2022-2030年全球酒精行动计划（英文）

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worldHealthorganization

Global

alcohol

actionplan

2022–2030

worldHealthorganization

Globalalcoholactionplan2022–2030.

ISBN978-92-4-009010-1(electronicversion)ISBN978-92-4-009011-8(printversion)

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iii

Contents

Foreword iv

Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreduce

theharmfuluseofalcoholasapublichealthpriority 1

Background 1

Settingthescene 1

Globalstrategytoreducetheharmfuluseofalcoholanditsimplementation 2

Goaloftheactionplan 8

Operationalobjectivesoftheactionplan 8

Operationalprinciples 9

Keyareasforglobalaction 10

Actionarea1:Implementationofhigh-impactstrategiesandinterventions 11

Actionarea2:Advocacy,awarenessandcommitment 13

Actionarea3:Partnership,dialogueandcoordination 16

Actionarea4:Technicalsupportandcapacity-building 20

Actionarea5:Knowledgeproductionandinformationsystems 23

Actionarea6:Resourcemobilization 27

Indicatorsandmilestonesforachievingglobaltargets 30

iv

Foreword

Alcoholuseisassociatedwithmanyhealthrisks,duetoitsintoxicating,toxicanddependence-producingproperties.Theimpactofharmfulalcoholuseonhealthisfar-reachingandextendsbeyondthosewhodrink,affectingotherslikevictimsofdrink-drivingandinterpersonalviolence,orchildrenwithfetalalcoholspectrumdisorders.

In2010theWorldHealthAssemblyendorsedtheGlobalstrategytoreducetheharmfuluseofalcohol,butitsimplementationhasbeenuneven,andtheglobalburdenofalcohol-relateddeathsanddisabilitycontinuestobehigh.Culturaldrinkingnormsandtraditions,powerfulcommercialinterestsandofteninsufficientgovernance,fundingandinfrastructurearebarrierstoimplementationofeffectivepoliciesandinterventionsthatcouldalleviatealcohol-relatedharm.

ThisGlobalalcoholactionplan2022–2030,adoptedbythe75thWorldHealthAssembly,hasbeendevelopedtoboostimplementationoftheGlobalstrategy,bytranslatingintentionsandcommitmentsintoaction,toachievetangibleresultsacrossanarrayofmeasurabletargets.Thatwillrequireunitedeffortsonthepartofgovernments,intergovernmentalorganizations,UNentities,academia,professionalassociationsandcivilsocietyorganizations,workingtogethertowardstheactionplan’sobjectives.

WHOiscommittedtosupportingallMemberStatestoimplementtheGlobalalcoholactionplantoreducealcohol-relatedharm,asweworktogethertofulfilourfoundingvisionofthehighestattainablestandardofhealthforallpeople.

DrTedrosAdhanomGhebreyesus

Director-General

WorldHealthOrganization

1

Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcohol asapublichealthpriority1,2

Background

Settingthescene

1.Alcoholconsumptionisdeeplyembeddedinthesociallandscapeofmanysocieties.Severalmajorfactorshaveanimpactonlevelsandpatternsofalcoholconsumptioninpopulations–suchashistoricaltrendsinalcoholconsumption,theavailabilityofalcohol,culture,economicstatusandtrendsinthemarketing3ofalcoholicbeverages,aswellasimplementedalcoholcontrolmeasures.Attheindividuallevel,thepatternsandlevelsofalcoholconsumptionaredeterminedbymanydifferentfactors,includinggender,ageandindividualbiologicalandsocioeconomicvulnerabilityfactors,aswellasthepolicyenvironment.Prevailingsocialnormsthatsupportdrinkingbehaviourandmixedmessagesabouttheharmsandbenefitsofdrinkingencouragealcoholconsumptiondelayappropriatehealth-seekingbehaviourandweakencommunityaction.

