Meeting to Develop a Standardized Tax Share Indicator for Alcoholic and Sugar-Sweetened Beverages (Washington, D.C., 24-25 July 2018)

[Executive summary]. Noncommunicable diseases (NCDs) are a major driver of morbidity and mortality in the Region of the Americas. They represent a major public health challenge that undermines social and economic development. The WHO Global Action Plan for Prevention and Control of Noncommunicable Diseases 2013-2020, endorsed by the 66th World Health Assembly, provides a road map and a menu of policy options. It recognizes implementing taxes on unhealthy products associated with NCDs—namely tobacco, alcoholic beverages, and sugar-sweetened beverages (SSBs)—as one of the most cost-effective regulatory policies to prevent NCDs. Although, the World Health Organization (WHO) does calculate and publish biennially a standardized and comparable indicator on tobacco taxation for all Member States, it does not count with comparable measurements of taxation on alcoholic beverages and SSBs. Such measurements are necessary to monitor tax policies, analyze trends and establish best practices in using taxation for NCD prevention. Since 2016, the Department of Noncommunicable Diseases and Mental Health (NMH) of the Pan American Health Organization/World Health Organization (PAHO/WHO) has worked towards addressing the gap measuring progress on alcoholic beverages and SSBs taxation in the Americas. NMH collected country-level information on prices as well as tax legislation and developed a methodology for calculating a tax share indicator. This indicator, estimating the share of total and excise taxes in the price of alcoholic beverages and SSBs, was calculated for ten countries. In order to receive feedbacks on its proposed methodology, discuss the progress and challenges in monitoring and evaluating taxation policies, and establish a roadmap to periodically collect tax legislation and prices and calculate the tax share for alcoholic beverages and SSBs in the Americas, NMH convened researchers and ministries of finance personnel for a two-day meeting in July 2018, in Washington D.C. The participants provided inputs on how to strengthen the proposed tax share indicator to adequately capture the intricacies, unique characteristics, and regional consumption patterns of these products. These valuable inputs will help to improve the methodology and facilitate future efforts to develop a standardized and comparable tax share indicator for alcoholic beverages and SSBs.

Antecedentes acerca de la reglamentación y el seguimiento de la comercialización de las bebidas alcohólicas para la protección de la salud pública

En este documento se presenta la evidencia relativa a los argumentos a favor de la reglamentación de la comercialización de las bebidas alcohólicas; asimismo, se muestran elementos claves que los países pueden considerar en la planificación, la formulación, la aplicación y la evaluación de la reglamentación eficaz. Se expone también el lenguaje legislativo que podría ayudar a los gobiernos a modificar las leyes vigentes y a llevar a la práctica los mecanismos de seguimiento. Este documento complementa el informe elaborado por la Organización Panamericana de la Salud (OPS) luego de una reunión inicial acerca de la reglamentación del alcohol, celebrada en enero del 2015. Por otro lado, se apoya firmemente en la Estrategia mundial para reducir el uso nocivo del alcohol, emanada de la Organización Mundial de la Salud (OMS); en el subsiguiente Plan de acción para reducir el consumo nocivo de alcohol, aprobado por la OPS, y en los planes de acción de la OMS y la OPS para la prevención y el control de las enfermedades no transmisibles, en resoluciones de la OPS sobre la salud y los derechos humanos y en la Estrategia sobre legislación relacionada con la salud. La primera versión fue elaborada por técnicos de la OPS y presentada en una reunión que tuvo lugar en julio del 2016, con expertos y representantes de varios Estados Miembros. Después de la reunión, el documento fue modificado en detalle por funcionarios de la OPS, a fin de incorporar las recomendaciones formuladas por los participantes.

PAHO Meeting on Alcohol Marketing Regulation. Final Report. / Reunión de la OPS sobre reglamentación de la comercialización del alcohol. Informe Final

Scope and Purpose An exploratory international meeting on regulation of marketing* of alcohol products** was held at the Pan American Health Organization (PAHO) headquarters in Washington, D.C., USA, 12–13 January 2015. The objectives of the meeting were to summarize the research on the effects of alcohol marketing on young people; review existing statutory and self-regulatory codes on marketing and examine their effectiveness; consider the implications of international trade agreements and other treaties for developing a global alcohol marketing code; and describe the experience of countries where alcohol marketing legislation has been recently enacted or proposed. Participants, including experts on tobacco control, food and nonalcoholic beverages, trade agreements, and health policy, as well as staff from nongovernmental organizations (NGOs), country offices, and World Health Organization (WHO) headquarters in Geneva, formulated key concepts on the way forward, based on the Global Strategy to Reduce the Harmful Use of Alcohol passed by the World Health Assembly in May 2010 (Resolution WHA63.13) and the Regional Plan of Action to Reduce the Harmful Use of Alcohol passed by PAHO’s 51st Directing Council in September 2011 (Resolution CD51.R14).

