Many interventions for the prevention and control of alcohol harm do exist.
WHO has identified a set of evidence-based alcohol policy “best buy” interventions that are not only highly cost-effective but also feasible and appropriate to implement within the constraints of national budgets. WHO has developed a costing tool to enable countries to add or substitute interventions according to national needs or priorities. A number of criteria play a role in the political decisions which best buy interventions to implement:
- Current and projected burden of disease,
- Fairness and feasibility of implementing interventions, and
- Political considerations.
Findings from WHO indicate that the price tag for scaled-up implementation of a core set of NCDs “best buy” interventions is comparatively low. Population-based measures for reducing tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, are estimated to cost US$ 2 billion per year for all LMICs – less than US$ 0.40 per person.
A highly cost-effective intervention is one that, on average, provides an extra year of healthy life (equivalent to averting one DALY) for less than the average annual income per person.
For example, in Eastern Europe, any intervention that produces a healthy year of life for less than US$ 9972 (the average GDP per capita) is deemed to be highly cost-effective; an intervention that does so for less than three times GDP per capita is still considered reasonable value for money or quite cost-effective. These threshold values are based on a recommendation by the WHO Commission on Macroeconomics and Health (2001) and the work of the WHO cost-effectiveness CHOICE project.
WHO, WEF report
Figure 4 shows – per WHO and WEF, population-based measures that address tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity, account for a very small fraction of the total price tag (US$ 2 billion per year – less than US$ 0.40 per person).
Current and projected burden of disease
Established evidence for the effectiveness and cost-effectiveness of interventions to reduce alcohol harm and its contribution to the overall burden of disease include examples from countries such as Brazil, China, Mexico, the Russian Federation and Viet Nam, and others. The following alcohol policy best buys measures are especially supported:
- Increasing excise taxes on alcoholic beverages;
- Regulating availability of alcoholic beverages, including minimum legal purchase age, restrictions on outlet density and on time of sale, and, where appropriate, governmental monopoly of retail sales;
- Restricting exposure to marketing of alcoholic beverages through effective marketing regulations or comprehensive advertising bans;
- Driving under the influence countermeasures including random breath testing, sobriety check points and blood alcohol concentration (BAC) limits for drivers at 0.5 g/l, with reduced limits or zero tolerance for young drivers;
- Treatment of alcohol use disorders and brief interventions for hazardous and harmful alcohol consumption.
The current available scientific evidence supports prioritization of multiple cost- effective policy actions – the so-called three alcohol policy best buys:
- Increasing alcohol beverage excise taxes,
- Restricting access to retailed alcohol beverages and
- Comprehensive advertising, promotion and sponsorship bans
WHO report, page 56