Hea l th equity; social determinants and the role of alcohol

1. Health equity; social determinants and the role of alcohol 4 European Alcohol Policy Conference “From Capacity to Action” 21-22 June 2010 Brussels Witold Zatoński 22 June 2010

2. HEM - research project 2004-2008 (no 2003121) • Objective: To identify and quantify health gap between eastern and western part of European Union and to determine how much of this gap is attributable to different causes of death and risk factors. • Eastern part of the EU: the new EU member states from central and eastern Europe - Bulgaria, Czech Rep., Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia (EU10) • Western part of the EU: the „old EU” – Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, UK (EU15) • See www.hem.waw.pl The final report is available at the project website:www.hem.waw.pl

3. Probability of dying before the age of 65, Europe, 2002 Huge disproportion in risk of premature dying in Europe: Only 7% of Spanish women die before the age of 65 Almost 60% of men in Russia do not reach age of 65

4. Los borrachos: Diego Rodriguez de Silva y Velazquez

5. Registry of vital record and statistics Los borrachos in Eastern Europe

6. Alcohol was a cause of more than half of all Russian deaths Alcohol accounts for most of the large fluctuations in Russian mortality

7. All causes mortality in Russia, men aged 20-64, 1980-2006 (rates per 100000, 3-year moving average) • How alcohol can influence health in Europe? • „natural experiment” in the last decades: case of Russia 1992-1994 collapse of Soviet Union 1998 rouble crash 1985 Gorbachev’s reform

8. Former Soviet Union countries – case of Russiamen aged 20-64, 1982-2006 (rates per 100000)3-year moving average

9. Alcohol harm Alcohol & gender

10. Alcohol-attributable deaths, 20-64

11. Alcohol & age

12. Drinking patterns by sex and age in Poland in 2002 percentage of respondents drinking more than 60 gram of pure alcohol per day

13. Mostly young people are dying from alcohol

14. Alcohol-attributable mortality, Poland, 2002 Number of deaths 10% 26% 11% 2%

15. Alcohol-attributable mortality continues to be a major health issue • In EU25 in 2002, about 190,000 men and women died from alcohol. • A large proportion of these deaths (128,000 - 67,5%)were in those between 20 and 64 years of age.

16. Liver cirrhosis as health harm indicators

17. Mediterranean countries – case of FranceLiver cirrhosis mortality in France, men aged 20-64, 1959-2002 (rates per 100000) • Steady continuous decline of liver cirrhosis mortality since 1975

18. Case of United KingdomLiver cirrhosis mortality in UK, men aged 20-64, 1959-2002 (rates per 100000) • Extraordinary increase since early 1980s

19. Liver cirrhosis mortality in men aged 20-64France vs. UK 1959-2006 • English become Europeans

20. Liver cirrhosis mortality in men aged 20-64Hungary vs. France 1959-1991

21. Former Soviet Union countries – case of RussiaLiver cirrhosis mortality in Russia, men aged 20-64, 1980-2006 (rates per 100000, 3-year moving average) Commentary: • July 1985 – Gorbachev’s alcohol reform • 1992-1994 – collapse of Soviet Union • 1998 – rouble crash

22. Liver cirrhosis mortality continues to be a major public health issue • In Europe in 2002, 95,609 men and 53,123 women died from liver cirrhosis. • A large proportion of these deaths (65,650 men and 30,914 females) were in those between 20 and 64 years of age.

23. Liver cirrhosis mortality in Poland by educational level, age group 20-64 years

24. Liver cirrhosis mortality in Poland by educational level, age group 20-64 years

25. Liver cirrhosis and lung cancer mortality in Poland by educational level, men, age group 20-64 years Liver cirrhosis Lung cancer

27. Recommendations on alcohol • Promoting the social unacceptability of binge drinking in the EU10 countries • Mobilizing public support • Protecting young people • Protecting people other than the drinker • Strengthening government regulation • Help needs to be available for people with problems • Focusing on their product, economic operators have the potential to reduce harm • Raising the voice of civil society • Capacity building • Towards the Europe-wide strategy • Expanding the evidence base

28. Policy

29. Examples of alcohol prices decline • In Switzerland since 1 July 1999 prices of imported alcohol decreased by 30-50% • In Finland since 1 January 2004 retail prices of vodka decreased by 36%, of wine by 3% and of beer by 13% • In Poland since 1 October 2002 prices of vodka decreased by 30%

30. Is alcohol an ordinary commodity?

31. Vodka as yoghurt?

32. Vodka doctor’s?

33. Prestige of vodka

34. Vodka as soft drink

35. At the airport in Prague – vodka shots and Evian chaser

36. From stigmatization to elimination of tobacco ads: big health warnings and total ads ban

37. OLD (UP TO 6%) AND NEW (20%) WARNIGS ON TOBACCO ADS IN THE PRESS AND ON BILLBOARDS Old health warning New health warning „Tobacco smoking causes cancer and cardiovascular diseases. Minister of Health” „Discover the taste of freedom ! ” „Really American. You can affort it.” „Discover the taste of freedom” „Minister of Health warns: tobacco smoking is the most frequent cause of cancer and cardiovascular diseases.”

39. Total ban tobacco ads. / 2001

44. Conclusions • Alcohol is or is not an ordinary commodity in the EU? • Alcohol health harm is not controlled in Europe, neither on the west (the „old” EU) nor on the east (the „new” EU) • Alcohol control policy in EU is not consistent • Strategic program for Alcohol Control in the European Union?