Community support intervention (s) for alcohol abuse in adults residing in Glasgow, UK; A Proposal
International perspective on alcoholic beverages abuse
Alcoholism is definitely a collective term for alcohol related disorders including, but not limited to, alcohol misuse, binge drinking and liquor dependence (World Health Organisation [Who have], 2016). Global alcohol intake levels this year 2010 were estimated to come to be 6.2 litres of pure alcohol in folks aged 15 years and above (WHO, 2017). In britain, the Health and Social Care Data Centre (2014) recommended that among the adult populace group, men and women should not consume a lot more than 3 and 4 devices of alcohol a working day, respectively. Furthermore, existing evidence trends on alcohol usage levels indicate that the higher the financial prosperity/wealth of the united states, the bigger the alcohol consumption amounts and so the lower the number of abstainers among the populations (WHO, 2017).
Additionally, statistics from the WHO (2017) indicate that in 2012, approximately 3.3 million recorded deaths globally were due to alcohol abuse, and at least 15.3 million persons are thought to have a drug and/or liquor disorder. Furthermore, 7.6% and 4% of the 3.3 million deaths globally were observed in men and women, respectively (WHO, 2017). Likewise, 139 million disability-adjusted life years (DALYs) documented in 2012 were connected with alcohol usage globally (WHO, 2017). Therefore, harmful alcohol usage is connected with negative health effects which impact on the quality of life of individuals and their families, as well as society all together because of reduced productivity levels and financial costs associated with treating and managing liquor misuse related conditions (National Institute for Health insurance and Care Excellence [NICE], 2011).
Alcohol abuse relative to Scotland
In 2007, a joint research undertaken by the Glasgow City Council, Strathclyde Police and NHS Greater Glasgow and Clyde indicated that increased rates of harmful alcoholic beverages consumption have been observed across Scotland, with an estimated increase expected within the next decade (Glasgow Town Council, Strathclyde Law enforcement and NHS Greater Glasgow and Clyde, 2007). The article indicated that at least 20.7% of all hospital admissions in the Glasgow region were associated with harmful alcohol consumption, that was associated with a cost of A?207 million to control appropriately. In 2015, a study by NHS Well being Scotland, indicated that 1 in 4 Scottish persons drink at hazardous amounts and about 36% and 17% of males and females, respectively, consume more than 14 units of alcohol every week (NHS Health Scotland, 2015). Furthermore, at least 1,150 alcohol related deaths were recorded in Scotland and 386 of these were women while 764 were males, a figure expected to increase if liquor misuse is not tackled in Scotland (National Records of Scotland, 2015). On top of that, in those aged between 45 and 59 years, major proportion of alcoholic beverages related deaths are found every year in Scotland (National Data of Scotland, 2015). Even so, although the figures indicate that the costs of harmful alcohol usage have declined over the last testmyprep couple of years in Scotland, the prices are normally still relatively greater than those documented in Wales and England, and for that reason more investment in managing alcohol misuse is still a public health priority (Monitoring and Analyzing Scotland’s Alcohol Technique (MESAS) work programme, 2014).
Research undertaken by the info Service Division, NHS Well being Scotland (2015/2016) indicated that about 90% and 10% of alcohol related medical center admissions were to frequently to general acute hospitals or psychiatric hospitals, respectively. Similarly, 48,420 patients are believed to have accessed major care equating to 94,630 alcohol related consultations in 2012/2013; higher rates seen in those aged 65 years and above (Scottish People Health Observatory [ScotPHO], 2017). Furthermore, 25% of all trauma patients and 33% of most major traumas in 2015 were connected with alcohol misuse (The Scottish Trauma Audit Group, 2016). In terms of societal costs of liquor misuse, a written report by the Scottish Federal government (2010) indicated that alcoholic beverages related harms cost about A?3.6 million annually in social care, crime, productivity, health as well as wider/indirect costs in Scotland. In addition, at least A?267 million every year is put in by the NHS Wellbeing Scotland on alcoholic beverages related care, and A?727 million a 12 months on managing alcoholic beverages related crimes across Scotland (Scottish Government, 2010).
