Alcohol: No Ordinary Commodity: Research and Public Policy

377 Pages·2010·1.43 MB·English

by  Thomas F. Babor

Alcohol:

No Ordinary Commodity
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Alcohol:

No Ordinary
Commodity

Research and
public policy
SECOND EDITION
Thomas Babor Harold Holder

Raul Caetano Ross Homel
Sally Casswell Michael Livingston
Griffith Edwards Esa Österberg
Norman Giesbrecht J ürgen Rehm
Kathryn Graham Robin Room

Joel Grube Ingeborg Rossow
Linda Hill
1
1

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and does not necessarily represent the stated policy of the Pan American Health Organization (PAHO).
First published 2003
Second Edition 2010
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Foreword
A lcohol is a source of pleasure for many consumers but it is also associated with a host
of problems that afflict individuals and society at large. In recent years a strong
body of evidence has emerged showing that these problems have increased in many
parts of the world. The link between heavy alcohol consumption and some non-
communicable diseases and injury is hardly contestable, and what was for some time
a tenuous link with infectious disease is today being confirmed by studies that show
the negative impact of alcohol on the outcomes of diseases like tuberculosis and HIV/
AIDS (Rehm et al . 2009).
M uch of what we know today about the impact of alcohol on health and social wel-
fare is, primarily, from studies conducted in western industrialized societies, but our
knowledge of alcohol problems in developing countries is increasing (Room e t al .
2002). In these societies most adults are abstainers, women drink much less than men,
and the pattern of consumption is characterized by drinking to intoxication. Through
the work of the World Health Organization, and as reported in this book, we know
that this pattern of consumption is a significant risk factor for burden of disease
(WHO 2002; 2008). And yet, this knowledge has not been matched by appropriate
policy responses to what is obviously a global public health menace.
It was not clear at the time, but the publication of the first edition of A lcohol: No
ordinary commodity in 2003 was a landmark event in the history of alcohol control
policies. Though it is difficult to measure the influence of a book, the world of alcohol
policy has not been the same since its publication. There is more widespread knowl-
edge among professionals and policy makers about the role that alcohol plays in soci-
ety. The book made it clear to us that alcohol problems respond to sound public
health measures; that because a measure is popular does not mean it is effective; and
that policy should be guided by the best available evidence. In practical terms the book
has served as the main resource material in alcohol policy training workshops and
policy development in a variety of countries. I have heard it described as the “alcohol
policy bible” by admirers, and its detractors have not been able to undercut its influ-
ence.
T his second edition of Alcohol: No ordinary commodity looks very much like the
first, except that all chapters have been updated, a new chapter has been added on the
alcohol industry, and the rating table of alcohol control measures has been revised.
You will find new information on the globalization of the alcohol industry, the poten-
tial impact of the industry's expansion into the emerging markets of the developing
countries, including the industry's role in the policymaking process in these countries.
Like the first edition, it does not pretend to have all the answers and popular strategies
that have historically not lived up to expectation are not dismissed offhandedly. In this
careful and painstaking analysis of a contentious issue in contemporary public health,
the authors do not claim that every effective strategy will produce similar results in
vi FOREWORD
every country; but whether the problem is illicit production and trade, or what to do
about heavy episodic (“binge”) drinking, there is no better guide than this book.
I have no doubt that this book will help to further strengthen our belief in evidence-
based alcohol policies.
In a future edition one hopes that the evidence base will be further strengthened
with more data and experiences from developing countries. It is to the interest of the
global alcohol research and policy community that the research and monitoring
capacity in these countries is enhanced. My hope is that the publication of this second
edition of Alcohol: No ordinary commodity will finally render the argument about alco-
hol’s contribution to economic development untenable (if it ever was), in the face of
clear evidence that alcohol does not drive but hurts development. With such a knowl-
edge base as provided by this book, there is indeed no excuse for any country or
municipality for not applying the lessons learned. The time is past for uninformed
