WHO Publishes Reporting About Alcohol Guide For Journalists

Isn’t consuming some alcohol good for your health?

Comprehensive, systematic reviews of the evidence conclude that no level of alcohol is safe to consume.

There are no known protective health effects from consuming alcohol, even at low levels.

But what about reports that a daily glass of red wine is good for your heart?

Widely publicized claims that consuming a glass of red wine a day can protect against cardiovascular disease are wrong and divert attention from the many harms of alcohol use.

Why are national alcohol use guidelines different from WHO recommendations?

Many countries have issued low-risk guidelines, usually recommending no more than 10 standard alcoholic drinks per week. WHO does not set particular limits because the evidence shows that the ideal situation for health is not to consume alcohol at all. Any alcohol use is associated with some risk, such as the risk of alcohol dependence, breast cancer (a linear relationship in women) or injury.

While adhering to national alcohol guidelines may keep individual risk levels low, from a public health perspective and at the population level, there are no levels of consumption at which no risks are involved.

If alcohol is so bad for you, why does nearly everyone consume it?

More than half of adults around the world do not consume alcohol; their perspectives are under-represented in the media, maintaining a common misconception that alcohol consumption is an inevitable part of life.

Isn’t alcohol consumption good for the economy?

Since alcohol consumption can sustain jobs and generate tax revenue, some assume it positively affects economic development.

However, alcohol harm decreases worker productivity and increases health-care, criminal justice and social services costs. The net effect is a lower gross domestic product (GDP).

The latest economic analysis undertaken under the auspices of WHO estimated that every additional US$ 1 invested in the most cost-effective alcohol interventions per person per year will yield an estimated economic return of US$ 9.13 by 2030.

Reducing alcohol harm contributes directly and indirectly to economic development, with demand and jobs created in other sectors. The output and employment provided by alcohol consumption can be replaced in other parts of an economy, while reducing alcohol use will help attain a number of the Sustainable Development Goals (SDGs), including the goals on ending poverty, quality education, gender equality, economic growth and reducing inequalities between and within countries.

Doesn’t using alcohol help people relieve stress?

Rather than relieving stress, drinking alcohol can cause psychological and physiological harm and can compound the effects of stress.

Isn’t alcohol safe as long as you drink responsibly?

Across the population, any level of alcohol consumption, regardless of the amount, is associated with a greater risk of loss of healthy life.

The vague notion of “responsible drinking” that is actively promoted by alcohol producers and marketers, does not define when to stop using alcohol or suggest the option of not consuming alcohol at all. It does, however, create a mistaken impression that the alcohol industry is part of the solution to harms caused by alcohol rather than a driver of the problem.

Moreover, the moralizing tone implicit in “responsible drinking” messages ignores the inherent risks in consuming alcohol, mischaracterizing its harms as the result of a small minority of individual alcohol users who cannot control their intake.

It also can perpetuate stigmatizing attitudes, wrongly blaming individual alcohol users as the cause of all health or social problems linked to alcohol, creating a sense of shame that stops them and their family members from seeking help when they need it.

Doesn’t most alcohol harm come from a minority group of heavy drinkers?

The common perception is that a small fraction of the population causes most of the harm linked to alcohol consumption. But alcohol-related cancers, accidents, injuries and violence are widely distributed across the population, including among those who consume small and low doses of alcohol. Even though heavy alcohol users are undoubtedly at high risk of alcohol-related harm, they contribute only a minority to the total alcohol casualties.

In this “prevention paradox”, most alcohol-related harm occurs among low-to-moderate risk alcohol users simply because they are more numerous in the population.

In this day and age, why is it said women should drink less alcohol than men?

Because alcohol is more harmful to women, if they begin to consume alcohol more like men (who currently consume the majority of alcohol and suffer most of the alcohol-related harms), women will experience far more negative health effects than men.

• How alcohol harms the body.
• How alcohol harms society.
• Alcohol acceptability in cultures.
• Alcohol consumption history and trends.
• What works to reduce alcohol consumption.

• Six tips for covering alcohol’s effects on public health and society.
• Alcohol story ideas.
• Glossary.
• Resources for journalists.

Most cost-effective: raising taxes on alcohol

Taxation offers the most cost-effective strategy for minimizing alcohol harm in most countries. WHO recommends that countries establish and enforce a taxation system that considers the alcohol content of the beverage, ban or restrict sales below cost and other price promotions, and institute minimum prices for alcohol.

