7.7 PUBLIC HEALTH ACTIONS From a public-health perspective, anti-smoking campaigns should focus on passive exposure to tobacco products. Here, the most effective solution is the so-called smoke-free environment, i.e., smoking is forbidden everywhere except for (few) designated smoking zones. Overall, the most effective steps to reduce both smokers and passive exposure are (in descending order from the most effective): 1) smoke-free environment 2) maximizing the price and increasing it regularly (through the excise tax) 3) uniform packaging (dominating pictorial warning, unsightly graphic appearance with hardly recognizable manufacturer and type of cigarettes – brand minimization) 4) completely “hiding” the products (this is a combination of a total ban on tobacco advertising, sponsorship by tobacco companies, and the imposition of the tobacco products themselves, so that they are not visible at all as if they did not exist). This can be complemented by a ban on selling tobacco products to people younger than 18. As usual in the field of public health, the main steps include creating effective legislation. Society can also be protected by timely health education – lecture events for children and youth along with educational campaigns for adults focused on non-smoking and healthy lifestyle. In general, a drug-free life is the optimal and desirable option.
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8
ALCOHOL OVERCONSUMPTION
Drinking alcoholic beverages is nowadays very popular for induction of euphoria, higher self-esteem, and loss of one’s inhibitions. The consumption is linked with enhancing gastronomic delights and supporting sociability. Nevertheless, regular drinking leads to addiction. Alcoholism has negative consequences not only for the addicted but also for his/her family, community, and the whole society. Alcohol consumption causes a variety of acute and chronic health problems. According to the WHO, alcohol kills up to 2.5 million people per year, including 320,000 young people aged 15–29 years, and is thus responsible for 4 % of all deaths. Alcohol consumption in the population has various forms – from complete abstinence to regular “heavy” drinking. Acute intoxication (drunkenness, inebriation) can be confirmed by toxicological examination of a blood sample. According to Kalina, intoxication can be classified into 6 phases (as shown below). Individual tolerance varies significantly and depends on genetic factors, body composition, frequency of consumption, and doses. 1. Alcoholic excitation (< 0.99 ‰): The person is talkative, slightly euphoric. From 0.08 ‰, people are not able to drive safely. 2. Mild intoxication (1.0–1.49 ‰): The person is talkative, euphoric, and has higher selfesteem. Psychomotorics are already affected by alcohol – reaction time is prolongated, ataxia and nystagmus can occur. 3. Moderate intoxication (1.5–1.99 ‰): Psychomotorics are significantly impaired, coordination disorders, slowing of movements, and worsening of concentration can occur. Other symptoms, including emotional lability (emotions can be positive or negative), overall inhibition, and loss of inhibitions can in extreme cases result in aggression, including suicide. 4. Heavy intoxication (2.0–2.99 ‰) manifests as dysarthria, impaired balance (inability to walk), mental disorders, severe behavioral disorders (aggression), or vomiting. 5. Very heavy intoxication (3.0–3.99 ‰): The person suffers from severe disorders of consciousness, slow and shallow breathing, and non-responsiveness to stimuli. Arrhythmia and respiratory or circulation failure can occur. 6. Risk of lethal intoxication (> 4.00 ‰), coma. The lethal dose for 50 % of the population is 5 ‰. Risky drinking is associated with chronic health impairment. This means intake higher than 350 g of ethanol (35 unit) per week in men and 210 g (21 units) per week in women. One unit is an equivalent of 10 g of alcohol, which is represented in 1 dcl of wine, 1 small 99
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glass of spirits, or 0.3 l of beer. However, there are studies that prove health benefits of low to moderate alcohol consumption (less than 28 units per week for men and less than 14 units per week for women) compared to complete abstinence. Small doses of alcohol have protective impact thanks to a decrease of coagulability, elevation of HDL cholesterolemia, or antioxidant effects of polyphenolic substances in wine and minerals in beer that lead to a reduction of cardiovascular mortality. Still, negative impacts of overconsumption are very severe. Besides addiction with its psychosocial consequences and personality deterioration, these include liver cirrhosis, acute and chronic pancreatitis, hypertension, liver cancer, tumors of oral cavity, pharynx, larynx, esophagus, stomach, large intestine, rectum, or breast. High consumption of alcohol increases cardiovascular mortality due to blood pressure elevation, hypertriglyceridemia, myocardial contractility disorders, and cardiomyopathy. Higher mortality is also caused by cerebral hemorrhage (lower coagulability combined with hypertension). In addition, alcohol overconsumption leads to disorders of the central nervous system and peripheral neuropathy. Central disorders are a result of neurotransmitters modulation, especially GABA (sedation and anesthetic effects) and NMDA (amnesia). Regular drinking of alcohol beverages is associated with lower neuronal density in the prefrontal cortex, cerebellum, and amygdala. Alcohol addiction can be accompanied by Korsakoff’s psychosis (caused by vitamin B1 deficiency) that manifests as encephalopathy, coordination disorders, and confusedness. During acute alcohol intoxication, the regulatory mechanisms set a lower body temperature and peripheral vasodilatation. Alcohol contributes to reproductive disorders and damaging the fetus (so-called fetal alcohol syndrome), which is caused by alcohol consumption during pregnancy. Apart from serious somatic symptoms, alcoholism has negative mental and social impacts too. These include mental disorders, especially depression and personality deterioration. Social consequences are for example increased aggressiveness. Up to 50 % of cases of domestic violence are committed under the influence of alcohol. This leads to family disintegration, child abuse, unemployment, suicide, criminal conduct, etc. Other consequences are traffic accidents or injuries in general, which create a social and economic burden as well. According to the WHO, the key strategies in this field are for example making use of the health-care system, setting policies concerning alcohol consumption of drivers, limitation of availability of alcohol and its marketing, or higher taxation and use of public resources. Regulation of alcohol consumption should be a priority of the public policy. Health protection of the population against overconsumption of alcohol The WHO developed a strategy that should provide a manual for the member states to create, implement, and put into practice a policy reducing negative impacts of alcohol consumption in the society. These national action plans should include the development, approval, and implementation of health policies and interventions that reduce alcoholism and its negative consequences. These policies and interventions are represented by regulation of prices as well as by taxation, restriction of alcohol selling times and spots, restrictions on selling alcohol to the youth, or agricultural and trade policy that controls and limits production and import of alcohol beverages. An important part of the strategy is limiting the advertising and protection of the vulnerable groups of population, such as pregnant women, children, and youth. Other arrangements are policy legislation associated with vehicle rules and ban on alcohol 100
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