Reunión de la OPS sobre reglamentación de la comercialización del alcohol. Informe Final / PAHO Meeting on Alcohol Marketing Regulation. Final Report

[Alcance y propósitos]. Durante los días 12 y 13 de enero de 2015 se celebró una reunión exploratoria internacional en la sede de la Organización Panamericana de la Salud (OPS), en Washington, D.C. (EUA), con los siguientes objetivos: resumir los resultados de investigación sobre los efectos de la comercialización* del alcohol** en los jóvenes; revisar los códigos estatutarios y auto-reguladores en materia de comercialización y analizar su efectividad; considerar las implicaciones de los convenios de comercio internacionales así como de otros tratados a fin de desarrollar un código global de comercialización del alcohol, y describir las experiencias de aquellos países donde se ha promulgado o propuesto recientemente una legislación relativa a la comercialización del alcohol. Los participantes de la reunión, en que se incluyeron expertos en el control de tabaco, alimentos y bebidas no alcohólicas, acuerdos comerciales y políticas de salud, además de funcionarios de organizaciones no gubernamentales, la sede de la OMS en Ginebra y las representaciones de los Estados Miembros de la OPS, formularon puntos claves para seguir adelante, basados en la Estrategia mundial para reducir el uso nocivo del alcohol que fuera aprobada por la Organización Mundial de la Salud (OMS) en mayo de 2010 (Resolución WHA63.13) y en el Plan de Acción Regional para Reducir el Consumo Nocivo de Alcohol aprobado por el 51˚Consejo Directivo de la OPS celebrado en septiembre de 2011 (Resolución CD51.R14).

Cuidados de compaixão: regulação da maconha medicinal nos Estados Unidos da América / compassionate care: regulation of medical marijuana in the United States of America

Trata-se de uma revisão integrativa de vinte e seis artigos acadêmicos publicados entre 2010 e2014, em revistas indexadas e revisadas por pares, que examinaram a relação entre aprovaçãode leis de maconha medicinal nos Estados Unidos e agravos à saúde pública locais. São abordadasas motivações que levaram cientistas sociais a pesquisar as repercussões da regulaçãoda maconha medicinal para a sociedade. As buscas realizadas em cinco bases de dados possibilitarama identificação dos efeitos mais relevantes das mudanças legislativas estaduais e dareforma política federal de 2009, que impulsionou a comercialização de maconha medicinal,sobre a saúde pública. Especificamente, a revisão se concentra sobre taxas de mortalidade poroverdose de analgésico opióide, taxas de suicídio, taxas de acidente de trânsito com vítimasfatais, taxas de criminalidade, potência da maconha, desvio de maconha medicinal para adolescentes,exposições pediátricas não intencionais à maconha e prevalência de uso de maconhailegal. Admite-se que a maconha poderá ressurgir como opção terapêutica no tratamentopaliativo e complementar de um grande escopo de condições de saúde crônicas e terminais.No senso comum brasileiro, a maconha permanece vinculada ao crime, e o uso fitoterápico daerva in natura, assim como de seus extratos vegetais, carregado de estigma. Os achados destarevisão, entretanto, não sustentam os fundamentos que apoiam a validade de algumas preocupaçõespúblicas comumente relacionadas com a regulação da substância, como a exacerbaçãode crimes violentos. Na verdade, seus resultados surpreendem ao demonstrar evidências deque leis de maconha medicinal podem reduzir a violência, o suicídio, a overdose de analgésicoopióide, o uso de álcool e os danos de saúde pública a ele associados.

This is an integrative review of twenty-six academic studies published in indexed and peer-reviewedjournals, between 2010 and 2014, that examined the relations between medical marijuanalaws approval in the United States and local public health associated harms. It addressesthe motivations that led social scientists to research the impacts of medical marijuana regulationon society. The searches were carried out in five databases, allowing to identify the mostrelevant effects of state legislative changes and the 2009 federal policy reform, which boostedmedical marijuana sales, on public health. Specifically, this review focuses on opioid analgesicoverdose mortality rates, suicide rates, traffic fatality rates, crime rates, marijuana potency,medical marijuana diversion among teenagers, unintentional marijuana pediatric exposuresand prevalence of illegal marijuana use. It is assumed that marijuana may resurface as a treatmentoption in palliative and complementary care for a wide scope of chronic and terminalhealth conditions. Historically and culturally, brazilians associate marijuana as linked to crimeand therefore stigmatize it regardless of whether the substance appears as herbal or as plantextracts. However findings from this review do not support the fundamentals that reinforcethe validity of some public concerns commonly related to marijuana regulation, such as theexacerbation of violent crimes. Surprisingly, its results in fact show evidence that medicalmarijuana laws may reduce violence, suicide, opioid analgesic overdose, alcohol use and publichealth harms associated with it.

Policies for alcohol restriction and their association with interpersonal violence: a time-series analysis of homicides in Cali, Colombia.

