Research Article: Comparative Analysis of Alcohol Control Policies in 30 Countries

Date Published: April 24, 2007

Publisher: Public Library of Science

Author(s): Donald A Brand, Michaela Saisana, Lisa A Rynn, Fulvia Pennoni, Albert B Lowenfels, Phillipa Hay

Abstract: BackgroundAlcohol consumption causes an estimated 4% of the global disease burden, prompting goverments to impose regulations to mitigate the adverse effects of alcohol. To assist public health leaders and policymakers, the authors developed a composite indicator—the Alcohol Policy Index—to gauge the strength of a country’s alcohol control policies.Methods and FindingsThe Index generates a score based on policies from five regulatory domains—physical availability of alcohol, drinking context, alcohol prices, alcohol advertising, and operation of motor vehicles. The Index was applied to the 30 countries that compose the Organization for Economic Cooperation and Development and regression analysis was used to examine the relationship between policy score and per capita alcohol consumption. Countries attained a median score of 42.4 of a possible 100 points, ranging from 14.5 (Luxembourg) to 67.3 (Norway). The analysis revealed a strong negative correlation between score and consumption (r = −0.57; p = 0.001): a 10-point increase in the score was associated with a one-liter decrease in absolute alcohol consumption per person per year (95% confidence interval, 0.4–1.5 l). A sensitivity analysis demonstrated the robustness of the Index by showing that countries’ scores and ranks remained relatively stable in response to variations in methodological assumptions.ConclusionsThe strength of alcohol control policies, as estimated by the Alcohol Policy Index, varied widely among 30 countries located in Europe, Asia, North America, and Australia. The study revealed a clear inverse relationship between policy strength and alcohol consumption. The Index provides a straightforward tool for facilitating international comparisons. In addition, it can help policymakers review and strengthen existing regulations aimed at minimizing alcohol-related harm and estimate the likely impact of policy changes.

Partial Text: Alcohol consumption contributes to more than 60 health problems that cause an estimated 4% of the global disease burden [1,2]. International differences in the occurrence of alcohol-associated disease derive from a complex interaction of drinking patterns, total alcohol consumption, and societal priorities. Governments impose various regulations to mitigate the adverse effects of alcohol while attempting to respect individuals’ rights to consume alcohol in moderation [3].

Countries attained a median score of 42.4, ranging from 14.5 (Luxembourg) to 67.3 (Norway; Figure 1). In spite of rather extreme methodological assumptions considered in the sensitivity analysis, relatively few countries (seven of 30) shifted more than five positions under any scenario (Table 2). It follows that most countries were not markedly affected by the choice of assumptions used to calculate scores. Median ranks and scores from the 16 scenarios varied hardly at all from baseline values (r = 0.99 for ranks as well as scores). For 29 of the 30 countries, median and baseline ranks differed by no more than two positions. For one country—Hungary—they differed by 2.5 positions. Even when baseline ranks and scores were compared with the extremes from the 16 scenarios—that is, with the ranks and scores that deviated most from baseline—the correlation coefficients were 0.87 for ranks and 0.92 for scores (p < 0.001 for each). These results suggest that the baseline Alcohol Policy Index is a reliable summary measure (for both ranks and scores) that is not biased against particular methodological scenarios. The World Health Organization places a high priority on controlling alcohol-related problems through effective economic and public health measures. Nevertheless, our Alcohol Policy Index revealed wide variation in the strength of alcohol control policies among the 30 countries in Europe, Asia, North America, and Australia that constitute the Organization for Economic Cooperation and Development. These countries received scores ranging from 14 to 67 out of a possible 100 points. Source: http://doi.org/10.1371/journal.pmed.0040151

 

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