National Workshop Report and Recommendations by Devparna Acharya

REPORT

CONTENTS

PREFACE PROGRAMME SCHEDULE ..................................................................................

CONCEPT NOTE .................................................................................................

BRIEF REPORT ......................................................................................................

RECOMMENDATIONS .........................................................................................

LIST OF PARTICIPANTS ........................................................................................

ANNEXURE Draft National Policy on Alcohol and Substance Abuse Prevention

Constitution of India “The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties and in particular, it shall endeavor to bring about Prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs, which are injurious to health” - Article 47, Directive Principles

PREFACE Indian Alcohol Policy Alliance (IAPA) feels proud to present the detailed Report of the National Workshop on ‘Developing a National Strategy to Reduce the Harmful Use of Alcohol in Tune with the WHO Global Strategy’ held at the India International Centre, New Delhi on 27th September 2010, organized jointly by the National Institute of Social Defence (NISD), Ministry of Social Justice & Empowerment, Govt. of India and Indian Alcohol Policy Alliance (IAPA) with technical support of the World Health Organization (WHO) – India Office. Please find attached herewith the Programme Schedule, Concept Note, Brief Report, Group Recommendations, List of Participants, besides, some of the important presentations for your kind information. The complete documents of the National Workshop including the detailed report, presentations, photographs, etc. can be found in the CD enclosed. As a continuation and follow-up of the “National Consultative Workshop of Stakeholders on Addressing the Problems Related to Alcohol Use” held at the NISD Conference Hall, New Delhi on 12 – 13 May 2010, this Workshop has further succeeded in bringing together all the major stakeholders on a common platform at a very vital time, when the World Health Assembly has adopted the Global Alcohol Strategy. The participation of Swami Agnivesh, Adv. A. Sampath, Member of Parliament, Mr. Derek Rutherford (UK) and Mr. Oystein Bakke (Norway) of the Global Alcohol Policy Alliance and Prof. Rajat Ray, Member, INCB & Chairman of the National Policy Drafting Committee have made a great difference. The Workshop had also seriously discussed the Draft National Policy Document on Alcohol & Substance Abuse. All the speakers were unanimous that successful implementation of the Global Strategy requires concerted action, effective governance and appropriate engagement of all relevant stakeholders. We are immensely pleased with the resourceful contribution and outcome of the Workshop. We express our sincere gratitude to the Hon’ble Minister Mr. D. Napoleaon, all the distinguished Guests, Speakers and Delegates for their meaningful leadership and active participation, which has contributed towards the success of this Workshop. We have no words to express our sincere thanks to Mr. K. M. Acharya IAS (Secretary, MSJE, GOI), Mrs. Purnima Singh IRS (Jt. Secretary, MSJE, GOI), Mr. Chaitanya Murti (Director, NISD), Mr. M. Sunil Kumar (Dy. Director, NISD), Dr. J. S. Thakur (Cluster Focal Point, WHO-India) and the officials of NISD for their relentless support and cooperation rendered in organizing this Workshop and look forward to their continued guidance and support in the future. With sincere wishes, Dr. S. Arul Rhaj

Johnson J. Edayaranmula

(Chairman, IAPA)

(Executive Director, IAPA)

NATIONAL WORKSHOP ON DEVELOPING A NATIONAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL IN TUNE WITH THE WHO GLOBAL STRATEGY (27th September, 2010 – India International Centre, New Delhi)

organized by National Institute of Social Defence Ministry of Social Justice & Empowerment, Govt. of India in collaboration with Indian Alcohol Policy Alliance (IAPA) with technical support of World Health Organization (WHO) – India

PROGRAMME 9:00 AM 10:00 AM

Registration Inaugural Session Vande Mataram Jyotirgamaya Welcome Address

: :

Felicitations

Special Address Chairman’s Address Keynote Address Inaugural Address Vote of Thanks

: : : : :

Lighting the Traditional Lamp Mr. Johnson J. Edayaranmula (Executive Director, IAPA)

Mrs. Purnima Singh IAS (Joint Secretary, Ministry of Social Justice & Empowerment)

Mr. Derek Rutherford

(Chairman, Global Alcohol Policy Alliance - GAPA)

Adv. A. Sampath

(Member of Parliament, Lok Sabha)

Dr. S. Arul Rhaj

(Chairman, IAPA & President, CMA)

Swami Agnivesh

(Veteran Social Activist)

Mr. D. NAPOLEON

(Hon”ble Minister of State for Social Justice & Empowerment)

Dr. Shanthi Ranganathan

(Hon. Secretary, IAPA)

11:30 AM 11:45 AM

Health Break Thematic Presentations Chairperson

: Dr. Tej Paul Ahluwalia (Dy. Director General, ICMR)

Speakers

: (1) Effective GO/NGO Coordination Mr. Derek Rutherford (Chairman, GAPA) (2) Alcohol Harm in the Development Perspective Mr. Oystein Bakke (Secretary, GAPA) (3) Guidelines for a National Strategy Dr. Kumar Rajan (National Consultant, WHO-India) Brief Q & A Session 1

12:45 PM 1:30 PM

Lunch Break Panel Discussion on National Strategy Chairperson

Dr. J. S. Thakur (Cluster Focal Point, WHO-India)

Panelist

(1) (2) (3) (4) (5)