Alcohol policies and interventions are often developed with the primary aim of reducing alcohol misuse as well as alcohol related cultural and health burden (NHS Health Scotland, 2015). Additionally, these policies or interventions could be formulated and applied at an area, regional, national, sub-nationwide and global level to ensure alignment and consistency of combating liquor misuse across care options (WHO, 2017). However, the NHS Scotland in joint collaboration with other government bodies like the Police have expressed a committed action to monitoring and evaluating alcohol misuse in Scotland with the aim of reducing the alcoholic beverages related health and social burden (Glasgow Town Council, Strathclyde Police and NHS Greater Glasgow and Clyde, 2007).
The goal of this essay is usually to explore the extent of alcoholic beverages misuse in Scotland and offer network support to the affected populations through the implementation of a relevant strategy/intervention to reduce harmful alcohol intake. The epidemiological factor of alcohol misuse/abuse will be discussed initially and thereafter followed with the identification of the relevant technique or intervention in combi nation with the implementation types of procedures, monitoring and evaluating its progress, based on a pre-specified assessment standards/framework, to make certain that it continues to meet up the needs of the population afflicted by alcohol misuse.
Epidemiological concern to exploring the amount of alcohol abuse among individuals in Scotland.
Research suggests that the most effective alcohol interventions and policies are those that contain combined measures that address the problem at a inhabitants level (WHO, 2007). Nevertheless, national levels ought to be aligned to local strategies to ensure consistency in the delivery of health care/support for liquor misuse (Faculty of Consumer Health UK, 2016).
Therefore, to initiate a strategy or intervention to overcome alcohol misuse in Scotland it really is fundamental that the epidemiology of alcoholic beverages misuse (such as risk factors, aetiology, incidence, prevalence, prognosis, current service analysis and the unmet have to have) is established based on data based medical literature that may take the type of systematic reviews or populace longitudinal studies or medical trials (National Institute for Health and Treatment Excellence, 2011). Furthermore, having a thorough understanding of the desires and priorities of these affected in addition to the payors and clinicians have to be devote to consideration prior to initiating an intervention to fight alcohol misuse (Griffin and Botvin, 2011). This could be undertaken by conducting a demands assessment which aims to recognize health issues of the patients in addition to establishing resource allocation to greatly help plan, and implement a technique or intervention that satisfies the unmet demand of alcohol abusers (Attention Information Scotland, 2015). Medical needs assessment should mainly be undertaken by a group of stakeholders representing numerous relevant perspectives including, however, not limited by, healthcare professionals, patients or patient teams and payors with the purpose of ensuring that all perspectives to reduce health inequalities have been explored, thus providing self-assurance that the proposed intervention to combat liquor misuse will be accessible to relevant individuals across care settings (Great, 2005).
Both quantitative and qualitative data are fundamental in determining and establishing the community profiles of those afflicted by alcoholic beverages misuse in Scotland (Fine, 2014). A qualitative framework enables the researchers to obtain an in-depth understanding of the views and perception of those consuming alcohol at unsafe levels and therefore the themed information can be utilised to form the focus and execution of the proposed intervention (Brownson et al. 2009). Additionally, qualitative framework can be utilised when it comes to focus groups, sound recordings and someone to one interviews across unique sample sizes and sample types to make sure generalisability of study results across individuals in Scotland who misuse liquor (Wilson et al. 2013). Alternatively, quantitative framework helps researchers to select what to focus on within the research predicated on data collected from individuals, and thus quantify the data by analysing it in an unbiased and objective way (Cairns et al. 2011). Therefore, this will help researchers profile the tendencies of alcoholic beverages misuse in Scotland and provide potential explanations of the noticed interactions between analysed variables (Jones and Sumnall, 2016). Therefore, both quantitative and qualitative info should be put in to consideration by the many stakeholders to help with making informed decisions on the most likely intervention to tackle liquor misuse in Scotland (Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) work program, 2014).
The nature of the info to be accumulated (i.e. principal and/or secondary) is often determined by the study question at hand (NICE CG21, 2010). For instance, in relation to alcohol misuse, both primary and secondary data are essential because in combination, the info provide a complete representation of the degree of the liquor misuse among men and women in Scotland, which could end up being limited if one or the additional were to be utilized to see policy making (Centre for Testimonials and Dissemination, 2008).
