Alcohol in EuropeConsumption, Harm and the Policy

Response

Dr Lars Møller

Programme Manager

World Health Organization

Regional Office for Europe

Alcohol related harm

Disease burden attributable to alcohol and tobacco in

factors in comparison with other risk factors in 2010 (Lim et

al, Lancet, 2012; 380: 2224-60, corrected)

Global risk factor ranks for all ages and sexes combined in

1990 and 2010, and percentage change

(Lim et al, Lancet, 2012; 380: 2224-60, corrected)

In Europe: high exposure, high burden of

mortality and disease

• For men between ages of 15 and 64, 1 in 7

deaths were caused by alcohol (clearly

premature deaths given the life expectancy in

Europe)

• For women of the same age category, 1 in 13

deaths are caused by alcohol

Most important risk factors for mortality among

young people 15–29 years, WHO EURO

0 20000 40000 60000

Alcohol use

Unsafe sex

Illicit drug use

High blood glucose

Physical inactivity

Occupational risks

Iron deficiency

Low fruit/vegetable consumption

Child sexual abuse

Unmet contraceptive needs

Men Women

Deaths Deaths

0 20000 40000 60000

Alcohol use

Occupational risks

Illicit drug use

Unsafe sex

Physical inactivity

Low fruit/vegetables

High blood glucose

Child sexual abuse

Unsafe health care inj.

Unsafe water/sanitation

Proportion of deaths for major disease

categories attributable to alcohol

IARC on alcohol and cancer

• Globally, alcohol-attributable cancers account for 25% of alcohol-

related deaths for women and 18% for men – making it one of

the largest entirely avoidable risk factors.

• Seven types of cancer are significantly associated with alcohol

use:

– Cancer of the oral cavity

– Esophagus

– Liver

– Pharynx

– Colorectum

– Female breast

– Larynx

Rehm J, Lachenmeier DW,

Room R. Medicine for Global

Health 2014; 12: 189.

Social costs of alcohol – 1.3% of GDP (EU)

€ 155.8 billion in 2010

41,4

12,6

27,7

45,2

11,3

17,6

Crime

Traffic accidents-damage

Health

Mortality

Absenteeism

Unimployment

(Anderson and Baumberg 2006).

Alcohol consumption

Total, unrecorded and recorded alcohol per capita (15+

years) consumption in litres of pure alcohol by WHO region

and the world, 2010

1,8 1,2 0,41,9 1,6 1,7 1,5

4,27,2

0,3

9

1,8

5,14,7

6

8,4

0,7

10,9

3,4

6,86,2

0

3

6

9

12

15

AFR AMR EMR EUR SEAR WPR World

Litre

so

f p

ure

alc

oh

ol

WHO Region

Unrecorded APC Recorded APC

Adult drinking (2010)

57,4

18,9

89,8

20,6

76,6

37,748

12,8

19,6

4,8

13

9,9

17,1

13,7

29,8

61,5

5,4

66,4

13,5

45,8 38,3

0

10

20

30

40

50

60

70

80

90

100

AFR AMR EMR EUR SEAR WPR World

WHO Region

Lifetime abstainers Former drinkers Current drinkers

Drinking among 15 to 19-year-olds (2010)