2.Alcoholisapsychoactivesubstancewithintoxicatinganddependence-producingproperties.Theaccumulatedevidenceindicatesthatalcoholconsumptionisassociatedwithinherenthealthrisks,althoughhealthconsequencesofalcoholconsumptionvarysignificantlyinmagnitudeandnatureamongdrinkers.Atthepopulationlevel,anylevelofalcoholconsumptionisassociatedwithpreventablenetharmsduetomultiplehealthconditionssuchasinjuries,alcoholusedisorders(AUDs),liverdiseases,cancersandcardiovasculardiseases,aswellasharmstopersonsotherthandrinkers.Severalaspectsofdrinkinghaveanimpactonthehealthconsequencesofalcoholconsumption,namelythevolumeofalcoholconsumedovertime;thepatternofdrinking,inparticulardrinkingtointoxication;thedrinkingcontext;andthequalityofthealcoholicbeverageoritscontaminationwithtoxicsubstancessuchasmethanol.RepeatedconsumptionofalcoholicbeveragesmayleadtothedevelopmentofAUDs,includingalcoholdependencethatischaracterizedbyimpairedregulationofalcoholconsumptionandmanifestedbyimpairedcontroloveralcoholuse,increasingprecedenceofalcoholuseoverotheraspectsoflifeandspecificphysiologicalfeatures.4

3.Thecurrentactionplanreferstothe“harmfuluseofalcohol”asdefinedintheglobalstrategytoreducetheharmfuluseofalcoholas“drinkingthatcausesdetrimentalhealthandsocialconsequencesforthedrinker,thepeoplearoundthedrinkerandsocietyatlarge,aswellaspatternsofdrinkingthatareassociatedwithincreasedriskofadversehealthoutcomes”.5Itsconceptismuchbroaderthantheclinicalconceptofdiagnosticcategoryof“harmfulpatternofuse”,whichrepresentsapartofthespectrumof“alcoholusedisorders”intheInternationalClassificationofDiseases.

1SeedecisionWHA75(11).

2PublishedseparatelyunderthetitleGlobalalcoholactionplan2022–2030.

3Inthisdocument,theterm“marketing”isusedtomeananyformofcommercialcommunicationormessagethatisdesignedtoincrease–orhastheeffectofincreasing–therecognition,appealand/orconsumptionofparticularproductsandservices.Itcomprisesanythingthatactstoadvertiseorotherwisepromoteaproductorservice.

4InternationalClassificationofDiseases,11thRevision(ICD-11).Geneva:WorldHealthOrganization;2021.

5DocumentWHA63/2010/REC/1,Annex3.

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Globalalcoholactionplan2022–2030

4.Theimpactoftheharmfuluseofalcoholonhealthandwell-beingisnotlimitedtohealth

consequences;itincurssignificantsocialandeconomiclossesrelatingtocostsinthejusticesector,costsfromlostworkforceproductivityandunemploymentandthecostsassignedtopainandsuffering.Theharmfuluseofalcoholcanalsoresultinharmtoothers,suchasfamilymembers,friends,co-workersandstrangers.Amongthemostdramaticmanifestationsofharmtopersonsotherthandrinkersareroadtrafficinjuriesandtheconsequencesofprenatalalcoholexposure,whichmayresultinthedevelopmentoffetalalcoholspectrumdisorders(FASDs).Thereisnosafelimitestablishedforalcoholconsumptionatanystageofpregnancy.Theharmstoothersmaybeverytangible,specificandtime-bound(e.g.injuriesordamage)ormaybelesstangibleandresultfromsuffering,poorhealthandwell-beingandthesocialconsequencesofdrinking(e.g.beingharassedorinsultedorfeelingthreatened).

5.Awarenessandacceptanceoftheoverallnegativeimpactofalcoholconsumptiononapopulation’shealthandsafetyislowamongdecision-makersandthegeneralpublic.Thisisinfluencedbycommercialmessagingandpoorlyregulatedmarketingofalcoholicbeverages,whichdeprioritizeeffortstocountertheharmfuluseofalcoholinfavourofotherpublichealthissues.TheCOVID-19pandemichighlightedtheimportanceofappropriatepolicyandhealthsystemresponsestoreducetheharmfuluseofalcoholduringhealthemergencies.

