International Alcohol Control Study: Analyses from the first wave

Alcohol is a leading risk factor for the global burden of disease and contributes to a range of social and economic harms. Globally, alcohol is estimated to be the seventh leading risk factor in 2016 in terms of disability adjusted years of life lost, and alcohol use is the leading risk factor in disability adjusted years of life lost between the ages of 15 and 49 years [1]. The 2016 global burden of disease analysis has confirmed more limited preventive effects from alcohol than have been previously claimed and identified a much larger risk of cancer due to alcohol [1]. A non-communicable disease target of 10% relative reduction in alcohol consumption has been established by the World Health Organization (WHO) [2]; alcohol is also recognised by the United Nations as a threat to sustainable development [3] and contributes economic costs of approximately 1%–2% of gross domestic product in several countries where these have been assessed [4]. Policy measures to restrict alcohol availability, curtail affordability and restrict alcohol marketing, when implemented, have reduced alcohol-related harm [5–7], however, such policies have not, as yet, been widely implemented and, while summarised in the WHO Global Strategy to Reduce Harmful Use of Alcohol, they have not been encapsulated into an international health treaty comparable with the Framework Convention on Tobacco Control. Substantially less groundwork is available in alcohol control, when compared with tobacco, on monitoring and encouraging legislation and implementation of effective alcohol policy. For example, WHO developed the policy package MPOWER to monitor and assist with countrylevel implementation to reduce demand for tobacco [8]. The Global Information System on Alcohol and Health (also developed by WHO) makes country-level alcohol consumption and policy data available, but does not provide resources for intervention implementation (although there have been some efforts at regional level [9] and a tool on taxation and pricing was recently published by WHO [10]). The lack of progress in alcohol control at the national and international levels is highlighted by the fact that alcohol attributable DALYs have increased by more than 25% over the years 1990–2016, driven primarily by increased consumption in South Asia, Southeast Asia and Central Asia, among both men and women [1]. Africa is now experiencing similar impacts to those in Asia as a result of targeting by the supranational alcohol corporations [11,12]. The implementation of alcohol policies is not only often politically difficult [5], but also more complex than that of tobacco for a number of reasons, including the availability of a range of beverages of different potencies and a wide range of prices in onand offpremise drinking contexts. In addition, unlike for tobacco, there are policies related to intoxication such as restrictions of sale to intoxicated patrons and drinkdriving legislation.