5 Cases of Alcohol as Cross-Cutting SDGs Obstacle

Understanding alcohol as cross-cutting obstacle to development

Movendi International shows that alcohol harm impedes progress towards 14 of 17 SDGs.

There are at least five distinct contexts that illustrate the pathways of alcohol as obstacle to sustainable development:

1. Alcohol’s contribution to poverty, hunger, and the resulting health and educational problems (SDGs 1, 2, 3, and 4),
2. Alcohol’s contribution to poorer children’s health, maternal mortality and poorer women’s health (SDGs 3, 4, 5, and 16),
3. Alcohol’s burden on healthcare systems and the gap in health service provision to the large number of people with alcohol use disorder and other alcohol-related mental illness (SDGs 3, 10, 16),
4. Alcohol’s contribution to lost human potential, impaired education and academic development, as well as productivity losses (SDGs 4, 8, and 10), and
5. Alcohol’s contribution to water insecurity and shortage as well as biodiversity loss, environmental degradation, and the climate crisis.

Understanding the potential of alcohol policy as catalyst for the SDGs

Alcohol policy initiative have the potential to promote social development through 

• facilitating poverty reduction, 
• promoting of health (for children, mothers, young people, the whole population), 
• strengthening of health systems, 
• improving access to and participation in education, 
• strengthening of women’s rights, 
• increasing economic productivity and growth, and 
• increasing equality – above all for vulnerable groups.

Case #1: Alcohol’s contribution to poverty, hunger, and the resulting health and educational problems (SDGs 1, 2, 3, 4, and 5)

The vicious cycle of alcohol, poverty, malnutrition, ill-health, and lack of progress on education and gender equality

In low- and middle-income countries (LMICs), alcohol tends to crowd out other more productive household spending, such as spending on education, healthcare and healthy food.

Both recognized and unrecognized alcohol expenditures have highly damaging impact on the most deprived families and communities. Desperately needed resources are being taken away from the little available for food and other basics.

A fourth example, from another part of the world, is Sri Lanka:

Evidence shows that the two lowest income categories spent more than 40% of their income on alcohol and tobacco use, while the next category spent 34.8% of their income on concurrent use.

People with lower socio-economic status spent less than those with higher income on alcohol and tobacco, but the expenditure constitutes a much larger share of their income.

This compromises the ability of low-income households to meet basic needs. 

In the family setting, alcohol is a major risk factor for poor educational outcomes.

The pandemic has aggravated the negative interaction between alcohol, family, and community norms and resources. WHO, UNODC and UNESCO list several risk factors regarding the family level:

• Parental substance use,
• Parental mental ill-health,
• Parental abuse and neglect, and
• Material poverty.

In Australia, over a million children (22% of all children) are negatively affected by the alcohol use of others – most often parents’ alcohol use:

• 79% of alcohol users with children under the age of 18 years living in their home reported consuming alcohol around their children,
• 13% of children are at risk of exposure to short-term high risk alcohol use in Australian households by at least one adult,
• Around 25% of fathers and 10% of mothers (in couple-plus-children families) had consumed at short-term risky levels two or more times a month in the past year.

This data illustrates the magnitude of harm that children experience from other’s (often parents’) alcohol use. Such harm affects health, well-being, and academic performance, including:

• Disruptions to family rituals, such as birthdays,
• Changes in and reversal of parent-child roles,
• Disturbed school attendance, eating, and bedtime routines,
• Limited or more aggressive communication,
• Diminished social connectedness, and
• Lack of finances and worsening relationships.

Case #2: Alcohol’s contribution to poorer children’s health, maternal mortality and poorer women’s health (SDGs 3, 4, 5, and 16)

Alcohol, maternal mortality, children’s (mental) health, women’s health and social justice

Alcohol remains the most overlooked risk factor for poor mental and physical health across the life course, pregnancy outcomes, and social development.

Alcohol use during pregnancy is a significant risk factor for adverse pregnancy outcomes, including stillbirth, premature birth, intrauterine growth retardation and low birth weight.