6.Thehealth,economicandsocialburdenattributabletoalcoholconsumptionislargelypreventable.Historically,inrecognitionoftheintoxicating,toxicanddependence-producingpropertiesofalcohol,therehavealwaysbeenattemptstoregulatetheproduction,distributionandconsumptionofalcoholicbeverages.Theprotectionofthehealthofpopulationsbypreventingandreducingtheharmfuluseofalcoholisapublichealthpriorityandshouldbeafocusofalcoholpoliciesandalcoholcontrolmeasuresimplementedatdifferentlevels.

Globalstrategytoreducetheharmfuluseofalcoholanditsimplementation

Theglobalstrategy6anditsmandate

7.Theglobalstrategytoreducetheharmfuluseofalcohol,whichwasendorsedbytheSixty-thirdWorldHealthAssemblyinMay2010(resolutionWHA63.13),remainstheonlyglobalpolicyframeworkforreducingdeathsanddisabilitiesduetoalcoholconsumptionintheirentirety–frommentalhealthconditionsandnoncommunicablediseases(NCDs)toinjuriesandalcohol-attributableinfectiousdiseases.TheglobalstrategybuildsonseveralWHOglobalandregionalstrategicinitiativesandrepresentsthecommitmentofWHOMemberStatestotakesustainedactionatalllevels.Followingtheendorsementoftheglobalstrategy,regionalactionplansalignedwiththeglobalstrategyweredevelopedorrevisedandadoptedinWHO’sRegionoftheAmericas(2011)andEuropeanRegion(2012),whilearegionalstrategyforreducingtheharmfuluseofalcoholwasdevelopedandadoptedintheWHOAfricanRegion(2013).

8.Theglobalstrategywasdevelopedtopromoteandsupportlocal,regionalandglobalactionstopreventandreducetheharmfuluseofalcohol.Itoutlineskeycomponentsforglobalactionandrecommendsaportfolioofpolicyoptionsandmeasuresthatcouldbeconsideredforimplementationandadjustedasappropriateatthenationallevel.Thesepolicyoptionstakeintoaccountnationalcircumstancessuchasreligiousandculturalcontexts;nationalpublichealthpriorities;andresources,capacitiesandcapabilities.Theglobalstrategyalsocontainsasetofprinciplesthatshouldguidethedevelopmentandimplementationofpoliciesatalllevels.

6Globalstrategytoreducetheharmfuluseofalcohol.Geneva:WorldHealthOrganization;2010.

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Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcoholasapublichealthpriority

9.Sincetheendorsementoftheglobalstrategyin2010,MemberStates’commitmenttoreducingtheharmfuluseofalcoholhasbeenreinforcedbytheadoptionofthepoliticaldeclarationsemanatingfromthehigh-levelmeetingsoftheUnitedNationsGeneralAssemblyonthepreventionandcontrolofNCDs,includingthedeclarationof2011andthesubsequentadoptionandimplementationoftheWHOGlobalactionplanforthepreventionandcontrolofNCDs2013–2020(NCD-GAP).In2019,theSeventy-secondWorldHealthAssembly(inresolutionWHA72.11)extendedtheNCD-GAPto2030,ensuringitsalignmentwiththe2030AgendaforSustainableDevelopment.TheNCD-GAPliststheharmfuluseofalcoholasoneoffourkeyriskfactorsformajorNCDs.ItenablesMemberStatesandotherstakeholderstoidentifyanduseopportunitiesforsynergiestotacklemorethanoneriskfactoratthesametime;strengthencoordinationandcoherencebetweenmeasuresforreducingtheharmfuluseofalcoholandactivitiesforpreventingandcontrollingNCDs;andsetvoluntarytargetsforreducingtheharmfuluseofalcoholandotherriskfactorsforNCDs.InMay2013,theSixty-sixthWorldHealthAssemblyadoptedthecomprehensiveNCDGlobalMonitoringFramework,inwhichthevoluntaryglobaltargetfortheharmfuluseofalcoholtobeachievedby

