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Member States Albania harm alcohol-related of interventions to reduce and cost-effectiveness Evidence for the effectiveness Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Evidence for the effectiveness Hungary Iceland Ireland and cost-effectiveness of interventions Israel Italy to reduce alcohol-related harm Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18 E-mail: [email protected]. Web site: www.euro.who.int Evidence for the effectiveness and cost–effectiveness of interventions to reduce alcohol-related harm ABSTRACT There is a substantial evidence base on the effectiveness of different policies in reducing the harm done by alcohol. Policies that regulate the economic and physical availability of alcohol are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drinking and driving and interventions individually directed to drinkers already at risk are also effective. The evidence shows that information and education programmes do not reduce alcohol-related harm; nevertheless, they have a role in providing information, reframing alcohol-related problems and increasing attention to alcohol on the political and public agendas. In all parts of the European Union, population-based interventions represent a highly cost– effective use of resources to reduce alcohol-related harm. Brief interventions for individual high-risk drinkers are also cost–effective, but are harder to scale up because of their associated training and manpower needs. Keywords ALCOHOL DRINKING – prevention and control HARM REDUCTION COST–BENEFIT ANALYSIS EVIDENCE-BASED PRACTICE PUBLIC POLICY HEALTH PROMOTION INTERVENTION STUDIES ISBN 978 92 890 4175 1 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2009 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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Contents Acknowledgements.......................................................................................v Foreword .....................................................................................................vii Summary .......................................................................................................1 Introduction ..................................................................................................5 What are alcohol policies? ................................................................... 5 What is the evidence base for alcohol policies?................................... 6 Political, sociocultural and economic factors that impact on harm...... 7 Stakeholders and alcohol policy........................................................... 7 Alcohol policy at different jurisdictional levels................................... 9 Alcohol policies in a European framework........................................ 10 Alcohol policies in a global framework ............................................. 11 What is Europe? ................................................................................. 15 The health, social and economic impact of alcohol ................................19 At individual level.............................................................................. 19 At societal level.................................................................................. 21 Health inequalities.............................................................................. 25 Raising awareness and political commitment.........................................28 Impact of education and information campaigns ............................... 28 Public support for alcohol policy measures ....................................... 33 Infrastructures for alcohol policy ....................................................... 37 Response of the health sector ....................................................................41 Screening and brief advice programmes ............................................ 41 Treatments for alcohol use disorders and alcohol dependence .......... 44 Community action......................................................................................47 Community activities ......................................................................... 47 Alcohol and the workplace................................................................. 50 Drink–driving policies and countermeasures .........................................55 Alcohol policy and drink–driving ...................................................... 55 Unrestricted breath-testing................................................................. 57 Licence suspension............................................................................. 58 Alcohol locks ..................................................................................... 59 Training for servers of alcohol and civil liability............................... 60 Designated driver and safe ride programmes..................................... 60 Educational programmes.................................................................... 61 Mass media campaigns....................................................................... 62 Addressing the availability of alcohol......................................................64 Minimum age for purchase of alcohol ............................................... 65 Number of outlets and outlet density ................................................. 65 Days and hours of sale ....................................................................... 68 Addressing the marketing of alcoholic beverages ..................................70 Advertising and expectancies............................................................. 70 Experimental studies .......................................................................... 71 Econometric studies ........................................................................... 72 Cross-sectional studies....................................................................... 73 Longitudinal studies........................................................................... 73 Self-regulation.................................................................................... 74 Pricing policies............................................................................................76 Price and the use of alcohol................................................................ 76 Price and younger drinkers................................................................. 78 Price and heavier drinkers.................................................................. 79 Price and alcohol-related harm........................................................... 79 Affordability of alcohol.....................................................................