Monitoring of Alcoholic Monitoring of Alcoholic Beverages Consumption Beverages Consumption

in Thailandin Thailand

Gun ChernrungrojGun Chernrungroj M.D., M.P.H., Ph.D.M.D., M.P.H., Ph.D.Non-communicable Disease Information Non-communicable Disease Information Center, Department of Disease Control, Center, Department of Disease Control,

Ministry of Public Health, Thailand Ministry of Public Health, Thailand

Background Background

Alcohol use is embedded in Thai SocietiesAlcohol use is embedded in Thai Societies In 2004, about 20.8 Thai used alcoholic In 2004, about 20.8 Thai used alcoholic

beverages.beverages. Constraints on production and trade and Constraints on production and trade and

on consumption of alcohol have been on consumption of alcohol have been weakened.weakened.

Alcohol has become one of the most Alcohol has become one of the most important risk to health.important risk to health.

Public Health and Social Public Health and Social Problems Caused by Harmful Problems Caused by Harmful

Use of AlcoholUse of Alcohol Domestic violenceDomestic violence Unintentional injuriesUnintentional injuries Damage nearly every organs in the Damage nearly every organs in the

bodybodyand cause more than 60 diseases and and cause more than 60 diseases and conditionsconditions Alcohol dependenceAlcohol dependence Liver cirrhosisLiver cirrhosis InjuriesInjuries

Burden of alcohol in Burden of alcohol in ThailandThailand

The most recent burden of disease study The most recent burden of disease study in 2542 Disability-adjusted life year in 2542 Disability-adjusted life year (DALY)(DALY)

Death from alcohol = 17,000 deaths (4%) Death from alcohol = 17,000 deaths (4%) Death and Disability = 540,000 year Death and Disability = 540,000 year

(5.8%) (global = 4%) (developed countries (5.8%) (global = 4%) (developed countries = 9.2%)= 9.2%)

Alcohol is the second most risk factors Alcohol is the second most risk factors that causes death and disability in Thai that causes death and disability in Thai population population

Burden of alcohol in Burden of alcohol in ThailandThailand

Estimated economic lost by alcohol Estimated economic lost by alcohol in 2546 13,007 – 33652 million baht in 2546 13,007 – 33652 million baht

0.22 – 0.56 of gross domestic 0.22 – 0.56 of gross domestic product (GDP)product (GDP)

Why monitoring Alcohol Why monitoring Alcohol use?use?

Quantitative estimate magnitude of Quantitative estimate magnitude of health problems caused by alcohol.health problems caused by alcohol.

Detection of changes of population Detection of changes of population consumption.consumption.

Documentation of the distribution Documentation of the distribution and spread of alcohol consumption.and spread of alcohol consumption.

Evaluation of control and prevention Evaluation of control and prevention measuresmeasures..

Characteristic of a monitoring Characteristic of a monitoring (surveillance) system(surveillance) system

Research Surveillance

Information

Health Policies & Programs

influence

evaluate

ResearchResearch

What is the health problem caused by What is the health problem caused by alcoholic beverages?alcoholic beverages?

What is the risk of getting the What is the risk of getting the diseases by alcohol consumption?diseases by alcohol consumption?

How to prevent new drinker? How to prevent new drinker? What is the most effective measure to What is the most effective measure to

prevent and control alcohol prevent and control alcohol consumption?consumption?

Surveillance or MonitoringSurveillance or Monitoring

What is the size of the problem of What is the size of the problem of alcohol consumption in population?alcohol consumption in population? Morbidity Morbidity Current drinkerCurrent drinker

What is the burden of alcohol What is the burden of alcohol consumption to the population?consumption to the population?

Existing Program and Existing Program and PoliciesPolicies

Do the existing programs and Do the existing programs and policies can reduce the burden from policies can reduce the burden from use of alcohol?use of alcohol?

How do we know?How do we know?

Framework of IndicatorsFramework of Indicators for Alcohol for Alcohol

MonitoringMonitoring ProductionProduction

Amount of production (Department of excise)Amount of production (Department of excise) Local productionLocal production Number of alcohol manufactureNumber of alcohol manufacture

Individual Consumption Individual Consumption Population (survey)Population (survey) QualitativeQualitative

Abstainer Abstainer Current drinkerCurrent drinker

QuantitativeQuantitative Average amount of drinkAverage amount of drink

Sources of DataSources of Data Burden of Alcohol consumption (Multiple Burden of Alcohol consumption (Multiple

sources)sources) Morbidity from harmful use of alcoholMorbidity from harmful use of alcohol Tax revenue from the Department of ExciseTax revenue from the Department of Excise Number of alcohol manufacturersNumber of alcohol manufacturers National SurveyNational Survey

