Table Of ContentOECD Health Policy Studies
Preventing Harmful Alcohol
Use
OECD Health Policy Studies
Preventing Harmful Alcohol
Use
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Please cite this publication as:
OECD (2021), Preventing Harmful Alcohol Use, OECD Health Policy Studies, OECD Publishing, Paris,
https://doi.org/10.1787/6e4b4ffb-en.
ISBN 978-92-64-59404-3 (print)
ISBN 978-92-64-48558-7 (pdf)
OECD Health Policy Studies
ISSN 2074-3181 (print)
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3
Foreword
Alcohol can be a source of individual pleasure and social enjoyment, and its production and trade represent
an important part of the economy in many countries. Harmful alcohol consumption, however, is a leading
risk factor for premature mortality, injuries and many non-communicable diseases such as cancer, liver
cirrhosis and injuries. These, in turn, have wider detrimental societal consequences.
The COVID-19 pandemic has led to changes in drinking habits, with a higher number of people reporting
an increase in volume and frequency of drinking compared to the number reporting lower alcohol
consumption. In Germany, the United Kingdom and the United States, overall alcohol sales slightly
increased by 3-5% in 2020 compared to 2019, according to preliminary estimates. COVID-19 has also
changed the places where people drink: while bars and restaurants were badly hit by lockdowns, retail
stores and e-commerce significantly increased their sales. The pandemic has also highlighted the
problems – in particular within the family sphere – associated with harmful levels of alcohol consumption.
Tackling harmful alcohol use therefore remains an important priority for governments.
Policies to tackle harmful alcohol consumption are complex and require trade-offs. This report sheds light
on these trade-offs by presenting new evidence on the health and economic impact of alternative options.
Analyses in this report focus on 52 OECD, European Union (EU27) and Group of 20 (G20) countries, and
show that life expectancy will be 0.9 years lower over the next 30 years due to diseases and injuries caused
by drinking more than 1 drink per day for women and 1.5 drinks per day for men, corresponding to a lower-
risk threshold specifically used for the simulation. These diseases and injuries cause medical costs equal
to about 2.4% of total health expenditure each year; they also damage children’s school performance and
labour force productivity. As a result, it is estimated that gross domestic product (GDP) will be 1.6% lower
on average in OECD countries annually over the next 30 years.
This report identifies policy gaps at the national level. For example, in many countries the implementation
of policies on the ground and their effectiveness at the population and individual levels are hindered by
poor implementation, limited resources or practical problems. Upscaling action to tackle harmful alcohol
consumption is effective in reducing harm and is shown to be an efficient investment. Combining policies
into packages that focus on limiting the promotion of alcohol to children; better police enforcement to
prevent alcohol-related traffic injuries; upscaling coverage of counselling for patients with harmful alcohol
consumption; and price policies to limit the affordability of alcohol, particularly for cheap alcohol, maximises
the impact. Investing in such policy packages can save millions of lives and generate savings that are
greater than the implementation costs. For every USD 1 invested, the estimates in this report suggest that
up to USD 16 is returned in economic benefit, excluding the impact on alcohol-related businesses. The
report also discusses approaches to minimise consequences for industry and businesses.
This report is a clear illustration of how better policies lead to better lives. By investing in health prevention,
policy-makers have the opportunity to reduce the burden of harmful alcohol consumption for future
generations, and to benefit economies.
PREVENTING HARMFUL ALCOHOL USE © OECD 2021
4
Acknowledgements
The Organisation for Economic Co-operation and Development (OECD) work on harmful alcohol use was
conducted on behalf of its Health Committee, between 2018 and 2020. Michele Cecchini was responsible
for the project, overseeing its development. He also led the production of Chapter 1. The production of
Chapters 2 and 8 was led by Sabine Vuik. Marion Devaux co-ordinated the production of the report and
led the production of Chapters 3, 5 and 7 as well as the country notes. Yevgeniy Goryakin led the
production of Chapter 4, while Jane Cheatley led the production of Chapter 6. Alexandra Aldea was in
charge of the modelling work, which is led by Aliénor Lerouge. Yvan Guillemette, from the Economics
Department, ran the analyses on the OECD long-term economic model and contributed to Chapters 4
and 7. Antoine Marsaudon, Marta Bertanzetti and Laura Suhlrie gave substantial contributions to,
respectively, Chapters 3, 6 and 7, while Andrea Feigl contributed to Chapter 4.
