Public health successes and missed opportunities

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Burden of alcohol-attributable mortality in the WHO European Region, 1990–2014 Fig. 80. Trends in age-standardized rates of adult mortality due to alcohol-attributable liver cirrhosis in the WHO European Region and selected subregions, 1990–2014 Rate per million 180 160 140 120 100 80 60 EU Central-western EU Mediterranean South-eastern WHO European Region Central-eastern EU Eastern WHO European Region WHO European Region 40 20 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Alcohol-attributable cancer mortality rates have shown relatively small variations over the observation period within regions, and predictably, the rates between regions reflect the consumption level, with the south-eastern WHO European Region having markedly lower consumption and lower alcohol-attributable cancer mortality (Fig. 81). Fig. 81. Trends in age-standardized rates of adult mortality due to alcohol-attributable cancer in the WHO European Region and selected subregions, 1990–2014 Rate per million 120 100 80 60 40 EU Central-western EU Mediterranean South-eastern WHO European Region Central-eastern EU Eastern WHO European Region WHO European Region 20 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Alcohol-attributable cardiovascular mortality varies widely between and within regions over time (Fig. 82). Cardiovascular causes of death, especially ischaemic categories, are impacted by fluctuations in heavy drinking occasions, and thus even relatively small changes in the level of consumption, which increase irregular or chronic heavy drinking, will have a considerable impact also on cardiovascular mortality. During the already-mentioned Gorbachev-era anti-alcohol campaign, alcohol consumption in the Soviet Union went down, even after correcting for increases in unrecorded alcohol (170) and, in association, deaths due to “circulatory disease” decreased, which was the code used for cardiovascular causes of death in the Soviet Union in 1987 (–9% in men from 1984, –6% in middle-aged women) (169). Cardiovascular 57
Public health successes and missed opportunities mortality changes were reversed when alcohol consumption increased again (169,170) (for discussions of causality and implications, see (156,177,195,196)). Fig. 82. Trends in age-standardized rates of adult mortality due to alcohol-attributable CVD in the WHO European Region and selected subregions, 1990–2014 1200 1000 800 EU Central-western EU Mediterranean South-eastern WHO European Region Rate per million 600 400 200 Central-eastern EU Eastern WHO European Region WHO European Region 0 -200 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 Mortality rates due to alcohol-attributable injury can be characterized by a dichotomy between a few countries (Belarus, Estonia, Kazakhstan, Latvia, Lithuania, the Republic of Moldova, the Russian Federation and Ukraine; see Fig. 50, 51 and 53) concentrated in a particular region (the eastern WHO European Region, see Fig. 83) with similar drinking levels and patterns, and the rest of the WHO European Region. Thus, all of the countries with higher-than-average rates are situated in the eastern part of the Region, from the Baltic countries in the north-east of the EU, over the Russian Federation to Kazakhstan in the south-eastern part of the WHO European Region. Fig. 83. Trends in age-standardized rates of mortality due to alcohol-attributable injury in the WHO European Region and selected subregions, 1990–2014 Rate per million 1000 900 800 700 600 500 400 300 EU Central-western EU Mediterranean South-eastern WHO European Region Central-eastern EU Eastern WHO European Region WHO European Region 200 100 0 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 58
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Public health successes and missed
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iv
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abbreviations CI CVD EU FAS GDP GIS
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Executive summary This report aims
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for voluntary behaviours. 1 Second,
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MONITORING ALCOHOL EXPOSURE The key
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Page 27 and 28: BURDEN OF ALCOHOL-ATTRIBUTABLE MORT
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Page 33 and 34: Table 1 contd Country Liver Liver C
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Page 71 and 72: CONCLUSION: THE NEED FOR AN ALCOHOL
Page 88: The WHO Regional Office for Europe
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