午夜福利1000集合

BILLIONS of people the world over drink alcohol to overcome shyness and animate their social lives 鈥� as people have done for millennia. For most drinkers, alcohol is associated above all with relaxation and conviviality, and people forget about its darker side. Yet doctors, governments and healthcare agencies are becoming so concerned about the effects of alcohol abuse that in January the executive board of the World 午夜福利1000集合 Organization agreed a plan to develop a global strategy to combat the damage alcohol can do.

The harm drinkers are doing to themselves, such as liver and brain damage, is only part of the problem. The plan has been given extra momentum by a growing recognition of the number of people who, while not themselves drunk, suffer as a result of the reckless or aggressive behaviour of those who are.

In Europe, perpetrators of half of all violent crime had been drinking, by Peter Anderson, a consultant for the European Commission and the WHO. The survey also found that 40 per cent of cases of domestic violence and 40 per cent of murders were committed by people who had been drinking, and that 10,000 alcohol-related road deaths a year are of people other than drunk drivers. Alcohol is responsible for 16 per cent of Europe鈥檚 cases of child abuse and neglect, and 5 to 9 million European children live in families adversely affected by alcohol.

Just as preventing harm to non-smokers from passive smoking became one of the foundation stones for the global Framework Convention on Tobacco Control, which came into force in 2005, so the 鈥減assive鈥� damage from drinking is seen by many as pointing up the need for the WHO plan. 鈥淭he tobacco convention sets out what makes good policy in tobacco control, and that鈥檚 what we need with alcohol,鈥� says Vivienne Nathanson, head of ethics at the British Medical Association (BMA), which in February launched its own anti-alcohol strategy. 鈥淲e need to learn the lessons we took too long to learn with tobacco.鈥�

Supporters of the WHO plan, including the World Medical Association and the BMA, say a global strategy is needed to counteract the influence of the alcohol industry. Any policy needs to be applied internationally to stop traffic from low-cost countries, Nathanson says.

The WHO plan will be discussed when government representatives meet on 19 May for the annual World 午夜福利1000集合 Assembly in Geneva, Switzerland. If they agree, the WHO will complete the draft strategy by 2010. 鈥淚t鈥檚 the first attempt to limit harm from alcohol globally, from proposals formulated in a single document,鈥� says Vladimir Poznyak, one of its main architects.

Poznyak says that the scale of alcohol-related harm began to emerge in a report by the WHO six years ago. It estimated that in 2002, alcohol killed 2.3 million drinkers prematurely, and accounted for 3.7 per cent of all deaths; in the same year, smoking accounted for 4.1 per cent of deaths. Drinking affected younger people disproportionately, accounting for 5 per cent of all deaths in people under 60, and for 7.5 per cent of all deaths in men in that age group.

Non-drinkers are also suffering as a result of other people鈥檚 drinking. 鈥淥f people killed in alcohol-related car crashes in the US, nearly half are people other than the drinking driver,鈥� says Ralph Hingson at the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in Bethesda, Maryland. 鈥淲e have 700,000 college students in fights, and 100,000 date rapes. These second-hand effects underscore the obligation to prevent under-age drinking.鈥�

鈥淥f those killed in alcohol-related car crashes in the US, nearly half are people other than the drinking driver鈥�

In the US, bingeing young people consume more alcohol than the rest of the population put together, so the government鈥檚 focus is on preventing teenagers from starting and delaying the age at which children begin drinking. Hingson backs the WHO approach and rejects the idea that clamping down on alcohol abuse is a 鈥渘anny-state鈥� intrusion on personal liberty. 鈥淲e have an obligation to protect people from behaviour that puts others at risk,鈥� he says.

In the UK, the government estimates that almost half a million people a year are victims of alcohol-related crime and a million children are adversely affected by heavy drinkers around them. 鈥淚t is a justifiable role of the state to protect citizens from harm caused by others,鈥� says John Krebs, former head of the Food Standards Agency.

鈥淭he tipping point for banning smoking in public places was third-party damage,鈥� says Ian Gilmore, president of the UK鈥檚 Royal College of Physicians, and lead author of a 2004 report that found a link between the price of alcohol and the amount consumed. 鈥淭hird-party damage from alcohol is much greater, in terms of violence and the damage to unborn children, the first sexual experience and the percentage of unwanted pregnancies and sexually transmitted diseases,鈥� Gilmore says. 鈥淎lcohol is the main player in all this.鈥� He adds that alcohol blurs the barrier between rape and consensual sex.

Figures from the WHO also show the toll is high in developing countries, usually from consumption of unlicensed, home-distilled spirits, which are hard to tackle with measures like taxation. As people get richer and can afford to drive and drink more, booze-related crashes increase too.

So what can the 鈥済lobal strategy鈥� hope to achieve, and which policies will work best? Unlike the tobacco convention, which obliges signatories to make specific anti-tobacco measures part of their national law, the planned alcohol strategy will not be legally binding and will allow individual countries to decide on their own laws. 鈥淚t will be a menu of recommended measures,鈥� says Poznyak. 鈥淥ur strategy will be based on the best available evidence and the best practices around the world.鈥�

It is generally agreed that the most effective way to cut the consumption of alcohol is to dramatically raise its cost by taxing drinks according to how much alcohol they contain (see 鈥淭he hidden cost of cut-price booze鈥�). 鈥淭he strongest evidence is for taxation and pricing,鈥� says Poznyak. Heavy drinkers and young binge drinkers are least able to afford the increased costs, Anderson says, so making drink expensive has the strongest effect on the people whose drinking is most damaging. Clampdowns on advertising also work, as does the introduction of laws clamping down on drink-driving in countries where growing wealth is making this a new problem.

National differences in culture and drinking patterns mean that the same solutions will not work everywhere, Posnyak says. One aim in creating a global strategy is to encourage governments to stand up to the alcohol industry鈥檚 lobbying against price rises and restrictions on availability.

This is certainly what happened with tobacco. 鈥淭he convention has helped governments to see the areas where tobacco legislation is necessary,鈥� says Nathanson. 鈥淕overnments now have the confidence to pass laws on matters such as smoke-free public places, advertising bans, labelling of cigarette packets and so on, confident that the tobacco industry can鈥檛 stop them. The alcohol industry is also a major global force, and a global strategy would be crucial to reducing their influence on governments.鈥�

The industry says it backs the idea of a WHO strategy, but favours targeting heavy-drinking individuals with controls such as drink-driving laws, rather than imposing population-wide measures such as tax hikes. 鈥淧rice controls and availability provide a framework in which interventions can be directed towards vulnerable groups,鈥� says Marcus Grant, president of the International Center for Alcohol Policies, a body funded by the alcohol industry.

Anderson says the very process of implementing the tobacco convention brought people together to win public support. 鈥淲ith alcohol, it will take time, but it will undoubtedly work. The industry will lobby like crazy to stop everything, but it鈥檚 the first global attempt to limit harm from alcohol, and it鈥檚 significant that it鈥檚 got this far.鈥�

Drugs and Alcohol 鈥� Learn more in our comprehensive special report.