APN Symposium. Emanuele Scafato

1. Recent experiences with barriers for public health-
oriented alcohol policies: ITALY
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

2. AWARH 2021 , 9th EDITION
S A F E R
Un'Europa più sicura
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

3. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
https://www.epicentro.iss.it/alcol/settimana-europea-alcol-2021

4. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

5. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

6. ◼NATIONAL HEALTH PLAN
◼LAWS and REGULATIONS, Law 125/2001
◼NATIONAL ALCOHOL AND HEALTH PLAN
◼Gain Health Program
ALCOHOL : the framework for action in ITALY

7. National PREVENTION plan
(Nat. Plan Alcohol and Health)
Program Gain Health
NATIONAL HEALTH PLAN
Piano Sanitario Nazionale
Alimentazione
Fumo
Attività fisica
Alcol
Italian strategies and health policies
Frame Law 125/2001

8. The Frame Law on Alcohol (nr 125/2001)
All over Europe, the 2001 n. 125 Italian
law represented a unique example of
implementation and full endorsement of
the WHO European Alcohol Action Plan
and of the European Charter on Alcohol
main principles reported in
the Italian frame Law at the
art. 2 as the aims of the law.

9. CHARTER ENDORSEMENT IN ITALY
FROM PRINCIPLES TO RIGHTS

10. ITALY. Alcohol policy development towards National
planning driven by WHO EAAP and EU strategy

11. The National Health Plan
• Promoting healthier lifestyles and habits (life skills);
• Tackling misleading risk-taking cultures;
• Improving settings (family, schools, communities);
• Strengthening health protection of the vulnerable groups;
• Decreasing “gradients” within and between groups (inequalities in
health) and reduce harm;
• Ensuring a wider range of initiatives devoted at the early detection of
alcohol abuse.
A National Prevention Plan is agreed by the STATE-REGIONS Conference mostly leaving to the
regional autonomies the setting and the implementation of Regioanl plans, strategies and
programs that are ONLY oriented by the National Health Plan.

12. Strategic areas of intervention
1. Information and education
2. Drinking and driving
3. Alcohol and work
4. Treatment of harmful/hazardous alcohol consumption
and alcohol dependence
5. Production and distribution’s responsibility
6. Social network to face risk factors alcohol related
7. Strengthening NGOs, voluntary organizations, self-help
and mutual aid groups
8. Monitoring harm done by alcohol and strengthening
alcohol policy
National Alcohol and Health Plan (PNAS)

13. ALCOHOL - ASSESSMENT & MONITORING
ISS-WHO CC FORMAL ROLES

14. http://www.epicentro.iss.it/alcol
INCREASING AWARENESS
ALCOHOL PREVENTION DAY 2001-2021

15. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
FINE !!!
SO WHAT PART OF THE
MISSION WENT BAD?
Which barriers were met for
public health-oriented
alcohol policies ?

16. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

17. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
SAFER : are the “best buys” affordable ?

18. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
ITALY - Alcohol policy scores
Low scores on pricing, marketing, health services response, prevent intoxication

19. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
ITALY - Alcohol policy scores

20. 9,7
23,6
2020
BES-ISTAT

21. COVID-19 & ALCOHOL :
How is going after the lockdown?
Rise in hazardous drinkers (M+F)

23. 2.45
2.66
2.48
2.30
2.19
1.67
1.93 1.87 1.90
1.74 1.83
1.46
1.80
1.12
1.21 1.29
0.98
1.11
0.83
1.12
0.94 0.94 0.87
0.97
0.80
0.94
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Men Women

24. Prevalent increase of alcohol frequency and volume consumption (Italy, 2020)
among drinkers already harmful
A rischio Low risk
33.58%
66,42%
65,92%
34,08%
A rischio
36.80
%
63,20
%
71,64
%
28,36
%
Low risk
Frequency Quantity
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
European SURVEY Alcohol consumption during the COVID-19 pandemic in Europe: Preliminary results for ITALY
European
Study
Group
on
Alcohol
use
during
the
COVID-19
pandemic

25. Health Services & COVID-19 :
unprepared and not ready
Thousand of new diagnosis, as
well as old and new treatments
and controls missed the
opportunity to acces any form of
prevention and are still waiting
health services reorganization to
ensure the continuity of care and
needed changes to avoid
problematic management of the
provision of care to Non-COVID
chronic and acute disease,
mental health and particularly for
Alcohol Use Disorders

26. COVID impact on mental health : increase from 6 % to 17 %
ALCOHOL as a main cause
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

27. ALCOHOL POLICIES in the post- COVID era
FILLING THE GAPS in Alcohol policy scores
López-Pelayo et al. BMC Medicine (2020) 18:241 ; E. Scafato et al. ALCOLOGIA 40/2020

28. Usually the key messages industry
players are used to advance with policy
makers are
1. drinkers are responsible of their
own alcohol related risk and harm
2. responsible drinking promoted by
industry is the key to educate
drinkers and prevent harm
3. tax increases or price policies dont
reduce alcohol harm
4. Availability and affordability policies
dont affect alcohol harm
5. alcohol policies are not needed
INFORMATION & ALCOHOL INDUSTRY : very far from “less is better”