• Maternal alcohol use is associated with higher mortality rates for pregnant women and infants. 
• Alcohol use during pregnancy is associated with increased morbidity and mortality in infants and children.

A 2017 landmark study showed that the global prevalence of alcohol use during pregnancy in the general population amounts to almost 10%. 

• 1 out of 13 women who consumed any alcohol at any point or frequency during pregnancy delivered a child with FASD.
• Globally, nearly 8 out of every 1,000 children in the general population are estimated to have FASD.
• The prevalence of fetal alcohol spectrum disorder among children and youth in the general population exceeds 1% in 76 countries 

Alcohol jeopardizes reproductive health and rights

Alcohol use has detrimental effects on the health of women and children. Alcohol consumption increases the risk of unintended pregnancies, through its contribution to unprotected sex. Alcohol use during pregnancy is also a risk factor for adverse pregnancy outcomes.

• Stillbirth, spontaneous abortion, and premature birth are some of the adverse pregnancy outcomes, due to alcohol.
• Alcohol use during pregnancy is linked with a dose‐response increase in miscarriage risk, and
• Evidence from Ghana shows that alcohol consumption is significantly associated with abortion-related maternal deaths:
  • Women who had ever consumed alcohol, frequent alcohol users, and even occasional alcohol users were about three times as likely to die from abortion-related causes compared to those who abstained from alcohol. 
  • Maternal age, marital status and educational level are factors that have a confounding effect on the observed association.

Alcohol fuels gendered violence in public and private spheres

Alcohol fuels a significant proportion of cases of violence against intimate partners both in and outside the household. 

• 65% of women experiencing intimate partner violence in India, Vietnam, Uganda, Zimbabwe, South Africa reported the perpetrator had used alcohol,
• There is a strong link between alcohol use and sexual aggression by young males,
• Focus groups in rural Rwanda show that women who are victims of domestic violence rank alcohol as number one factor. Also in Uganda and Malawi did alcohol use by the perpetrator play a pivotal role in gendered domestic violence.

Case #3: Alcohol’s burden on healthcare systems and the gap in health service provision to the large number of people with alcohol use disorder and other alcohol-related mental illness (SDGs 3, 8, 10, 16)

Alcohol damage, unsustainable healthcare systems and GDP loss

Alcohol is one of the biggest and least recognized barriers to universal health coverage (UHC) and sustainable healthcare systems.

The health, social, and economic burden of alcohol is rising, especially in low- and middle-income countries which already can ill-afford the productivity losses, healthcare costs, and household impoverishment due to alcohol.

• In Sri Lanka, 80% of General Practitioners were frequently confronted with patients who had alcohol use disorders.
• Ca. 1 in 5 patients in the UK hospital system use alcohol heavily, and one in 10 are alcohol-dependent.
• Alcohol contributes to over 400 varieties of illness and injury, thus placing a considerable burden on both national healthcare budgets and systems. 
• For example, OECD countries spend an average of 2.4% of health spending on dealing with the harm caused by alcohol – and the figure is much higher in some countries. 
• In Thailand, a 2023 study estimated the cost of alcohol’s harm to others in workplaces. The past-year prevalence of harm from co-workers’ alcohol use was 17.8% among the employed population. In total, 28.8 million hours of extra work was attributed to co-workers’ alcohol use in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (US$57.8 million).
• In the European Union, premature deaths from cancer due to alcohol cost €4.58 Billion in productivity losses alone.
• In South Africa, the combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 – 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP.

A remarkable study from 2019 estimated the health impact and economic burden of alcohol use in India:

Between 2011 and 2050, deaths due to alcohol would lead to a loss of 258 million life years. Treatment of these conditions will impose an economic burden of INR 3127 billion (US$ 48.11 billion) on the health system. Societal burden of alcohol, inclusive of health system cost, out of pocket expenditure and productivity losses will be INR 121,364 billion (US$ 1867 billion). Even after adjusting for tax receipts from sale of alcohol, alcohol poses a net economic loss of INR 97,895 billion (US$ 1506 billion). This amounts to an average loss of 1.45% of the gross domestic product (GDP) per year to the Indian economy.