Many more people deserve credit for the work presented in this book. The production of this report
benefited greatly from the inputs and comments received from other OECD colleagues, national experts,
member states representatives and other stakeholders.
Within the OECD, the authors would like to thank Lucy Hulett and Lydia Wanstall for the editorial
assistance. Hannah Whybrow and Guillaume Haquin provided administrative assistance. Stefano
Scarpetta, Mark Pearson and Francesca Colombo provided senior leadership and advice throughout the
project. Franco Sassi provided inputs in the initial phases of the designing of the project. Francesca
Borgonovi from the Education Directorate provided inputs and comments.
Special thanks go to Artur Furtado, Attila Balogh and Hana Horka (European Commission) who followed
the development of the project since its conceptualisation and provided inputs throughout. The authors
would like to thank both French bodies “Mission Interministérielle de Lutte contre les Drogues et les
Conduites Addictives” and “Délégation à la sécurité routière”, and the members of the Swiss Federal Office
of Public Health who commented on earlier versions of the work and contributed to the development of
this project since its initiation.
For its work on public health, the OECD maintains a close partnership with the World Health Organization
(WHO) and its Regional Offices. Authors would like to Carina Ferreira-Borges (WHO-Europe) and
Maristela Monteiro (PAHO) for their comments on the different drafts of the report.
Preliminary versions of the chapters of this book were presented and discussed at meetings of the OECD
Expert Group on the Economics of Public Health (EGEPH), chaired by Brian Ferguson and Amber Jessup,
and at the December 2020 meeting of the OECD Health Committee, chaired by Hans Brug. Country
experts and delegates are too many to name individually, but the authors would like to thank in particular
delegates from Australia, Canada, Chile, Colombia, Costa Rica, Czech Republic, France, Germany, Israel,
Japan, Korea, Lithuania, Portugal, Slovenia, Switzerland, the United Kingdom, the United States, the
European Commission and the Joint Research Centre of the European Commission for their constructive
comments throughout the process. In addition, the authors would like to acknowledge useful comments
from the Business and Industry Advisory Committee to the OECD (BIAC) and the Trade Union Advisory
Committee to the OECD (TUAC).
PREVENTING HARMFUL ALCOHOL USE © OECD 2021
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The authors would like to thank the following organisations and institutions for providing the data used in
the analyses presented in this report. These organisations and institutions do not bear any responsibility
for the analysis or interpretation of the data.
The Health Behaviour in School-aged Children (HBSC) surveys (2001/02, 2005/06, 2009/10,
2013/14) produced by the HBSC international network co-ordinated by the HBSC International
Co-ordinating Centre based at the Child and Adolescent Health Research Unit in the University of
St Andrews, Scotland. The HBSC data are managed by the HBSC Data Management Centre
based at the Department of Health Promotion and Development of the University of Bergen,
Norway.
The Global Information System on Alcohol and Health (GISAH) managed by the World Health
Organization.
The European Health Interview Survey (EHIS) 2014, managed by Eurostat.
The Canadian Community Health Survey 2015-16, managed by Statistics Canada.
The 1970 British Cohort Study, managed by the Centre for Longitudinal Studies at University
College London, funded by the Economic and Social Research Council, and accessed through the
UK Data Service.
The Health Survey for England 2016, managed by Health Surveys Unit of NatCen Social Research
and the Research Department of Epidemiology and Public Health at University College London.
The French ‘Baromètre santé’ 2017, run by Santé Publique France.
The Korean National Health and Nutrition Examination Survey (KNHANES) 2018, managed by the
Korea Centers for Disease Control and Prevention.
