What’s next for WHO’s global strategy to reduce the harmful use of alcohol?

Almost 10 years after the World Health Assembly adopted the Global strategy to reduce harmful use of alcohol, and seven years after the inclusion of alcohol as one of the key risk factors in the World Health Organization’s (WHO’s) Global action plan for the prevention and control of noncommunicable diseases 2013–2030, Member States have made little progress in addressing alcohol use as a risk factor for health. We reach this conclusion based on analysis of Member States’ self-reports of actions to reduce the harmful use of alcohol. We used data on alcohol policies from two recent surveys conducted by WHO: a 2015 global questionnaire on the progress on the global alcohol strategy since 2010,1 answered by 138 Member States, and the 2016 Global survey on alcohol and health, answered by 173 Member States. Results were published in WHO’s 2018 Global status report on alcohol and health,2 mostly with data from the 2016 survey, but also including some data from the 2015 survey. Both surveys showed that progress on alcohol policies has been slow. The alcohol strategy outlined 10 areas,3 with three identified as the most effective and cost–effective interventions to reduce alcohol-related harm, costing less than 100 United Sates dollars (US$) per disability-adjusted life year averted. These interventions include strengthening restrictions on alcohol availability, bans or comprehensive restrictions on alcohol advertising across multiple media platforms and increasing alcohol excise taxes. Of these three interventions, countries were most active on taxes, because most depend on tax revenues for national budgets. Member States appear unaware of taxes’ critical public health role in managing the affordability of alcohol. Most countries (155 of the 163 non-Muslim countries responding to the 2016 survey) apply sales tax to beer. The 2015 survey on policy changes revealed that 78 (62%) of the 126 countries that answered this question reported increasing alcohol taxes since 2010; however, only a third of these increases were described by Member States as substantial. In 45 (36%) of these 126 countries, taxes on beer stayed roughly the same. More than two thirds of countries (68%) with excise taxes did not adjust them for inflation, so the likely effect is that alcohol taxes, and by extension prices, have fallen because they are based on beverage volumes, which do not change. Regarding alcohol marketing, the least restrictive policies were the most common, with small countries, globally, and countries in Africa and the Americas most likely to have no restrictions. According to the 2015 survey, since 2010, 8% (11/138) of countries reported a decrease in progress in this area, while 34% (47/138) reported an increase; 58% (80/138) stayed about the same. Smaller countries, overall, lagged behind their larger counterparts. Countries that reported increases in regulation of marketing of alcoholic beverages had on average twice as many residents as countries that reported decreases (average population of 52.9 million versus 22.5 million). Seven countries introduced a new total ban on alcohol marketing since 2010; however, there has been little regulation of new marketing techniques, an area where industry activities are quickly growing. For example, in the United States of America in 2017, according to Advertising Age, a global beer company spent nearly US$ 1 billion on unmeasured marketing including digital, nearly 60% more than it spent on the traditional measured media channels of print, radio and television.4 Results are worst for physical availability, where aside from minimum age purchase laws, most restrictions, such as limits on days and hours of sale, or on licenses to produce, distribute or sell alcohol, declined over time. Underscoring a key disparity, alcohol availability policies are becoming less restrictive in low-income countries. Growing evidence of harm