Meeting the Global NCD Target of at Least 10% Relative Reduction in the Harmful Use of Alcohol: Is the WHO European Region on Track?

Abstract

Background: The Global Action Plan for the Prevention and Control of Noncommunicable Diseases set the target of an “at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context”. This study investigated progress in the World Health Organization (WHO) European Region towards this target based on two indicators: (a) alcohol per capita consumption (APC) and (b) the age-standardized prevalence of heavy episodic drinking (HED). Methods: Alcohol exposure data for the years 2010–2017 were based on country-validated data and statistical models. Results: Between 2010 and 2017, the reduction target for APC has been met with a decline by −12.4% (95% confidence interval (CI) −17.2, −7.0%) in the region. This progress differed greatly across the region with no decline for the EU-28 grouping (−2.4%; 95% CI −12.0, 7.8%) but large declines for the Eastern WHO EUR grouping (−26.2%; 95% CI −42.2, −8.1%). Little to no progress was made concerning HED, with an overall change of −1.7% (−13.7% to 10.2%) in the WHO European Region. Conclusions: The findings indicate a divergence in alcohol consumption reduction in Europe, with substantial progress in the Eastern part of the region and very modest or no progress in EU countries.

Past and Future Alcohol-Attributable Mortality in Europe

“…Moreover, we avoided unrealistically large future differences between countries in age-standardised AAMF levels by assuming that the current increases in AAMF observed for selected countries will eventually turn into declines. This assumption was motivated by the observation of a wave-shaped pattern of an increase followed by a decline in AAMF in a number of European countries (see Figure 1); by the large reductions in alcohol consumption that have recently occurred, particularly in Eastern Europe [27], by the decrease in alcohol use among the youth [14]; by the recent implementation of strong alcohol prevention policies in European countries [27]; and by evidence that prevention policies have the power to bend increases into declines [27].…”

“…For the North-Western European countries, the observed (past) increases in AAMF reflect (temporarily) increasing (Finland, Iceland, Ireland, Norway, Sweden, United Kingdom) or stagnating alcohol consumption patterns (Belgium, Denmark, The Netherlands) [7,11], which have been attributed to the increased availability and affordability of alcohol [44], combined with an expanding culture of heavy episodic drinking that is especially dangerous to health [45]. The implementation of (successful) preventive policies targeting these recent unfavourable patterns (e.g., [27]), has most likely resulted in the recent stagnation of the increase or the declines in alcohol consumption, and consequently alcohol-attributable mortality, in these countries. We projected that AAMF levels will converge across countries, but also that for men, AAMF levels will be higher in Eastern and South-western European countries than in North-western European countries.…”

“…For selected Eastern and North-Western European countries in particular, we recommend the more extensive implementation of policies or restrictions that have proven to be effective in reducing alcohol consumption and, in turn, alcohol-attributable mortality. The aim of such policies is generally to reduce the affordability, availability and marketing of alcohol (see [27,47] for further details). For example, there is evidence that that countries that have more restrictions on alcohol advertising also have the lowest prevalence of hazardous drinking among middle-aged people [48], and that setting a minimum price for a unit of alcohol can reduce alcohol consumption among harmful drinkers [49].…”

Impact of introducing a minimum alcohol tax share in retail prices on alcohol-attributable mortality in the WHO European Region: A modelling study

“…4 Nonetheless, these Eastern European countries were the main drivers of the overall regional reduction in alcohol per capita consumption in recent years as they have substantially reduced both drinking and alcohol-attributable harm. 42 The introduction of various alcohol control policies, which included not only taxation measures to increase prices but also comprehensive marketing and availability restrictions, contributed to this development, although improved access to healthcare and quality of care as well as other factors were also at play. 14 Moreover, it is sometimes difficult to evaluate the impact of single measures like taxation increases or marketing restrictions because of their interacting effects, and because different measures are usually implemented at the same time as part of a broader policy package.…”

Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? Results of a simulation study

“…In contrast to most previous simulation studies, we publish the entire code and all input data alongside our results, encouraging other researchers to further develop and apply the proposed simulation model. Given the projected underachievement of achieving global goals in reducing alcohol consumption [ 14 , 39 ], in particular in Western European countries [ 40 , 41 ], applications of the simulation model may help to inform policy makers about the efforts required to achieve these targets. There are examples where it is possible to achieve high coverage of the measurement of alcohol consumption amongst PHC patients.…”