More than 3m people died as a result of harmful use of alcohol in 2016, according Global Status Report on Alcohol and Health 2018 published by the World Health Organisation (WHO). This represents one in 20 deaths. More than three quarters of these deaths were among men. Overall, the harmful use of alcohol causes more than 5% of the global disease burden.
The Global Status Report on Alcohol and Health 2018 presents a comprehensive picture of alcohol consumption and the disease burden attributable to alcohol worldwide. It also describes what countries are doing to reduce this burden.
“Far too many people, their families and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said Dr Tedros Adhanom Ghebreyesus, director-general of WHO. “It’s time to step up action to prevent this serious threat to the development of healthy societies.”
Of all deaths attributable to alcohol, 28% were due to injuries, such as those from traffic crashes, self-harm and interpersonal violence; 21% due to digestive disorders; 19% due to cardiovascular diseases, and the remainder due to infectious diseases, cancers, mental disorders and other health conditions.
Despite some positive global trends in the prevalence of heavy episodic drinking and number of alcohol-related deaths since 2010, the overall burden of disease and injuries caused by the harmful use of alcohol is unacceptably high, particularly in the European Region and the Region of Americas.
Globally an estimated 237m men and 46m women suffer from alcohol-use disorders with the highest prevalence among men and women in the European region (14.8% and 3.5%) and the Region of Americas (11.5% and 5.1%). Alcohol-use disorders are more common in high-income countries.
An estimated 2.3bn people are current drinkers. Alcohol is consumed by more than half of the population in three WHO regions – the Americas, Europe and the Western Pacific.
Europe has the highest per capita consumption in the world, even though its per capita consumption has decreased by more than 10% since 2010. Current trends and projections point to an expected increase in global alcohol per capita consumption in the next 10 years, particularly in the South-East Asia and Western Pacific Regions and the Region of the Americas.
The average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits.
Worldwide, more than a quarter (27%) of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%). School surveys indicate that, in many countries, alcohol use starts before the age of 15 with very small differences between boys and girls.
Worldwide, 45% of total recorded alcohol is consumed in the form of spirits. Beer is the second alcoholic beverage in terms of pure alcohol consumed (34%) followed by wine (12%). Worldwide there have been only minor changes in preferences of alcoholic beverages since 2010. The largest changes took place in Europe, where consumption of spirits decreased by 3% whereas that of wine and beer increased.
In contrast, more than half (57%, or 3.1bn people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months. “All countries can do much more to reduce the health and social costs of the harmful use of alcohol,” said Dr Vladimir Poznyak, coordinator of WHO’s management of substance abuse unit. “Proven, cost-effective actions include increasing taxes on alcoholic drinks, bans or restrictions on alcohol advertising, and restricting the physical availability of alcohol.”
Higher-income countries are more likely to have introduced these policies, raising issues of global health equity and underscoring the need for greater support to low- and middle-income countries.
Almost all (95%) countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media.
“We would like to see member states implement creative solutions that will save lives, such as taxing alcohol and restricting advertising. We must do more to cut demand and reach the target set by governments of a 10% relative reduction in consumption of alcohol globally between 2010 and 2025,” added Tedros.
Reducing the harmful use of alcohol will help achieve a number of health-related targets of the Sustainable Development Goals, including those for maternal and child health, infectious diseases, noncommunicable diseases and mental health, injuries and poisonings.
Dr James Nicholls, director of research and policy development at Alcohol Concern/Alcohol Research UK, said the figures confirm that alcohol consumption and harm is falling in Europe, showing that cultures and behaviour around alcohol can change. Still, he is quoted in The Guardian as saying: “Europe remains the highest-consuming region globally, and we know that it is still a major cause of ill-health in the UK – especially in more deprived areas.”
The report reveals that in the UK, the total alcohol consumed per person among drinkers aged 15 and over was 7.6 litres for women and 21.8 litres for men. What’s more, 13% of men and 4.7% of women in the UK were deemed to have alcohol-use disorders; the average for the European region was 8.8%.
Nicholls said the report flags that, overall, there is a growth in alcohol consumption in developed countries that reflects concerted efforts by alcohol producers to export a “European” drinking culture across the world.
Rajiv Jalan, professor of hepatology at University College London, said that among the key issues was the age of consumption, with almost 44% of 15-19 year olds in European region being active drinkers. “We allow our kids to drink from the age of 16, underage drinking, and I think that is a serious issue that we need to hit on the head,” he said. “Kids are going to casualty drunk from school parties.”
Jalan called the report a wake-up call, saying it is “seriously worrying” that in Europe alcohol is responsible for more than 10% of all deaths. He said: “The biggest problem that we have is that, certainly in Europe and if you focus more on the UK, there isn’t really a strategy which is all-encompassing in order to address this death rate. All the different elements that are known to work have not yet been implemented.”
Noting that while Scotland had recently introduced minimum alcohol pricing, England had not followed suit, Jalan said all eyes were now on Scotland to see if lessons could be learned for other countries from the policy. “Hopefully that will show a difference, but by that time many, many other people will be dead,” he said.