Studies repeatedly find that increasing the price of alcohol is associated with reductions in alcohol consumption and alcohol-related morbidity and mortality, including liver cirrhosis deaths, violence, driving under the influence of alcohol and sexually transmitted infections.

A small part of the literature also suggests that the benefits of higher alcohol prices also extend to the education sector, increasing the likelihood of secondary school graduation and post-secondary enrolment.

A 2022 study found that raising taxes on alcohol to a minimum of 15% in the WHO European Region, which has the highest level of alcohol use globally, could avert more than 130,000 deaths per year.

Increasing taxes on alcohol has the added benefit of generating more revenue for strengthening health systems or other critical public services.

Highly cost-effective: restricting the availability of alcohol

As a highly cost-effective “best-buy” intervention, WHO recommends countries enact and enforce regulations on the physical availability of alcohol by reducing the hours of sale, fixing an appropriate minimum age for purchase or consumption of alcoholic beverages and reducing the density of outlets.

The widespread existence of licensing systems regulating alcohol shows the potential for effective alcohol availability limits.

In practice, it is common for countries to increase the availability of alcohol by increasing the number of licences to produce, distribute and sell alcohol. Across the globe, increased hours and days of sale have been linked to increased alcohol consumption and related harm. For example, the 2003 introduction of 24-hour alcohol availability in the United Kingdom saw increased levels of crime and antisocial behaviour between 03:00 and 06:00, increased police expenditure and resource allocation during the early hours, and increased alcohol-related hospital admissions.

Conversely, reducing the opening hours of bars from 24 hours a day to closure at 23:00 in Diadema, Brazil, was associated with a 44% drop in homicides.

Effective: providing brief interventions

There is evidence that brief interventions – short, non-confrontational conversations with nurses or other health-care providers – can motivate high-risk alcohol users to think about or plan a change in their alcohol user.

Proactive approaches in health-care settings are essential to a comprehensive national alcohol policy. WHO’s Alcohol Use Disorders Identification Test (AUDIT) was developed to screen high risk alcohol use and assist in brief assessment in primary care settings. It can help identify heavy alcohol use as the cause of the presenting illness. It also provides a framework for intervention to help high-risk alcohol users reduce or quit alcohol consumption and thereby avoid further harm.

Possibly effective: health warning labels

WHO recommends labelling alcoholic beverages with information about the harm caused by alcohol to increase awareness. While the evidence is not robust that warning labels on alcoholic beverages reduce consumption or change individual behaviour, raising awareness cannot be discounted, as it is a preliminary step towards behaviour and policy change.

Moreover, comprehensive health warning labels on tobacco products have been consistently shown to influence social norms, improve health knowledge and reduce consumption behaviours.

The first study to experimentally test evidence-informed alcohol health warning labels in the real world took place in the Yukon, a territory in northwestern Canada. It found that adding warning labels to alcohol bottles decreased total sales by 6.9% compared with sales in regions without labels.

Ineffective: corporate social responsibility initiatives (CSR)

There are irreconcilable differences between the goals of governments to protect and promote people’s health and well-being and the economic operators in the alcohol industry pursuing maximum profit through increased alcohol consumption.

Corporate social responsibility initiatives by the alcohol industry are a strategy to legitimize its participation in the public health agenda and divert attention from evidence-based strategies that reduce alcohol harm.

Presenting the industry as a reliable and necessary public health actor implies that the consumption of alcohol and its related harm result solely from an individual choice rather than being the product of contextual conditions, such as investment and marketing.

Alcohol industry CSR has been shown to promote mixed messages about alcohol harm and undermines scientific evidence. Meanwhile, some alcohol industry-sponsored educational programmes have increased alcohol-related harm and have been linked with efforts to circumvent or prevent regulation.

Further, there is little or no evidence for the effectiveness of designated driver campaigns, which constitute the cornerstone of the industry’s strategy to reduce impaired driving.

As promoted by the industry, “responsible drinking” campaigns can be interpreted as a marketing tool and a tactic to influence public beliefs about the alcohol industry.

Countries should consider developing a framework for managing conflicts of interest that builds on the work in nutrition and tobacco.

Highly cost-effective: regulating alcohol marketing

Banning or comprehensively restricting alcohol marketing, advertising, sponsorships and promotion is a cost-effective way to eliminate one of the causes of underage alcohol use. Alcohol is the leading killer of young people world wide. Stopping young people from consuming alcohol eliminates a high risk of dependence later in life.