And in 2024, researchers studied the societal value of lost health due to alcohol harm in India. Then they compared the amount with revenue from alcohol excise taxes for India in 2019. The study revealed a net loss of ₹4.4 trillion.

At least 7% of the global adult population have an AUD. But health systems are ill-equipped to adequately deal with only this specific type of alcohol harm.

• Only 14% of countries indicated treatment coverage of more than 40% (not even every second AUD person).
• 28% of countries have very limited or close to zero treatment coverage.
• Most countries (40%) do not even know the level of treatment coverage.

In 2010, the World Health Report wrote:

“Raising taxes on alcohol to 40% of the retail price could have [a big] impact. Estimates for 12 low-income countries show that [alcohol] consumption levels would fall by more than 10%, while tax revenues would more than triple to a level amounting to 38% of total health spending in those countries. Even if only a portion of the proceeds were allocated to health, access to services would be greatly enhanced.“

World Health Report, 2010, WHO

A 2022 study from Lithuania found that implementing common sense limits on alcohol availability led to marked reductions in ER visits for alcohol poisoning in men.

Case #4: Alcohol’s contribution to lost human potential, impaired education and academic development, as well as productivity losses (SDGs 4, 8, and 10)

Alcohol versus quality education, productivity, and human capital

Alcohol is an obstacle to development by jeopardizing human capital. It is a major risk factor for lost human potential throughout the life course.

Human capital loss in childhood, adolescence, and youth

Children, adolescents and youth bear a disproportionate burden of alcohol harm.

The pathways are many: For example, parents have an immense influence over their children’s behavior during adolescence and on their children’s well-being through the life-course. Adolescents growing up with parents who have alcohol use problems are more likely to turn to self-destructive behaviors such as suicide attempts.

Alcohol use during pregnancy is a significant risk factor for adverse pregnancy outcomes, including stillbirth, premature birth, intrauterine growth retardation and low birth weight. A 2017 landmark study showed that the global prevalence of alcohol use during pregnancy in the general population amounts to almost 10%. Alcohol use during pregnancy risks a child’s health and development.

The effects of parental substance use disorders can lead to the following problems in their children:

• Mental health problems,
• Relationship problems,
• Financial problems,
• Family problems, and
• Imitation of risky behaviors.

Alcohol is neurotoxic to brain development, potentially leading, in childhood and adolescence, to structural hippocampal changes, and in adulthood to reduced brain volume.

Especially in poorer communities, in families affected by alcohol use disorder, and in Low- and Middle Income Countries (LMICs), alcohol tends to crowd out other more productive household spending, for example on education, healthcare and healthy food – thereby seriously eroding human potential.

Alcohol is linked with many negative education-related consequences, including poor school engagement and performance, and school drop-out. There is strong evidence of causation at least from frequent alcohol use to adverse health, social and educational outcomes.

Alcohol clearly fuels all these risk factors for human capital, contributing to:

1. Parental roles being neglected and abandoned,
2. Scarce resources being wasted on alcohol, instead of healthy food, leisure time activities and school material,
3. Resulting health issues further exacerbating the dire situation, fueling the vicious cycle,
4. Norms and conditions for academic performance being undermined and eroded.

Alcohol use by both parents/ caregivers as well as children/ youth causes several negative education-related consequences in high- as well as low-and middle-income countries:

• Poor school engagement and performance, 
• Truancy, 
• Lower educational attainment, 
• Early school drop-out, and
• Incompletion of secondary school and post-secondary education.

Alcohol harm erodes human capital in women and girls

Regarding women and girls, alcohol fuels gender inequality, perpetuates harmful stereotypes and norms, and is a major risk factor for violence against women – all adding to substantial loss of human potential due to alcohol-fuelled exclusion and oppression of women and girls.

Losing human potential due to inequalities

Alcohol frequently fuels and fortifies inequalities between and within countries, hindering the development of human capital in less privileged societies, communities and neighborhoods.

Inequalities in alcohol-related harm exist based on factors including economic status, education, gender, ethnicity and place of residence. Harms from a given amount of alcohol consumption are higher for poorer alcohol users and their families than for richer alcohol consumers.