2025isdefinedasatleast10%relativereduction,asappropriate,withinthenationalcontext,andmeasuredbyindicatorsacrossthreedomains,includingtotalalcoholpercapitaconsumptionwithinacalendaryearinlitresofpurealcohol,age-standardizedprevalenceofheavyepisodicdrinking,andalcohol-relatedmorbidityandmortality.7

10.Theinternationalmandatetoreducetheharmfuluseofalcoholwasfurtherstrengthenedwiththeadoptionofthe2030AgendaandtheSustainableDevelopmentGoals2030(SDG2030).Reducingtheharmfuluseofalcoholwillcontributetoprogresstowardstheattainmentofthemultiplegoalsandtargetsofthe2030AgendaandtheSDGs,includingSDGgoal1onendingpoverty;SDGgoal4onensuringaqualityeducation;SDGgoal5onachievinggenderequality;SDGgoal

8onpromotingdecentworkandeconomicgrowth;SDGgoal10onreducinginequalitieswithinandamongcountries;andSDGgoal16onpromotingpeaceandprovidingjusticeandstronginstitutions.Inviewofthenegativeimpactoftheharmfuluseofalcoholonthedevelopmentandoutcomesofmanydiseasesandhealthconditions,includingmajorNCDsandinjuries,theeffectivereductionoftheharmfuluseofalcoholwillmakeasubstantialcontributiontowardstheattainmentofSDGgoal3(Ensurehealthylivesandpromotewell-beingforall),inparticularSDGtarget3.5(Strengthenthepreventionandtreatmentofsubstanceabuse,includingnarcoticdrugabuseandharmfuluseofalcohol).ThisreflectsthebroaderimpactoftheharmfuluseofalcoholonhealthinareasbeyondNCDsandmentalhealth(SDGtarget3.4),suchasroadtrafficaccidents(SDGtarget3.6),reproductivehealth(SDGtarget3.7),universalhealthcoverage(SDGtarget3.8)andinfectiousdiseases(SDGtarget3.3).

11.Oneoftheguidingprinciplesoftheglobalstrategystatesthatpublicpoliciesandinterventionstopreventandreducealcohol-relatedharmshouldbeguidedandformulatedbypublichealthinterestsandbasedonclearpublichealthgoalsandthebestavailableevidence.Evidenceofthecost-effectivenessofalcoholpolicyoptionsandinterventionswasupdatedinarevisionofAppendix3totheNCD-GAP,whichwasendorsedbytheHealthAssemblyinresolutionWHA70.11.Thisresultedinanewsetofenablingandrecommendedactionstoreducetheharmfuluseofalcohol.Themostcost-effectiveactionsorbestbuysincludeincreasingtaxesonalcoholicbeverages;enactingandenforcingbansorcomprehensiverestrictionsonexposuretoalcoholadvertisingacrossmultipletypesofmedia;andenactingandenforcingrestrictionsonthephysicalavailabilityofretailedalcohol.Byprioritizingthemostcost-effectivepolicymeasures,theWHOSecretariatandpartnerslaunchedtheSAFERinitiative,withtheprimaryobjectiveofsupportingWHOMemberStatesinreducingtheharmfuluseofalcoholbyenhancingtheongoingimplementationoftheglobalstrategyandotherWHOandUnitedNationsstrategies.TheWHO-led

7DocumentWHA66/2013/REC/1,Annex4,Appendix2..

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SAFERinitiativefocusesonthesupportforimplementationofcost-effectivepolicyoptionsandinterventions.Italsoaimstoprotectpublichealth-orientedpolicy-makingagainstinterferencefromcommercialinterestsandestablishstrongmonitoringsystemstoensureaccountabilityandtrackprogressintheimplementationofSAFERpolicyoptionsandinterventions.

