Director General of SICAD – Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências
Director of the European Monitoring Centre for Drugs and Drug Addiction
Member of the portuguese parliament Luísa Salgueiro
Representatives of the European Commission
Ladies and gentleman,
Having the opportunity to coordinate the work of a joint action with partner European countries is always a big opportunity for a member state. In this particular case, a project linked with the prevention of alcohol-related harm, it is a conjunction of actions that are incorporated in our main national concerns and in the programmed interventions according to the National Health Plan of Portugal, in the milestones programmed until 2016, and in the National Plan for the Reduction of Addictive Behaviors and Dependencies 2013-2020.
The Portuguese Government, as a whole, has very high expectations regarding the results of this Joint Action which involves and mobilizes 32 entities of the EU (European Union), which will participate as associate partners, and 28 other partners with a collaborating status, representing 27 member states, and additionally Iceland, Norway and Switzerland.
These partners, whether associate or collaborating, are public entities, non-governmental organizations of various sectors and universities, or international organizations, like the OECD (The Organization for Economic Co-operation and Development), the World Health Organization, the European Monitoring Centre for Drugs and Drug Addiction, and the Pompidou Group.
The relevance of both the participants and the topic reveals the importance of this happening and raises a high responsibility to which Portugal will correspond the best possible way.
This is an ambitious three-year project, but once objectives are met, we will have a collection of data and information, instruments, strategy design, and a collection of good practices to be disseminated, resulting from a process of group consent among partners who are involved.
With the support of the remaining Member States represented in CNAPA, Portugal has accepted the challenge of being the main partner, by presenting the proposal of the Joint Action and coordinating all the work of the whole project.
The Ministry of Health has been committed with this initiative since the beginning, through SICAD, which gave us a guarantee of rigor, innovation and entrepreneurship, in an area which requires a particular ability to develop both intersectorial and interdisciplinary approaches, mobilizing organizations representing several sectors of demand and offer, in this concrete case in the area of harmful use of alcohol, and public entities responsible for the execution of ministerial policies that cross each other, being able to boost resources and results.
This has lead to the elaboration of the new National Plan for the Reduction of Addictive Behaviors and Dependencies for 2013-2020, in which alcohol issues are integrated.
This is an interministerial plan on the topic of addictive behavior and dependencies with a balanced approach between demand and offer.
The National Plan aims to consolidate and deepen a cross-sectorial public policy integrated and efficient with regards to its scope, in a way to obtain sustainable gains in health and social welfare.
The citizen-centered lifecycle approach, covering a series of steps and contexts, orients a series of proposals of intervention that are based in principles such as pragmatism, humanism, quality and innovation.
Some of the objectives and milestones of this plan are according and correspond to the objectives of the Joint Action.
The alcohol-related problems, in particular with harmful use, generate concern and mobilize large financial and human resource investment in the Ministry of Health. However, the consequences of harmful use or abuse are beyond the scope of the Ministry.
This is a clear investment and a source of concern to be shared with other ministries, with private sector entities, civil society, universities, which can contribute to the definition of strategies and uniform policies, facilitating the adaptation and harmonization of interventions in multiple contexts (work, road, school and university).
This month, a new law on road safety has came out, with the reduction of the legal limit of blood concentration of alcohol for professional drivers and recently licensed drivers. In 2012, we have introduced changes for the minimum age for purchasing spirituous drinks, now being 18 years of age, and at the same time we gave limited the places for selling during the night.
We must also highlight a balanced tax policy that has lead to progressive increases in the taxes on alcoholic drinks, whether with the increase on VAT, or with the increase of specific taxes on drinks containing alcohol.
In the European Union, the harmful use of alcohol has strongly contributed to the global burden of disease and is the 3rd among the main risk factors of premature death and disease.
The concept of harmful use of alcohol is broad, and includes alcohol consumption that causes health and social harm for the consumer, for those who surround him and to society in general, and also consumption patterns associated with a greater risk of negative health results.
Based on the Global Status Report on Alcohol and Health (2011) from the World Health Organization, it has been estimated that in 2008, the harmful use of alcohol has been responsible for 3,2% of the global mortality and for 4% of the global burden of disease, expressed in Disability Adjusted Life Years.
The harmful use of alcohol is one of the main avoidable risk factors of neuropsychiatric diseases (anxiety, depression, alcohol dependency, central and peripheral nervous system lesion, cognitive damage and dementia) and other non-communicable diseases, such as gastrointestinal disease (liver cirrhosis and pancreatitis), endocrine and metabolic disease (obesity, type II diabetes), several cancers (oropharynx, esophagus, larynx, liver and breast), cardiovascular disease (hypertension, stroke, cardiac arrhythmia and coronary heart disease), immune system disease and reproductive and pre-natal disease.