Furthermore, the hierarchy of proof is dictated by the nature of the analysis design informing the evidence, and thus several stakeholders will put unique weight to the study evidence obtained from various study designs (Scottish Intercollegiate Recommendations Network, 2015). For example, research suggestions consider randomised handled trials (RCTS) as the top-notch study design as a result of limited bias associated with the design and style and exploration of proof, and therefore evidence from RCTs is known as to come to be of robust and of high quality (NICE, 2006; Higgins and Green, 2011). Subsequent from the RCTS, the other analysis designs of interest include cohort analyses, case-control, circumstance series and expert, in that order, are believed to be valuable in answering selected types of research queries (Centre for Evaluations and Dissemination, 2008). Nevertheless, meta-analyses and systematic assessments of RCTs receive more excess weight in the hierarchy to be able to provide robust data to inform decision making. However, it should be noted that conducting a RCT to establish alcohol misuse will be considered unethical by many stakeholders and for that reason, qualitative studies or real life evidence studies will be considerably more plausible to explore the idea at length (National Institute on Alcohol Abuse and Alcoholism, 2017).
Therefore, after concern of the aspect/type of facts in combo with the epidemiology of liquor misuse among people in Scotland, a short intervention that would be thought to be both clinically and cost effective would be a plausible approach (WHO, 2014). The brief intervention incorporates policy guidelines, training, as well as education on alcohol misuse to help patients and healthcare service providers make educated decision on its applicability (Anderson et al. 2009). Brief interventions are desired over other types, such as alcoholic beverages taxation because they try to provide health and social support to alcoholic beverages abusers and so they are more likely to be motivated to help change attitudes towards harmful drinking (Institute for Liquor Studies, 2013). Therefore, a plausible intervention will include various phases such as for example planning, preparing additional stakeholders for the intervention, establishing an
intervention team, identifying implications/benefits and harms along with sharing information on the intervention with the relevant stakeholders and ensure that informed consent from users of the intervention is definitely devote to consideration ahead of implementation (Holland, 2016).
Monitoring and analysis of the intervention
Monitoring and analysis of an ABI is normally fundamental in ensuring that the intervention is match for purpose and offers anticipated outcomes to those in need of care (National Collaborating Centre for Methods and Equipment, 2010). Monitoring and analysis of an intervention follows a couple of criteria which measures the potency of the intervention including the RE-AIM version which aims to judge the Reach, Efficacy, Adoption, Implementation and Maintenance (Glasgow et al. 1999). For instance, the Reach category sets in to factor the proportion and characteristics of liquor abusers that access the intervention and will be assessed on an individual level which aims to supply first-hand information on what sufferers’ thoughts are (NICE, 2014). However, given the difficulty in accessing info on the non-respondents it is challenging to determine why the intervention was not deemed essential to suit their needs and therefore, this creates difficulties quantifying the cost performance of an intervention that was made to reach a sizable proportion of individuals (Vogt et al. 1998). Efficacy of the ABI considers the measuring of both negative and positive outcomes to ensure that a balanced evaluation of evidence is assessed on the worthiness of the intervention to those who want to reduce liquor misuse (National Collaborating Center for Methods and Equipment, 2010). Additionally, the ABI should aim to accumulate behavioural, biologic, and quality of life outcomes which are key in assessing whether clients are profiting from the program or elsewhere (NHS Scotland, 2017). Additionally, it is essential to establish if payors are purchasing a priceless intervention, and if health care professionals are delivering the approach correctly or it requires to be adapted for every single individual to optimize outcomes (Kaplan et al. 1993).
The adoption of the ABI consumes to point of view the proportion of health care settings using the intervention across Scotland (NHS Scotland, 2017). This could be within the community, hospitals, and work and leisure adjustments to make certain that the hard to reach populations receive the opportunity to gain access to the intervention without incurring significant costs (Alcoholic beverages Concentrate Scotland, 2017). Although immediate observation might provide measurable outcomes, audits, surveys and interviews may provide further evidence to support the monitoring and analysis of the ABI (Scottish Government, 2017). Similarly, the implementation and repair of the ABI is usually fundamental in assessing the degree to which the intervention provides been executed in real life setting as intended, along with the extent to which the intervention is definitely sustained over a pre-specified period of time (WHO, 2014). Implementation could be assessed at an individual level, and maintenance could be accessed both at an individual and organisation level to make sure alignment and consistency in the delivery of the ABI. Nevertheless, the RE-AIM framework across the five categories isn’t often devote to consideration across options to evaluate alcohol interventions, and therefore the time points for analysis of optimal performance of the ABI in Scotland tend to be dependent on amount of available source within the care options which make generalisability of results across settings challenging to ascertain (Institute for Alcohol Analyses, 2013; Scottish Government, 2017).