BACKGROUND: Cali, Colombia, has a high incidence of interpersonal violence deaths. Various alcohol control policies have been implemented to reduce alcohol-related problems. The objective of this study was to determine whether different alcohol control policies were associated with changes in the incidence rate of homicides. METHODS: Ecologic study conducted during 2004-08 using a time-series design. Policies were implemented with variations in hours of restriction of sales and consumption of alcohol. Most restrictive policies prohibited alcohol between 2 a.m. and 10 a.m. for 446 non-consecutive days. Moderately restrictive policies prohibited alcohol between 3 a.m. and 10 a.m. for 1277 non-consecutive days. Lax policies prohibited alcohol between 4 a.m. and 10 a.m. for 104 non-consecutive days. In conditional autoregressive negative binomial regressions, rates of homicides and unintentional injury deaths (excluding traffic events) were compared between different periods of days when different policies were in effect. RESULTS: There was an increased risk of homicides in periods when the moderately restrictive policies were in effect compared with periods when the most restrictive policies were in effect [incidence rate ratio (IRR) 1.15, 90% confidence interval (CI) 1.05-1.26, P = 0.012], and there was an even higher risk of homicides in periods when the lax policies were in effect compared with periods when the most restrictive policies were in effect (IRR 1.42, 90% CI 1.26-1.61, P < 0.001). Less restrictive policies were not associated with increased risk of unintentional injury deaths. CONCLUSION: Extended hours of sales and consumption of alcohol were associated with increased risk of homicides. Strong restrictions on alcohol availability could reduce the incidence of interpersonal violence events in communities where homicides are high.

Sponsorship of physical activity programs by the sweetened beverages industry: public health or public relations?

The growing evidence on the association between consumption of sugar-sweetened beverages, obesity and other chronic diseases has highlighted the need to implement policy actions that go beyond programs exclusively focused on individual responsibility. In order to protect their commercial goals in Latin America, the sugar-sweetened beverage industry practices intense lobbying at high government levels in several countries across the region. This strategy is accompanied by corporate social responsibility programs that fund initiatives promoting physical activity. These efforts, although appearing altruistic, are intended to improve the industry's public image and increase political influence in order to block regulations counter to their interests. If this industry wants to contribute to human well being, as it has publicly stated, it should avoid blocking legislative actions intended to regulate the marketing, advertising and sale of their products.

Alcohol and drug consumption, depressive features, and family violence as associated with complaints to the Prosecutor's Office in Central Mexico.

The article is aimed at reporting the characteristics of the population detected at State Prosecutors' Offices including the two such offices that existed in the city selected for the study, one located in a general hospital for the inspection of violence-related cases (n = 156); and the second in the facility where all detainees are taken when arrested (n = 129), and where victims can file a complaint (n = 186). A household survey undertaken among the population 18 to 65 years of age (n = 887) was used as a group of reference. Both studies were undertaken in Pachuca City, the capital of Hidalgo, located 100 km from Mexico City during the second half of 1996. Face-to-face questionnaires were used to obtain sociodemographic data, drug use and drinking patterns, depressive symptomatology, and family violence. Discriminant and logistic regression analysis were undertaken. The age group from 18 to 24 displayed the highest number of legal complaints and arrests (OR = 1.773). The likelihood for appearing at a State Prosecutor's Office was higher for those living in an atmosphere of threats and injuries within the family (OR = 19) and for those that reported alcohol consumption on the day of the event (OR = 14). Extremely high rates of family violence were obtained in this sample, increasing the likelihood of arriving at the Prosecutor's Office either because arrested or for being a victim. Results confirm the relationship between alcohol use, depression, and violence, reinforcing the need to prevent alcohol abuse, especially among youth.

A partial ban on sales to reduce high-risk drinking South of the border: seven years later.

OBJECTIVE: On weekend evenings, thousands of youths (ages 20 and younger) and young adults (ages 21-25) residing in communities along the U.S. border cross into Mexico to patronize all-night bars where the drinking age is 18, rather than 21, and where the price of alcohol is considerably less than in the United States. On January 1, 1999, Juárez, Mexico, implemented a 2 AM (instead of 5 AM) bar-closing policy. The number of crossers and their blood alcohol concentration levels on return were reduced in the year following this policy change. The present study's objective was to determine the long-term (7-year) effect of the earlier-closing bar policy on cross-border drinking in Mexico. METHOD: Analyzed data (1998 to August 2005) were from quarterly breath-test surveys at the El Paso (Texas)/Juárez (Mexico) border, bar observations in Juárez, and trauma data in El Paso. RESULTS: Bar surveys in Juárez show that the 2 AM closing policy, initiated 7 years ago, continues to be enforced, as has the reduction (89%) in youthful crossers returning after 3 AM. The number of underage youths returning earlier in the evening (before 3 AM), however, unchanged for 2 years after the policy change, has doubled recently. CONCLUSIONS: The early closing of bars in Juárez has a continuing positive impact on the reduction of the number of those returning after 3 AM. Although initially there appeared to be no displacement of the late returnees into the early hours (before 3 AM), the number of bar visitors crossing and returning earlier has been steadily increasing. Suggestions for reducing cross-border heavy episodic drinking are described.