Dr. Shanthi Ranganathan (Member, WHO Expert Committee) Dr. Rakesh Lal (Professor of Psychiatry, AIIMS, Ministry of Health) Mr. M. Sunil Kumar (Dy. Director, NISD, Ministry of SJ&E) Mr. C. S. Pran (Director – Programmes, NYKS, Ministry of Youth) Mrs. Prabhat Shobha Pandit (Secy., All India Prohibition Council)

2:45 PM

Brief Q & A Session Concurrent Working Groups on National Strategy

3:45 PM 4:00 PM

Group 1 - Advocacy & Prevention Chair – Ms. Monika Arora (Director, HRIDAY-SHAN & Trustee, IAPA)) Group 2 – Treatment & Rehabilitation Chair – Dr. Rajesh Kumar (Executive Director, FINGODAP) Group 3 – Coordination & Networking Chair – Mr. Tushar Sampat (Cyber Specialist, Pune) Health Break Plenary Session Chairperson Co-Chair

4:30 PM

: :

Dr. Nimesh G. Desai (Director, IHBAS & Trustee, IAPA) Dr. Atreyi Ganguli (Cluster Assistant, NCD, WHO-India)

Presentations from Working Groups General Discussion Finalization of Draft National Strategy Valedictory Session Welcome Address Address

: :

Address

Keynote Address Closing Remarks Vote of Thanks

: : :

National Anthem

Mr. M. Sunil Kumar (Dy. Director, NISD)

Mr. Morten Lonstad

(Secretary General, Alcohol, Drugs & Development)

Mr. Chaitanya Murti

(Director, NISD)

Prof. Rajat Ray

(Member INCB & Head, Dept. of Psychiatry, AIIMS)

Dr. S. Arul Rhaj

(Chairman, IAPA)

Dr. Vinay Aggarwal

(Former Secretary General, IMA & Trustee, IAPA)

For further information, please contact National Institute of Social Defence (NISD) Ministry of Social Justice & Empowerment West Block-1, Wing - 7, Ground Floor R.K. Puram, New Delhi – 110 066 Ph: 011-26106325 / 26173257 Email: msunilk@rediffmail.com

Indian Alcohol Policy Alliance 69, IInd Floor, Hargovind Enclave, Karkardooma New Delhi-110 092 Ph: 011 – 43016058 / 43016059 Email: iapa.delhi@gmail.com

CONCEPT NOTE

DEVELOPING A NATIONAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL IN TUNE WITH THE WHO GLOBAL STRATEGY Background The World Health Assembly in May 2010, adopted unanimously the WHO Global Alcohol Strategy, supported by all the 193 Member Countries. According to WHO, the disease burden attributable to harmful use of alcohol is significant and in many countries the public health problems caused by the harmful use of alcohol represent a substantial health, social and economic burden. The harmful use of alcohol is ranked as the fifth leading risk factor for premature death and disability in the world. It is the leading cause of death and disability in developing countries with low mortality, the third among the leading risk factors in developed countries, after tobacco and blood pressure, and eleventh in developing countries with high mortality rates. Although there are regional, national and local differences in levels, patterns and context of drinking, in 2002 harmful use of alcohol was estimated to cause about 2.3 million premature deaths worldwide (3.7% of global mortality) and to be responsible for 4.4% of the global burden of disease. Harmful drinking is a major avoidable risk factor for neuropsychiatric disorders and other non-communicable diseases such as cardiovascular diseases, cirrhosis of the liver and various cancers. Harmful drinking among young people and women is an increasing concern across many countries. Harmful drinking is associated with numerous social consequences, such as road traffic accidents, crimes, violence, unemployment and absenteeism. It generates health-care and societal costs. The health and social consequences tend to hurt less advantaged social groups most and contribute to disparities in health between and within countries. Aims and objectives The WHO Global Strategy has five objectives: a) raised global awareness of the magnitude and nature of the health, social and economic problems caused by harmful use of alcohol, and increased commitment by governments to act to address the harmful use of alcohol; b) strengthened knowledge base on the magnitude and determinants of alcoholrelated harm and on effective interventions to reduce and prevent such harm; c) increased technical support to, and enhanced capacity of, Member States for preventing the harmful use of alcohol and managing alcohol-use disorders and associated health conditions; 3

d) strengthened partnerships and better coordination among stakeholders and increased mobilization of resources required for appropriate and concerted action to prevent the harmful use of alcohol; e) improved systems for monitoring and surveillance at different levels, and more effective dissemination and application of information for advocacy, policy development and evaluation purposes. The harmful use of alcohol and its related public health problems are influenced by the general level of alcohol consumption in a population, drinking patterns and local contexts. Achieving the five objectives will require national actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health. Special attention needs to be given to reducing harm to people other than the drinker and to populations that are at particular risk from harmful use of alcohol, such as children, adolescents, women of child-bearing age, pregnant and breastfeeding women, indigenous peoples and other minority groups or groups with low socio-economic status. Guiding Principles The protection of the health of the population by preventing and reducing the harmful use of alcohol is a public health priority. The following principles will guide the development and implementation of policies at all levels; they reflect the multifaceted determinants of alcohol-related harm and the concerted multi-sectoral actions required to implement effective interventions. a) Public policies and interventions to prevent and reduce alcohol-related harm should be guided and formulated by public health interests and based on clear public health goals and the best available evidence. b) Policies should be equitable and sensitive to national, religious and cultural contexts. c) All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions to prevent and reduce harmful use of alcohol. d) Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted. e) Protection of populations at high risk of alcohol-attributable harm and those exposed to the effects of harmful drinking by others should be an integral part of policies addressing the harmful use of alcohol. f) Individuals and families affected by the harmful use of alcohol should have access to affordable and effective prevention and care services. g) Children, teenagers and adults who choose not to drink alcohol beverages have the right to be supported in their non-drinking behaviour and protected from pressures to drink.