Alcohol misuse presents a substantial burden on medical and social areas of parents in Scotland both in the brief and long term. Offered the quantifiable burden in the alcohol misuse related illness, crime and costs of management, it has necessitated a modification in the harmful consumption levels of alcoholic beverages in Scotland through the implementation of ABIs together with national and local plans. The epidemiology of liquor misuse in Scotland through existing literature from both most important and secondary data sources is key in providing a comprehensive insight into the alcohol misuse circumstances as time passes, and the way the issue could be addressed.A� Likewise, the execution of ABI across treatment settings in Scotland ensures that the population at have is given usage of caution through education and training on the harms of abnormal alcohol intake in the brief and long term.
Additionally, this means that the patients receive the option to get care, after knowledgeable consent, and so are able to take control of their care. Therefore, healthcare providers have the duty of attention to promoting self-confidence among alcohol abusers to greatly help them come up with various coping ways of alter their attitudes and behaviours. For all those that decline health care, the possibility to access care down the road should be provided, but most importantly their decisions should be respected. The monitoring and analysis of the intervention also needs to encompass a couple of pre-specified criteria such as the RE-AIM framework to determine efficiency of the intervention as well as the cost performance of the ABI over time.
Alcohol Focus Scotland. (2017) Liquor licencing in your network; how you can get involved [online]. [Viewed 28 March 2017] Available from: http://www.alcohol-focus-scotland.org.uk/media/133477/Community-licensing-toolkit.pdf.
Alcohol Research UK, 2014. Delivering Liquor IBA Broadening the bottom from overall health to non-health context: Review of the literature and scoping. London. Middlesex University.
Anderson, P., Chisholm, D andFuhr, D.C., 2009. Effectiveness and cost-performance of plans and programmes to lessen the harm due to alcohol. Lancet [online]. 373(06), pp. 2234- 46. [Viewed 28 March 2017]. Obtainable from:A� A� A� http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60744-3/abstract
Brownson R., Chriqui J and Stamatakis K., 2009. Understanding evidence based public overall health policy. Am J People Health [online]; 99 (9): 1576-1583. [Viewed 28 March 2017]. Obtainable from: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2008.156224
Cairms, G., Purves, R., Bryce, S andMcKell, J., 2011 Investigating the potency of Education with regards to Alcoholic beverages: A Systematic Investigation of Essential Elements for Optimum Performance of Promising Techniques and Delivery Strategies in School and Relatives Linked Alcohol Education. [online] [Viewed 28 March 2017] Available from:A� http://alcoholresearchuk.org/downloads/finalReports/FinalReport_0083.pdf
Care Information Scotland, 2015 Assessment of health or care demands. [Viewed 28 March 2017]. Available from: http://www.careinfoscotland.scot/topics/how-to-get-care-services/assessment-of-your-care-needs/.
Centre for Evaluations and Dissemination, 2008. Systematic Reviews; CRD’s instruction for undertaking evaluations in health care [Online]. CRD. [Viewed 27 March 2017]. Available from: https://www.york.ac.uk/media/crd/Systematic_Reviews.pdf.
Elzerbi, C., Donoghue, K andDrumond C., 2015. A assessment of the efficacy of brief interventions to reduce hazardous and harmful alcohol consumption between European and non-European countries: a systematic review. Addiction [online].110 (April), pp. 1082- 1091. [Viewed 28 March 2017]. Available from: http://onlinelibrary.wiley.com/doi/10.1111/put.12960/abstract.
Faculty of Public Well being UK, 2016. Alcohol and Public Health; Location Assertion. [Online]. PH UK. [Viewed 27 March 2017]. Available from: http://www.fph.org.uk/uploads/ps_alcohol.pdf.