In general, lower socioeconomic groups consume less alcohol overall and are more likely to live free from alcohol, but they experience higher levels of alcohol-related harm than wealthier groups with the same level of consumption – a significant challenge to human capital development in more vulnerable settings.

Alcohol consumption causes death and disability relatively early in life. Globally, alcohol is the number one risk factor disease, disaability, and death among people between the ages of 15 and 49. This is the age range in which people are typically at their most productive economically.

Loss of healthy, quality life years due to alcohol

Alcohol is a leading risk factor for healthy live years lost and for loss of quality of life – which are other ways of expressing alcohol’s adverse effect on human capital.

In high-income countries older people suffer from increasing alcohol harm, threatening their potential to participate in family and community life.

In 2023, the World Health Organization (WHO) released its largest review of the world’s mental health. The report illustrates alcohol as risk factor that undermine mental health.

Key facts about the global mental health burden: 

• In 2019, nearly a billion people – including 14% of the world’s adolescents – were living with a mental disorder. 
• Suicide accounted for more than 1 in 100 deaths.
• 58% of suicides occurred before age 50. 
• Mental disorders are the leading cause of disability, causing 1 in 6 years lived with disability. 

Alcohol’s role in the global mental health burden

The new report cites older WHO estimates that 283 million people had alcohol use disorders in 2016 – a large mental health burden worldwide, given that overall 970 million people globally were living with a mental disorder in 2019.

The report addresses alcohol use as a risk factor that can undermine mental health. Alcohol use is highlighted as one of the risk factors which perpetuate the vicious cycle of mental ill-health and poverty. 

The report includes alcohol use disorders as a mental health problem and treating AUD as part of the solution. Examples of investing in mental healthcare packages including for alcohol use disorders are included in the report. 

For example, in South Asia and sub-Saharan Africa, the cost of scaling up delivery of an integrated package for epilepsy, depression, bipolar disorder, schizophrenia, and heavy alcohol use has been calculated at US$3 – $4 per capita. The return on investment for that would be 500 – 1000 healthy years of life for every million dollars spent. 

Case studies from South Africa and Uzbekistan show investing in a mental healthcare package which included alcohol use disorders led to significant return on investment. 

Case #5: Alcohol’s contribution to water insecurity and shortage as well as biodiversity loss, environmental degradation, and the climate crisis (SDGs 2, 6, 12, 13, and 15)

Alcohol and the triple planetary crisis

Big Alcohol is fueling the climate crisis in multiple ways. Water and food insecurity, environmental degradation, pollution, greenhouse gas emissions, and green-washing are part of the alcohol industry’s sustainability footprint

Alcohol production, water insecurity and malnutrition are linked in multiple ways:

• The scarcity of freshwater is a threat to human hygiene, sanitation (SDG 3) and food security (SDG 2) and can have serious negative implications for economic development (SDG 8). 
• Alcohol production fuels water insecurity.

Evidence from a large Australian population health survey illustrates these interlinkages:

Heavy consumption of non-core foods – energy-dense and nutrient-poor foods high in saturated fat, added sugars and salt, and alcohol – contributes up to 36% of the water-scarcity impacts and is the primary factor differentiating healthier diets with lower water-scarcity footprint from poorer quality diets with higher water-scarcity footprint.

Evidence from Sweden also shows that alcohol accounts for a large part of Sweden’s total climate footprint. Considering that alcohol harms both human and planetary health, alcohol prevention is an important tool in the response to the climate crisis.

According to the BBC climate change food calculator alcohol, particularly beer, fuels climate change.

When calculating for emissions from one pint of beer – taken 3 to 5 times a week and within the guidelines for alcohol use provided by NHS – it amounts to 139kg of greenhouse gas emissions per year.

In Historic Move, UN Declares Healthy Environment a Human Right

In 2022, the UN General Assembly declared access to a clean and healthy environment a universal human right.

The resolution notes that the right to a healthy environment is related to existing international law. The newly right will be crucial in tackling the triple planetary crisis.