National Statistical OfficeNational Statistical Office Ministry of Public HealthMinistry of Public Health

National Health Examination SurveyNational Health Examination Survey Behavior Risk Factor Surveillance SystemBehavior Risk Factor Surveillance System

Situation of Production and Sell of Situation of Production and Sell of AlcoholAlcohol

2543 government stop monopolized 2543 government stop monopolized alcohol productionalcohol production

In 2547 In 2547 66 manufacturers (company) 66 manufacturers (company) 5943 groups of Distilled alcohol home 5943 groups of Distilled alcohol home

and cottage industryand cottage industry 1960 groups of Fermented home and 1960 groups of Fermented home and

cottage industrycottage industry

Situation of alcohol consumption in Situation of alcohol consumption in populationpopulation

Indirect methodIndirect method Total alcohol production/population Total alcohol production/population Underestimated Underestimated No data of local production, illegal brewing, No data of local production, illegal brewing,

smuggling and tourist alcohol. smuggling and tourist alcohol. Not account for tourist (20 million/year) and Not account for tourist (20 million/year) and

migrant labor (approx 3 million) (mostly migrant labor (approx 3 million) (mostly actively drink)actively drink)

In 2543: over produced before stop In 2543: over produced before stop monopolized market (in 2543 WHO & FAO monopolized market (in 2543 WHO & FAO reported: Thailand ranked No 5 in the world)reported: Thailand ranked No 5 in the world)

Production of Liquor and Beer 2537-Production of Liquor and Beer 2537-25472547

ปริ�มาณเคริองดื่มแอลกอฮอล�ที่� เสี�ยภาษี�ในปริะเที่ศไ ที่ย 2537-2547

557743 795 736 734 666 641 760

504

1185

1541

509 616 714863 950

666

1148 1149 1218

2506

00

500

1000

1500

2000

2500

3000

2537 2538 2539 2540 2541 2542 2543 2544 2545 2546 2547

ปริ�มา

ณ(ล�าน

ล�ตริ

)

เหล้�าเบี�ยร์�

ปร์ มาณยอดจำ�าหน่�ายสุ�ร์าร์ะหว่�างป� ปร์ มาณยอดจำ�าหน่�ายสุ�ร์าร์ะหว่�างป�2530- 2540 (2530- 2540 (ล้�าน่ล้ ตร์ล้�าน่ล้ ตร์), ), ปร์ มาณสุ�ร์า ปร์ มาณสุ�ร์า

เบี�ยร์�แล้ะแอล้กอฮอล้�ที่�!คน่ไที่ยที่�!อาย� เบี�ยร์�แล้ะแอล้กอฮอล้�ที่�!คน่ไที่ยที่�!อาย� 15 15 ป�ขึ้%&น่ไปบีร์ โภคต�อคน่ต�อป� ป�ขึ้%&น่ไปบีร์ โภคต�อคน่ต�อป� ((ล้ ตร์ต�อคน่ต�อล้ ตร์ต�อคน่ต�อ

ป�ป�))

0

100

200

300

400

500

600

700

800

900

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

mil

lio

n l

iter

s

0

5

10

15

20

25

lite

r p

er p

erso

n

spirit consumption(million litres)

spirit

Beer

pure alcohol

DirectDirect Survey in populationSurvey in population Definition, questionnaire, and Definition, questionnaire, and

methodology of survey. methodology of survey. Prevalence of current drinker, abstainer, Prevalence of current drinker, abstainer,

binge drinkerbinge drinker Average amount and frequency of Average amount and frequency of

alcohol drinking (per week/ per year)alcohol drinking (per week/ per year)

Survey related to Alcohol Survey related to Alcohol consumption in Thailand consumption in Thailand

Survey of tobacco and alcohol Survey of tobacco and alcohol consumption by National Statistical consumption by National Statistical OfficeOffice

National Health Examination Survey National Health Examination Survey by MOPHby MOPH

Behavior Risk Factor Surveillance Behavior Risk Factor Surveillance System by MOPHSystem by MOPH

Major indicators in SurveysMajor indicators in Surveys

Tobacco & Tobacco & Alcohol Alcohol

SurSur

NHENHE BRFSSBRFSS

Current Current drinkerdrinker

√√ √√ √√

Binge Binge drinkerdrinker

√√ √√

Average Average drink/weedrink/weekk

√√ √√

Drink and Drink and drive/ridedrive/ride

√√ √√

DefinitionDefinition

Alcohol consumption Alcohol consumption Individual practices with respect to use Individual practices with respect to use

of alcoholic beverages of all types of alcoholic beverages of all types including beer, wine, fortified wine, and including beer, wine, fortified wine, and distilled spirit. distilled spirit.