Fitzgerald, N., Molloy, H., MacDonald, F., and McCambridge, J., 2015. Alcohol simple interventions practice following training for multidisciplinary health insurance and social care teams: A qualitative interview research. Drug and Alcohol Assessment [online]. 34(March), pp.185-193. [Viewed 27 March 2017]. Available from: https://dspace.mix.ac.uk/bitstream/1893/21668/1/Fitzgerald_et_al-2015- Medicine_and_Alcohol_Review.pdf
Glasgow Town Council, Strathclyde Police and NHS Greater Glasgow and Clyde, 2007. Glasgow City; Joint Alcohol Coverage Assertion. [Viewed 27 March 2017]. Available from: http://www.glasgow.gov.uk/CHttpHandler.ashx?id=3804&p=0
Glasgow R, Vogt T andBoles S., 1999. Evaluating the general public health impact advertising interventions: the RE-Goal framework. Am J General public Health [online]. 89: 1322-1327. [Online]. [Viewed 27 March 2017]. Obtainable from: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.89.9.1322
Griffin K and Botvin G., 2011. Proof based interventions for avoiding substance make use of disorders in adolescents. Psychiatr Clin N Am [online]. 19 (3): 505-526. [Viewed 27 March 2017]. Available from: http://www.sciencedirect.com/science/article/pii/S1056499310000210
Higgins JPT and Green S., 2011. Cochrane Handbook for Systematic Assessments of Interventions; General options for Cochrane Assessments [online]. [Viewed 27 March 2017]. Obtainable from:A� http://handbook.cochrane.org/front_page.htm
Holland K., 2016 Staging an intervention for an alcoholic. [Online]. [Viewed 27 March 2017]. Obtainable from: http://www.healthline.com/health/alcohol-addiction-intervention#Overview1
Information Serviced Division, NHS Wellness Scotland (2015/2016) Alcohol-Related Hospital Figures Scotland 2015/16. [Online]. [Viewed 28 March 2017]. Available from: https://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2016-10-25/2016-10-25-ARHS-Report.pdf?12266176940
Institute of Alcohol Analyses, 2013. Economic Costs of Alcohol. [Online]. London. Institute of Alcoholic beverages Studies. [Online]. [Viewed 26 March 2017]. Available from:A� http://www.ias.org.uk/Alcohol-knowledge-centre/Economics-impacts/Factsheets/Econ.
Jones, L., and Sumnall H., 2016 Understanding the relationship between poverty and liquor misuse. Centre for Consumer Well being, Faculty of Education, Health insurance and Network, Liverpool John Moores University, Henry Cotton Campus.
Kaplan, RM., 2016. The Hippocratic Predicament: Affordability, Access, and Accountability in American Wellbeing Care. NORTH PARK, Calif: Academic Press Inc; 1993.
Monitoring and Evaluating Scotland’s Alcohol Technique (MESAS) work programme.,2014. Evaluation of Scotland’s Alcohol Strategy. [Online]. [Viewed 28 March 2017]. Obtainable from: http://www.healthscotland.com/documents/24485.aspx
National Collaborating Center for Methods and Tools, 2010. Assessing the general public health impact of wellness advertising initiatives. [Online]. Hamilton. McMaster University. [Viewed 26 March 2017]. Available from: http://www.nccmt.ca/resources/search/70
National Institute for Health insurance and Care Excellence, 2005. Health Needs Assessment: A practical information https://testmyprep.com/lesson/how-to-write-a-tok-essay-tips. [Online]. London: National Institute for Health and Care Excellence. [Viewed 27 March 2017]. Available from: http://www.nice.org.uk/aboutnice/whoweare/aboutthehda/hdapublications/healthneedsassessmentapracticalguide.jsp.
National Institute for Health insurance and Care and attention Excellence, 2011. Services for the identification and treatment of dangerous drinking, hazardous drinking and alcohol dependence in children, youthful people and adults: Commissioning Lead. London: NICE.
