributed to the report include: Fredrik Ansker, Sally Cruse, Michael Dean, Nina Elberich, Elise Gehring, Wenjing Huang, Angelos Kassianos, Dan Liu, Celine Miyazaki, Even Myrtroen, Eugenie Ng, Ifeoma Onyeka, Derrick Ssewanya, Karin Strodel, Helen TamTham and Christina von Versen.

Finally, WHO gratefully acknowledges the financial support of the Government of Norway for the development and production of this report.

ABBREVIATIONS

15+ population of those aged 15 years and older AAF alcoholattributable fraction AD alcohol dependence AFR WHO African Region AIDS acquired immunodeficiency syndrome AMR WHO Region of the Americas APC alcohol per capita consumption ASDR agestandardized death rate AUD alcohol use disorder BAC blood alcohol concentration CI confidence interval CVD cardiovascular disease DALY disabilityadjusted life year EMR WHO Eastern Mediterranean Region EUR WHO European Region ESPAD European School Survey Project on Alcohol and Other Drugs FAOSTAT Food and Agriculture Organization of the United Nations (FAO) statistical database FAS fetal alcohol syndrome GDP gross domestic product GENACIS Gender, alcohol, and culture: an international study GISAH WHO Global Information System on Alcohol and Health GSHS Global Schoolbased Student Health Surveys HED heavy episodic drinking HIV human immunodeficiency virus HU harmful use of alcohol ICD International Classification of Diseases MA moving average mhGAP WHO Mental Health Gap Action Programme MLPA minimum legal purchase age

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