The Mexican ‘Encuesta Nacional de Consumo de Drogas, Alcohol y Tabaco’ (ENCODAT) 2016-17,
managed by Comisión Nacional contra las Adicciones.
The New Zealand Christchurch Health and Development Study (CHDS), run by the University of
Otago, made available for this study upon request.
The US National Health and Nutrition Examination Survey (NHANES) 2015, managed by National
Center for Health Statistics, Centers for Disease Control and Prevention.
The US National Longitudinal Study of Adolescent to Adult Health (Add Health) 1994-2009,
managed by the Carolina Population Center, University of North Carolina at Chapel Hill, and
accessed through the CPC Dataverse.
The Russia Longitudinal Monitoring Survey (RLMS), conducted by the Higher School of Economics
and ZAO “Demoscope”, together with the Carolina Population Center, University of North Carolina
at Chapel Hill, and the Institute of Sociology of the Russian Academy of Sciences, accessed
through the CPC Dataverse.
The work was funded through regular contributions from OECD member countries and received support
from grants from the Health Programme of the European Union, and from the governments of France and
Switzerland.
The contents of this book do not necessarily reflect the views of individual OECD member countries, or those of the
European Commission.
This publication has been produced with the financial and substantive assistance of the European Union. The contents
of this report are the sole responsibility of the OECD and can in no way be taken to reflect the views of the European
Union.
PREVENTING HARMFUL ALCOHOL USE © OECD 2021
6
Editorial: Preventing harmful
alcohol consumption to promote
healthier and stronger recovery
after COVID-19
The COVID-19 pandemic has significantly changed the way we live. To contain the spread of the
virus and avoid overwhelming our health services, following the two or even three waves of the virus,
governments around the world implemented drastic measures to limit physical interaction and mobility.
This led to the shutdown of most non-essential activities – from schools to factories; from shops to
recreational activities – in the first wave and to repeated, albeit often less stringent, measures in the
following waves. These measures have been effective in keeping people at home. For example, 39% of
workers in OECD countries shifted to teleworking, and millions of children switched to online learning
and home schooling. Leisure time was also affected with, for example, a sharp increase in time spent
online.
Early evidence suggests that the “new normal” caused by the pandemic had a significant effect
on our lifestyles, including drinking habits. Across 11 countries, 36% of individuals said that they
had increased consumption of alcohol. An overall increase in consumption was also confirmed by
government sources monitoring sales, at least in some countries for which data are available. For
example, in the United Kingdom, total alcohol duty receipts showed a 4.5% increase in the period April
to October 2020, compared to the same period in the previous year. Similarly, US data from 15 states
suggest a 4% increase in the quantity of alcohol sold in the period January to August 2020, compared
to the same period in the previous year. German data show an increase in alcohol tax revenues of 3.3%
in 2020, compared to 2019.
People increased drinking frequency. Among individuals in the 11 countries, 43% increased their
drinking frequency, compared to a quarter of adults who decreased their drinking. The probability of binge
drinking – drinking more than 80% of a bottle of wine or 1.5 litres of beer per drinking occasion – did not
change for nearly half of the population. About 29% of the respondents reported binge drinking less
frequently, though 23% said they were binge drinking more frequently.
Predictably, people also changed the places where they drink alcohol. Restaurant reservations
declined sharply, falling to practically zero when lockdowns were enforced. Alcohol sales in bars and
restaurants therefore plummeted, but alcohol consumption increased at home. Sales in retail stores, and
in particular online sales, also grew significantly. Stockpiling in the early phases of the pandemic may have
been a key driver of these trends.
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Lockdown and stay at home orders exacerbated some of the negative behaviours associated with
harmful alcohol consumption, such as domestic violence. One in four women experience intimate
partner violence in their lifetime, and one in three children experience some form of violence by parents or
other family members. During the pandemic, there was an increase in the number of emergency calls to
hotlines to report domestic violence in countries including Austria, Italy, Mexico, Spain and the
United Kingdom, to name a few. Across EU countries there was a 60% rise in emergency calls about
domestic violence.