Implementationoftheglobalstrategysinceitsendorsement8

12.Sincetheendorsementoftheglobalstrategy,itsimplementationhasbeenunevenacrossWHOregionsaswellaswithinregionsandcountries.Thenumberofcountrieswithawrittennationalalcoholpolicyhassteadilyincreasedandmanycountrieshaverevisedtheirexistingalcoholpolicies.However,thepresenceofwrittennationalalcoholpoliciescontinuestobemostcommoninhigh-incomecountriesandleastcommonamonglow-incomecountries,withwrittennationalalcoholpoliciesmissingfrommostcountriesintheAfricanRegionandtheRegionoftheAmericas.Thedisproportionateprevalenceofeffectivealcoholcontrolmeasuresinhigher-incomecountriesraisesquestionsaboutglobalhealthequity.Specifically,itunderscorestheneedformoreresourcesandgreaterprioritytobeallocatedtosupportthedevelopmentandimplementationofeffectivepoliciesandactionsinlow-andmiddle-incomecountries.

Challengesinimplementationoftheglobalstrategy

13.Considerablechallengesremainforthedevelopmentandimplementationofeffectivealcoholpolicies.Thesechallengesrelatetothecomplexityoftheproblem;differencesinculturalnormsandcontexts;theintersectoralnatureofcost-effectivesolutions,includingpricingstrategies,andassociatedlimitedlevelsofpoliticalwillandleadershipatthehighestlevelsofgovernment;andtheinfluenceofpowerfulcommercialinterestsinpolicy-makingandimplementation.Thesechallengesoperateagainstabackgroundofcompetinginternationaleconomiccommitments.Thelimitedavailabilityofcomprehensiveandreliabledataonalcoholconsumptionandrelatedharm,generatedatthenationallevel,presentsadditionalchallengesfortheevaluationoftheimpactofimplementednationalpolicyresponsesinmanycountries.Coordinationandcooperationatalllevelsfordealingwiththesechallengesisfurthercomplicatedbycontextsinwhichtheresponsibilityforactionstoreducetheharmfuluseofalcoholisdispersedbetweendifferententities–includinggovernmentdepartments,differentprofessionsandtechnicalareas.

14.Theproductionofalcoholicbeverageshasbecomeincreasinglyconcentratedandglobalizedinrecentdecades,particularlyinthebeerandspiritssectors.AsignificantproportionofalcoholicbeveragesisconsumedatheavydrinkingeventsassociatedwithsignificanthealthrisksandheavydrinkingisoftenassociatedwiththepresenceofAUDs.Thishighlightstheinherentcontradictionbetweentheinterestsofalcoholproducersandpublichealth.Atthesametime,thereismountingevidencethatanylevelofalcoholconsumptionisassociatedwithhealthrisks.Somecountriesexperiencesubstantialchallengesinprotectingalcoholpolicydevelopmentfromcommercialinterests,whiletheissueofsafeguardingalcoholpolicydevelopmentatalllevelsfromalcoholindustryinterferenceisconsistentlypresentedasamajorchallengeininternationalpolicydialogues.Stronginternationalleadershipisneededtocounterinterferencefromcommercialinterestsinalcoholpolicydevelopmentandimplementationinordertoprioritizethepublichealthagendaforalcoholinthefaceofthestrongcommercialinterestsassociatedwithalcoholbeverageproductionandtrade.Competinginterestsacrossthewholeofgovernmentatthecountrylevel,includinginterestsrelatedtotheproductionandtradeofalcoholandgovernmentrevenuesfromalcoholtaxationandsales,oftenresultinpolicyincoherenceandtheweakeningofalcoholcontrolefforts.Thesituationvariesatnationalandsubnationallevelsandisheavilyinfluencedbythecommercialinterestsofalcoholproducersanddistributors,religiousbeliefs

8SeedocumentEB146/7/Add.1.

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Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcoholasapublichealthpriority

andspiritualandculturalnorms.Generaltrendstowardsderegulationinrecentdecadeshaveoftenresultedintheweakeningofalcoholcontrols,tothebenefitofeconomicinterestsandattheexpenseofpublichealthandwell-being.