29. CONSUMERS : 49 % want information
16 % declare intention to REDUCE drinking
on the basis of this information

30. Labelling effects on wine industry
Mandatory nutrition labelling will have several effects on the wine industry.
Producers' expectations of consumer reactions largely agree with the findings
of recent qualitative studies focusing on wine consumers. While nutritional
information is unlikely to have an effect on consumer demand, the listing of
ingredients is likely to create consumer confusion and uncertainty,
weakening wine's image as a natural product.
“This creates the opportunity for some wineries to focus on clean labelling
strategies by completely avoiding additives that require labelling.
From a production point of view, mandatory nutrition labelling is likely to
• increase costs due to changes in oenological practices,
• the increased need for laboratory analyses and
• more challenging labelling processes.
Large wineries are better informed, and likely to be better equipped, to react to
labelling changes”.
E. Pabst et al. / Wine Economics and Policy 8 (2019) 103-113

31. SELF-REGULATION vs REGULATION
Is not an option to follow mandatory indications

32. 670.000 harmful consumers (+18 yrs) are the top priority in order to prevent the higher risk of
premature mortality by cancer , liver cyrrosis and traffic accidents
Europe’s Beating Cancer Plan target “to reduce by 10% the number of alcohol
harmful consumers within 2025 has been disputed by wine industry “

33. BEAT CANCER : decrease alcohol consumption VS harmful use
How to balance ? Which message for prevention?
???

34. EU BEAT CANCER PLAN : IS THERE ROOM FOR DIALOGUE ?
How can alcohol industry compromise on alcohol prevention when it comes to legal obligation to
its shareholders to maximize profits ?

35. The alcohol industry can be a major barrier
to a public health oriented action plan on alcohol

36. In March, one among the Italian associations of wine
producers issued a communication encouraging people
to consume “moderate” amounts of wine that would
supposedly protect against coronavirus infection. The
idea was that wine could help disinfect the mouth and
throat.
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
COVID-19 and corporate social responsibility in communication
ITALY – March 12, 2020

37. The fight against the FAKE NEWS on ALCOHOL & COVID-19
A number of initiatives mainly disseminated
by mean social media and web pages tried to
spread FAKE NEWS on the preventive
properties of alcohol on COVID. In Italy the
fake messages were disseminated mainly by
some wine associations and grappa cantines
suddenly tackled by specific campaignes by
ISS- Istituto Superiore di Sanità and by the
Ministry of Health also translating and
adapting visuals and documents by WHO
EURO as a response to the huge problem
worldwide .
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

38. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
ALCOHOL, COVID-19 and FAKE NEWS debunking

39. NATIONAL HEALTH SERVICES’ RESPONSE
EIBI-IPIB

40. E. SCAFATO, ISS CNAPA 22/10/2013 Luxemburg
http://www.amphoraproject.net/w2box/data/e-book/AMPHORA%20ebook.pdf

41. ALCOHOL & MENTAL HEALTH & ACCESS TO SERVICES
Criticism: preparedness – readiness
Waiting for reorganization of
SERVICES belonging to the
National Health System network
and a SHIFT towards much more
appropriate model enabling the
early identification of harmful
drinkers and those in need to
treatment, currently more than
90 % never identiifed and never
referred to any clinical
competence.
STIGMA but also lack in medical
training culture undermine what
can help people be supported in
thei need to change
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

42. Early Identification and Brief Intervention EIBI – (IPIB)
NOT MANDATORY – NO FUNDING
EIBI - IPIB
TRAINING PROGRAM

43. SCREENING AND BRIEF INTERVENTION as investment for health – ITALY
A MISSED OPPORTUNITY

44. MEAN BARRIER
THE NEED FOR FUNDING ALCOHOL RESEARCH ON ALCOHOL PREVENTION…

45. Conclusions
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
The overall experience is that industry use its
influence to obviously ensure increasing profits for
their shareholders and invest its economic power
often prevailing on policy making. From a public
health perspective this represents the real
challenge to try to push for a much more balanced,
sustainable approach feeding cost effective
measures to reduce harms due to alcohol
consumption.

46. Collaborating with alcohol industry it’s OK ?
Is it possible to collaborate with alcohol industry on common targets ?
Is it possible to create a loyal dialogue ?
Is it possible … ?
Everything is possible BUT…
The need to address and tackle the alcohol industry interference in Public
Health policy development will be always on board, the only way is to invest
into a new way of policy making, much more aware of the role that
prevention must play*
*Partnering with alcohol industry on public health is not okay, WHO says.
BMJ 2019;365:l1666 doi: 10.1136/bmj.l1666 (Published 9 April 2019)

47. Outcomes for the Third Millennium
INVESTING FOR HEALTH
• H. EDUCATION
• H. PREVENTION
• H. PROTECTION
• SOCIAL INFLUENCE
• FACILITATION
• ADVOCACY
EMPOWERMENT & PARTECIPATION
Rome ISS 1999

48. The need for RENEWING the challenge
for the FUTURE is STILL ...
INVESTING FOR HEALTH

49. NOTHING IS IMPOSSIBLE,
…. but usually takes more time from “I can’t do it” to “I did it” !
Learning from the mistakes of others , time is running…
Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità

50. Osservatorio Nazionale Alcol – WHO CC ITA-79 – Istituto Superiore di Sanità
Grazie per l’attenzione
scafato@iss.it alcol@iss.it