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SUBSTANCE USE AND SUBSTANCE USE DISORDERS Psychoactive substance use (including alcohol and illicit drugs) is an important risk factor for poor health globally. 11,73 The use of dependence producing substances may result in development of substance use disorders. The intoxicating effects of psychoactive substances, or their toxic effects on organs and tissues, or the mode of their administration, are also contributing factors to the development of diseases, injuries and other health conditions. 12 TRENDS In 2012, 5.9% of all deaths worldwide was attributable to alcohol consumption with a significant proportion of alcohol-attributable deaths from cardiovascular diseases and injuries (Figure 7.9). Worldwide alcohol consumption in 2010 was 6.2 litres of pure alcohol per person age 15 or older: 38% of the world population age 15 or older had drunk alcohol in the past 12 months, and 16% engaged in heavy episodic drinking. 11 There is considerable global variation (Figure 7.10), but no clear global trend between 2005 and 2010 could be observed in alcohol per capita consumption. It is estimated that in 2013, some 27 million people in the world suffered from drug use disorders, and almost half of them (12.2 million) injected drugs of which an estimated 1.65 million were living with HIV. 12 About 5% of the population between ages 15 and 64 used illicit drugs in 2013. Since 2006, the number of people using illicit drugs has increased by 38 million, while the number of problem users remained fairly constant at 27 million since 2008. Figure 7.9 Distribution of alcohol-attributable deaths, by broad cause category, 2012 11 Neonatal conditions 0.1% Intentional injuries 8.7% Unintentional injuries 17.1% Infectious diseases 8.0% Gastrointestinal diseases 16.2% Cancers 12.5% Neuropsychiartric disorders 4.0% Cardiovascular diseases and diabetes 33.4% Figure 7.10 Total alcohol per capita (15+ years) consumption in litres of pure alcohol, 2010 74 0 1700 3400 Per capita consumption (litres) Per capita consumption (litres)
POSITIVE DEVELOPMENTS Political will: Increasing political will, as reflected by global agreements on reducing the harmful use of alcohol and the UN General Assembly resolutions to address the drug problem globally, including the resolution to hold a special session of the UN General Assembly on the world drug problem in 2016. Linking with the NCD agenda: Recognition of the harmful use of alcohol as a key risk factor for NCDs and endorsement of the global target of 10% relative reduction in the harmful use of alcohol by 2025 in the NCD Global Monitoring Framework. Better data: Gradually, more data are becoming available on alcohol and illicit drug use in the world through WHO and UNODC databases and global reports, leading to increased awareness and supporting data on the impact of alcohol and drug use on population health and development. Interagency collaboration: Within the UN system and beyond on addressing the harmful use of alcohol and the world drug problem, for instance, WHO and UNODC developed a programme on drug dependence treatment and care. 75 CHALLENGES Stigma and neglect: Stigmatization of substance use disorders and low priority given to these conditions in health systems in spite of the scope of preventable disease and social burden associated with psychoactive substance use. Lack of resources and response capacity: Limited capacity of international institutions and limited investment in public health responses to substance use disorders at all levels. There is limited involvement of the public health sector in drug policy development and implementation in many countries and poor interaction between drug control and public health governmental sectors. Data gap: Insufficient quality data on levels and patterns of substance use, especially for illicit drugs and especially in low- and middleincome countries. Commercial interests: Interfering with public health interests with regard to policies and regulations for legally traded substances such as alcohol and prescription drugs. Prescription drug abuse: Increased non-medical use of prescription medicines. STRATEGIC PRIORITIES The clear recognition of the substance use issue under SDG Target 3.5 (strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol) is a major achievement. Going forward, strategies will be based on the implementation of global policy frameworks and action plans with a focus on public health policies and health systems, including the implementation of the WHO global strategy on harmful use of alcohol. Key activities will include: • public health advocacy and partnerships to strengthen commitment and capacity of governments and relevant parties at all levels to reduce the harmful use of alcohol worldwide; • increased technical support and capacity-building to create, enforce and sustain the necessary policy and legal frameworks; • strengthened international activities regarding the production and dissemination of knowledge on trends in alcohol consumption, alcohol-attributable harm and the societal responses; • mobilization and pooling of available resources to support global and national action to reduce harmful use of alcohol in identified priority areas. With regard to other psychoactive substance use and drug use disorders, action will be based on strengthening public health responses to the world drug problem and increasing engagement of the health sector in the prevention and treatment of substance use disorders. It is expected that by 2030 countries will have developed or revised their relevant national policies and programmes to increase treatment coverage for substance use disorders. Key activities will include: 18 • articulating ethical and effective policy options to reduce harmful use of substances and the associated health and social consequences, while ensuring access to controlled medicines for medical purposes; • raising awareness of the disease burden due to harmful psychoactive substance use; • strengthening partnerships and international collaboration and information exchange; • disseminating evidence of effectiveness and cost-effectiveness of strategies and interventions in primary prevention, early intervention, treatment, rehabilitation and social reintegration; • providing normative guidance, technical support and capacitybuilding in the area of prevention and treatment of substance use disorders and associated health conditions; • promoting an integrated health service response to substance use disorders, including primary health care and community-based specialized health and social services; • supporting the production and dissemination of knowledge on the epidemiology of substance use and its health consequences; • maintaining and further developing the global information system on prevention and treatment resources for substance use disorders. 76 MENTAL HEALTH AND SUBSTANCE USE 167
