Making alcohol both more expensive and less available, and banning advertising are highly cost-effective strategies to reduce alcohol-related harm

June 25, 2009

Of the interventions to reduce alcohol-related harm, making alcohol both more expensive and less available, and banning advertising are the most cost-effective strategies. School-based education does not reduce harm, although it does have a role in providing information. The various measures to reduce alcohol-related harm are detailed in the second paper in the Lancet Series on Alcohol and Global Health, written by Dr Peter Anderson, University of Maastricht, Netherlands, and colleagues.

The authors review the effect of alcohol policy for the nine policy target areas included in the report by WHO to the 2008 World Health Assembly. On availability, the authors say that extending alcohol sale times can redistribute the times alcohol-related incidents occur, but does not reduce them. Reducing days or hours of alcohol sale leads to fewer alcohol problems, including murder and assault. A rise in alcohol prices leads to less alcohol consumption and related harm in both high-income and low-income countries. Policies that increase alcohol prices delay the start of drinking, slow young people's progression towards drinking large amounts, and reduce young people's heavy drinking and binge drinking activity.

As well as availability and affordability, the authors found that brief advice at a family doctor's surgery was an effective healthcare intervention for those with hazardous and harmful alcohol use but not yet severely dependent. Establishment of a legal blood-alcohol limit, and reducing it, is effective in reducing drink-driving casualties, as is intense random roadside breath-testing by police. Other measures with evidence of effectiveness are a lower or zero blood-alcohol limit for new drivers, driving licence suspension, and an ignition interlock which prevents a car being started when the driver is intoxicated.

The authors then looked at the cost effectiveness of policies in these nine areas, and concluded that reducing availability, increasing price and banning advertising were the most cost-effective measures to reduce alcohol-related harm. The authors say: "Taxation policies cost fairly little to implement but reap substantial health returns."

The authors recommend six key policy approaches for countries in which alcohol is normally available:
  1. Minimum tax rates for all alcoholic beverages, at least proportional to alcoholic content, should be introduced and increased regularly in line with inflation.
  2. Government monopolies for retail alcohol sales should be established, with a minimum purchase age of 18-21 years; if not feasible, a licensing system should be introduced restricting outlet density and hours of sale.
  3. A ban on direct and indirect alcohol advertising.
  4. Legal concentrations of blood alcohol for driving should be established, and gradually reduced.
  5. Widespread simple help should be made available in general practices and other primary healthcare facilities.
  6. Educational programmes should not be implemented in isolation, but to increase awareness ahead of implementation of other more effective intervention packages.


They conclude: "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."
-end-
Dr Peter Anderson, University of Maastricht, Netherlands T) +34 618075217 E) peteranderson.mail@gmail.com

For full Series paper, see: http://press.thelancet.com/alcseries2.pdf

Lancet

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