5. ALCOHOL POLICY AND INTERVENTIONS
5.1 Situation analysis
5.1.5 Regulating the availability of alcohol
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repeat offenders. Other common drink–driving penalties included licence suspension, short-term detention, imprisonment and vehicle impoundment.
Flat fine
Type of penalty
Ignition interlocks Mandatory treatment Community/public service
Licence suspension Mandatory education
Penalty points Licence revocation Vehicle impoundment
Imprisonment Progressive fine
Short-term detention
Number of countries
First offence Repeat offence 160
140 120 100 80 60 40 20
Figure 5.9 Type of drink−driving penalties by type of offence and number of countries, 2016
(n = 151 reporting countries except 149 for mandatory education (first and second offences); 152 for imprisonment and licence revocation for first offences, and flat fines, progressive fines, penalty points and community service for repeat offences; 153 for vehicle impounded for first offences and licence suspension for second offences; 154 for flat fines for first offences, and short-term detention for first offences and vehicle impoundment and imprisonment for repeat offences; and 155 for short-term detention for repeat offences)
138
112
96 86 81
64 64
44 37 33 31
11
133 131
101 97
85 96
66
54 46
39 42
14 0
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Most responding countries use licensing systems: of the 141 countries with a licensing system, about half (55%) had licensing at every level of the alcohol market (i.e. import, production, distribution, retail sales and export). Most countries (141, or 86%) reported national licensing for at least one level of the alcohol production and distribution system for at least one beverage type; two additional countries reported subnational licensing for at least one level of the alcohol market.
While the widespread presence of licensing systems regulating alcohol shows that the potential for effective regulation exists, in practice it is also common for countries to increase the availability of alcohol by increasing the number of licences to produce, distribute and sell alcohol. Of the countries with an alcohol licensing system, most reported an increase in the number of licences to distribute (55% for beer, 52% for wine and 51% for spirits) and sell alcohol (60% for beer, 57% for wine and 57% for spirits). In addition, about two in five countries reported growth in the number of licences to produce alcohol (45% for beer, 43% for wine and 41% for spirits).
However, there was considerable regional variation in these increases in alcohol availability.
No countries in the Eastern Mediterranean Region increased the number of licences for alcohol production, distribution or retail sales. In contrast, larger percentages of countries in the African and South-East Asia regions increased the number of licences for alcohol retail sales and distribution; in addition, increases in the number of licences for alcohol production were often concentrated in low-income countries. At least 70% of low-income countries increased the number of licences for all types of distribution and sales.
Alcohol monopolies exist when governments exercise exclusive control over the alcohol market or some aspect of it; such monopolies may occur at the level of the import, production, distribution, retail sales and/or export. Fifty countries (30%) reported the use of control over the alcohol market for at least one level. Monopolies over imports (36 responding countries) and retail sales (35 countries) were most common for spirits, while monopolies for imports (33 responding countries), production (32 countries) and distribution (31 countries) were most common for beer. The number of reporting countries with a monopoly over exports (26) did not differ by beverage type. Of the countries with monopoly control of at least one level of the alcohol market, 19 (38%) had a monopoly at all levels.
Some countries employ a combination of licensing and monopoly systems, with 47 countries reporting a licensing system and a monopoly over at least one level of the market. However, it was more common for countries to use licensing alone (94 countries) and 20 countries reported that they did not use either licensing or monopoly systems.
5.1.5.2 Restrictions on on-premise and off-premise sales of alcoholic beverages
Regulating the hours and days of sale and the density of alcohol outlets (i.e. the concentration of alcohol outlets in a geographical location) is another effective method for restricting the physical availability of alcohol at the population level. Less than one third of reporting countries indicated the existence of regulations on outlet density and/
or days of sale (24–28% for days and 19–26% for outlet density, depending on the type of premise) (Table 5.1). Regulations on hours of sale, location of outlets and sales to intoxicated patrons were more common. More than half of responding countries reported national regulations for on-premise and off-premise outlet hours of sale.
Eighty-four countries (52%) reported restrictions for on-premise hours of wine sales and 85 countries (53%) reported such restrictions for beer and spirits. Similar numbers of
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countries reported national restrictions for off-premise hours of beer sales (83 responding countries, 52%) as well as wine and spirits sales (84 responding countries, 52%). Far fewer countries (39 countries, 24%) reported national regulations for the on-premise days of sale for beer, wine and spirits in 2016, though slightly more reported such regulations for the days of off-premise sales for beer (43 countries, 27%), wine (44 countries, 28%) and spirits (43 countries, 27%).
The WHO Eastern Mediterranean Region consistently had the highest prevalence of countries with alcohol availability restrictions, with 100% of responding countries reporting regulations for on-premise alcohol outlet locations and 88% for off-premise locations.
Alcohol outlet density regulations – for on-premise or off-premise consumption – were rare outside of the Eastern Mediterranean Region. The prevalence of restrictions on specific events, on-premise sales to intoxicated persons and off-premise sales at petrol stations rose with national income.
