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Alcohol control policies and alcohol consumption: an international comparison of 167 countries
  1. Joana Madureira-Lima1,
  2. Sandro Galea2
  1. 1Department of Sociology, University of Oxford, Oxford, UK
  2. 2Boston University School of Public Health, Boston University, Boston, USA
  1. Correspondence to Joana Madureira-Lima, Department of Sociology, University of Oxford, Oxford OX1 3UQ, UK; joana.lima{at}


Background Alcohol control policy has a fundamental role in limiting negative health, economic and social harm caused by alcohol consumption. However, there is substantial international heterogeneity in country-level policy adoption, implementation and monitoring. Comparative measures so far focused on Europe or the Organisation for Economic Co-operation and Development countries.

Methods We created an Alcohol Control Policy Index (ACPI) for 167 countries using five different methodological approaches. National policies were sourced from WHO’s Global Information System on Alcohol and Health. We assessed ACPI’s criterion-related validity by calculating the strength of the association among the different approaches. As for content validity, we tested whether the resulting scores explained variations in alcohol per capita consumption cross-nationally, controlling for gross domestic product, population age, urbanisation and world region using OLS and random coefficients models.

Results Index scores and ranks from different methodological approaches are highly correlated (r=0.99). Higher scores were associated with lower consumption across the five methods. For each 1 score increase in the ACPI, the reduction in per capita alcohol consumption varies from −0.024 L (95% CI (−0.043 to −0.004) to −0.014 L (95% CI (−0.034 to 0.005). We obtain larger coefficients and p values <0.005 when estimating random coefficients.

Conclusion ACPI offers a measure of alcohol control policy across countries that makes use of a larger number of countries than its predecessors, as well as a wider range of methodologies for its calculation, both of which contribute to its validity. Furthermore, it shows that the statutory strictness of alcohol control policies is associated with lower levels of alcohol consumption.

  • alcohol
  • public health policy
  • prevention
  • epidemiology of chronic non communicable diseases

Statistics from


  • Contributors The framing and methodological approach was decided jointly by both authors. JML collected the data, compiled the data set and undertook the analysis. SG provided theoretical and methodological guidance.

  • Funding JML is the recipient of a doctoral scholarship from the Portuguese Foundation for Science and Technology and a Fulbright Scholarship.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We used a theoretical scoring framework developed by the WHO Regional Office for Europe (WHO Regional Office for Europe, unpublished data, 2016). Permission was obtained from the authors.

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