h) Public policies and interventions to prevent and reduce alcohol related harm should encompass all alcoholic beverages and surrogate alcohol. National Policies and Measures The harmful use of alcohol can be reduced if effective actions are taken by countries to protect their populations. Nations have a primary responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Such policies require a wide range of public health-oriented strategies for prevention and treatment. Depending on the characteristics of policy options and national circumstances, some policy options can be implemented by non-legal frameworks such as guidelines or voluntary restraints. Successful implementation of measures should be assisted by monitoring impact and compliance and establishing and imposing sanctions for non-compliance with adopted laws and regulations. Sustained political commitment, effective coordination, sustainable funding and appropriate engagement of State Governments as well as from civil society and economic operators are essential for success. All relevant decision-making authorities and Stakeholders should be involved in the formulation and implementation of alcohol policies. The policy options can be grouped into 10 recommended target areas, namely, (a) leadership, awareness and commitment (b) health servicesâ&#x20AC;&#x2122; response (c) community action (d) drinkâ&#x20AC;&#x201C;driving policies and countermeasures (e) availability of alcohol (f) marketing of alcoholic beverages (g) pricing policies (h) reducing the negative consequences of drinking and alcohol intoxication (i) reducing the public health impact of illicit alcohol and informally produced alcohol (j) monitoring and surveillance. POLICY OPTIONS AND INTERVENTIONS Area 1. Leadership, Awareness and Commitment Sustainable action requires strong leadership and a solid base of awareness and political will and commitment. The commitments should ideally be expressed through 5

adequately funded comprehensive and inter-sectoral national policies that clarify the contributions, and division of responsibility, of the different partners involved. The policies must be based on available evidence and tailored to local circumstances, with clear objectives, strategies and targets. The policy should be accompanied by a specific action plan and supported by effective and sustainable implementation and evaluation mechanisms. The appropriate engagement of civil society and economic operators is essential. For this area policy options and interventions include: 1) developing or strengthening existing, comprehensive national and state strategies, plans of action and activities to reduce the harmful use of alcohol; 2) establishing or appointing a main institution or agency, as appropriate, to be responsible for following up national policies, strategies and plans; 3) co-ordinating alcohol strategies with work in other relevant sectors, including cooperation between different levels of governments, and with other relevant health-sector strategies and plans; 4) ensuring broad access to information and effective education and public awareness programmes among all levels of society about the full range of alcohol-related harm experienced in the country and the need for, and existence of, effective preventive measures; 5) raising awareness of harm to others and among vulnerable groups caused by drinking, avoiding stigmatization and actively discouraging discrimination against affected groups and individuals. Area 2. Health Servicesâ&#x20AC;&#x2122; Response Health services are central to tackling harm at the individual level among those with alcohol-use disorders and other health conditions caused by harmful use of alcohol. Health services should provide prevention and treatment interventions to individuals and families at risk of, or affected by, alcohol-use disorders and associated conditions. Another important role of health services and health professionals is to inform societies about the public health and social consequences of harmful use of alcohol, support communities in their efforts to reduce the harmful use of alcohol, and to advocate effective societal responses. Health services should reach out to, mobilize and involve a broad range of players outside the health sector. Health services response should be sufficiently strengthened and funded in a way that is commensurate with the magnitude of the public health problems caused by harmful use of alcohol. For this area policy options and interventions include: 1) increasing capacity of health and social welfare systems to deliver prevention, treatment and care for alcohol-use and alcohol-induced disorders and co-morbid conditions, including support and treatment for affected families and support for mutual help or self-help activities and programmes; 6

2) supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings; such initiatives should include early identification and management of harmful drinking among pregnant women and women of child-bearing age; 3) improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome and a spectrum of associated disorders; 4) development and effective coordination of integrated and/or linked prevention, treatment and care strategies and services for alcohol-use disorders and comorbid conditions, including drug-use disorders, depression, suicides, HIV/AIDS and tuberculosis; 5) securing universal access to health including through enhancing availability, accessibility and affordability of treatment services for groups of low socioeconomic status; 6) establishing and maintaining a system of registration and monitoring of alcoholattributable morbidity and mortality, with regular reporting mechanisms; 7) provision of culturally sensitive health and social services as appropriate. Area 3. Community Action The impact of harmful use of alcohol on communities can trigger and foster local initiatives and solutions to local problems. Communities can be supported and empowered by governments and other stakeholders to use their local knowledge and expertise in adopting effective approaches to prevent and reduce the harmful use of alcohol by changing collective rather than individual behaviour while being sensitive to cultural norms, beliefs and value systems. For this area policy options and interventions include: 1) supporting rapid assessments in order to identify gaps and priority areas for interventions at the community level; 2) facilitating increased recognition of alcohol-related harm at the local level and promoting appropriate effective and cost effective responses to the local determinants of harmful use of alcohol and related problems; 3) strengthening capacity of local authorities to encourage and coordinate concerted community action by supporting and promoting the development of municipal policies to reduce harmful use of alcohol, as well as their capacity to enhance partnerships and networks of community institutions and nongovernmental organizations; 4) providing information about effective community-based interventions, and building capacity at community level for their implementation; 5) mobilizing communities to prevent the selling of alcohol to, and consumption of alcohol by, under-age drinkers, and to develop and support alcohol-free environments, especially for youth and other at-risk groups; 7

