Dear Neil,
Thanks to the HIFA forum discussions on Alcohol Use Disorder (AUD) which enables to learn about interesting experiences and research from our HIFA colleagues in various countries.
I would like to add the inclusion of community participation in policies to address adolescents and children education early.
1. Do people understand the health, socio-economic and environmental harms of alcohol? What matters to them? How can they be better informed? How to reduce stigma?
- Awareness on healthy lifestyle today has come a long way which has also created an interest in adolescents. As per the UNESCO publication ‘Globally, on average, about one in four 13-15 year olds report having used alcohol during the last 12 months – twice as many as used tobacco’.
- Alcohol Use Disorder (AUD) in past and even today is seen more of a stigma (compared to smoking) and delay in seeking health care service support.
- Infographics (posters) should be freely (without cost) available on AUD for community engagement particularly in LMICs.
- There are several challenges with AUD such as:
Alcohol is not so easy to acquire; it is drunk privately (not on the streets such as smoking); social drinking is recently getting more acceptability as a social, modern and economic lifestyle status; its costs varies from very cheap to very expensive
2. Do health workers have adequate knowledge to prevent and manage alcohol use disorders among their patients? What matters to them? How can they be better informed?
- All health facilities should be encouraged to establish a program with ‘trained staff’ on AUD in order to help not only patients but also their staff.
- Medical, Nursing and Allied Health Sciences should be encouraged to get ‘formal training’ (tools, online courses) on AUD during their medical school curriculum.
- Basic Training course (tools) on AUD should be developed to encourage more patient participation during their hospital stay or in outpatient clinics and community engagement for dissemination.
- AUD for TV screening should be included along with what is shown normally on immunisations, maternal and children health, while patients are waiting at the out-patient clinic.
- Health care workers should have access to updated evidence-based information (social media, scientific platforms etc.) on AUD.
3. What is the role of the alcohol industry? What can be done to address misinformation from the alcohol industry?
- It is important to engage the alcohol industry and communities in order to bring policy change through evidence-based information (e.g. every cigarette packet has a warning message in bold, this change took several years).
4. Do public health professionals and policymakers have adequate knowledge to prevent and treat alcohol use disorders in their country? What are current national policies and what more can be done to fully implement those policies?
- Most of the countries have either national guidelines or policies for alcohol use disorders. (Ref. UNESCO booklet10 in collaboration with UNODC and WHO: Good policy and practice in health education. Education sector responses to the use of alcohol, tobacco and drugs. 2017).
- However, these are not implemented at the grassroot level involving the communities.
- The education sector with its varied actors can be mobilised as a solid ecosystem to bring a change in the early adolescent period. AUD should be included in the education curriculum particularly in ‘the primary school children’.
- School systems can reach a very wide audience in the community for policy changes.
- During adolescence the brain is at a crucial stage of developing and studies have shown that repeated alcohol use can have long lasting serious neurological consequences. (ref. 2015).
- Emphasis on ‘awareness programs for adolescents’ can make a difference.
A long-term follow-up study showed that school children who were provided with either ‘universal web-based prevention for all students’ or ‘preventive interventions for high risk students’ or provided a ‘combination of both these interventions’ could benefit with long-lasting effects of reduction of risky and harmful drinking until their adulthood in comparison to those children provided with only ‘health education as usual’. (ref. Journal of the American Academy of Child and Adolescent Psychiatry April 2022)
- Of the WHO’s four priority areas for global action, three areas align to HIFA’s vision:
public health advocacy and partnership; technical support and capacity building ; production and dissemination of knowledge
5. How can we define and measure alcohol use disorders?
The National Institute on Alcohol Abuse and Alcoholism:
- defines binge drinking as a pattern of drinking that brings a person’s blood alcohol concentration, or BAC, to 0.08 grams per deciliter or above.
- This typically happens when men consume five or more drinks, and when women consume four or more drinks, in about two hours.
Best wishes
Dr Meena Nathan Cherian, MBBS, MD (Anaesthesia)
(Former WHO Lead Emergency and Essential Surgical Care Program, Geneva, Switzerland).
Director, Global Health New Challenges:online courses, Geneva Foundation for Medical Education & Research (GFMER), Switzerland. <http://www.gfmer.ch/surgery/cancer.htm> www.gfmer.ch/surgery/cancer.htm
Senior Advisor, Global Action, International Society of Geriatric Oncology (SIOG), Switzerland. Permanent Committees - SIOG <https://siog.org/about-us/governance/leadership/permanent-committees/>
Adjunct Prof.The Chinese University of Hong Kong,Shenzhen,China. <https://med.cuhk.edu.cn/en/teacher/371> https://med.cuhk.edu.cn/en/teacher/371
WHO-HIFA Working Group on Essential Health Services and COVID-19; mHEALTH-INNOVATE. <http://www.hifa.org/> www.hifa.org
Geneva, Switzerland. <mailto:+41%20763837253> +41 763837253(m); <mailto:cherianm15@gmail.com> cherianm15@gmail.com
HIFA profile: Dr Meena Nathan Cherian was a professor of anaesthesiology from Christian Medical College Hospital, Vellore, India. She trained, worked, and taught in several countries, USA (Johns Hopkins Hospital), Southeast Asia and Africa. She worked at the World Health Organization Headquarters, Geneva, Switzerland, as the Emergency and Essential Surgical Care Program Lead where she created the ‘surgical care’ program resulting in the first World Health Assembly Resolution on ‘Emergency and Essential Surgical Care and Anaesthesia in the context of Universal Health Coverage’.
Currently she works as the Director, Global Health New Challenges program, Geneva Foundation for Medical Education and Research, Geneva, Switzerland; Adjunct Prof. The Chinese University of Hong Kong, Shenzhen, China; Senior Advisor, Global Action, International Society of Geriatric Oncology, Switzerland; Member of the WHO-HIFA Working Group on Essential Health Services and COVID-19; and HIFA mHEALTH-INNOVATE Working Group.
