5. ALCOHOL POLICY AND INTERVENTIONS
5.2 Progress since the Global strategy to reduce the harmful use of alcohol
The SDGs serve as the backdrop for this section on trends in implementing and enforcing national alcohol policies across the world. To reach the goal of reducing noncommunicable diseases by a third by 2030, the SDGs will rely on strengthening the prevention of the harmful use of alcohol, which in turn will depend on countries’ uptake of evidence-based alcohol policies – particularly the three “best buys”.
Between 2008 and 2016, WHO Member States made changes in alcohol policies.
Many WHO Member States implemented the “best buys” – alcohol policies included in Appendix 3 of the Global action plan for the prevention and control of noncommunicable diseases (WHO, 2011a). WHO administered a survey in 2015 called the WHO Global Questionnaire on Progress in Alcohol Policy (WHO, 2011a), to discern progress in alcohol policies and interventions since the release of the Global strategy; gains (and losses) can also be detected by comparing answers from the Global Survey of Alcohol and Health in different years. Overall, the most consistent gains related to the best buy of price, while progress in the advertising and availability best buys was mixed.
116
5.2.1 Trends in pricing policies
Based on the 2015 WHO Global Survey on Progress in Alcohol Policy, tax increases were the most commonly implemented “best buy” policy area since 2010. Some 59%
of reporting countries indicated that they had established or increased an excise tax on alcohol since 2010, and 5 billion people were covered by alcohol excise tax increases since 2010. However, there were no net increases in the number of countries reporting the use of excise taxes in the Global Survey of Alcohol and Health from 2008 to 2016.
This implies that the countries reporting increases on the 2015 survey were increasing the level of existing alcohol excise taxes.
5.2.2 Trends in marketing restrictions on alcoholic beverages
Trends in this “best buy” policy area were mixed. Using the same methods of calculating advertising restrictiveness as in Box 5.7, the Global Survey of Alcohol and Health showed there was a linear increase in the number of countries reporting more restrictive advertising policies for beer across all media types (Figure 5.22) as well as product placements on public television. However, substantial numbers of countries reported no action regarding restriction of beer advertising before or after 2010 on the 2015 WHO Global Questionnaire on Progress in Alcohol Policy. Consistent with the previous sections of this report, few countries reported progress in developing regulations for new media since 2010. However, seven countries introduced a new total marketing ban since 2010, which brings the number of countries in the world with such a ban to 21.
5.2.3 Trends in regulations of physical availability of alcohol
There was no net gain in the policy area of availability, as advances were largely undermined by losses. For example, the number of countries reporting restrictions on outlet density (on-premise and off-premise) in the Global Survey on Alcohol and Health steadily decreased from 2008 to 2016 (Figure 5.23). There were similar decreases for restrictions on days of sale, though these were offset by stark increases in restrictions on on-premise hours of sale.
Most 1 restrictive
Media type 0.9
0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1
Note: The social media question was not asked in 2008.
Least restrictive
Advertising restrictiveness
2008 2012 2016
Social media Internet Cinema
Point of Billboards sale Print
Local radio Public
radio Private/
commercial television National television
Figure 5.22 Trends in restrictions on advertising beer, by number of countries, 2008–2016
(n = 135 reporting countries, except point of sale [127], Internet [128] cinema and billboards [129], print [130], private/commercial television [132], public radio [133] and social media [143])
0.72 0.79
0.87
0.660.71 0.78
0.68 0.75
0.89
0.63 0.71
0.83
0.51 0.57
0.69
0.35 0.46
0.57 0.51
0.56 0.63 0.51
0.58 0.66
0.00 0.29 0.36 0.35 0.40
0.42
0
117
80 70 60 50 40 30 20 10
Number of countries
Density Days Hours
On-premise 2008 2012 2016
Note: Off-premise restrictions not asked in the same format in 2008.
0
30 30 28 33
25 24
64 66 68
Density Days Hours
Off-premise 26
20
33 31
58 68
Figure 5.23 Trends in restrictions for density, days and hours of sale for beer by premise type and number of countries, 2008−2016
(n = 125 reporting countries)
Data from the 2015 WHO Global Questionnaire on Progress in Alcohol Policy support these trends of an overall lack of progress: 16 countries reported fewer regulations on hours of sale and 15 reported more. Seven countries reported fewer regulations on days of sale, while eight reported more. Another striking trend is the lack of regulation: 42 countries reported no regulations on days or hours of sale since 2010. There was progress in raising the national minimum drinking age: 10 countries increased the purchase age for on-premise consumption and eight increased it for off-premise consumption since 2010.
However, lack of regulation also tempered these findings as 12 countries still did not have a minimum purchase age (on-premise and off-premise) by 2015.
