Elsevier

The Lancet

Volume 373, Issue 9682, 27 June–3 July 2009, Pages 2234-2246
The Lancet

Series
Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol

https://doi.org/10.1016/S0140-6736(09)60744-3Get rights and content

Summary

This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

Introduction

The first paper in this Series1 summarised the global burden of ill health and the economic cost attributable to alcohol use and alcohol-use disorders, noting that 4·6% of all ill health and premature death worldwide is due to alcohol, with poorer populations and lower-income countries having a greater disease burden per litre of alcohol than higher-income populations and countries. This second paper in the Series reviews the evidence for the effectiveness of policies and programmes to reduce the avoidable harm caused by alcohol, largely on the basis of an analysis of published systematic reviews and meta-analyses, which were identified through searches of the Cochrane library, Medline, Web of Science, and Web of Knowledge with specific search terms for each target policy area. Reference sections of identified papers were cross-checked to identify other relevant studies contributing to this review. This paper briefly summarises the harm to be reduced, and reviews the evidence for effective policies and programmes and estimates their cost-effectiveness. It concludes with a short overview of the implications for policy development and implementation. Since most countries do not have adequate programmes in place, the third paper in the Series will describe how policies and programmes need to be scaled up, concluding with a global call to action.2

Key messages

  • •

    A substantive evidence base of systematic reviews and meta-analyses inform alcohol policy

  • •

    Making alcohol more expensive and less available are highly cost-effective strategies to reduce harm

  • •

    Banning of alcohol advertising, drink-driving countermeasures, and individually-directed interventions to drinkers already at risk are also cost-effective approaches

  • •

    School-based education does not reduce harm, but public information and education programmes can increase attention to alcohol on public and political agendas

  • •

    If more stringent alcohol policies are not put into place, global alcohol-related harm is likely to continue to increase

Section snippets

Harm caused by alcohol

Alcohol is an intoxicant that affects a wide range of structures and processes in the CNS. By interacting with personality characteristics, associated behaviours, and sociocultural expectations, it is a causal factor for intentional and unintentional injuries and harm to people other than the drinker,3 including reduced job performance4 and absenteeism,5 family deprivation,6 interpersonal violence,7 suicide,8 homicide,9 crime,10 and fatalities caused by driving while under the influence of

Effectiveness of alcohol policies

Alcohol policies have been defined as sets of measures aimed at keeping the health and social harms from the use of alcohol to a minimum.38 There are also a variety of other policies that can reduce or increase alcohol-related problems, but which are not normally described as alcohol policies, since they are not implemented specifically to reduce alcohol-related harm as a primary aim—eg, general road safety measures. Much of the published work to establish the effectiveness of alcohol policies

Cost and cost-effectiveness of alcohol policies

The effect of harmful use of alcohol extends beyond the direct health-related consequences to drinkers (mortality and morbidity effects) to a broader set of social costs, including criminal damage, violence, and lost productivity in the workplace. Documentation of these social costs is important in itself, because the negative spill over effects (or so-called externalities) imposed on society as a result of the private consumption of alcohol represent instances of market failure, which is a

Implications for policy development

A main goal of alcohol policy is to promote public health and social wellbeing. Additionally, policy can address market failures by deterring children from using alcohol, protecting people other than drinkers from the harm caused by alcohol, and providing all consumers with information about the effects of alcohol. Further, the notion of stewardship implies that liberal states have a duty to look after important needs of people individually and collectively.99 It emphasises the obligation of

Conclusions

A substantial evidence base exists for the effectiveness of different policies in reducing the harm caused by alcohol. Essentially, policies that regulate the environment in which alcohol is marketed (economic and physical availability and commercial communications) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving are effective, as are individually-directed interventions to drinkers already at risk. However, the evidence shows that

References (110)

  • J Rehm et al.

    Alcohol

  • TW Mangione et al.

    Employee drinking practices and work performance

    J Stud Alcohol

    (1999)
  • AM Roche et al.

    Workers' drinking patterns: the impact on absenteeism in the Australian work-place

    Addiction

    (2008)
  • G Gururaj et al.

    Burden and socio-economic impact of alcohol—the Bangalore study (Alcohol Control Series No. 1)

    (2006)
  • D Gil-González et al.

    Alcohol and intimate partner violence: do we have enough information to act?

    Eur J Public Health

    (2006)
  • T Cargiulo

    Understanding the health impact of alcohol dependence

    Am J Health-Syst Pharmacy

    (2007)
  • J Rehm et al.

    Alcohol-attributable mortality and potential years of life lost in Canada 2001: implications for prevention and policy

    Addiction

    (2006)
  • A Richardson et al.