15.Alcoholremainstheonlypsychoactiveanddependence-producingsubstancethatexertsasignificantimpactonglobalpopulationhealththatisnotcontrolledattheinternationallevelbylegallybindingregulatoryinstruments.Thisabsencelimitstheabilityofnationalandsubnationalgovernmentstoregulatethedistribution,saleandmarketingofalcoholwithinthecontextofinternational,regionalandbilateraltradenegotiations.Italsohamperseffortsastoprotectthedevelopmentofalcoholpoliciesfrominterferencebytransnationalcorporationsandcommercialinterests.Thishaspromptedcallsforaglobalnormativelawonalcoholattheintergovernmentallevel,modelledontheWHOFrameworkConventiononTobaccoControl.9DiscussionsaboutthefeasibilityandnecessityofsuchalegallybindinginternationalinstrumentindicatedalackofconsensusamongMemberStatesonthisissue.

16.Informallyandillegallyproducedalcoholaccountsforanestimated25%oftotalalcoholconsumptionpercapitaworldwideandinsomejurisdictionsexceedshalfofallthealcoholconsumedbythepopulation.Informalandillegalproductionandtradearedifferentinnatureandrequiredifferentpolicyandprogrammeresponses.Informalproductionanddistributionofalcoholareoftenembeddedinculturaltraditionsandthesocioeconomicfabricsofcommunities.Illicitalcoholproductionisassociatedwithsignificanthealthrisksandchallengesforregulatoryandlawenforcementsectorsofgovernments.Thecapacitytodealwithinformalorillicitproduction,distributionandconsumptionofalcohol,includingsafetyissues,islimitedorinadequate,particularlyinjurisdictionswhereunrecordedalcoholmakesupasignificantproportionofallthealcoholconsumed.

17.Satelliteanddigitalmarketingpresentagrowingchallengefortheeffectivecontrolofalcoholmarketingandadvertising.Alcoholproducersanddistributorshaveincreasinglymovedtowardsinvestingindigitalmarketingandusingsocialmediaplatforms,whichareprofit-makingbusinesseswithaninfrastructuredesignedtoallow“programmaticnativeadvertising”thatisdata-drivenandparticipatory.Internetmarketingcrossesborderswithevengreatereasethansatellitetelevisionandisnoteasilysubjectedtonational-levelcontrol.Inparallelwiththegreateropportunityformarketingandsellingalcoholthroughonlineplatforms,deliverysystemsarerapidlyevolving,imposingconsiderablechallengesontheabilityofgovernmentstocontrolalcoholsales.Fromapublichealthperspective,recentdevelopmentsinmarketing,advertisingandpromotionalactivitiesrelatedtoalcoholicbeveragesareofdeepconcern,includingthoseimplementedthroughcross-bordermarketingandthosetargetingorreachingouttochildren,adolescentsandyoungpeople.

18.Limitedtechnicalcapacity,humanresourcesandfundinghindereffortstodevelop,implement,enforceandmonitoreffectivealcoholcontrolinterventionsatalllevels.Technicalexpertiseinalcoholcontrolmeasuresisofteninsufficientatnationalandsubnationallevels,asaretheavailablehumanandfinancialresourcesatalllevelsofWHOfortheprovisionofrequiredtechnicalassistanceandthecompilation,disseminationandapplicationoftechnicalknowledgeinpractice.Fewcivilsocietyorganizationsprioritizealcoholasahealthriskormotivategovernmentstotakeactioncomparedtothenumberoforganizationsthatsupporttobaccocontrol.IntheabsenceofphilanthropicfundingandwithlimitedresourcesinWHOandotherintergovernmentalorganizations,therehasbeenlittleinvestmentincapacity-buildinginlow-andmiddle-incomecountries.

9AuYeungSL,LamTH.UniteforaFrameworkConventionforAlcoholControl.Lancet.2019;393(10183):1778–1779.doi:10.1016/S0140-6736(18)32214-1.

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19.Thelackofsufficientlydevelopednationalsystemsformonitoringalcoholconsumptionandthei