Drinking and its burden in a global perspective: Policy considerations and options
Drinking and its burden in a global perspective: Policy considerations and options
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DOI：
10.1159/000072223
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发表时间：
2003-10-01
影响因子：
3.9
通讯作者：
Monteiro, M
中科院分区：
文献类型：
--
作者：
Room, R;Graham, K;Monteiro, M
目的：确定全球范围内酒精消费和酒精问题的规模和特征对政策的影响，并总结有关降低酒精问题发生率的政策制定者可用战略有效性的结论。设计/方法/背景：这篇总结性文章借鉴了之前文章的发现和文献综述。研究结果和结论：饮酒量是造成饮酒危害的主要因素。由于消费和相关问题往往随着经济发展而增加，发展中经济体的决策者应特别意识到有必要制定政策，尽量减少酒精消费的总体增长。在世界许多地方，未记录的消费也是政策的一个重要考虑因素，并给酒精控制政策带来困难。饮酒方式也是导致酒精相关危害的一个重要因素。尽管一些饮酒模式已被证明对健康有益，但由于酒精对冠状动脉疾病的净影响在世界大多数地区是负面的，因此提倡戒酒或总体上减少饮酒的政策可能是最安全的选择。此外，零星中毒在世界许多地方很常见，至少在中短期内，政策不太可能改变这种饮酒模式。与此同时，由于伤害在酒精造成的负担中占很大比例，因此应当加强这些政策，制定有针对性的减少伤害战略，例如饮酒和驾车对策以及侧重于减少特定高风险环境中与酒精有关的暴力的干预措施。酒精消费是全球疾病负担的一个主要因素，应被视为全球、区域和世界上绝大多数国家的公共卫生优先事项。考虑到世卫组织全球疾病负担项目估计的酒精负担主要包括与饮酒有关的健康问题，制定酒精政策的必要性就更加强烈。然而，从现有的有限证据来看，与饮酒有关的社会问题似乎至少造成了同样多的负担。此外，社会和健康危害的负担不仅落在饮酒者身上，也落在其他人身上。关于减少酒精问题的政策干预有广泛的文献。有效的战略包括控制分销和销售、税收、酒驾对策、卫生工作者或咨询人员的简短干预以及选定的减少伤害措施。有必要编写越来越多的文献来比较评价这种战略的成本效益。此外，需要国际协定来支持国家战略的有效性。版权所有(C) 2003 S. Karger AG，巴塞尔。
Aims: To identify the policy implications of the magnitude and characteristics of alcohol consumption and problems, viewed globally, and to summarize conclusions on the effectiveness of the strategies available to policyrnakers concerned with reducing rates of alcohol problems. Design/Methods/Setting: This summative article draws on the findings of the articles preceding it and of reviews of the literature. Findings and Conclusions: Overall volume of consumption is the major factor in the prevalence of harms from drinking. Since consumption and associated problems tend to increase with economic development, policymakers in developing economies should be especially aware of the need to develop policies to minimize overall increases in alcohol consumption. Unrecorded consumption is also an important consideration for policy in many parts of the world, and poses difficulties for alcohol control policies. Drinking pattern is also an important contributing factor toward alcohol-related harm. Although some drinking patterns have been shown to produce beneficial health effects, because the net effect of alcohol on coronary disease is negative in most parts of the world, policies that promote abstinence or lower drinking overall may be the safest options. Moreover, sporadic intoxication is common in many parts of the world, and policies are unlikely to change this drinking pattern at least in the short to medium term. At the same time, because injuries comprise a large proportion of the burden of alcohol, it is appropriate to enhance these policies with targeted harm reduction strategies such as drinking and driving countermeasures and interventions focused on reducing alcohol-related violence in specific high-risk settings. Alcohol consumption is a major factor for the global burden of disease and should be considered a public health priority globally, regionally, and nationally for the vast majority of countries in the world. The need for alcohol policy is even stronger when it is taken into consideration that the burden of alcohol estimated in the WHO Global Burden of Disease project includes primarily health problems related to drinking. From the limited evidence available, however, social problems related to drinking seem to impose at least as much burden. Moreover, the burden for both social and health harms fall not only on the drinker, but also on others. There is a broad literature on policy interventions to reduce alcohol problems. Effective strategies include controls over distribution and sale, taxation, drinking-driving countermeasures, brief interventions by health workers or counselors, and selected harm reduction measures. There is a need to develop the growing literature on comparative evaluations of cost-effectiveness of such strategies. In addition, international agreements are needed to support the effectiveness of national strategies. Copyright (C) 2003 S. Karger AG, Basel.