    Alcohol, crime and disorder: a study of young adults Home Office Research Study 263

    (2003)
  • CJ Cherpitel et al.

    The causal attribution of injury to alcohol consumption: a cross-national meta-analysis from the emergency room collaborative alcohol analysis project

    Alcohol Clin Exp Res

    (2003)
  • SC Kalichman et al.

    Alcohol use and sexual risks for HIV/AIDS in sub-Saharan Africa: systematic review of empirical findings

    Prev Sci

    (2007)
  • LR Cook et al.

    Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review

    Sex Transm Dis

    (2005)
  • JC Fisher et al.

    The association between HIV-infection and alcohol use: a systematic review and meta analysis of African Studies

    Sex Transm Dis

    (2007)

  • Alcohol-related birth defects: an update

    Alcohol Res Health

    (2001)
  • VB Faden et al.

    The effects of alcohol on physiological processes and biological development

    Alcohol Res Health

    (2005)
  • Y Taki et al.

    Both global gray matter volume and regional gray matter volume negatively correlate with lifetime alcohol intake in non-alcohol-dependent Japanese men: a volumetric analysis and a voxel-based morphometry

    Alcohol Clin Exp Res

    (2006)

  • Neuroscience of psychoactive substance use and dependence

    (2004)
  • C Parry et al.

    Alcohol and infectious diseases: an overlooked causal linkage?

    Addiction

    (2009)
  • K Lönnroth et al.

    Alcohol as a risk factor for tuberculosis—a systematic review

    BMC Public Health

    (2008)

  • IARC monographs on the evaluation of carcenogenic risks to humans. Alcoholic beverage consumption and ethyl carbamate (urethane)

  • DW Lachenmeier et al.

    Carcinogenicity of acetaldehyde in alcoholic beverages: risk assessment outside ethanol metabolism

    Addiction

    (2009)
  • G Corrao et al.

    Alcohol and coronary heart disease: a meta-analysis

    Addiction

    (2000)
  • V Bagardi et al.

    Does drinking pattern modify the effect of alcohol on the risk of coronary heart disease? Evidence from a meta-analysis

    J Epidemiol Community Health

    (2008)
  • B Taylor et al.

    Determination of lifetime injury mortality risk in Canada in 2002 by drinking amount per occasion and number of occasions

    Am J Epidemiol

    (2008)
  • J Rehm et al.

    Method for moderation: measuring lifetime risk of alcohol-attributable mortality as a basis for drinking guidelines

    Int J Methods Psychiatr Res

    (2008)
  • DW Lachenmeier et al.

    The composition of alcohol products from markets in Lithuania and Hungary, and potential health consequences: a pilot study

    Alcohol Alcohol

    (2009)
  • DW Lachenmeier et al.

    Surrogate alcohol: what do we know and where do we go?

    Alcohol Clin Exp Res

    (2007)
  • T Norström et al.

    Mortality and population drinking. Alcohol in postwar Europe: consumption, drinking patterns, consequences and policy responses in 15 European countries

    (2001)
  • J Rehm et al.

    Global monitoring of average volume of alcohol consumption

    Soz Präventivmed

    (2002)
  • W Zatonski

    Closing the health gap in European Union

  • T Blakely et al.

    Distribution of risk factors by poverty

  • L Rabinovich et al.

    The affordability of alcoholic beverages in the European Union. Understanding the link between alcohol affordability, consumption and harms

    (2009)
  • AD Lopez et al.

    Global burden of disease and risk factors

    (2006)

  • WHO Technical Report Series, 2nd report

    (2007)
  • R Room et al.

    Alcohol in developing countries: a public health approach

    (2002)
  • A Allamani et al.

    Why the decrease in consumption of alcoholic beverages in Italy between the 1970s and the 2000s? Shedding light on an Italian mystery

    Contemp Drug Probl

    (2007)

  • Report by the Secretariat. 61st World Health Assembly A61/13

  • L Jones et al.

    A review of the effectiveness and cost-effectiveness of interventions delivered in primary and secondary schools to prevent and/or reduce alcohol use by young people under 18 years old. Alcohol and schools: review of effectiveness and cost-effectiveness. NICE: main report (PHIAC 14.3a)

  • J Petrie et al.

    Parenting programmes for preventing tobacco, alcohol and drug misuse in children <18 years: a systematic review

    Health Educ Res

    (2007)
  • M Stead et al.

    A systematic review of social marketing effectiveness

    Health Educ

    (2007)
  • TF Babor et al.

    Alcohol: no ordinary commodity. Research and public policy

    (2003)

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