58,4

29

82,7

15,9

85,8

48,7 53,9

12,3

18,3

7,3

14,5

5,9

1412

29,3

52,7

10

69,5

8,2

37,3 34,1

0

10

20

30

40

50

60

70

80

90

100

AFR AMR EMR EUR SEAR WPR World

WHO Region

Lifetime abstainers Former drinkers Current drinkers

Total average alcohol per capita consumption, recorded and

unrecorded, 2008-2010, men and women

0

2

4

6

8

10

12

14

16

18

20

Turk

ey

Aze

rbaija

n

Tajik

ista

n

Isra

el

Turk

men

ista

n

Kyrg

yzsta

n

Uzbe

kis

tan

Arm

enia

FY

R M

ace

don

ia

Ita

ly

Alb

ania

Ma

lta

Bosnia

& H

erz

ego

vin

a

Icela

nd

No

rwa

y

Geo

rgia

Mo

nte

neg

ro

Sw

ede

n

Cypru

s

Ne

therl

and

s

Esto

nia

Kazakhsta

n

Gre

ece

Austr

ia

Sw

itzerl

and

Belg

ium

Spain

De

nm

ark

Bulg

aria

Slo

ven

ia

UK

Germ

any

Lu

xe

mbo

urg

Irela

nd

Fra

nce

Cro

atia

La

tvia

Fin

land

Pola

nd

Serb

ia

Port

ug

al

Slo

vakia

Czech R

epu

blic

Hu

nga

ry

Ando

rra

Ukra

ine

Ro

man

ia

Ru

ssia

Lithu

ania

Mo

ldova

Bela

rus

Litre

sof

pure

alc

ohol

-50,0

-40,0

-30,0

-20,0

-10,0

0,0

10,0

20,0

30,0

40,0

50,0

Azerb

aija

n

Tu

rkey

Italy

An

dorr

a

Slo

venia

Hungary

Ta

jikis

tan

Irela

nd

Kyrg

yzsta

n

FY

R M

acedonia

Denm

ark

Cro

atia

UK

Sw

eden

Luxem

bourg

Po

rtuga

l

Fra

nce

Sp

ain

Ka

zakhsta

n

Tu

rkm

enis

tan

Be

lgiu

m

Esto

nia

Germ

any

Republic

of M

old

ova

Russia

n F

edera

tio

n

Au

str

ia

Slo

vakia

Gre

ece

Po

lan

d

Sw

itzerlan

d

Ukra

ine

Cze

ch R

epublic

Neth

erla

nds

Bu

lga

ria

Fin

lan

d

Norw

ay

Isra

el

Bo

sn

ia a

nd

Herz

eg

ovin

a

Latv

ia

Lith

uania

Cyp

rus

Arm

enia

Icela

nd

Rom

ania

Be

laru

s

Alb

an

ia

Uzb

ekis

tan

Ma

lta

Se

rbia

Georg

ia

% change in alcohol consumption 2005 - 2010

%change

Slovenia: decrease in total

consumption of 25% or 5% a

year.

Prevalence (%) of heavy episodic drinking (HED) among the

total population (15+ years) and adolescents by WHO region

and the world, 2010

5,7

13,7

0,1

16,5

1,6

7,7 7,56,3

18,4

0,1

31,2

1,1

12,5 11,7

0

10

20

30

40

AFR AMR EMR EUR SEAR WPR World

HE

Dp

reva

len

ce

(pe

rcen

tage

of p

op

ula

tion

)

WHO Region

Adults (15+ years) Adolescents (15–19 years)

Alcohol use during the past 30 days, boys (ESPAD, 2011)

0

10

20

30

40

50

60

70

80

90

%

Alcohol use during the past 30 days, girls (ESPAD, 2011)

0

10

20

30

40

50

60

70

80

%

Being drunk during the past 30 days, boys (ESPAD, 2011)

0

5

10

15

20

25

30

35

40

%

Being drunk during the past 30 days, girls (ESPAD, 2011)

0

5

10

15

20

25

30

35

40

%

Alcohol dependence, males

0

5

10

15

20

25

Tajik

ista

n

Ita

ly

Ne

therl

and

s

Spain

Turk

ey

Ro

man

ia

Ma

lta

Icela

nd

Ukra

ine

Gre

ece

Geo

rgia

De

nm

ark

Czech R

epu

blic

Belg

ium

Lu

xe

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Germ

any

Fra

nce

Cypru

s

Port

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Turk

men

ista

n

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kis

tan

Kyrg

yzsta

n

Isra

el

FY

R M

ace

don

ia

Alb

ania

Arm

enia

Aze

rbaija

n

Bosnia

& H

erz

ego

vin

a

Serb

ia

Mo

ldova

Mo

nte

neg

ro

Kazakhsta

n

Ando

rra

Cro

atia

Irela

nd

Fin

land

Bulg

aria

Sw

ede

n

Sw

itzerl

and

Austr

ia

La

tvia

Pola

nd

UK

Lithu

ania

No

rwa

y

Esto

nia

Slo

vakia

Slo

ven

ia

Ru

ssia

Hu

nga

ry

Bela

rus

Perc

enta

ge o

f adult m

ale

popula

tion

Alcohol dependence, females

0

0,5

1

1,5

2

2,5

3

3,5

4

Tajik

ista

n

Spain

Geo

rgia

Turk

ey

Ne

therl

and

s

Ita

ly

Ukra

ine

Ro

man

ia

Ma

lta

Czech R

epu

blic

Icela

nd

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vakia

Germ

any

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xe

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aria

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men

ista

n

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and

FY

R M

ace

don

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& H

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Port

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Mo

ldova

Pola

nd

Mo

nte

neg

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Kazakhsta

n

Cypru

s

Cro

atia

Fin

land

Belg

ium

Lithu

ania

De

nm

ark

Esto

nia

Irela

nd

Slo

ven

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Austr

ia

Sw

ede

n

No

rwa

y

UK

Hu

nga

ry

Ru

ssia

Bela

rus

Perc

enta

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f adult f

em

ale

popula

tion

Alcohol policy

European Alcohol Action Plan1992 and 2000

Endorsed the Global

strategy to reduce the

harmful use of alcohol

in the WHA resolution

63.13

63rd World Health Assembly (17-21 May, 2010)