On-premise Off-premise
WHO Region Beer (%) Wine (%) Spirits (%) Beer (%) Wine (%) Spirits (%)
Density
AFR 24 24 24 15 15 15
AMR 32 32 32 26 26 26
EMR 75 75 75 75 75 75
EUR 10 10 10 8 10 10
SEAR 33 33 33 17 17 17
WPR 41 41 41 24 18 18
World 26 26 26 19 19 19
Hours
AFR 48 48 48 39 41 41
AMR 66 66 66 56 56 56
EMR 88 88 88 75 75 75
EUR 36 36 36 50 50 50
SEAR 88 88 88 75 75 75
WPR 59 53 53 59 59 59
World 53 52 53 52 52 52
Days
AFR 13 13 13 15 15 15
AMR 26 26 26 26 26 26
EMR 88 88 88 88 88 88
EUR 10 10 10 20 22 22
SEAR 63 63 63 57 57 57
WPR 47 47 47 41 41 35
World 24 24 24 27 28 27
Table 5.1 Percentage (in %) of reporting countries with on-premise and off-premise regulations by type of regulation, beverage type and WHO region, 2016
(n = 158 countries except regulations on off-premise days of sale [159], regulations on days of sale [160], regulations for hours of sale [161])
5.1.5.3 National minimum age for purchase
Increasing the national legal minimum age for purchase of alcohol can reduce alcohol consumption and related harms among young people (Wagenaar & Toomey, 2002), and particularly drink–driving crashes (Shults et al., 2001). Age restrictions can apply to the consumption of alcohol both on premises or off premises. This report focuses on the on-premise minimum legal age limits for purchase because these regulations are more common.
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In 2016, 152 countries (93%) reported a national or subnational minimum legal purchase age for on-premise beer and wine sales and 151 countries (92%) reported a minimum legal age for purchase of spirits. In countries that have minimum legal purchase ages for alcohol, the minimum ages range from 13 years to 25 years (Figure 5.10). By far, the most common age limit is 18 years: 108 countries have an on-premise and off-premise 18-years legal purchase age for beer and wine, while three further countries have an 18-years legal purchase age for either on-premise or off-premise spirits.
However, several (11) countries reported having no on-premise age limits for beer and wine sales/consumption or for spirits (12 responding countries). Countries without a legal minimum purchase age tended to be low-income or lower-middle-income; the greatest number of countries without such a policy was in the WHO African Region.
Eight countries without a minimum legal purchase age for on-premise beer sales in 2012 reported one in 2016. Most (5 countries, 63%) set their new age limit at 18 years, while two countries set lower ages (15 years and 13 years for males and 16 years for females) and one country set an older age limit of 21 years. An additional six countries increased the minimum purchase age for on-premise beer consumption between 2012 and 2016, with most of these countries (83%) increasing their limits to 21 or 25 years (see Section 5.2.3 for more details).
Box 5.4 South Africa’s availability restrictions in the Liquor Amendment Bill
The 2011 Global status report ranked South Africa as a country with one of the riskiest patterns Global status report ranked South Africa as a country with one of the riskiest patterns Global status report of alcohol consumption, and with the highest reported alcohol consumption in Africa (WHO, 2011b). Among those who consume alcohol, nearly one in two men (48.1%) and two in five women (41.2%) engage in heavy episodic drinking (WHO, 2011b). South African adults aged 15 years and older consume an average of 9.5 litres each year, which is substantially higher than the African regional average of 6.2 litres per person (WHO, 2011b). This pattern of consumption results in high levels of alcohol-related harms, including interpersonal violence, traffic crashes and HIV/AIDS.
One of the most challenging problems with controlling the physical availability of alcohol in South Africa was inheriting thousands of unlicensed bars/pubs (called shebeens) after the fall of Apartheid. During Apartheid, non-white South Africans were prohibited from entering bars/pubs or selling alcohol themselves, so unlicensed shebeens sprang up as an alternative.
Without oversight, shebeens were often open late into the night and they were the site of violent acts and risky sexual behaviours. To address this problem, the Liquor Amendment Bill proposes prohibiting licensed distributors from selling alcohol to unlicensed establishments. Under this new legislation, these producers could be held liable for any damages caused by their products.
In addition, the Liquor Product Amendment Bill proposes broadening the classifications of regulated alcohol to include all beers and fermented beverages, casting them under the authority of the Department of Agriculture, Forestry and Fisheries (Business Tech, 2018).
In addition to targeted regulation of shebeens, the proposed legislation also includes comprehensive availability restrictions to restrict trading hours and days, increase the minimum legal purchase age from 18 to 21 years and prohibit alcohol sales within 500 metres of sensitive locations (e.g. places of worship, schools, recreational facilities and treatment centres, among others) (Republic of South Africa, 2016).
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Note: Burkina Faso has a minimum age for purchasing alcohol of 13 years for males and 16 years for females. This country is categorized as age 13.
Number of countries
None Sub-
national 13 14 15 16 21
Minimum purchase age (years) 120
100 80 60 40 20
25
17 18 19 20
Beer Wine Spirits
0
Figure 5.10 Minimum age limits for on-premise sales of beer, wine and spirits, by number of countries, 2016
(n = 164 reporting countries)
11 11 12
3 3 3 1 1 1 1 1 1 1 1 0
15 15 11
2 2 2 1 1 1 5 5 6 1 1 1
14 14 14 108 108111
5.1.5.4 Restrictions on drinking in public
Some countries also have restrictions on alcohol consumption in public places (Figure 5.11). Such restrictions are most commonly applied to educational buildings (146 countries), followed by health-care establishments (139 countries). Restrictions were least common at leisure events (73 countries) and in parks (71 countries).
Note: The numbers in each coloured bar indicate the number of countries in that category, whereas the length of each coloured bar indicates the percentage of countries in the category.
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Percentage (%) of countries
Healthcare Education Government offices Public
transport Parks,
streets, etc. Sporting
events Leisure events Type of public place
Total ban Partial ban Voluntary/self-regulation No restrictions Subnational
Figure 5.11 Restrictions on alcohol consumption in public places by type of public place and percentage (in %) of countries, 2016
(n = 164 reporting countries)
90 80 70 60 50 40 30 20 10
Workplaces Religious places 92
1
17 30 24
57 1
15 47 44
84 1
21 34 24
22 1
33 35 73
50 1
34 29 50
38 1
33 21 71
71 1
19 31 42
81 1
23 30 29
92 1
17 30 24
99 1
19 28 17
0