6) providing community care and support for affected individuals and their families; 7) developing or supporting community programmes and policies for subpopulations at particular risk, such as young people, unemployed persons and indigenous populations, specific issues like the production and distribution of illicit or informal-alcohol beverages and events at community level such as sporting events and town festivals. Area 4. Drink Driving Policies and Countermeasures Driving under the influence of alcohol seriously affects a person’s judgment, coordination and other motor functions. Alcohol-impaired driving is a significant public health problem that affects both the drinker and in many cases innocent parties. Strong evidence-based interventions exist for reducing drink–driving. Strategies to reduce harm associated with drink–driving should include deterrent measures that aim to reduce the likelihood that a person will drive under the influence of alcohol, and measures that create a safer driving environment in order to reduce both the likelihood and severity of harm associated with alcohol-influenced crashes. In some countries, the number of traffic-related injuries involving intoxicated pedestrians is substantial and should be a high priority for intervention. For this area policy options and interventions include: 1) introducing and enforcing an upper limit for blood alcohol concentration, with a reduced limit for professional drivers and young or novice drivers; 2) promoting sobriety check points and random breath-testing; 3) administrative suspension of driving licences; 4) graduated licensing for novice drivers with zero-tolerance for drink–driving; 5) using an ignition interlock, in specific contexts where affordable, to reduce drinkdriving incidents; 6) mandatory driver-education, counselling and, as appropriate, treatment programmes; 7) encouraging provision of alternative transportation, including public transport until after the closing time for drinking places; 8) conducting public awareness and information campaigns in support of policy and in order to increase the general deterrence effect; 9) running carefully planned, high-intensity, well-executed mass media campaigns targeted at specific situations, such as holiday seasons, or audiences such as young people. Area 5. Availability of Alcohol Public health strategies that seek to regulate the commercial or public availability of alcohol through laws, policies, and programmes are important ways to reduce the 8

general level of harmful use of alcohol. Such strategies provide essential measures to prevent easy access to alcohol by vulnerable and high-risk groups. Commercial and public availability of alcohol can have a reciprocal influence on the social availability of alcohol and thus contribute to changing social and cultural norms that promote harmful use of alcohol. The level of regulation on the availability of alcohol will depend on local circumstances, including social, cultural and economic contexts as well as existing binding international obligations. In some developing and low- and middle-income countries, informal markets are the main source of alcohol and formal controls on sale need to be complemented by actions addressing illicit or informally produced alcohol. Furthermore, restrictions on availability that are too strict may promote the development of a parallel illicit market. Secondary supply of alcohol, for example from parents or friends, needs also to be taken into consideration in measures on the availability of alcohol. For this area policy options and interventions include: 1) establishing, operating and enforcing an appropriate system to regulate production, wholesaling and serving of alcoholic beverages that places reasonable limitations on the distribution of alcohol and the operation of alcohol outlets in accordance with cultural norms, by the following possible measures: a. introducing, where appropriate, a licensing system on retail sales, or public health-oriented government monopolies; b. regulating the number and location of on-premise and off-premise alcohol outlets; c. regulating days and hours of retail sales; d. regulating modes of retail sales of alcohol; e. regulating retail sales in certain places or during special events; 2) Establishing an appropriate minimum age for purchase or consumption of alcoholic beverages and other policies in order to raise barriers against sales to, and consumption of alcoholic beverages by, adolescents; 3) adopting policies to prevent sales to intoxicated persons and those below the legal age and considering the introduction of mechanisms for placing liability on sellers and servers in accordance with national legislations; 4) setting policies regarding drinking in public places or at official public agenciesâ&#x20AC;&#x2122; activities and functions; 5) adopting policies to reduce and eliminate availability of illicit production, sale and distribution of alcoholic beverages as well as to regulate or control informal alcohol. Area 6. Marketing of Alcoholic Beverages Reducing the impact of marketing, particularly on young people and adolescents, is an important consideration in reducing harmful use of alcohol. Alcohol is marketed through 9

increasingly sophisticated advertising and promotion techniques, including linking alcohol brands to sports and cultural activities, sponsorships and product placements, and new marketing techniques such as e-mails, SMS and podcasting, social media and other communication techniques. The transmission of alcohol marketing messages across national borders and jurisdictions on channels such as satellite television and the Internet, and sponsorship of sports and cultural events is emerging as a serious concern in some countries. It is very difficult to target young adult consumers without exposing cohorts of adolescents under the legal age to the same marketing. The exposure of children and young people to appealing marketing is of particular concern, as is the targeting of new markets in developing and low- and middle-income countries with a current low prevalence of alcohol consumption or high abstinence rates. Both the content of alcohol marketing and the amount of exposure of young people to that marketing are crucial issues. A precautionary approach to protecting young people against these marketing techniques should be considered. For this area policy options and interventions include: 1) setting up regulatory or co-regulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures, for alcohol marketing by: a. b. c. d.

