The WHO Global Alcohol Strategy represents a collective commitment by WHO Member States to reduce the global burden of disease caused by alcohol consumption. The strategy includes evidence-based policies and interventions that protect health and save lives if adopted, implemented and enforced.
The policy options and interventions available for national action can be grouped into a policy model of crucial and recommended target areas, which are mutually supportive and complementary. The 9 most fundamental areas are:
- Leadership, awareness and commitment
- Health services’ response
- Community action
- Availability of alcohol
- Marketing of alcoholic beverages
- Pricing policies
- Policies and countermeasures to tackle driving under the influence of alcohol
- Reducing the public health impact of illicit alcohol and informally produced alcohol
- Monitoring and surveillance.
Leadership, awareness and commitment
Sustainable action requires strong leadership and a solid base of awareness and political will and commitment. The commitments should be expressed through adequately funded comprehensive and intersectoral national policies that clarify the contributions, and division of responsibility, of the different partners involved. The policies must be evidence-based, rights-based and tailored to local circumstances, with clear objectives, strategies and targets. The policy should be accompanied by a specific action plan and supported by effective and sustainable implementation and evaluation mechanisms. The appropriate engagement of civil society is crucial. Conflict of interest that arise from involving the alcohol industry need to eliminated.
For this area policy options and interventions include:
- Developing or strengthening existing, comprehensive national and subnational strategies, plans of action and activities to reduce alcohol use;
- Establishing or appointing a main institution or agency, to be responsible for following up national policies, strategies and plans;
- Alcohol in All Policies and whole-of-government approach: Mainstreaming alcohol strategies with work in other relevant sectors, including cooperation between different levels of governments, and with other relevant health-sector strategies and plans;
- Raising awareness of harm to others and among vulnerable groups caused by alcohol use, avoiding stigmatization and actively discouraging discrimination against affected groups and individuals.
Health services’ response
Health services are central to tackling harm at the individual level among those with alcohol-use disorders and other health conditions caused by alcohol use. Health services should provide prevention and treatment interventions to individuals and families at risk of, or affected by, alcohol-use disorders and associated conditions.
Health services response should be sufficiently strengthened and funded in a way that is commensurate with the magnitude of the public health problems caused by alcohol harm, and in order to be able to reach out to communities to provide services, inform and raise awareness of alcohol-related harm.
For this area policy options and interventions include:
- Increasing capacity of health and social welfare systems to deliver prevention, treatment and care for alcohol-use and alcohol-induced disorders and co-morbid conditions, including support and treatment for affected families and support for mutual help or self-help activities and programmes;
- Supporting initiatives for screening and brief interventions at primary health care and other settings; such initiatives should include early identification and management of alcohol use among pregnant women and women of child-bearing age;
- Improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome and a spectrum of associated disorders;
- Development and effective coordination of integrated and/or linked prevention, treatment and care strategies and services for alcohol-use disorders and co-morbid conditions, including illicit drug-use disorders, depression, suicides, HIV/AIDS and tuberculosis;
- Securing universal access to health including through enhancing availability , accessibility and affordability of treatment services for groups of low socio-economic status;
- Establishing and maintaining a system of registration and monitoring of alcohol- attributable morbidity and mortality, with regular reporting mechanisms.
Community action
The impact of alcohol harm on communities can trigger and foster local initiatives and solutions to local problems. Communities can be supported and empowered by governments and other stakeholders to use their local knowledge and expertise in adopting effective approaches to prevent and reduce alcohol harm by changing collective rather than individual behaviour.
For this area policy options and interventions include:
- Supporting rapid assessments in order to identify gaps and priority areas for interventions at the community level;
- Facilitating increased recognition of alcohol-related harm at the local level and promoting high-impact and cost-effective responses to the local determinants of alcohol use and related harm;
- Strengthening the capacity of local authorities to encourage and coordinate concerted action by supporting and promoting the development of municipal policies to reduce alcohol harm, along with building their capacity to enhance partnerships and networks of community institutions and civil society;
- Providing information about effective community-based interventions and building capacity at community level for their implementation;
- Mobilising the communities to prevent selling of alcohol to and consumption by, and to develop and support alcohol-free environments – especially for children and youth and at-risk groups;
- Providing community care and support for affected individuals and their families;
- Developing or supporting community programmes and policies for subpopulations at particular risk, such as young people, unemployed persons and indigenous populations, specific issues like the production and distribution of illicit or informal-alcohol beverages and events at community level such as sporting events and town festivals.