This refers to the three main interlinked environmental threats that humanity currently faces:

Analysis of the impact of alcohol on the Sustainable Development Goals (SDGs) shows that all three environmental threats are fueled by alcohol – by alcohol production, distribution, and other aspects of the alcohol industry.

Through its multiple health, social and economic harms, alcohol is a massive obstacle to sustainable human development, adversely affecting all three dimensions of development and reaching into all aspects of society.

Alcohol adversely affects 14 out of 17 SDGs and a total of 54 targets.

Healthy environment as a Human Rights requires states to consider the impact of climate change, the unsustainable management and use of natural resources, the pollution of air, land and water, the unsound management of chemicals and waste, and the resulting loss in biodiversity and to take measures to protect people’s Human Right to a healthy environment. These considerations also include alcohol across multiple SDGs.

Not green after all: Alcohol fuels greenhouse gas emissions, global warming

Very few people actually think of alcohol in terms of its climate impact. For achieving the goals of the 2030 Agenda, a more comprehensive understanding of the alcohol industry is critical.

Alcohol production, consumption fuels climate crisis

• The contribution made by the alcohol consumed in the UK accounts for 1.46% of the UK’s total greenhouse gas emissions. The share of beer in alcohol’s total emissions amounts to 65%.
• In a lifecycle analysis of a Spanish beer, production and transport of raw materials used in beer production was found to contribute over one third of the total global environmental impact of the beer production lifecycle.

Alcohol production, consumption fuels climate crisis

Alcohol, particularly beer, fuels the climate crisis, according to calculations of greenhouse gas emissions. The yearly amount of Australian beer consumption is equal in emissions to a car driving 1.94 billion km – the equivalent of 48 000 car rides around the world. Emissions related to beer production and consumption cause the biggest damage to the climate when compared to other beverages such as coffee or tea.

Other aspects of the alcohol industry contributing to global warming, greenhouse gas emissions, high energy use, pollution and waste of natural resources are:

• Refrigeration in the hospitality sector,
• Use of fertilizers,
• Water use,
• Packaging,
• Waste,
• Transport of raw material, and
• Distribution of the products.

The unsustainable management and use of natural resources

Alcohol production threatens sustainable use of natural resources. For example, the global importance of cereal crops to the human diet cannot be over stated. Cereals are by many criterea the most important group of food crops produced in the world. They are energy dense, and important sources of dietary protein, carbohydrates, the B complex of vitamins, vitamin E, iron, trace minerals, and fiber. The global cereal consumption directly provides about 50% of protein and energy necessary for the human diet.

The production of alcoholic beverages is very resource-intensive and not environmentally sustainable

• For instance, cereals are diverted from food production to the making of alcohol such as whiskey and beer (barley; sorghum), vodka (wheat), bourbon (rye), sake (rice).
• By some estimates, up to 92% of brewing ingredients are wasted.

In 2018 a scientific analysis by Poore and Nemecek showed that lowering alcohol consumption by 20% can help to:

• reduce land use of alcohol production by 39% on average;
• reduce greenhouse gas emissions by 31% to 46%; and
• reduce scarcity-weighted fresh water withdrawals by 87%.

The negative impact of alcohol production on availability of cereal crops for food, water security and food waste as well as the energy-consuming production processes are causing externalities that are unsustainable.

The pollution of air, land and water by Big Alcohol

Alcohol production degrades ecosystems and threatens biodiversity. Often permissions for alcohol production are granted without adequate environmental impact studies. But on the U.S. west coast, in Washington State, activists and experts detail how increased alcohol production will degrade farmland, jeopardize local food production and threaten the ecosystem.

Alcohol productions leads to biodiversity loss

King County, Washington State: The alcohol industry adversely impacts rural and agricultural land, locally grown food supply and salmon migrating through local rivers by degrading all agricultural production districts and destroying the Sammamish Valley river ecosystem.

Another example of Big Alcohol pollution is provided by liquor giant Diageo: Recently, The Scottish Environment Protection Agency found that Diageo has been operating three sites in Scotland without climate regulation permits for six years. This breach has now resulted in a serious fine. 

