Alcohol policies should bear public acceptance - WHO

Dr. Viraj PERAMUNA

THE World Health Organisation in a Alcoholic policy guidelines for action for member countries state that in formulating policies it is critically important to see that they are acceptable to the public, and politically feasible too.

At a time when authorities are considering to formulate more stringent policies to combat alcoholism and related problems, it is best that they give thought to this WHO document. Alcohol Policy - A Guide for Action, released in December 1995, as it has many valid points to consider.

Among the recommendations made are the following:

Public acceptance and political feasibility are of critical importance in selecting alcohol policies.

The evidence for the scope, seriousness and costs of alcohol problems has to be stated and the public helped to understand better the case for policy choice. Public education on the nature of policy issues is itself part of the job of policy makers.

Fortunately feasibility and acceptance are not fixed quantities nor any more immutable than levels of alcohol consumption and harm, and there are rational grounds for optimism.

As is demonstrated particularly clearly in much of the Western world by at least partial success of action against drinking and driving, scientifically well-based policies combined with political commitment and public support can succeed.

Preventative policy must take cognizance of a number of issues:

* The target for action embraces a wide range of alcohol-related problems, far wider than any narrow medical concept of 'alcoholism'.

* These problems are pervasive and distributed widely through the drinking population, rather than being concentrated only among heavy drinkers. Heavy drinkers and 'alcohol abusers' do not live in their own separate world but are in a very real sense products of their society.

They are influenced by much the same factors that affect the generality of drinkers - the social acceptability of drinking and heavy drinking, the cost of alcohol and how easy it is for it to be obtained.

* Preventative measures which influence the generality of drinkers also affect heavy and problematic drinkers.

* The overall level of a population's drinking is significantly related to the level of alcohol-related problems in that population.

Increases in per capita consumption of alcohol will normally be followed by an increase in drinking across the drinking population and an increase in the number of heavy drinkers.

It follows that preventative policy cannot be targeted exclusively at the relatively small minority of 'alcoholics' or 'alcohol abusers'. If it is to be effective, policy must also be concerned with the whole population and with the overall level of consumption.

To conceive of these intrinsically complementary approaches as contradictory alternatives is unhelpful and mistaken. If overall consumption is allowed to run free and go high, more targeted interventions will be rendered null and void.

Nor should policies to influence overall consumption be avoided or diverted on the grounds that 'moderate' drinking reduces the risk of coronary heart disease.

Assuming the reality of the protective effect, most developed countries are already consuming greatly more alcohol than is required to obtain optimum benefit. An attempt to put about a message encouraging drinking on the basis of hoped-for gains in CHD prevention would be likely to result in more harm to the population than benefit

The Policy Mix

As alcohol problems arise in many different situations and affect diversities of people there is no one policy panacea: inevitably, the needed policies will be a mix rather than a master stroke.

Some policy measures have fairly immediate and direct effects on levels of consumption and harm. Others have more indirect and long-term effects by helping to change the general social climate.

Taxation of alcohol is an effective mechanism for reducing alcohol problems across the board. The notion that heavy or dependent drinkers are immune to the influence 'of price is demonstrably incorrect.

But with entire scientific accuracy, alcohol taxation is a readily available instrument which can be applied to save lives and avert alcohol-related suffering.

Influencing physical access to alcohol can make a significant contribution to the prevention of alcohol problems. Measures include a minimum legal drinking age; restrictions on hours or days of sale; server training and policies on number, type or location of sales outlets.

Countries which already deploy such useful contributions to public health would be unwise to dismantle them because political sentiment turns against 'restrictiveness,' with the reasons for these measures having been introduced in the first place forgotten.

Modern trade agreements such as the North American Free Trade Agreement and the European Union have considerable potential effects on alcohol policy.

While economic interests are primary in such agreements, there are good reasons therefore to consider their potential effects on alcohol consumption and the level of harm.

Drink-driving

Drink-driving countermeasures are effective if vigorously enforced and given a high public profile.

Treatment of alcohol problems can support public health goals and to split off prevention and treatment as two separate or alternative spheres of activity is unhelpful.

If treatment is to make a significant, population-wide impact on drinking problems, it must be delivered on an appropriate and community wide scale.

There is strong evidence for the effectiveness of simple forms of help given in general or primary-care settings.

School-based education, public education, warning labels and advertising restrictions can be added to the policy mix but that must be on the basis of reasonable hope of long-term pay-off, rather than evidence of the kind which supports the above group of strategies.

No bird flu risk in eating chicken - Dr. Wanasinghe

EX-PERADENIYA Veterinary Faculty Senior Lecturer Vet. Research officer and Chairman All Island Poultry Breeders Association Dr. D. D. Wanasinghe assured the public not to panic on the current situation in Bird flu, and that it was perfectly safe to eat chicken as any virus would get killed in the process of cooking on fire we do in this part of the world.

He regretted that some stories carried in the media on the bird flu incidents created an unnecessary fear in the public that one could get infected even by consuming chicken. This is far from being the truth.

Dr. Wanasinghe was speaking at the Healthwatch Medical Crossword Draw No 19 held on Wednesday March 8 at the Colombo Apollo Hospital Board Room as a guest speaker on the subject of bird flu.