European action plan to reduce the harmful use

of alcohol (EAAP) 2012–2020 – 10 action areas

• Leadership, awareness and commitment, as sustainable intersectoral

action requires strong leadership and a solid base of awareness and

political will

• Health services’ response, as these services are central to tackling health

conditions in individuals caused by harmful alcohol use

• Community action, as governments and other stakeholders can support

and empower communities in adopting effective approaches to prevent and

reduce harmful alcohol use

• Policies and countermeasures on drink–driving, as it is extremely

dangerous to drivers, passengers and other people using the roads

• Availability of alcohol, as public health policies to regulate commercial or

public availability have proved to be very effective in reducing the general

level of harmful use and drinking among minors

EAAP 2012–2020 – 10 action areas

• Marketing of alcoholic beverages, as systems are needed to protect

people, particularly children and young people, from advanced advertising

and promotion techniques

• Pricing policies, as most consumers, particularly heavy drinkers and

young people, are sensitive to changes in the prices of alcohol products

• Reducing the negative consequences of drinking and alcohol

intoxication, in order to minimize violence, intoxication and harm to

intoxicated people

• Reducing the public health impact of illicit and informally produced

alcohol, as its consumption could have additional negative health

consequences due to its higher ethanol content and potential contamination

with toxic substances

• Monitoring and surveillance, as relevant data create the basis for the

appropriate delivery and success of responses

Implementation of the WHO European action plan

to reduce the harmful use of alcohol 2012 - 2020

Action area Score WHO European

Region median WHO European Region

minimum observed WHO European Region

maximum observed

Leadership, awareness and commitment

20 17 0 30

Health services’ response 11 9 0 14

Community and workplace action 10 6 0 12

Drink–driving policies and countermeasures 20 16 4 24

Availability of alcohol 19 23 4 40

Marketing of alcoholic beverages 8 13 0 28

Pricing policies 10 10 0 25

Reducing the negative consequences of drinking and alcohol intoxication

2 1 0 3

Reducing the public health impact of illicit alcohol and informally produced alcohol

6 8 0 9

Monitoring and surveillance 25 20 0 35

TOTAL POINTS 131 121 62 197

Availability of alcohol

• Indicators

– Lowest age limit for on-premise alcohol service and off-

premise alcohol sale

– Control of retail sales (monopoly / licensing)

– Restrictions on alcohol availability by time (hours / days)

– Restrictions on alcohol availability by place (density /

locations)

– Restrictions on sales at specific events

– Alcohol-free public environments (public transport and

public areas (such as parks or streets))

Marketing of alcoholic beverages

• Indicators

– Legally binding restrictions on alcohol advertising

– Legally binding restrictions on product placement

– Legally binding restrictions on industry sponsorship for

sporting events

– Legally binding restrictions on industry sponsorship for

youth events

– Legally binding restrictions on sales promotions by

producers, retailers and owners of pubs and bars

Pricing policies

• Indicators

– Requirement to offer non-alcoholic beverages at a lower

price

– Adjustment of taxation level for inflation

– Minimum price policy

– Additional levy on specific products

– Ban on below-cost selling

– Ban on volume discount

– Affordability of alcoholic beverages (average prices)

Alcohol policy implementation in EURO

• 51 MS have a blood alcohol concentration

limit of 0.5 g/L or less for driving

• 47 MS have a legally binding regulations on

alcohol advertising

• 46 MS are using random breath-testing

• 43 MS have a minimum 18-year age limit for

off-premise sales of alcohol

• 38 MS have a written national or subnational

alcohol policy

Alcohol policy implementation in EURO

• 36 MS have a legally binding restrictions on

alcohol product placement

• 15 MS require health warnings on alcohol

advertising

• 13 MS adjust taxation for inflation

• 9 MS require product information on alcohol

containers

Global:

http://who.int/gho/gisah

WHO European Region:

http://who.int/gho/eisah

European Union:

http://who.int/gho/eusah

Thank you!

Contact details:

LMO@euro.who.int

Website: http://www.euro.who.int/alcohol

European information system on alcohol

and health:http://who.int/gho/eisah