In 2016, the harmful use of alcohol resulted in about 3 million deaths, or 5.3% of all deaths around the world, with most of these occurring among men, a new report from the World Health Organization (WHO) concludes.
Although the report documents some positive trends in alcohol consumption — notably, a drastic reduction in parts of Eastern Europe — the general level of alcohol consumption and related disease burden is “unacceptably high,” Vladimir Poznyak, MD, PhD, Department of Mental Health and Substance Abuse, WHO, said during a press briefing.
And this level of consumption is projected to increase in coming years, along with related harms, including injuries, violence, and cardiovascular and other diseases.
In several parts of the world, policies are not sufficient to reverse these trends, said Poznyak. This means that the target of 10% relative reduction in alcohol consumption being put forward in the global monitoring framework for noncommunicable diseases will be missed.
“We have a clear discrepancy between the magnitude of the problem caused by harmful use of alcohol and the resources and commitment to introduce and implement cost-effective and effective measures,” he added.
The WHO’s Global Status Report on Alcohol and Health 2018 was released September 21.
Missing the Target
The United Nations’ Sustainable Development Goals (SDGs) aim to end poverty, protect the planet, and ensure prosperity around the world by 2030. The goals include health targets, such as reducing alcohol-related harm.
“I think some countries will miss the target and not advance the SDG-relevant targets if this issue will continue to be stagnating at the point that we presented in our report,” Poznyak said.
The new document paints a comprehensive picture of the levels and patterns of alcohol consumption worldwide, the health and social consequences of harmful alcohol use, and steps that some of the 194 WHO member states are taking to reduce this burden.
In 2016, 28% of the deaths linked to alcohol were due to injuries from such things as traffic accidents, self-harm, and violence; 21% were related to digestive disorders; and 19% were related to cardiovascular diseases. The remainder were related to infectious diseases, cancers, mental disorders, and other health conditions.
Mortality resulting from alcohol consumption is higher than that caused by tuberculosis, HIV/AIDS, and diabetes, the report states.
Among the other facts and figures in the report:
- Some 2.3 billion people around the world drink alcohol, and alcohol is consumed by more than half of the population in North America, South America, Europe, and the Western Pacific.
- Europe has the highest per capita alcohol consumption, although its per capita consumption has decreased by more than 10% since 2010.
- Although Europe has the highest levels of alcohol consumption, Africa bears the heaviest burden of disease and injury attributed to alcohol.
- Global alcohol per capita consumption is expected to increase in the next decade, particularly in Southeast Asia, the Western Pacific, and the Americas.
- More than a quarter (27%) of all 15- to 19-year-olds worldwide consume alcohol. Rates are highest in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%).
- Total alcohol consumption per capita among those older than 15 years around the world rose from 5.5 liters of pure alcohol in 2005 to 6.4 liters in 2010 and remained at that level in 2016.
- People who drink consume on average 32.8 grams of pure alcohol per day (about two glasses of wine, a large bottle of beer, or two shots of spirits). The amount consumed is about 20% higher in Africa and 20% lower in Southeast Asia.
- People who drink increased their alcohol consumption since 2000 in almost all regions except Europe.
- Worldwide, 44.8% of total recorded alcohol (ie, that which is accounted for in official statistics) is consumed in the form of spirits. The second most consumed type of alcoholic beverage is beer (34.3%), followed by wine (11.7%).
- Only minor changes in beverage preferences have occurred globally since 2010. The largest changes took place in Europe, where the share of total recorded consumption of spirits decreased by 3% and that of wine and beer increased.
- Globally, an estimated 237 million men and 46 million women have alcohol-use disorders, with the highest prevalence in Europe and the Americas.
There are a few bright spots in the report. For example, the prevalence of heavy episodic drinking, defined as drinking 60 or more grams of pure alcohol on at least one occasion at least once per month, decreased globally from 22.6% in 2000 to 18.2% in 2016 among the total population. However, the prevalence rate remains high among those who drink, especially in parts of Eastern Europe and in some sub-Saharan African countries.
Also, there has been a sharp reduction of alcohol use and related harm in Eastern Europe, particularly in the Russian Federation.
Since 2010, the government in Russia has implemented several measures, Poznyak noted. These include the following: setting a minimum price for spirits, including the country’s major spirit, vodka; increasing excise taxes on alcoholic beverages; setting stricter penalties for drunk driving; and banning media advertising, sales of alcohol in gasoline stations, and sponsorships involving alcoholic beverages.
However, the worldwide burden is still enormous. In the foreword to the report, Tedros Adhanom Ghebreyesus, PhD, WHO director-general, called on countries to demonstrate the “political will and capacity” to meet targets of the SDGs.
Some countries, in addition to Russia, appear to be taking heed. The percentage of countries with a written national alcohol policy has steadily increased from 2008. In 2016, 80 countries reported having such a policy, eight countries had subnational policies, and 11 others had a total ban on alcohol.
Most of the responding countries (97) have a maximum permissible blood alcohol concentration (BAC) at or below 0.05% while driving. On the other hand, 37 countries reported having a BAC limit of 0.08%, and 31 have no BAC limit.
Almost all of the countries (95%) have alcohol excise taxes, but fewer than half use other price strategies, such as banning below-cost selling or volume discounts.
Poznyak said during the press briefing that pricing policies are among the most cost-effective options for reducing the harmful use of alcohol.
“Excise taxes on alcohol as well as other pricing measures significantly impact the levels of consumption. That’s why any increase in alcohol taxation and decrease in affordability of alcohol would bring public health benefits,” he said.
He added that these kind of measures are “not very popular” in some countries, “particularly when drinking is so deeply embedded in traditions.”
Still, most countries have some type of restriction on beer advertising. Total bans are most common for television and radio and are less common for the Internet and social media.
Poznyak told reporters that he believes that from a public health perspective, industry sponsorships of such events as the World Cup of soccer and the Olympics “don’t bring good results and should be stopped.”
But it’s up to FIFA (the international soccer governing body) and the International Olympic Committee to make these decisions, he said. “We have a dialogue with these entities, and we hope that public health benefits will prevail over commercial benefits.”
This is the latest in a series of WHO global status reports on alcohol. Previous reports were released in 1999, 2001, 2004, 2011, and 2014.
WHO. Global Status Report on Alcohol and Health 2018. Published online September 21, 2018. Full report