While the alcohol industry maintains that advertising does not affect consumption and is not aimed at young people, industry data shows that alcohol advertising emphasizes recruiting alcohol users, particularly younger ones.

Ubiquitous alcohol marketing also creates an environment that makes a recovery from alcohol dependence more difficult.

A common finding is that around half of the alcohol consumed by a population is consumed by 10% of current alcohol users, making heavy and dependent alcohol users a crucial target for alcohol sales and advertising. Alcohol-dependent patients frequently report a stronger urge to consume alcohol when confronted with alcohol-related cues.

With the advent of algorithmic online marketing techniques targeting individuals based on their past behaviours, unchecked alcohol marketing can also interfere with individuals’ efforts to reduce or quit alcohol use.

Effective: enacting driving under the influence (DUI) countermeasures

Drivers with a blood alcohol concentration (BAC) of 0.02–0.05 g/dl have at least a three times greater risk of dying in a vehicle crash. This risk increases at least six times with a BAC of 0.05–0.08 g/dl.

In recent decades, many countries have successfully reduced DUI related crashes, using evidence-driven, context-relevant legislation, consistently enforced and well understood by enforcement officials and the public.

Best practice for DUI laws includes a BAC limit of 0.05 g/dl for the general population and a BAC limit of 0.02 g/dl for young or novice drivers.

Australia is one country that has adopted the legal 0.05 g/dl limit, introducing it in the 1980s with large-scale police enforcement through random breath testing. This was supported by various other interventions, including publicity, community activity programmes, and variations in licensing and distribution arrangements for alcohol. While DUI is still a significant cause of death and injury on the country’s roads, alcohol as a factor in crashes was almost halved in Australia over 30 years, and there is now a strong community view that the behaviour is socially irresponsible and unacceptable.

Effective: minimum unit pricing

Where taxation is not considered a viable policy option, setting minimum prices for alcoholic beverages or regulating discount prices can help reduce economic availability (affordability).

Increasing the price of alcohol has been found to reduce acute and chronic harm related to alcohol among people of all ages, indicating that heavy or high-risk alcohol users are no exception to the basic rule that alcohol consumers respond to changes in alcohol prices.

After Scotland introduced minimum unit pricing in 2018, the research found that alcohol sales in the country fell by 7.7%, the reductions occurring mostly in households that bought the most alcohol.

The same study found an 8.6% decrease in alcohol sales in Wales after it introduced minimum unit pricing in 2020.

Minimum unit pricing specifically targets low-cost products to protect alcohol users at the most significant risk of harm, who tend to consume the cheapest alcohol.

Ineffective: public service announcements

Messages dealing with “responsible drinking”, the hazards of driving under the influence of alcohol (DUI) and related concerns have been a largely ineffective counter-response to the frequent, high-quality, pro-alcohol advertisements people are exposed to through the mass media.

Moreover, when the alcohol industry sponsors nongovernmental organizations’ road safety campaigns, it has been found to boost alcohol brand reputation instead of effectively addressing DUI.

Research shows that while public service announcements and other education and information campaigns have led to some improved knowledge about alcohol’s harms, they have little impact on alcohol use. To succeed at the individual level, public service announcements likely require a corresponding public policy to support the introduction of more effective measures to reduce alcohol consumption.

Ineffective: industry self-regulation

While the alcohol producers maintain they can regulate their own marketing activities, researchers have found that guidelines are routinely not followed, causing excessive alcohol marketing exposure to young people and other vulnerable populations.

Studies find that young people who are more exposed to alcohol marketing are more likely to start consuming alcohol early and engage in binge and hazardous alcohol use.

WHO has also found that the lack of regulations to address cross-border marketing of alcohol has led to a growth in sophisticated online marketing that targets children and adolescents, women and heavy alcohol users.

While the alcohol industry also participates in developing alcohol policy in many countries, research has found it has extensively misrepresented evidence of alcohol-related cancer risks. Alcohol marketing regulation is one of WHO’s three “best buys” for cost-effective policies to prevent and control alcohol harm as a risk factor for NCDs.

Regulations must be coherent, strategic and adaptable, and all related regulatory bodies and processes must be independent of the alcohol industry, given the commercial interests that often conflict with those of public health.