How policy can tackle alcohol harms: insights from the global evidence base

A special report published in the New England Journal of Medicine has made four key policy recommendations to tackle alcohol harms.

The report was put together by an expert working group convened by the International Agency for Research on Cancer (IARC), including Professor Robin Room from the Centre for Alcohol Policy and Research (Latrobe University), a member organisation of Alcohol Change Victoria. 

Alcohol is a major public health concern, linked to several cancers and other serious health issues. In 2020 alone, alcohol was responsible for more than 740,000 new cancer cases worldwide. 

Reducing alcohol use lowers the risk of cancers such as oral, oesophageal, and breast cancer, while also reducing the risk of violence, crash fatalities, and unintentional injury and death. Given this, the IARC asks: what policies actually lead people to drink less?

Raising the price of alcohol through tax or minimum unit pricing

The most consistent finding was that increasing the price of alcohol through taxes or minimum unit pricing (the lowest allowed price, for a fixed volume of alcohol) leads to less drinking.

In the United States for example, a 21% tax increase for beer and 90% each for wine and spirits in Illinois reduced alcohol purchases by more than 6% among people drinking heavily, and by 5% for high income households. In Australia, a 70% tax increase on ‘ready-to-drink’ beverages led to nearly 9% fewer drinks consumed per day.

Across studies conducted in Australia, Canada, and the United Kingdom, minimum unit pricing was found to be an effective alcohol policy. Minimum unit pricing has been successful in Scotland, with a policy of 50 pence per UK unit of alcohol reducing alcohol sales by about 3% per adult. 

Limiting alcohol availability

Policies that reduce how easy it is to access alcohol are effective. These include:

• Limiting where alcohol can be sold by reducing outlet density. Fewer alcohol outlets mean fewer alcohol-related hospitalisations, violence, and alcohol consumption.

• Restricting when alcohol can be sold. In Sweden, allowing Saturday sales in addition to weekdays led to a 3.7% increase in per capita alcohol sales, while restricting alcohol sales on Sundays in the US was associated with a decrease in alcohol consumption of up to 8.6%. 

• Increasing the minimum drinking age. Most studies observed that increases in minimum purchase or drinking age were accompanied by reductions in alcohol consumption. For example, raising the legal drinking age from 18 to 19 in New York cut drinking among 18-year-olds by 21%, while a 1 year increase in the minimum purchase age in five European countries was associated with an almost 10% decrease in alcohol consumption.

Alcohol ad bans

Strong restrictions on alcohol ads across TV, print, and outdoor media are linked to drops in alcohol use. For instance, Norway’s comprehensive marketing ban in 1975 cut alcohol consumption by 7%, while other studies looking at 20 OECD countries found similar trends.

What this means for policymakers

The Working Group's conclusion based on the evidence is clear: alcohol control policies, especially those targeting pricing, access, advertising, and legal drinking/purchasing age, are effective ways to reduce drinking across populations.

These findings align with the World Health Organization's Global Alcohol Action Plan 2022–2030 and its ‘SAFER’ initiative, which outlines five key policy areas: strengthening restrictions on availability, enforcing drink-driving laws, improving access to screening, brief interventions, and treatment, banning alcohol advertising, and raising prices through taxes.

Alcohol harms are preventable, and this global evidence shows us that the right mix of government policy can make a real difference. For policymakers, the message is clear: when it comes to reducing alcohol harm, there are tools that work. The challenge now is to use them.

This NEJM article draws on the work resulting in this just-published volume from the International Agency for Research on Cancer.