A report by the World Health Organization (WHO), Making the WHO European Region SAFER, provides an overview of alcohol-attributable burden of disease in the WHO European Region.1 It also updates the changes in alcohol consumption between 2010 and 2016 and provides guidance for countries to implement high-impact alcohol policies.

The report analyses the implementation of alcohol control policies of the European Action Plan to Reduce the Harmful Use of Alcohol 2012–2020 (EAPA), focusing on the five high-impact strategies of the WHO-led SAFER initiative:

1. Strengthen restrictions on alcohol availability
2. Advance and enforce drink-driving countermeasures
3. Facilitate access to screening, brief interventions, and treatment
4. Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion
5. Raise prices on alcohol through excise taxes and pricing policies.

Alcohol use in WHO European Region

According to the report, almost no progress was made in the WHO European Region towards implementing these evidence-based, effective alcohol control measures, while levels of consumption remained higher than in any other WHO region worldwide. Although, overall, there was a decrease in per capita alcohol consumption in the WHO European Region (from 11.2 litres per capita in 2010 to 9.8 litres in 2016), these improvements were limited to mainly countries in the eastern part of the region, where the level of alcohol-attributable harms remains very high. Of the 51 member states of the region, 34 countries reported decreases in alcohol consumption between 2010 and 2016. However, Ireland was one of 17 countries where an increase was noted. Ireland ranked fifth for levels of alcohol use in member states in 2016, a 5.6% increase from 2010. Although the impact of Covid-19 may have led to an overall reduction in alcohol consumption in the region, the report advises that current projections estimate that there will be little change in alcohol consumption in the next decade.

Prevalence of heavy episodic drinking (HED), defined as 60 grams or more of pure alcohol on at least one occasion over the previous 30 days, declined by 16.3% on average between 2010 and 2016; the overall prevalence of HED was 26.4% in the adult (15+ years) population. However, Ireland was one of a number of countries that reported higher than the member state average for HED.

Alcohol-attributable mortality

Overall, there was a decrease from 2010 to 2016, although one in 10 deaths among adults in the WHO European Region were alcohol attributable (i.e. deaths that would not have occurred in the absence of alcohol use). Among those aged 20–24 years, this increased to one in four deaths (23.3%). Of alcohol-attributable deaths, 14.3% were caused by cancer. In Ireland, there was little change in the percentage of alcohol-attributable fractions of all-cause deaths between 2010 and 2016.

Overall, a decrease in alcohol-attributable disability-adjusted life years (DALYs) was noted from 2010 (40 million) to over 30 million in 2016 in the WHO European Region. The largest proportions of alcohol-attributable mortality were observed in Eastern European countries. However, these were also the countries with the largest relative reductions in alcohol-attributable mortality and alcohol consumption between 2010 and 2016. The report noted that Eastern European countries experienced greater harm despite similar or lower levels of drinking.

Implementation of SAFER initiative

The average implementation of the WHO’s SAFER effective and cost-effective measures for alcohol policies in the WHO European Region was poor. In 2016, of the five SAFER key areas, only drink-driving countermeasures were well implemented in the WHO European Region (80%). However, implementation of other measures was generally poor, specifically those related to the WHO ‘best buys’ (i.e. increasing taxes on alcohol, banning alcohol advertising, and restricting the availability of alcohol) and health service responses (i.e. provision of screening and brief interventions for alcohol and treatment of alcohol use disorders). Pricing policies were the worst-performing policy area in the region (17%) in 2016, despite being the most cost-effective type of policy and recognised as a best buy measure to reduce the disease burden. In fact, in the region, overall, alcohol had become increasingly affordable due to a failure to adjust alcohol taxes for inflation. Furthermore, a snapshot of the policy indicators for the year 2019 showed that little progress had been made between 2016 and 2019 in the implementation of alcohol control measures.

Conclusion

The report concludes that more decisive action is needed to reduce alcohol intake as a modifiable risk factor and alcohol-attributable harms as a completely preventable component of the disease burden. Covid-19 has disrupted our way of living immensely and an increase in alcohol consumption could be caused by rising levels of anxiety and other mental health problems related to stress. However, it is still too early to gauge the long-term impact of Covid-19 on people’s drinking patterns.

Although commercial operators are making the case for less, not more, regulation of alcohol, the available evidence strongly opposes the notion that economies can recover while neglecting the health of their populations through inadequate regulation of alcohol. The SAFER initiative underlines that a healthy economy is driven by a healthy population and that to improve the health of all Europeans we need a reinvigorated commitment to tackling all causes of preventable ill-health, including alcohol. WHO’s European Programme of Work 2020–2025 envisages a world where the vulnerable are protected, no one is left behind, and people are enabled to live safer, healthier, and better lives.

1          WHO Regional Office for Europe (2021) Making the WHO European Region SAFER: developments in alcohol control policies, 2010–2019. Copenhagen: WHO Regional Office for Europe. https://www.drugsandalcohol.ie/34060/