arguments about what works and what does not. Instead, it is time to act in concert
with the global community and under the leadership of the World Health Organization
to develop and implement effective national strategies to reduce the harm associated
with the consumption of this unusual commodity.
References
Rehm J. , Anderson P. , Kanteres F. , Parry C.D , Samokhvalov A.V , and Patra J. ( 2009 ) Alcohol,
social development and infectious disease . Stockholm : European Union .
Room R. , Jernigan D. , Carlini-Marlatt B . e,t a l. 2002 ) Alcohol in developing societies: A public
health approach . Geneva : WHO .
World Health Organization ( 2002 ) The world health report 2002: Reducing risks, promoting
healthy life . Geneva : WHO .
World Health Organization ( 2008 ) The global burden of disease: 2004 updates . Geneva : WHO .
Isidore S. Obot, PhD, MPH
Professor and Head
Department of Psychology
University of Uyo
and
Director
Centre for Research and
Information on Substance
Abuse (CRISA)
Uyo, NIGERIA
Authors’ preface to the
second edition
From a public health perspective, alcohol consumption plays a major role in the causa-
tion of disability, disease, and death on a global scale. It also contributes substantially
to family dysfunction, violence, and psychiatric disorder. With the increasing globali-
zation of alcohol production, trade, and marketing, it is becoming apparent that
alcohol control policy needs to be understood not only from a national but also from
a global perspective.
I n the past 50 years considerable progress has been made in the scientific under-
standing of the relationship between alcohol and health. Ideally, the cumulative
research evidence should provide a scientific basis for public debate and governmental
policymaking. However, much of the scientific evidence reported in academic publi-
cations has little apparent relevance to prevention strategy or treatment policy. To
address this need for a policy-relevant translation of the alcohol research literature, a
small group of experts under the leadership of Professor Griffith Edwards established
in 1992 the Alcohol and Public Policy Project (APPP). The group recruited an inter-
national team of research scientists, consulted with experts throughout the world, and
in the course of fewer than two years critically evaluated the accumulated knowledge
on how to deal with alcohol problems in the public policy arena. The outcome of this
work was A lcohol Policy and the Public Good (Edwards et al. 1994) and Alcohol and
Public Policy: Evidence and Issues (Holder and Edwards 1995).
A t a 1998 alcohol policy conference in Chicago, IL, USA, a small group of the APPP
authors agreed to begin plans for work on another volume, based on the increasing
knowledge base, the changing climate of alcohol policy, and international trends in
drinking problems. The text of that volume, A lcohol: No Ordinary Commodity—
Research and Public Policy (Babor et al. 2003) evolved through the development of
background papers, the discussion of this material at five plenary meetings held in dif-
ferent parts of the world, and many stages of drafting. Like the previous books in this
series, N o Ordinary Commodity is a written rather than an edited volume, built on the
joint input of all those involved, and speaking with one voice to the reader. Sponsored
by the World Health Organization and the UK Society for the Study of Addiction, the
major purpose of this volume was not only to show why alcohol is indeed no ordinary
commodity, but also to direct attention to the emerging arsenal of evidence-informed
policy options available to policymakers at the local, national, and international levels.
A lthough alcohol has been recognized since time immemorial as a special product
requiring special controls on its production and availability, it was only since the 19th
century that academics took an active interest in the effects of alcohol policies on
individuals and populations. Building on this tradition, the modern era of alcohol
policy research can be traced to the landmark publication of A lcohol Control Policies
in Public Health Perspective (Bruun et al. 1975a), which showed how alcohol
policy could be informed by an emerging corpus of epidemiological, theoretical, and
viii AUTHORS’ PREFACE TO THE SECOND EDITION
intervention research. Continuing in that vein, the first edition of A lcohol: No Ordinary
Commodity attempted to synthesize what was new and relevant to alcohol policy on an
international level. We are pleased that the book was recognized by the British Medical
Association as worthy of first prize in the public health category of its 2004 medical
book competition, and has been cited repeatedly by the World Health Organization as
an authoritative source in its plans to develop a Global Strategy on Alcohol.
The present volume was conceived out of a recognition that the scientific evidence
for effective alcohol policy is expanding rapidly in many areas, and is therefore peri-