regulating the content and the volume of marketing; regulating direct or indirect marketing in certain or all media; regulating sponsorship activities that promote alcoholic beverages; restricting or banning promotions in connection with activities targeting young people; e. regulating new forms of alcohol marketing techniques, for instance social media; 2) development by public agencies or independent bodies of effective systems of surveillance of marketing of alcohol products; 3) setting up effective administrative and deterrence systems for infringements on marketing restrictions. Area 7. Pricing Policies Consumers, including heavy drinkers and young people, are sensitive to changes in the price of drinks. Pricing policies can be used to reduce underage drinking, to halt progression towards drinking large volumes of alcohol and/or episodes of heavy drinking, and to influence consumersâ&#x20AC;&#x2122; preferences. Increasing the price of alcoholic beverages is one of the most effective interventions to reduce harmful use of alcohol. A key factor for the success of price-related policies in reducing harmful use of alcohol is an effective and efficient system for taxation matched by adequate tax collection and enforcement. Factors such as consumer preferences and choice, changes in income, alternative sources for alcohol in the country or in neighbouring countries, and the presence or 10

absence of other alcohol policy measures may influence the effectiveness of this policy option. Demand for different beverages may be affected differently. Tax increases can have different impacts on sales, depending on how they affect the price to the consumer. The existence of a substantial illicit market for alcohol complicates policy considerations on taxation in many countries. In such circumstances tax changes must be accompanied by efforts to bring the illicit and informal markets under effective government control. Increased taxation can also meet resistance from consumer groups and economic operators, and taxation policy will benefit from the support of information and awareness-building measures to counter such resistance. For this area policy options and interventions include: 1) establishing a system for specific domestic taxation on alcohol accompanied by an effective enforcement system, which may take into account, as appropriate, the alcoholic content of the beverage; 2) regularly reviewing prices in relation to level of inflation and income; 3) banning or restricting the use of direct and indirect price promotions, discount sales, sales below cost and flat rates for unlimited drinking or other types of volume sales; 4) establishing minimum prices for alcohol where applicable; 5) providing price incentives for non-alcoholic beverages; 6) reducing or stopping subsidies to economic operators in the area of alcohol. Area 8. Reducing the Negative Consequences of Drinking and Alcohol Intoxication This target area includes policy options and interventions that focus directly on reducing the harm from alcohol intoxication and drinking without necessarily affecting the underlying alcohol consumption. Current evidence and good practices favour the complementary use of interventions within a broader strategy that prevents or reduces the negative consequences of drinking and alcohol intoxication. In implementing these approaches, managing the drinking environment or informing consumers, the perception of endorsing or promoting drinking should be avoided. For this area policy options and interventions include: 1) regulating the drinking context in order to minimize violence and disruptive behaviour, including serving alcohol in plastic containers or shatter-proof glass and management of alcohol-related issues at large-scale public events; 2) enforcing laws against serving to intoxication and legal liability for consequences of harm resulting from intoxication caused by the serving of alcohol; 3) enacting management policies relating to responsible serving of beverage on premises and training staff in relevant sectors in how better to prevent, identify and manage intoxicated and aggressive drinkers; 4) reducing the alcoholic strength inside different beverage categories; 11

5) providing necessary care or shelter for severely intoxicated people; 6) providing consumer information about, and labelling alcoholic beverages to indicate, the harm related to alcohol. Area 9. Reducing the Public Health Impact of Illicit Alcohol Consumption of illicit or informally produced alcohol could have additional negative health consequences due to a higher ethanol content and potential contamination with toxic substances, such as methanol. It may also hamper governmentsâ&#x20AC;&#x2122; abilities to tax and control legally produced alcohol. Actions to reduce these additional negative effects should be taken according to the prevalence of illicit and/or informal alcohol consumption and the associated harm. Good scientific, technical and institutional capacity should be in place for the planning and implementation of appropriate national, regional and international measures. Good market knowledge and insight into the composition and production of informal or illicit alcohol are also important, coupled with an appropriate legislative framework and active enforcement. These interventions should complement, not replace, other interventions to reduce harmful use of alcohol. Production and sale of informal alcohol are ingrained in many cultures and are often informally controlled. Thus control measures could be different for illicit alcohol and informally produced alcohol and should be combined with awareness raising and community mobilization. Efforts to stimulate alternative sources of income are also important. For this area policy options and interventions include: 1) good quality control with regard to production and distribution of alcoholic beverages; 2) regulating sales of informally produced alcohol and bringing it into the taxation system; 3) an efficient control and enforcement system, including tax stamps; 4) developing or strengthening tracking and tracing systems for illicit alcohol; 5) ensuring necessary cooperation and exchange of relevant information on combating illicit alcohol among authorities at national and international levels; 6) issuing relevant public warnings about contaminants and other health threats from informal or illicit alcohol. Area 10. Monitoring and Surveillance Data from monitoring and surveillance create the basis for the success and appropriate delivery of the other nine policy options. Local, national and international monitoring and surveillance are needed in order to monitor the magnitude and trends of alcoholrelated harms, to strengthen advocacy, to formulate policies and to assess impact of interventions. 12