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from M I L L E N N I U M DEVELOPMEN
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WHO Library Cataloguing-in-Publicat
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CONTENTS vii Abbreviations 1 1 From
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7 153 Mental health and substance u
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IHR IPCC ITN LLIN MCV MDG MDR TB mh
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SUMMARY This report aims to describ
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sourced development finance. 11 The
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Despite their overall success, the
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The 13 targets that underpin the br
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Box 1.1 Life expectancy improvement
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40 Advanced research on European he
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SUMMARY The SDGs position health as
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Figure 2.2 Trends in fertility by r
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Ageing Populations around the world
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The recent influx of refugees into
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and implementing policies and progr
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that dialogue is to demonstrate an
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One of the challenges we face as we
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Most recently, the right to health
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2100 Figure 2.15 Global average sur
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Figure 2.17 Proportion of health fa
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42 World development report 2014: r
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3 UNIVERSAL HEALTH COVERAGE
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UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
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SUMMARY Deaths among pregnant women
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Figure 4.3 MDG and SDG targets rela
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have declined from 25% to 14% betwe
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Chapter 5). As noted above, there h
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Figure 4.8 Wealth-related inequalit
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young children. 61 Specific indicat
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CHALLENGES Access to skilled care a
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CHALLENGES Scaling up effective int
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CHALLENGES Leaving no country behin
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CHALLENGES Endemic countries: Polio
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Figure 4.22 Prevalence of stunting
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CHALLENGES Spurring action in count
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CHALLENGES Ending child marriage: D
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43 Financing global health 2014: sh
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5 INFECTIOUS DISEASES
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Infectious and parasitic diseases a
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Figure 5.4 Global number of deaths
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International TB funding increased
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Improving quality of care: The qual
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Table 5.1 Summary of specific targe
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HIV/AIDS More than 30 years since t
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TUBERCULOSIS TB is a treatable and
Page 126 and 127: MALARIA Almost half the world’s p
Page 128 and 129: NEGLECTED TROPICAL DISEASES NTDs 89
Page 130 and 131: HEPATITIS Viral hepatitis is caused
Page 132 and 133: WATERBORNE DISEASES Waterborne dise
Page 134 and 135: CHOLERA Cholera is an acute diarrho
Page 136 and 137: SEXUALLY TRANSMITTED INFECTIONS STI
Page 138 and 139: NOTES AND REFERENCES 1 Global Healt
Page 140 and 141: 84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185: Injuries, whether sustained acciden
Page 186 and 187: due to limited data. However, the s
Page 188 and 189: aiming to stop the predicted increa
Page 190 and 191: ROAD TRAFFIC INJURIES Every year, a
Page 192 and 193: VIOLENCE AND HOMICIDE There were an
Page 194 and 195: WAR AND CONFLICT In 2012, an estima
Page 196 and 197: DISASTERS Disasters are often assoc
Page 198 and 199: NOTES AND REFERENCES 1 Global repor
Page 201 and 202: SUMMARY In September 2015, heads of
Page 203 and 204: A 10-page declaration precedes the
Page 205 and 206: THE PLACE OF HEALTH IN THE SDGs 1 H
Page 207 and 208: that health systems providing integ
Page 209 and 210: FOLLOW-UP AND REVIEW 9 Monitoring t
Page 211 and 212: NOTES AND REFERENCES 1 Transforming
Page 213 and 214: WHO South-East Asia Region: Banglad
Page 216: ISBN 978 92 4 156511 0
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