odically in need of updating and expansion into new areas of knowledge. The policy
needs of communities and nations change with each new generation and each new
epidemic of alcohol-related problems, especially in less-resourced countries where
policy-relevant research is desperately needed. Those parts of the world, particularly
in Asia, Africa, and Latin America, which have traditionally had weak alcohol controls
and relatively low aggregate levels of alcohol consumption, are being threatened by
an expansion of commercial production and advanced marketing by the alcohol
industry. These developments are likely to increase their susceptibility to alcohol-
related problems.
T his situation led the authors to re-examine the epidemiological data underpinning
our original thesis that alcohol is no ordinary commodity, and to provide a critical
evaluation of what had previously been ignored in the alcohol control debate: the role
of the alcohol industry. Combined with new studies on the effectiveness of alcohol
taxes and availability restrictions, new information about the impacts of alcohol mar-
keting, and an expanding array of other evidence-based policies, the authors felt there
was more than enough reason for a second edition. We therefore offer this volume as
our contribution to the debate over how best to formulate, implement, and sustain a
Global Strategy on Alcohol, which the World Health Organization has been charged
with presenting to the World Health Assembly in 2010.
A s we noted in our preface to the first edition, the purpose of this book is to describe
recent advances in alcohol research that have direct relevance to the development of
alcohol policy on the local, national and international levels. That focus has not
changed, nor has our interest in providing updated evaluations of the effectiveness,
generalizability, and cost of alcohol control strategies. We hope that by expanding our
purview and updating the science base, this edition of N o ordinary commodity will
continue to inform the policy debate, empower the policymaker, and demonstrate
how research can contribute to the advancement of a public policy response that
reduces the social and personal harms related to alcohol consumption.
The Authors
A note on terminology and technical terms
K ey terms that have technical or linguistic meanings that would not be familiar to the
general reader are defined in the Glossary at the end of the book. These terms are
indicated in bold when they are first used in a given chapter. Most often the terms
refer to words or concepts used in epidemiology, alcohol research, addiction medicine,
or popular culture in different parts of the world.
Preface
The harmful use of alcohol is among the leading risk factors for the burden of disease
in the Region of the Americas, contributing to violence, injuries, suicides, chronic
noncommunicable diseases, and mental health disorders besides alcohol dependence.
It disproportionally affects individuals, families and societies in low and middle
income countries of the Region and contributes to worsening inequities in health.
Alcohol consumption is increasing particularly among young people and it is also
starting at earlier ages, despite the scientific evidence of the risk of early alcohol use
and the later development of alcohol dependence.
The Pan American Health Organization (PAHO) has increased technical coopera-
tion to countries in the Region to respond to alcohol related problems in a more
comprehensive way. In 2005, PAHO organized with the support of the government of
Brazil the First Pan American Conference on Alcohol Public Policies , with participants
from 26 countries of the Region, who signed the Brasilia Declaration. PAHO has also
coordinated research on alcohol and domestic violence and is supporting training of
health professionals in primary health care to screen and provide a brief intervention
for those at risk of developing alcohol problems.
PAHO has contributed to the development of the World Health Organization
(WHO) strategy to reduce harmful use of alcohol, by organizing a regional consulta-
tion meeting in 2009 and by contributing technical expertise to various documents,
expert meetings and policy discussions with Member States.
I n response to the need for evidence on the effectiveness, costs and generalizability
of various alcohol policies and the relative role of various stakeholders, including the
alcohol industry, I am pleased to introduce this book, which is an updated and
expanded second edition of the landmark book published in 2003 by Oxford University
Press and WHO. PAHO will support the publication of the Spanish version as well,
aimed at reaching out to a much broader audience in the Americas Region.
I hope this publication will not only contribute to the discussions at global level but
also provide support for effective country responses to the harmful consumption of
alcohol.
Mirta Roses Periago
Director, PAHO