Monitoring should also capture the profile of people accessing services and the reason why people most affected are not accessing prevention and treatment services. Data may be available in other sectors, and good systems for coordination, information exchange and collaboration are necessary in order to collect the potentially broad range of information needed to have comprehensive monitoring and surveillance. Development of sustainable national information systems using indicators, definitions and data-collection procedures compatible with WHOâ&#x20AC;&#x2122;s global and regional information systems provides an important basis for effective evaluation of national efforts to reduce harmful use of alcohol and for monitoring trends at state, regional and national levels. Systematic continual collection, collation and analysis of data, timely dissemination of information and feedback to policy-makers and other stakeholders should be an integral part of implementation of any policy and intervention to reduce harmful use of alcohol. Collecting, analysing and disseminating information on harmful use of alcohol are resource-intensive activities. For this area policy options and interventions include: 1) establishing effective frameworks for monitoring and surveillance activities including periodic national surveys on alcohol consumption and alcohol-related harm and a plan for exchange and dissemination of information; 2) establishing or designating an institution or other organizational entity responsible for collecting, collating, analysing and disseminating available data, including publishing national reports; 3) defining and tracking a common set of indicators of harmful use of alcohol and of policy responses and interventions to prevent and reduce such use; 4) creating a repository of data at the country level based on internationally agreed indicators and reporting data in the agreed format to WHO and other relevant international organizations; 5) developing evaluation mechanisms with the collected data in order to determine the impact of policy measures, interventions and programmes put in place to reduce the harmful use of alcohol. NEED OF A NATIONAL STRATEGY & ACTION PLAN A National Strategy with short-term and long-term Action Plan need to be evolved to address the public health harm and social consequences of alcohol, in tune with the WHO Global Strategy. Mechanisms shall be formulated to: (a) provide leadership; (b) strengthen advocacy; (c) formulate evidence-based policy options; (d) promote networking and exchange of experience among stakeholders; (e) strengthen partnerships and resource mobilization. 13

This Workshop will discuss the appropriate relevant strategies that can be adopted at various levels, through a process which include Thematic Presentations highlighting the issues in general; a Panel Discussion involving Major Stakeholders; followed by Concurrent Working Group Discussion based on three broad areas â&#x20AC;&#x201C; (1) Advocacy & Prevention; (2) Treatment & Rehabilitation; and (3) Co-ordination & Networking. And finally in the Plenary Session, we hope to develop a Draft National Strategy Document, which will guide the future planning and implementing process, towards realizing a National Strategy in tune with the WHO Global Strategy.

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BRIEF REPORT Introduction A one day Workshop on ‘Developing a National Strategy to Reduce the Harmful Use of Alcohol in Tune with the WHO Global Strategy’ was held at the India International Centre, New Delhi on 27th September 2010, organized jointly by the National Institute of Social Defence (NISD), Ministry of Social Justice & Empowerment, Govt. of India and Indian Alcohol Policy Alliance (IAPA) with technical support of the World Health Organization (WHO) – India Office. More than 60 officials and delegates representing different Stakeholders which include Government Ministries/Departments, National NGO’s and Professional Agencies participated in the Workshop. Inaugural Session The Workshop began with the Patriotic Song ‘Vandermataram’. The Hon’ble Minister of State for Social Justice & Empowerment, Govt. of India Mr. D. Napoleaon accompanied by the distinguished guests inaugurated the Workshop by lighting the traditional lamp. In his inaugural address the Hon’ble Minister Mr. D. Napoleon called for concerted and united efforts from the part of all Stakeholders towards addressing the problems related to alcohol use in the country. Renowned Social activist Swami Agnivesh in his keynote address urged the Government of India to adopt stringent strategies to wean away the harm inflicted by alcohol in the community. Mrs. Prurnima Singh IRS, Joint Secretary, Ministry of Social Justice & Empowerment reiterated the commitment of the Ministry in adopting and implementing the National Policy on Alcohol and Substance Abuse. Mr. Derek Rutherford (Chairman, Global Alcohol Policy Alliance) congratulated the Govt. of India and the WHO India Office for the invaluable support and efforts towards realizing the objectives of the WHO Global Alcohol Strategy. Adv. A. Sampath, Member of Parliament highlighted the significance of involving Trade Unions and Local Self Group Organizations in the campaign against alcohol harm. Dr. S. Arulrhaj (Chairman, IAPA & President, Commonwealth Medical Association) presided over the inaugural session. He reiterated the commitment of Indian Alcohol Policy Alliance in implementing the WHO Alcohol Strategy in India. Mr. Johnson J. Edayaranmula (Executive Director, IAPA) delivered the welcome address and Dr. Shanthi Ranganathan (Hony. Secretary, IAPA) proposed the vote of thanks. Prof. Nimesh G. Deasai was the master of ceremony.