He went on to say:

The AI group of viruses that causes bird flu disease is normally found in wild birds' intestine but can be highly pathogenic to domestic birds and humans.

It causes flu like respiratory disease in humans with symptoms like sudden fever, cough and shortness of breath for which no vaccine has been discovered yet.

There is no evidence that one can get contaminated with the bird flu virus by eating chicken and other poultry.

Bird flu is caused by a virus. Like all other viruses, avian influenza is destroyed by the heat of normal cooking. The virus is not spread from cooked chicken.

The high temperatures used by Sri Lankans whilst cooking chicken would take care that any virus, if present would be killed. WHO has confirmed that eating cooked chicken is safe.

Has it come to Sri Lanka?

Since the detection of bird flu in neighbouring India, there is growing concern about outbreak of the disease in Sri Lanka.

However, it has been reported that since Sri Lanka is an island the risk is very minimal and there is no need to panic. Epidemiological sources confirmed that no patient suffering from the deadly avian flu virus or poultry birds had been diagnosed in Sri Lanka.

The epidemiological unit has also stated that had the virus infected a flock of birds it would kill nearly 50 to 80% of birds within 48 hours and such cases had not been reported in Sri Lanka so far.

It has also been reported that the migrating period of birds to Sri Lanka is over and the birds are now flying back.

Therefore there is no threat of bird flu entering Sri Lanka from migrating birds.

How is the country prepared and what precautions have been taken?

In Sri Lanka, though no cases of Avian Influenza have been reported so far, the imports of poultry and related products have been tightly controlled since the first global cases of bird flu two years ago.

At present all imports of poultry into the country is totally banned.

Since the recent reports of outbreak in India, the import of maize from India is banned. Hitherto India had been supplying 90% of Sri Lanka's annual requirement of 200,000 tonnes of maize for chicken feed.

The quarantine officials would take action to destroy any consignment of illegal import of any poultry and related products.

To balance out the shortage of chicken feed, the Government has sought the advice of WHO on sterilizing the feed.

Health Ministry has already conducted several training programmes to the chicken farm owners.

The Government has taken action to improve the health services and laboratory facilities in 20 hospitals in 20 districts to cater to suspected cases of the disease.

Impact on rural economy

The impact of the reduction in chicken and processed chicken products would have serious impacts on our economy in many ways.

Presently, the contribution to GDP from the livestock sector is around 0.9% and out of this, poultry comprises about 70%

About 75,000 farmer families and 200,000 input providers are self employed in this industry. Altogether about one million people depend on this industry as a means of livelihood.

Most of those engaged in poultry in the Sri Lanka are women. Also many Samurdhi beneficiaries and rural youth have taken to poultry farming. Thus, this industry discourages the migrations of rural folk to cities.

Development of conjoined twins

K. M. C. KUMARAGE of Kitulampitiya Galle wanted to know how conjoined (siamese) twins are developed in the womb. Prof. Rohan Jayasekera Professor of Anatomy, and Director Human Genetic Unit of the Colombo Medical Faculty in a recent talk on this subject explained it thus. He had sent an article on this subject to us and here we quote from the article.

Conjoined Twins - It happens this way.

The fertilization of the female egg by the male sperm produces an initial single cell, the zygote (see diagram) which now begins to divide and produce mass cells in the first week following fertilization.

These cells then migrate to one side of the developing structure, forming two areas, a large fluid filled space below and a mass of cells above called the inner cell mass.

It is this mass that develops into a single human embryo which then matures into a foetus or splits completely to produce monozygotic twins.

Rarely this inner cell mass may divide late and incompletely, leading to the development of two embryos instead of one.

The error here is the incomplete separation into monozygotic twins, who will now stay attached to each other due to the incomplete nature of the division and develop to maturity.

The sites of attachment may very with possible fusions at the level of the head, chest, abdomen or pelvis on at a combination of points.

Thurstan Health Watch 2006

ANNUAL Thurstan Health Watch Programme presented by the 67-68 group of the Thurstan OBU is scheduled to take off on Sunday March 19 at the CR & FC grounds at 7.30 a.m.

This is the second year this event is being held to educate the young and old the importance of staying healthy and to educate on healthcare needs. The overwhelming response received last year has encouraged the organizers to add new features to this year's programme.

The event which is being held with the idea of promoting good health habits among those 'busy lifestyles' will kick off with a walk by the participants and their families.

Thereafter two presentations will be made by eminent physician and past President of the SLMA Dr. Sunil Seneviratne Epa on 'Lifestyles' and Dr. Narendra Pinto well-known orthopaedic surgeon and past President of the College of Surgeons on 'physical injuries and prevention'.

Well-known toast master Niranjan de Silva will wind up the sessions with a talk on 'Humour the best medicine'.

The event will end the sessions with a healthy breakfast and a medical check-up by courtesy of Navaloka Hospital and an eye clinic to be conducted by Eric Rajapakse opticians.

Those who are willing to join the 'Health Watch Programme' are requested to make their reservations with Dinko Abeygunawardena of 'Symphony' on TP 4517596.