Availability of alcohol
Public health strategies that seek to regulate the commercial or public availability of alcohol through laws, policies, and programmes are important ways to reduce the general level of alcohol use and harm. Such strategies provide essential measures to prevent easy access to alcohol by vulnerable and high-risk groups. Commercial and public availability of alcohol can have a reciprocal influence on the social availability of alcohol and thus contribute to changing social and cultural norms that promotes harmful use of alcohol.
In some low-and middle-income countries, informal markets are a major source of alcohol and formal controls on sale need to be complemented by actions addressing illicit or informally produced alcohol. Secondary supply of alcohol, for example from parents or friends, needs also to be taken into consideration in measures on the availability of alcohol.
For this area policy options and interventions include:
Establishing, operating and enforcing an appropriate system to regulate production, wholesaling and serving of alcoholic beverages that places reasonable limitations on the distribution of alcohol and the operation of alcohol outlets:
- Introducing, a licensing system on retail sales, or public health oriented government monopolies;
- Regulating the number and location of on-premise and off-premise alcohol outlets;
- Regulating days and hours of retail sales;
- Regulating modes of retail sales of alcohol;
- Regulating retail sales in certain places or during special events;
- Establishing an appropriate minimum age for purchase or consumption of alcoholic beverages and other policies in order to raise barriers against sales to, and consumption of alcoholic beverages by, adolescents;
- Adopting policies to prevent sales to intoxicated persons and those below the legal age and considering the introduction of mechanisms for placing liability on sellers and servers in accordance with national legislations;
- Setting policies regarding drinking in public places or at official public agencies’ activities and functions;
- Adopting policies to reduce and eliminate availability of illicit production, sale and distribution of alcoholic beverages as well as to regulate or control informal alcohol.
Marketing of alcoholic beverages
Reducing the impact of marketing, particularly on children, young people and adolescents, is an important consideration in preventing alcohol harm, early onset of alcohol consumption and the reduction of overall alcohol use and related harm.
Marketing could refer, as appropriate and in accordance with national legislation, to any form of commercial communication or message that is designed to increase, or has the effect of increasing, the recognition, appeal and/or consumption of particular products and services. It could comprise anything that acts to advertise or otherwise promote a product or service.
Alcohol is marketed through increasingly sophisticated advertising and promotion techniques, including linking alcohol brands to sports and cultural activities, sponsorships and product placements, and new marketing techniques such as e-mails, SMS and podcasting, social media and other communication techniques. The transmission of alcohol marketing messages across national borders and jurisdictions on channels such as satellite television and the Internet, and sponsorship of sports and cultural events is emerging as a serious concern.
It is very difficult to target young adult consumers without exposing cohorts of children and adolescents under the legal age to the same marketing. The exposure of children and young people to alcohol marketing is of particular concern, as is the targeting of new markets in developing and low-and middle-income countries with a current low prevalence of alcohol consumption or high abstinence rates.
Both the content of alcohol marketing and the amount of exposure of young people to that marketing are crucial issues. A precautionary approach to protecting young people against these marketing techniques should be considered.
For this area policy options and interventions include:
- Setting up regulatory frameworks, with a legislative basis, for alcohol marketing by:
- Regulating the content and especially the volume of marketing;
- Regulating direct or indirect marketing in certain or all media;
- Regulating sponsorship activities that promote alcoholic beverages;
- Banning promotions in connection with activities targeting young people;
- Regulating new forms of alcohol marketing techniques, for instance social media;
- Development by public agencies or independent bodies of effective systems of surveillance of marketing of alcohol products;
- Setting up effective administrative and deterrence systems for infringements on marketing restrictions.
Pricing policies
Consumers, including heavy alcohol users and young people, are sensitive to changes in the price of alcohol products. Pricing policies can be used to reduce underage alcohol consumption, to halt progression towards consuming large volumes of alcohol and/or episodes of heavy use, and to influence consumers’ preferences.
Increasing the price of alcoholic beverages is one of the most effective interventions to reduce alcohol use and related harm. A key factor for the success of price-related policies in reducing alcohol use is an effective and efficient system for taxation matched by adequate tax collection and enforcement.
Factors such as consumer preferences and choice, changes in income, alternative sources for alcohol in the country or in neighbouring countries, and the presence or absence of other alcohol policy measures may influence the effectiveness of this policy option. Demand for different beverages may be affected differently. Tax increases can have different impacts on sales, depending on how they affect the price to the consumer.