Thematic Presentations Dr. T. P. Ahluwalia (Dy. Director General, Indian Council of Medical Research) chaired the Session. Three presentations on ‘Effective GO-NGO Coordination”, ‘Alcohol Harm in the Development Perspective’ and ‘Guidelines for a National Strategy’ was presented by Mr. Derek Rutherford (Chairman, GAPA), Mr. Oystein Bakke (Secretary, GAPA) and Dr. Kumar Rajan (National Consultant, WHO-India) respectively, which was followed by a brief question & answer session. Panel Discussion on National Strategy The Panel Discussion on National Strategy was chaired by Dr. J. S. Thakur (Cluster Focal Point, WHO-India). Dr. Shanthi Ranganathan (Member, WHO Expert Committee) and Dr. Rakesh Lal (Professor of Psychiatry, AIIMS) presented an overall view representing the NGO and GO sectors. This was followed by an open discussion in which delegates representing various agencies shared their views. Concurrent Working Groups on National Strategy The Panel Discussion was followed by Three Concurrent Working Group Sessions on (1) Advocacy and Prevention, (2) Treatment and Rehabilitation, and (3) Coordination and Networking. Ms. Monika Arora (Director, HRIDAY-SHAN & Trustee, IAPA), Dr. Shanthi Ranganathan (Secretary, TTRCRF, Chennai) and Mr. Tushar Sampat (Cyber Specialist, Pune) chaired and facilitated the Concurrent Working Groups. The Recommendations of the Working Groups are enclosed separately. Plenary Session The Recommendations of the Concurrent Working Groups were presented at the Plenary Session. This was followed by an open discussion in which the delegates actively interacted. Dr. Nimesh G. Desai (Director, IHBAS & Trustee, IAPA) and Dr. Atreyi Ganguli (Cluster Assistant, NCD, WHO-India) served as the Chair and Co-chair respectively. Valedictory Session Prof. (Dr.) Rajat Ray (Member, INCB & Chairman of the National Policy Drafting Committee of the Govt. of India) was the Chief Guest at the Valedictory Session. Dr. Ray presented an overview of the Indian situation and shared the various processes in the development of the National Policy on Alcohol and Substance Abuse Prevention. Mr. Morten Lonstad (Secretary General, FORUT Alcohol, Drugs & Development, Norway) delivered a special address. Mr. Derek Rutherford and Dr. S. Arul Rhaj shared their closing remarks. Mr. Vinod Varghese (Programme Manager, IAPA) proposed the vote of thanks. The National Consultative Workshop concluded with the National Anthem at 5.30 pm.

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RECOMMENDATIONS

Recommendations from Concurrent Working Groups Working Group on ‘Advocacy & Prevention’ Intensive mobilization and sensitization of all stakeholders on a development platform -

Community level State level National Level

Media advocacy using Television / Radio Involvement of Hero’s (Movie or Sports) as ambassadors of prevention campaigns Comprehensive ban on surrogate advertisement Intensive sensitization workshop at all platforms Promote school intervention programmes - Sensitize people about illicit alcohol and trade through Media Promote healthy life style Strengthen Government and NGO co-ordination towards advocacy Intensive Involvement of Youth and Women group in India Ensuring increased Human & Financial resources Advocacy on Scientific evidence based policy - Awareness creation workshop National co-ordination mechanism (One minister to co-ordinate) Common consensus among various Ministry (Involvement of Ministers and Parliamentarians) - Finance, Tourism, Information, HRD, Broadcasting, Health, Social Justice, Youth, Women, Panchayati Raj, Surface Transport Involvement of all stakeholders - Involvement of RWA, Faith Organization, Panchayat, Media Capacity building of stakeholders involved in preventive measure Sensitize vote bank to create Political will =================== 17

Working Group on ‘Treatment & Rehabilitation’ Treatment goal Strategies Research

: Total Abstinence : Should be clear : Should be on improvement of life quality

Components - Awareness about escape ‘Possibilities of treatment” should be conveyed - Treatment should be affordable and accessible - Dependents – too get help/treatment/counseling - For street users community programmes should be organized - Child centric advocacy should implement - Village centric intervention - Treatment should provide through primary health department (Special focus on people who use heavily occasionally, but not addicted) - Advocacy among prison inmates Treatment Components Easy treatment option should be available (based on dependency on alcohol) Evidence based therapy must be used (Yoga, Music and spiritual can be used) Family needs to be oriented and empowered Sensitization of Community Life skills training to prevent relapse. Networking with other agencies for vocational rehabilitation After Care Programme

: Alternative source of recreation

Treatment Team - A comprehensive team (Psychiatrist, Psychologist, Trained Physician, Social Worker, Family member, Recovering addict, volunteers, etc.) - Repeated training programmes for capacity building - Minimum standards to be established - Ethical standards to be established - Professionalism to be given more importance - Continuity of all programmes (regular funding from government, corporate and individuals) - Treatment outcome should be documented and evaluated on a regular basis - Programmes should be safe and with quality - Respect Human rights - Scaling up of service based upon experience

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Working Group on ‘Coordination & Networking’ Co-ordination and Networking being an ongoing activity and involving numerous stakeholders and various entities (including Govt.) need to use existing available technology to effectively engage all the stakeholders which shall result in greater exchange of ideas, experiences and discussions. The existing platform of http://addictionsupport.aarogya.com which was initiated by NISD and Ministry of Social Justice and Empowerment and also supported by UNODC can be easily used as such or modified to have an exclusive platform to strengthen coordination and networking. Such a clearing house can effectively cut down costs in co-ordination and networking whilst also increasing co-ordination and networking. WHO, NISD and IAPA, can create a committee to monitor its implementation. Numerous valuable and innovative initiatives can flow from such a platform. Such initiatives need to find a connect in the real world and linkages such as the addictionsupport.aarogya.com’s “Brick and Click” model may be adopted. Emphasis needs to be laid on all of IAPA’s activities percolating down at the local level and involving grassroots. Such an approach combined with effective utilization of the suggested platform could translate into a powerful advocacy group with due weight. Effective utilization of local language and mobile telephony (the suggested platform has proven use of two way sms obviating the need for knowledge of computers and internet) could be utilized to further co-ordination and networking objectives. A focused effort to impart need to know level of training on utilizing the recommended platform could act as a powerful multiplier. It is recommended to put in efforts to seek the active participation of all stakeholders using multiple methods the way UNDP’s Solutions Exchange and other popular social media platform have done. The group was of the opinion that specific co-ordination and networking possibilities are numerous and discussing them would be beyond the scope of the current group. This was because of the limited time available. The group therefore felt that the above suggestions would be the most appropriate and concrete form of recommendations which could, if implemented, vastly contribute to co-ordination and networking. With a view to translate such concurrent group discussions into concrete results, the group felt the need for time bound committed action and a quick start. The group offers to help with setting up of the recommended platform. xxxxxxxxxxxxxxxxx 19