In 2019, volunteers in 51 countries collected plastic waste and global beer manufacturer’s products were identified among the most frequent corporate plastic pollution.
Coca-Cola was named the world’s number one global plastic polluter (second year in a row), followed by Nestlé and Pepsico, according to an audit conducted by Break Free From Plastic. Global beer giants AB InBev, Carlsberg and Heineken are also listed among the leading plastic polluters in the world. In Europe, Heineken is in fact the third biggest polluter.

In Kenya, the pollution effects of brewery waste water on the Ruaraka river have been studied and documented since the 1990s. Kilani and Otieno write already in 1991:

The Tusker Brewery at Ruaraka (located about 6 km from Nairobi City Centre) is the largest brewery plant in Kenya, producing about 2.25 million litres of beer per day. The effluent from the plant is discharged directly into the Ruaraka River without any form of pretreatment.”

Kilani and Otieno, 1991

Drinking water or producing alcohol?

By 2025, an estimated 1.8 billion people will live in areas plagued by water scarcity, with two-thirds of the world’s population living in water-stressed regions. 785 million people don’t have clean water close to home. 70% of the world’s water resources are used for agriculture and irrigation, according to the Food and Agriculture Organization of the United Nations.

A third of the world’s biggest groundwater systems are already in distress and about 4 billion people, representing nearly two- thirds of the world population, experience severe water scarcity during at least one month of the year.

The effects on poor communities are most severe, when scarce resources are drained for the production of alcohol instead of sustaining community life and development.

Alcohol production is a threat to water security in many regions of the world

• The water footprint of wine is horrible:
  • To get 1 liter of wine, 870 liters of water are needed.
• The water footprint of beer is horrific:
  • Per 1 liter of beer, 298 liters of water have to be used.

All this is happening at the same time as the alcohol industry is causing major emissions of chemicals into waterways in its production, around the world and is fueling water insecurity.

For instance, in Cape Town, South Africa, 2018, the drought was so acute that the municipal water had to be turned off, while the wine industry spread over ever larger land areas and used more and more of the water reserves. And in northern Mexico, communities are boycotting AB In-Bev, the world’s largest beer producer, over their breweries causing water shortages.

Mexico is facing a water crisis with northern parts of the country being acutely affected. For example, record low levels of rainfall in the northern state of Nuevo León have resulted in the city’s dams drying up and groundwater running low. People suffer with no water coming from taps and children are getting sick due to poor sanitation. But Big Beer keeps on guzzling what little water there is to produce their beer products.

And yet, Big Beer continues like it’s any other regular day, guzzling up what little water there is left in northern Mexico to keep manufacturing their beer products. Even as stores run out of stocks of water, shelves are filled with beer and soda.

You’d open the tap and there wouldn’t be a drop of water. The brewing factories, though, produced and produced and produced,” said Blanca Guzmán, a resident of Monterrey, where Heineken operates a plant, as per The New York Times.

Blanca Guzmán, a resident of Monterrey, Mexico

In Mexico, about two and a half liters of water is used to make one liter of beer. Brewers in Mexico obtain rights to gain access to water from the federal government. These water rights can last decades allowing beer companies to keep draining water to make beer – a non-essential carcinogenic product. Meanwhile, local communities suffer from water scarcity. But what matters to the beer industry are profits and Mexico, being the world’s largest beer exporter, is profitable.

Major multinational beer companies Heineken, Anheuser-Busch InBev, and Constellation Brands all operate large plants in northern Mexico ignoring the region’s increasing droughts.

Heineken land grab shatters lives and livelihoods in Ethiopia

Revelations by investigative journalist Olivier van Beemen show that Heineken built a new brewery on land on the outskirts of Addis Abba, capital city of Ethiopia, that belonged to local people, including farmers. To make space for the beer giant’s factory, Heineken forced an entire community to relocate, shattering lives and livelihoods.

This example shows how water insecurity, food insecurity, land rights and biodiversity, as well as environmental sustainability and community resilience are intertwined and harmed by the products and practices of alcohol companies.