the disease burden

Around the world, approximately 3 million people each year die from alcohol-related causes. This is the equivalent of one person every 10 seconds.[1] Alcohol is a major determinant of ill health and one of the four most common preventable risk factors for NCDs. Alcohol consumption contributes to diabetes, heart disease, liver cirrhosis and stroke. Consumption is also causally linked to at least seven types of cancers. [30] In addition, alcohol can weaken the immune system, and contributes to respiratory and infectious diseases, including a significant contribution to tuberculosis(TB) deaths in low-income countries and to HIV/AIDS. [1,4]

The cancer burden – a downplayed danger

Alcohol is a cancer-causing agent. There is strong scientific evidence of a causal relationship between alcohol use and multiple types of cancer, including cancers of the head and neck, mouth, esophagus, liver, breast and colon. For alcohol-attributable cancers, generally the higher the level of alcohol consumption, the higher the risk. [30, 31] Worldwide, up to 27 percent of the disease burden due to specific cancers in those over 50 years old is attributable to alcohol. [4] In the Caribbean, 37 percent of cancers in women are linked to alcohol consumption. [32, 33]

Harm to Others

Alcohol can hurt people other than the alcohol user. Alcohol plays a significant and deadly role in violent incidents: in homicides, car crashes, falls, child abuse and violence against women.[7] A woman’s use of alcohol during pregnancy also risks Fetal Alcohol Spectrum Disorders (FASD), a condition that can lead to lifelong physical, mental and neurological problems.[34]

• In Europe, alcohol is a factor in 40 percent of all homicides.[20]

• In Australia, alcohol was involved in 34 percent of incidents involving intimate partner violence in 2014, and in 29 percent of family violence incidents in 2014.[35]

• Among South African women experiencing intimate partner violence, almost half reported that alcohol played a role.[36]

• In the United States, more than 10 percent of children live with a parent with an alcohol use problem. [9]

The Economic Burden

The economic burden of alcohol worldwide is substantial, accounting for up to 5 percent of the GDP in some countries. [6] Alcohol burdens the health system, productivity, social welfare, public safety and the justice system. [7] The economic costs of alcohol dwarf the contribution of the alcohol trade to the economy, harming productivity in the workplace, jeopardizing the economic sustainability of the health care and welfare systems, and eroding GDPs.

• Every year, alcohol is estimated to cost society $249 billion in the United States and 156 billion euros in the European Union. [80, 12]

• In South Africa, the cost of alcohol harm is calculated to be as much as 12 percent of the GDP. [80]

The Expanding Burden

In recent years, alcohol consumption has been increasing around the globe as the alcohol industry expands operations and markets, especially in Eastern Europe, Asia, Africa and Latin America. [5] Alcohol consumption poses health and social risks across populations, but the risks and consequences are magnified in low- and middle-income countries. (LMICs) [1]

Low and Middle-Income Countries

Alcohol harm represents an especially concerning and rapidly growing health, social, economic, and human rights problem in low- and middle-income countries.

Though the world’s wealthiest countries have the highest rates of alcohol use, the largest increases in levels of alcohol use, exposure and burden are in low- and middle-income countries. [1] According to the World Health Organization, the lower the economic development of a region or country, the higher the attributable mortality, burden of disease and injury per liter of alcohol consumed. [1] The harmful use of alcohol presents challenges to low- and middle-income countries undergoing economic transition. Often, these countries lack effective regulation or have health systems that are not equipped to handle the concomitant increase in the alcohol-attributable burden.

Young People

A 2014 global survey on alcohol and health assessed five-year trends in alcohol use. The survey found that 71 percent of countries reported an increase in underage alcohol use over the five years, and 80 percent of countries showed an increase in alcohol use among those between the ages of 18 and 25. [80] The marketing of carbonated and sugary alcoholic drinks, as well as other alcohol formulations that appeal to the young, sometimes termed “alcopops,” are equated with more frequent alcohol use, early onset of alcohol consumption and more alcohol-related consequences, such as violence, injuries, and hospitalizations. [37, 38]

With the exception of the Eastern Mediterranean region, heavy episodic drinking among adolescents (ages 15-19) and young adults (ages 20-24) is around 45 to 55 percent. More than a quarter of all 15- to 19-year-olds globally are current drinkers—amounting to 155 million adolescents. [1]

Evidence indicates that underage alcohol consumption and related harm is a global problem.

• In South Africa, the average age at which adolescents try alcohol is 13 years old, and about 25 percent of adolescents report binge drinking in the past month. [39]

• In Scotland, over 70 percent of 15-year-olds reported consuming alcohol to the point of intoxication. [40]

• Approximately one in five men across most Caribbean countries report binge drinking. [33]

The later the onset of initiation, the lower the likelihood of a pattern of harmful use of alcohol later in life. Youth who start using alcohol before age 15 are six times more likely to develop alcohol dependence than those who begin consuming alcohol at age 21.[9] There is concern that youth alcohol use is commencing earlier, as young people are being targeted by alcohol advertising campaigns. [37]

Young Women

Heavy use of alcohol is being normalized for women by alcohol industry marketing tactics that target them. [41] In Australia, the number of women aged 18 to 24 being admitted to the hospital because of alcohol doubled between 1998 and 2006.[17] The percentage of children who had tried alcohol by age 15 increased significantly in the 2000s across 34 industrialized countries—more among girls than boys.[17]

Alcohol, Global Health and Development

Countries are committed, but slow to act

Alcohol use has been acknowledged by countries as a health and development priority through the endorsement of the WHO Global Strategy to Reduce the Harmful Use of Alcohol, and through integration into global targets for NCDs and sustainable development.[1, 7] WHO strategy calls for global, regional and national actions on alcohol consumption and for an increased focus on the wider social determinants of health. Special attention is given to reducing harm to people other than the user and to populations that are at particular risk from harmful use.

Reducing alcohol use has also been specifically integrated into the UN’s 2030 Agenda’s Sustainable Development Goals (SDGs) across several targets. Among them: Strengthen the prevention and treatment of substance abuse, including…the harmful use of alcohol. Reducing alcohol use is also directly relevant to several other global health targets including a 2020 target to halve the number of global deaths and injuries from road crashes. Alcohol use is an obstacle to achieving 13 of the 17 SDGs.[8]

However, countries are not on track to reduce global alcohol use and meet targets.[8, 42] Projections based on past trends suggest that a lack of progress on this indicator will constrain global health and development.[8, 43]