5.2.4 Trends in written national alcohol policies
A higher percentage of reporting countries indicated that they had written national alcohol policies in 2016 than in 2008 (Figure 5.24). The percentage of countries with a written national alcohol policy steadily increased from 36% (60 responding countries) in 2008 to 38% (67 countries) in 2012 and then 46% (79 countries) in 2016. Of the 79 countries that reported a written national alcohol policy in 2016, 66 (84%) referenced WHO in their policy, and all of the remaining countries indicated they had consulted a WHO strategy or recommendations to develop their policy without an explicit reference. In addition, many WHO Member States have revised their national alcohol policy since the Global strategy was released in 2010; 49 countries (73% of countries reporting the year of policy revision) revised their strategies since 2010 (2 countries in 2010 and 2011, 6 countries in 2012–2014, 9 countries in 2015, and 18 countries in 2016).
118
Number of countries
AFR AMR EMR EUR SEAR WPR World
WHO Region 2008 2012 2016
80 70 60 50 40 30 20 10 0
10 8 13
8 10 8
3 4
1
27 30 34
3 2 5 5 8 9
56 62
70
Figure 5.24 Trends in national written alcohol policies by WHO region and number of countries, 2008−2016
(n = 148 reporting countries)
5.2.5 Trends in drink–driving policies and countermeasures
In response to the 2015 WHO Global Questionnaire on Progress in Alcohol Policy, 16 countries reported lowering the national BAC limit for the general population since 2010.
Only two countries reported raising their national BAC limit above the 0.05 level between 2008 and 2016 in the Global Survey on Alcohol and Health (Figure 5.25). BAC limits must be enforced in order to be effective, and more than half (52%) of reporting countries reported increasing the scope or intensity of enforcement of sobriety checkpoints since 2010. These trends were evident in the Global Survey on Alcohol and Health, where the number of countries reporting the use of sobriety checkpoints and random breath-testing gradually increased substantially between 2008 and 2016 (Figure 5.26).
Number of countries
AFR AMR EMR EUR SEAR WPR World
WHO Region 2008 2012 2016
80 70 60 50 40 30 20 10 90
0
9 11 9 10 12 12
4 4 2
41 42 41
4 4 3 6 7 9
74 80 76
Figure 5.25 Trends in blood alcohol concentration (BAC) limits at or below 0.05% for the general population, by WHO region and number of countries, 2008−2016
(n = 120 reporting countries)
119
Number of countries
AFR AMR EMR EUR SEAR WPR World
WHO Region 2008 2012 2016
140 120 100 80 60 40 20
Note: The question on sobriety checkpoints was not asked 2008, and the 2008 survey had a different format for asking about random breath-testing. The 2008 survey asked separately about random breath-testing at roadside checkpoints and use of special mobile units. The 2012 and 2016 questionnaires asked only about random breath-testing.
0 12
28 32 7
23 21
0 2 2
18 48 48
2 6 8 5 12 13
44 119124
Figure 5.26 Trends in use of sobriety checkpoints or random breath-testing by WHO region and number of countries, 2008−2016
(n = 164 reporting countries)
The effectiveness of national BAC limits depends on the level of enforcement. The Global Survey on Alcohol and Health defines high enforcement in terms of enforcers being equipped with the necessary tools, enforcement activities being conducted regularly and during high-risk times, enforcement occurring in rural and urban areas, and penalties/
fines being applied to persons caught violating the BAC limit. Conversely, low levels of enforcement mean that one or more of these criteria are not met. Countries rated their level of enforcement on a scale from 0 to 10, where 0 means poorly enforced and 10 means well enforced. Figure 5.27 categorized these scores into low (scores 0–3), mid (scores 4–7) or high levels (scores 8–10). The number of countries reporting low levels and mid-levels of enforcement steadily decreased from 2008 to 2016, while the number of countries reporting high levels steadily increased.
Number of countries
Low Mid High
Level of enforcement 2008 2012 2016
60 50 40 30 20 10 0
20 18
14
47 42
37
48 39 32
Figure 5.27 Trends in levels of enforcement for the national blood alcohol concentration (BAC) limit, by number of countries and year
(n = 99 reporting countries)
120
5.2.6 Trends in reducing the negative consequences of drinking
Warning and consumer labels have been an area of some progress since 2010: 18 countries reported adding such labels in the 2015 survey. Overall, 852 million people are covered by the new warning labels introduced since 2010, bringing the total population covered by warning labels to 3.5 billion. This progress was confirmed on the 2016 survey:
between 2008 and 2016, the number of countries reporting warning labels on alcohol advertisements and bottles increased by 47% and 48%, respectively.
5.2.7 Trends in health services’ response
There was also substantial progress in the level of screening and brief interventions since 2010. Overall, 52% of reporting countries indicated that they increased the level of screening and brief interventions for hazardous and harmful drinking in primary care settings since 2010. However, most of this progress was confined to high-income and upper-middle-income countries.