Alcohol Policy Scores and Alcohol-Attributable Homicide Rates in 150 Countries
More comprehensive state-level alcohol policy environments are associated with lower alcohol-attributable homicide rates in the U.S., but few studies have explored this internationally. This study tests whether 3 national-level alcohol policy scores are associated with alcohol-attributable homicide rates.
Data were from the 2016 WHO Global Survey on Alcohol and Health and the 2017 Global Burden of Disease Study (N=150 countries).
In 2020, the authors calculated domain-specific alcohol policy scores for physical availability, marketing, and pricing policies. Higher scores represented more comprehensive/restrictive alcohol policy environments.
Negative binomial regressions with Benjamini–Simes–Hochberg multiple testing correction measured the associations between policies and alcohol-attributable homicide rates. The authors stratified countries by World Bank income group to determine whether the associations differed among low- and middle-income countries.
A 10% increase in the alcohol policy score for pricing was associated with an 18% lower alcohol-attributable homicide rate among all the countries and with a 14% decrease among 107 low- and middle-income countries.
More controls on days and times of retail sales and affordability of alcohol as well as adjusting excise taxes for inflation were associated with a 4%–5% lower alcohol-attributable homicide rate in the full sample.
Countries with policies that reduce alcohol’s affordability or days/hours of sales tend to have fewer alcohol-attributable homicides, regardless of their income level.
Alcohol-attributable homicide rates are highest in low- and middle-income countries; policies that raise alcohol-relative prices may hold promise for curbing these harms.
The findings around alcohol price suggest the importance of strategies such as alcohol taxes, which are widely underutilized globally, failing to keep up with inflation in most countries, and consequently losing their preventive value.
Stratification of countries by income group was a first step toward addressing the gap in evidence regarding what works to prevent alcohol’s harms in LMIC settings.
Future research should evaluate whether recent policy changes are associated with changes in the rate of alcohol-attributable homicides.
Given that the per capita prevalence of alcohol-attributable homicide increased since 1990 by 19.5% and 39.6% in lower middle−and upper middle−income countries, respectively, this line of research could identify an important tool to help address the inequitable distribution of alcohol-attributable homicide across income groups and countries.
What are alcohol policy scores?
Alcohol policy scores (APSs) measure the combinations of alcohol policies with statistical efficiency.
Alcohol policy scores facilitate understanding of the alcohol policy environment how comprehensive or imperfect they are.
Brand et al. pioneered an APS combining 5 policy domains – availability, drinking context, price, advertising, and driving under the influence of alcohol. They found that more comprehensive policy environments were associated with reduced per capita alcohol consumption.
In 2017, the WHO European Regional Office constructed 10 domain-specific APSs corresponding to the action areas in the WHO Global Alcohol Strategy.
Researchers have not tested the associations between these APSs and harms among geographically and economically diverse countries. To address this gap, this study explores whether the 3 WHO Europe domain-specific APSs corresponding to the alcohol policy best buys – the most effective interventions reducing alcohol-related harm across populations costing less than US$100 per disability-adjusted life year averted – are linked with alcohol-attributable homicide rates in a diverse sample of countries.
This study also examines (1) whether the association between APSs differs between high-income countries and LMICs and (2) which APS sub-indicators (i.e., components of domain-specific APSs) are associated with alcohol-attributable homicide rates.