WhiteBook2_Part1 - 182

Discussion
For many countries, slowing down or reversing the rising proportion of digestive disorder
burden attributable to high BMI may be an area for prioritisation. Despite the wealth of
available guidance on population-level interventions and policy options for preventing and
tackling obesity, no country in the WHO European region is on track to halt the rise in obesity
by 2025.140 The challenge for some countries is to recognise the limits of individual-based
interventions and to acknowledge obesity as a population-health problem requiring
approaches to prevention that address the environments in which people live.140 141
Since the year 2000, the majority of UEG member countries appear to have experienced
decreases in the proportion of burden attributable to smoking for disorders such as peptic
ulcer disease, gallbladder and biliary disease, oesophageal cancer, liver cancer, colon and
rectum cancer, stomach cancer, and pancreatic cancer. Exposure to smoking has generally
decreased across the world over the past decade; progress that is likely linked to legislative
tobacco-control measures, including regulation and taxation.142 143 Nonetheless, not all
member countries have experienced decreases in the proportion of digestive disorder
burden attributable to smoking. Room for improvement is possible given the wide variation
in prevalence rates of tobacco use between countries.143 137 144
Alcohol use contributes towards a large share of the overall burden of digestive disorders
amongst UEG member countries. Estimates suggest, many countries have experienced
increases in the proportion of burden attributable to alcohol use for disorders such as
cirrhosis, pancreatitis, liver cancer, colon and rectum cancer, and oesophageal cancer,
although some improvements have been made particularly in Southern and Western Europe
since the year 2000. More recently, certain countries within Eastern Europe have
experienced reductions in alcohol consumption and alcohol attributable burden of disease,
likely linked to progress made in implementing alcohol control policies.145 Even in countries
where alcohol attributable burden of disease appears to have decreased over time, levels of
harm due to alcohol remain high.146 Further reductions in alcohol consumption are not
expected unless countries increase efforts to accelerate progress in the implementation of
evidence-based alcohol control policies.145 146
Some relatively low alcohol drinking countries in Northern Africa appear to have experienced
increases in the proportion of digestive disorder burden attributable to alcohol use since the
year 2000. For countries such as Egypt with high prevalence rates of liver disease due to viral
hepatitis, even small increases in alcohol consumption levels could have considerable
consequences.147 International alcohol producers are increasingly extending their markets to
countries whose populations do not traditionally drink alcohol,145 and this may have
important implications for public health policy planning within these countries.
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