The harmful consumption of alcohol has several consequences in Public Health. There are references in the scientific literature that indicate that this kind of alcohol consumption contributes to increase the morbidity burden related to communicable disease, such as tuberculosis and HIV/AIDS infection.
The impact of the harmful use of alcohol in social (involvement in various violent actions, crime, child abuse) and economic (absenteeism due to illness or occupational accident, decrease in productivity due to premature death, increase in admissions in emergency services, outpatient and number of admission days) problems is flagrant and significant.
Another important proportion of the burden of disease associated with the harmful consumption of alcohol is intentional and accidental harm, in particular harm that results from road accidents, violence and suicide.
The Joint Action addresses concerns that were discussed in CNAPA, such as the need of a better access to comparable data on consumption patterns and harmful effects of alcohol. The results of the work produced by the Work Packages of this Action will contribute to a better understanding of the national realities, through the harmonization of both concepts and data collection, and facilitating monitoring of this phenomenon in some of its components.
Guidelines for risk reduction and reduction of harmful use of alcohol, having in mind vulnerable groups (teenagers, pregnant women, families directly or indirectly affected by alcohol consumption of a third party) and other broader social determinants of health in specific contexts and related to risk level and patterns of consumption, one of the topics we are willing to cover, are essential instruments for professionals in practice and other stakeholders.
The investment and the expected results from this Joint Action will allow for national and European diagnoses based on an improvement on the quality of data and subsequent international comparability, allowing decision makers potential decisions to redefine more efficient strategies and policies with added value for health and society in general.
This Joint Action is therefore and opportunity to strengthen alliances, to share and consolidate knowledge, to explore consensual areas and to identify determining factors at the bottom of divergent approaches for the adoption of adequate and harmonized measures for the prevention of harmful use of alcohol.
It will also contribute for the implementation of the EU Strategy on alcohol, working as an incentive for the Member States to continue the work around the identified common priorities in the Strategy, building a platform for the exchange of information, and at the same time promoting the strengthening of both cooperation and coordination between the states.
The EU Strategy to support the member states in the reduction of alcohol-related harm, adopted in October 2006, was an answer to the increasing awareness of the impact of the harmful use of alcohol on health. The need to have a better involvement and support from the EU, in order to coordinate and complement national needs, was the key moment in the adoption of the documents.
After all these years since the adoption, Portugal firmly supports the continuation of the efforts at EU level in health protection through prevention and reduction of harmful use of alcohol.
I would like to express our clear will for the European Commission to proceed their work on alcohol and health, and therefore develop a new EU Strategy on alcohol for the post-2013 period. Portugal is committed to work with the remaining Member States in both technical and political matters.
We are following the evolution of consumption patters closely, which start to shift from moderate traditional consumption patterns to peaks of abuse, as well as the emergence of younger consumers and also among people who are socially and economically more vulnerable.
Our experience, as a southern European country which has a longstanding alcohol consumption and in which significant reductions in the per capita consumption have been observed recently, has an added expertise and knowledge that we make available, as always, to other countries.
The fact that we are proudly a country that produces high quality alcoholic drinks implies we have an added responsibility in defending people, young people and other vulnerable groups, but also the defense of moderate alcohol consumption.
The recent economic crisis has determined changes in the European social context, to which no country was immune. The new social perspective, with the increased unemployment and ageing, aggravated by decreased birth rate, increased costs with health technology, uncontrolled migration, increase of chronic diseases and transmission of communicable diseases justify health promotion interventions and prevention of disease at a never before seen degree of necessity.
From all this, a greater attention over specific aspects of alcohol policy through the next years is vital for everyone, not leaving behind the economic dimension associated with the production and selling of drinks containing alcohol which can not, in any circumstance, overrule our responsibility and obligation to protect citizens’ health.
It is crucial to search for answers based on the identification of specific and prioritary objectives, measurable for each of the main identified areas in the current Strategy. These objectives should be relevant in all Member States to which EU’s action can have an added value, coordinated and complemented by national policies.
The identification of clear and specific measures to be implemented has to contribute to minimize the impact the harmful use of alcohol could have in health, and will certainly have if nothing is done against it.
With joint efforts I am sure we will complete this task. I wish you a pleasant stay in Portugal, where we are honored to host the EMCDDA, and hope it matches your expectations.
Thank you very much.
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Publication date: 31.01.2014