For this area policy options and interventions include:
- Establishing a system for specific domestic taxation on alcohol accompanied by an effective enforcement system, which may take into account, as appropriate, the alcoholic content of the beverage;
- Regularly reviewing prices in relation to level of inflation and income;
- Banning or restricting the use of direct and indirect price promotions, discount sales, sales below cost and flat rates for unlimited drinking or other types of volume sales;
- Establishing minimum prices for alcohol where applicable;
- Providing price incentives for alcohol-free beverages;
- Stopping subsidies to economic operators in the area of alcohol.
Policies and countermeasures to tackle driving under the influence of alcohol
Alcohol-impaired driving is a significant public health problem that affects both the alcohol user and in many cases innocent parties. Strong evidence-based interventions exist for reducing driving under the influence of alcohol. Strategies to reduce harm associated with driving under the influence of alcohol should include deterrent measures that aim to reduce the likelihood that a person will drive under the influence of alcohol, and measures that create a safer driving environment in order to reduce both the likelihood and severity of harm associated with alcohol-influenced crashes.
In some countries, the number of traffic-related injuries involving intoxicated pedestrians is substantial and should be a high priority for intervention.
For this area policy options and interventions include:
- Introducing and enforcing an upper limit for blood alcohol concentration, zero tolerance is most effective;
- Promoting sobriety check points and random breath-testing;
- Administrative suspension of driving licences;
- Graduated licensing for novice drivers with zero-tolerance for driving under the influence of alcohol;
- Using an ignition interlock, in specific contexts where affordable;
- Mandatory driver-education, counselling and, as appropriate, treatment programmes;
- Conducting public awareness and information campaigns in support of policy and in order to increase the general deterrence effect..
Reducing the public health impact of illicit alcohol and informally produced alcohol
Consumption of illicitly or informally produced alcohol could have additional negative health consequences due to a higher ethanol content and potential contamination with toxic substances, such as methanol. It may also hamper governments’ abilities to tax and control legally produced alcohol.
Actions to reduce these additional negative effects should be taken according to the prevalence of illicit and/or informal alcohol consumption and the associated harm. Good scientific, technical and institutional capacity should be in place for the planning and implementation of appropriate national, regional and international measures. Good market knowledge and insight into the composition and production of informal or illicit alcohol are also important, coupled with an appropriate legislative framework and active enforcement.
These interventions should complement, not replace, other interventions to reduce alcohol use and related harm.
Production and sale of informal alcohol are ingrained in many cultures and are often informally controlled. Thus control measures could be different for illicit alcohol and informally produced alcohol and should be combined with awareness raising and community mobilization. Efforts to stimulate alternative sources of income are also important.
For this area policy options and interventions include:
- Good quality control with regard to production and distribution of alcoholic beverages;
- Regulating sales of informally produced alcohol and bringing it into the taxation system;
- An efficient control and enforcement system, including tax stamps;
- Developing or strengthening tracking and tracing systems for illicit alcohol;
- Ensuring necessary cooperation and exchange of relevant information on combating illicit alcohol among authorities at national and international levels;
- Issuing relevant public warnings about contaminants and other health threats from informal or illicit alcohol.
Monitoring and surveillance
Data from monitoring and surveillance create the basis for the success and appropriate delivery of the other policy options. Local, national and international monitoring and surveillance are needed in order to monitor the magnitude and trends of alcohol-related harms, to strengthen advocacy, to formulate policies and to assess impact of interventions.
Monitoring should also capture the profile of people accessing services and the reason why people most affected are not accessing prevention and treatment services. Data may be available in other sectors, and good systems for coordination, information exchange and collaboration are necessary in order to collect the potentially broad range of information needed to have comprehensive monitoring and surveillance.
Development of sustainable national information systems using indicators, definitions and data-collection procedures compatible with WHO’s global and regional information systems provides an important basis for effective evaluation of national efforts to reduce harmful use of alcohol and for monitoring trends at subregional, regional and global levels. Systematic continual collection, collation and analysis of data, timely dissemination of information and feedback to policy-makers and other stakeholders should be an integral part of implementation of any policy and intervention to reduce alcohol use and prevent alcohol harm.
For this area policy options and interventions include:
- Establishing effective frameworks for monitoring and surveillance activities including periodic national surveys on alcohol consumption and alcohol-related harm and a plan for exchange and dissemination of information;
- Establishing or designating an institution or other organizational entity responsible for collecting, collating, analysing and disseminating available data, including publishing national reports;
- Defining and tracking a common set of indicators of alcohol harm and of policy responses and interventions to prevent and reduce alcohol use;
- Creating a repository of data at the country level based on internationally agreed indicators and reporting data in the agreed format to WHO and other relevant international organizations;
- Developing evaluation mechanisms with the collected data in order to determine the impact of policy measures, interventions and programmes put in place to reduce the harmful use of alcohol.