LIST OF PARTICIPANTS

S. No.

Name

Organization

Hon'ble Shri. D. Napoleon

Hon'ble Minister of State for Social Justice & Empowerment, Govt. of India

Swami Agnivesh

Renowned Social Activist

Adv. A. Sampath, M.P.

Member of Parliament, (Lok Sabha)

Mrs. Purnima Singh, IRS

Joint Secretary, Ministry of Social Justice & Empowerment, Govt. of India

Mr. Chaitnya Murti

Director, NISD

Mr. M. Sunil Kumar

Dy. Director, NISD

Mr. Derek Rutherford

Chairman, GAPA

Mr. Oystein Bakke

Secretary, GAPA

Mr. Morten Lonstad

Secretary General, Alcohol, Drugs & Development

Dr. J. S. Thakur

Cluster Focal Point, WHO-India

Dr. Kumar Rajan

National Consultant, WHO-India

Dr. Atreyi Ganguli

Cluster Assistant, NCD, WHO-India

Prof. Rajat Ray

Member INCB & Head, Dept of Psychiatry, AIIMS

Dr. Rakesh Lal

Professor, AIIMS

Dr. T. P. Ahluwalia

Dy. Director General, ICMR

Mr. C. S. Pran

Programme Director, Nehru Yuva Kendra Sangathan

Dr. Rajesh Kumar

Director, SPYM / FINGODAP

Mr. Tushar Sampat

Cyber Specialist, Pune

Mrs. Prabhat Shobha Pandit

Secretary, All India Prohibition Council

Dr. S. Arul Rhaj

Chairman, IAPA & President, CMA

Dr. Shanthi Ranganathan

Hon. Secretary, IAPA

Dr. Vinay Aggarwal

Indian Medical Association &Trustee, IAPA

Dr. Nimesh G. Desai

Director, IHBAS & Trustee, IAPA

Ms. Monika Arora

Director, HRIDAY-SHAN & Trustee IAPA

Mr. Johnson J. Edayaranmula

Executive Director, IAPA

Mr. Surendra

All India Prohibition Council

Mrs. Chandra Prabha Pandey

All India Women's Conference

Mr. Balachandran

All India Women's Conference

Mr Srinivasa Vara Prasad V

Amardeep India

Mr. Abhijeet Roy

Association for Social Health In India (ASHI)

Ms Mamta Shrivastava

Association for Social Health In India (ASHI)

Prof. S. Singh

Bonded Labour Liberation Front (Bandhu Mukti Morcha)

Ms. Niharika Puri

Centre for Social Research

Mr. Surendra Kumar

Gandhi Peace Foundation

Dr. Ravinder Singh

Indian Council of Medical Research (ICMR)

Mr. Vishal Nayan

CAT – India Delhi Liaison Office

Mr. Devinder Bhagat

Indian Committee of Youth Organizations (ICYO)

Rev. Prasad Mathew

Mar Thoma Syrian Church

Mr. Jitin S. George

Mar Thoma Syrian Church

Dr. Kanchan Kapur

MUSKAN

Mr. Hemant Kumar

MUSKAN

Dr. Bharat Bhushan

Navjyoti India Foundation

Cmde. Sunil Minhas, VSM

National Cadet Corps

Ms. Anjna Masih

National Council of Churches in India

Mr. Rajiv John

National Council of YMCA’s of India

Mrs. Anuvrinda Varkey

National Council of YWCA’s of Delhi

Mr. Hemant Sharma

National Service Scheme (NSS)

Dr. S. K. Sahini

National Service Scheme (NSS)

Mr. Sambuddha Chakarborty

Nehru Yuva Kendra Sangathan

Mr. Bhuvnesh Jain

Nehru Yuva Kendra Sangathan

Mr. Vivek Nayan

Pradan, Jharkand

Mr. Niranjan Chichuan

Rajeev Gandhi Foundation

Mr. Sunil Kumar

Ramakrishna Mission

Mr. Vinod Varghese

Shikhar Development Foundation

Mr. A. B. Chattri

The Bharat Scouts & Guides

Mr. S S. Ray

The Bharat Scouts & Guides

Ms. Seema Gupta

Voluntary Health Association of India (VHAI)

Mr. H. R. Bangia

IAPA, Hony. Secretary, Haryana

L. .D. Sody Bascar

Ministry of Social Justice and Empowerment

Ms. Shipra Bisaria

IAPA, New Delhi