AbstainerAbstainer absence of alcohol use as a lifelong absence of alcohol use as a lifelong

practicepractice

Quantities of Alcohol Quantities of Alcohol consumptionconsumption

Amount of Alcohol in different type of Amount of Alcohol in different type of beveragesbeverages

Type Type Ethanol content Ethanol content (%)(%) Thai BeerThai Beer 5 - 6 (USA 3.5)5 - 6 (USA 3.5) Hard liquor 28 - 40Hard liquor 28 - 40 WineWine 12 - 1312 - 13

Definition of alcohol useDefinition of alcohol use

AbstainerAbstainer Current drinkerCurrent drinker Ex-drinkerEx-drinker Binge drinkerBinge drinker Average of consumption per weekAverage of consumption per week Standard DrinkStandard Drink

Number of current drinker, age > 15.Number of current drinker, age > 15. 2534 - 2547 2534 - 2547 (million)(million)

จำ!านวนผู้$�ดื่มสี%ริาหริอเคริองดื่มม'นเมา

12.4 13.7 15.3 16.15

10.5 11.9 13 13.57

1.8 1.7 2.3 2.57

0

5

10

15

20

2534 2539 2544 2547 2547(HE)

ป(

จำ!านวนผู้

$�ดื่ม(ล�านคน)

total

male

female

ริ�อยละของผู้$�ดื่มสี%ริาพ. ศ2534-2547

31.5 31.6 32.6 32.742.32

53.7 55.4 55.9 55.5 58.6

9.5 8.1 9.8 10.326.93

0

20

40

60

80

2534 2539 2544 2547 2547(HE)

ป(

ริ�อยละ(ความชุ%ก)

total

male

female

Prevalence of Current Drinker,Prevalence of Current Drinker,

age > 15, 2534 - 2547age > 15, 2534 - 2547

Morbidity caused by alcoholMorbidity caused by alcohol

Reported cases of alcoholic liver Reported cases of alcoholic liver diseasedisease

Other alcohol related diseases and Other alcohol related diseases and injuriesinjuries Multiple causesMultiple causes

Number of Alcoholic liver diseases 2539 - Number of Alcoholic liver diseases 2539 - 25452545

จำ!านวนผู้$�ป,วยในที่�ไ ดื่�ริ-บการิว�น�จำฉั-ยว0าเป1นโริคต-บจำากแอลกอฮอล� 2539-2545

72247821

6920

83219123

9961

11345

0

2000

4000

6000

8000

10000

12000

2539 2540 2541 2542 2543 2544 2545

ป((พ.ศ.)

จำ!านว

นผู้$�ป,ว

ย

ร์าย

ริ�อยละของการิบาดื่เจำ3บที่�เก�ยวข�องก-บการิใชุ�เคริองดื่มแอลกอฮอล�

จำ!าแนกตามสีาเหต%สี!าค-ญ ป( 2543-2547

2543 2544 2545 2546 2547

อ%บ-ต�เหต%การิขนสี0ง 32.8 33.6 33.6 33.2 38.6

อ%บ-ต�เหต%พล-ดื่ตกหกล�ม 8.1 8.9 9.2 9.5 9.6

การิต-5งใจำที่!าริ�ายตนเอง 20.6 20.9 20.8 22.8 21.3

การิถู$กที่!าริ�าย 50.9 51.1 52.1 60.6 58.4

อ%บ-ต�เหต%แริงเชุ�งกลว-ตถู%สี�งของ 6.5 5.9 6.8 7.3 7.3

Summary of SituationSummary of Situation

Alcohol production and consumption Alcohol production and consumption are on the rise and very rapid in are on the rise and very rapid in most recent years.most recent years.

Disease and Injuries related to Disease and Injuries related to alcohol consumption have been alcohol consumption have been rising.rising.

Both number of drinkers and amount Both number of drinkers and amount of alcohol are also increase.of alcohol are also increase.

Future work for effective Future work for effective alcohol monitoring systemalcohol monitoring system

Increase standard and method of Increase standard and method of alcohol production data collection.alcohol production data collection.

National standard of definition of National standard of definition of alcohol consumption and survey alcohol consumption and survey methodology.methodology.

Strengthening evidence for sound Strengthening evidence for sound policy development.policy development.

More analysis for special groups of More analysis for special groups of concern: who are affected the most? concern: who are affected the most?