National Institute for Health insurance and Attention Excellence, 2014. Community engagement to improve health [online]. London: Good. [Viewed 27 March 2017]. Obtainable from:: http://publications.pleasant.org.uk/lgb16
National Institute on Alcohol Abuse and Alcoholism., 2017. Administering alcohol in human being studies. [Online]. [Viewed 27 March 2017]. Obtainable from: https://niaaa.nih.gov/Resources/ResearchResources/job22.htm
National Information of Scotland., 2015. Alcoholic beverages related Deaths. [Online]. [Viewed 27 March 2017]. Obtainable from: https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/alcohol-related-deaths/main-points
NHS Health Scotland., 2015 Alcohol Focus Scotland. Available from: http://www.alcohol-focus-scotland.org.uk/alcohol-information/alcohol-facts-and-figures/
NHS Scotland., 2017. Alcoholic beverages brief interventions; primary health care pack. [Online]. [Viewed 28 March 2017]. Obtainable from: http://www.healthscotland.scot/media/1282/primary-care-cribsheet_jan2017_english.pdf
NICE CG24., 2010.A� Alcohol-use disorders: avoiding the development of hazardous and unsafe drinking [Online]. [Viewed 27 March 2017]. Obtainable from: http://www.alcohollearningcentre.org.uk/_library/48984.pdf
NICE., 2006. Options for development of NICE public health advice. [Online]. [Viewed 27 March 2017]. Available from: https://www.nice.org.uk/guidance/ph1/evidence/methods-for-development-of-nice-public-health-guidance-120988045
Scottish Government, 2009. Changing Scotland’s Romantic relationship with Liquor: A Framework for Action. [Online]. [Viewed 28 March 2017]. Available from: http://www.gov.scot/Resource/Doc/262905/0078610.pdf
Scottish Government, 2010. Cost of illness method of derive estimates of the cost of liquor misuse in Scotland. [Online]. [Viewed 29 March 2017]. Available from: http://www.gov.scot/Publications/2009/12/29122804/0
Scottish Government, 2017. Alcoholic beverages Short Interventions. [Online]. [Viewed 29 March 2017]. Available from: http://www.gov.scot/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/alcoholbriefinterventionsStandard
Scottish Intercollegiate Suggestions Network, 2015. A guideline developer’s handbook. [Online]. [Viewed 27 March 2017]. Obtainable from: http://www.sign.ac.uk/pdf/sign50.pdf
Scottish Public Wellness Observatory, 2017. Alcohol: wellbeing harm. [Online]. [Viewed 29 March 2017]. Obtainable from: http://www.scotpho.org.uk/behaviour/alcohol/data/health-harm
The Health and Social Care Information Centre, 2014. Statistics on Alcohol. [Online]. [Viewed 28March 2017]. Obtainable from: http://content.digital.nhs.uk/catalogue/PUB15483/alc-eng-2014-rep.pdf
The Scottish Trauma Audit Group. (2016) Audit of Trauma Supervision in Scotland. [Online]. [Viewed 29 March 2017]. Obtainable from: http://www.stag.scot.nhs.uk/Publications/main.html
Vogt TM, Hollis JF, Lichtenstein E., Stevens, V. J., Glasgow, R. E and Whitlock, E. 1998.The medical care system and prevention: the need for a new paradigm. HMO Pract. 12:6-14.
Wilson, GB., Kaner, EFS., Crosland, A good., Ling, J., McCabe, K., Haighton, CA., 2013. A Qualitative Study of Alcoholic beverages, Health insurance and Identities among UK Men and women in Later Existence. PLoS ONE 8(8): e71792. doi: 10.1371/journal.pone.0071792
World Health Organisation, 2016. Alcohol epidemiology, monitoring an data program. [Online]. WHO. [Viewed 27 March 2017]. Available from: http://www.who.int/substance_abuse/activities/gad/en/
World Health Organisation, 2017. Management of drug abuse; Alcohol. [Online]. WHO. [Viewed 27 March 2017]. Obtainable from: http://www.who.int/substance_abuse/facts/alcohol/en/
World Health Organization, 2014. Global Status Survey on Alcohol and Health. [Online]. Geneva: World Health Firm. [Online]. WHO. [Viewed 27 March 2017]. Obtainable from: http://apps.who.int/iris/bitstream/10665/112736/1/9789240692763-eg.pdf
World Health Organization, 2007. Evidence-based strategies and interventions to reduce alcohol-related damage. [Online]. WHO. [Viewed 28 March 2017]. Obtainable from: http://www.who.int/gb/ebwha/pdf_files/WHA60/A60_14-en.pdf