It is difficult to know whether these changes will continue when living conditions go back to normality, but
the experience of previous crises suggests that we may see an increase in problematic drinking in
the medium term. Excessive alcohol consumption can be a response to high stress levels. Increased
alcohol use is also common after traumatic events. Undoubtedly, COVID-19 has disrupted people and
communities across the world, creating the conditions for long-term physical and mental distress. The
associated economic crisis caused unemployment to rise by almost 60% (from 5.3% to 8.4%) across
OECD countries in 2020. The reopening of the economy will also be associated with the removal of support
measures for distressed companies and workers, possibly leading to bankruptcies and further
unemployment, which will take time to reabsorb. The path to recovery therefore remains long and difficult,
increasing the risk that individuals will engage in harmful patterns of drinking to cope with stress.
These factors make the findings of this report even more relevant and timely. Preventing Harmful
Alcohol Use highlights the fact that harmful patterns of alcohol consumption such as underage drinking,
heavy drinking or binge drinking are highly prevalent in some population groups. Monthly binge drinking is
a habit for one in three adults in OECD countries, and women with higher education and people with the
lowest and the highest incomes are particularly at risk. Among adolescents, one in five has been drunk at
least twice in their lifetime. During confinement, women, parents of young children, middle-aged people,
people with higher incomes and individuals with depressive and anxiety symptoms reported the highest
increases in alcohol consumption.
Preventing alcohol-related diseases and injuries reduces the burden on health care services, which
are already under heavy pressure from COVID-19, and will foster a stronger economic and social
recovery in the aftermath of the pandemic. For many people, alcohol consumption is an enjoyable part
of their social life. But harmful patterns of alcohol consumption are dangerous for health and costly for
societies. Preventing harmful alcohol use has a triple dividend. First, during the pandemic it helps
individuals cope with infections by protecting against the effects of harmful alcohol use on the immune
system. Second, it reduces pressure on health care services. Hospitals and health care workers are
already under enormous strain to provide care to patients with COVID-19. Reducing health system
utilisation from harmful alcohol use helps doctors focus both on patients with COVID-19 and on patients
requiring urgent care for other conditions. For example, South Africa – one of the countries implementing
an alcohol sales ban – experienced a 65% drop in access to emergency rooms for trauma-related cases
linked with alcohol use during the pandemic. Third, a healthier and more productive population will be
better able to help restart economic activities and social life in the aftermath of the pandemic.
The OECD analyses conclude that a comprehensive “PPPP approach” – including actions to protect
children from alcohol promotion; policing to limit alcohol-related injuries and violence; primary care to help
patients with harmful patterns of alcohol consumption; and pricing to limit the affordability of cheap alcohol
– is both effective and cost-effective to tackle harmful alcohol consumption. Investing in a policy package
built around the PPPP approach saves millions of lives and generates savings that are greater than the
implementation costs.
Investing in protecting children and people with problematic drinking is particularly important.
During the pandemic, children increased screen time by 50%, including TV and social media, on-demand
and online video, and online entertainment. This is likely to have increased their exposure to alcohol
advertising, which is correlated to the probability of experimenting with drinking for the first time. Only a
PREVENTING HARMFUL ALCOHOL USE © OECD 2021
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handful of countries have strong legislation to protect children from online alcohol advertising on social
media, however. In addition, there is a need for further support for people with harmful drinking patterns
and alcohol use disorders. It is estimated that less than 10% of them receive support from health care
services in Europe and the United States. If, as seems conceivable, the number of individuals with harmful
patterns of alcohol consumption and alcohol use disorders increases in the aftermath of the pandemic,
health services need to be ready to meet the challenge.
COVID-19 has caused huge suffering. But, as with any crisis, it also brings opportunities. It has put a
spotlight on the effects of stress, anxiety and depression on individuals. Part of the response must be to
help people deal with the problems they have with alcohol consumption. This report shows that tackling
harmful alcohol drinking and preventing chronic diseases can support efforts to “build back better”.
Stefano Scarpetta
Director for Employment, Labour and Social Affairs
OECD
PREVENTING HARMFUL ALCOHOL USE © OECD 2021
