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Global Status Report on Alcohol and Health 2018 Global Status Report on Alcohol and Health 2018 ISBN 978-92-4-156563-9 GLOBAL STATUS REPORT ON ALCOHOL AND HEALTH REPORT GLOBAL STATUS Global status report on alcohol and health 2018 Global status report on alcohol and health 2018 Global status report on alcohol and health 2018 ISBN 978-92-4-156563-9 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC- SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Global status report on alcohol and health 2018. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Printed in Switzerland. CONTENTS FOREWORD .........................................................vii ACKNOWLEDGEMENTS ............................................. viii ABBREVIATIONS ......................................................x EXECUTIVE SUMMARY ...............................................xii 1. REDUCING THE HARMFUL USE OF ALCOHOL: A KEYSTONE IN SUSTAINABLE DEVELOPMENT ......................................2 1.1 Alcohol in the context of the United Nations 2030 Agenda for Sustainable Development ......................................................2 1.2 Alcohol and SDG 2030 health targets .................................3 1.2.1 Reproductive, maternal, newborn, child and adolescent health .........5 1.2.2 Infectious diseases ............................................6 1.2.2.1 Risky sexual behaviour and sexually transmitted infections .....7 1.2.2.2 Viral hepatitis ...........................................7 1.2.2.3 Tuberculosis ............................................8 1.2.3 Major noncommunicable diseases ................................8 1.2.3.1 Cardiovascular diseases ..................................8 1.2.3.2 Cancers ...............................................8 1.2.3.3 Liver diseases ..........................................9 1.2.4 Alcohol and mental health ......................................10 1.2.4.1 Alcohol intoxication .....................................11 1.2.5 Injuries, violence, homicides and poisonings .......................12 1.2.5.1 Injuries ...............................................12 1.2.5.2 Traffic injuries..........................................12 1.2.5.3 Aggression and violence .................................12 1.2.5.4 Homicides ............................................13 1.2.5.5 Alcohol poisoning ......................................13 1.3 Alcohol and inequalities – across countries and within society ...........14 1.3.1 Drinking versus abstention: variations by socioeconomic level within a society and across societies .............................14 1.3.2 Variations in amount and pattern of drinking by status within a society ..14 1.3.3 Patterns of change in drinking with economic development in a society . 15 1.3.4 Health harm from alcohol use: less for more affluent drinkers .........15 1.3.5 “Harm per litre” is greater for the poor than for the affluent in a given society ............................................16 1.3.6 “Harm per litre” and socioeconomic development of societies ........18 1.4 Alcohol and use of other psychoactive substances .....................19 iii Global status report on alcohol and health 2018 2. GLOBAL STRATEGIES, ACTION PLANS AND MONITORING FRAMEWORKS ...................................................24 2.1 Global strategies and action plans ..................................24 2.1.1 Regulation of alcohol and other psychoactive substances at international level ..........................................24 2.1.2 Global strategy to reduce the harmful use of alcohol (WHO, 2010) .....25 2.1.3 Alcohol in global strategies and action plans on NCDs and mental health ................................................27 2.2 Global monitoring frameworks .....................................28 2.2.1 Global and regional information systems on alcohol and health ........29 2.2.2 The NCD Global Monitoring Framework ...........................30 2.2.3 Tracking progress in achieving the sustainable development goals ......31 2.3 Key indicators for global monitoring frameworks on alcohol and health ...31 2.4 National monitoring systems and their key components ................32 3. ALCOHOL CONSUMPTION .........................................38 3.1 Levels of consumption .............................................38 3.1.1 Current drinking and abstention rates .............................39 3.1.2 Total alcohol per capita consumption (APC) ........................41 3.1.3 Total alcohol per capita consumption (APC) among drinkers ...........42 3.1.4 Unrecorded alcohol consumption ................................43 3.1.5 Trends in current drinking and abstention ..........................44 3.1.6 Trends in total alcohol per capita consumption (APC).................45 3.1.7 Trends in total alcohol consumption among drinkers .................46 3.2 Patterns of drinking ...............................................46 3.2.1 Most consumed beverages .....................................46 3.2.2 Heavy episodic drinking (HED) ..................................47 3.3 Factors that have an impact on alcohol consumption ...................49 3.3.1 Alcohol use in young people ....................................49 3.3.2 Alcohol use in women .........................................54 3.3.3 Economic wealth .............................................56 3.4 Projections of alcohol consumption up to 2025 ........................58 4. HEALTH CONSEQUENCES .........................................62 4.1 Changes in our understanding of the health consequences of alcohol consumption .....................................................63 4.2 Alcohol-attributable mortality and the burden of disease ................63 4.2.1 The alcohol-attributable burden of infectious diseases ...............67 4.2.2 The alcohol-attributable burden of noncommunicable diseases ........69 4.2.2.1 Malignant neoplasms ...................................69 4.2.2.2 Diabetes mellitus ......................................71 4.2.2.3 Alcohol use disorders, alcohol poisonings and fetal alcohol syndrome ............................................72 4.2.2.4 Epilepsy and other neuropsychiatric disorders ...............73 4.2.2.5 Cardiovascular diseases .................................73 4.2.2.6 Digestive diseases .....................................75 4.2.3 The alcohol-attributable burden of injuries .........................76 4.2.4 Factors that have an impact on health consequences ................78 4.2.4.1 Impact by age .........................................78 4.2.4.2 Impact by gender ......................................80 4.2.4.3 Impact by economic status ..............................82 4.3 Trends in the alcohol-attributable health burden, 2010−2016 .............84
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