WHO Global assessment of public-health problems caused by harmful use of alcohol for 2002

Alcohol is ranked as the fifth leading risk factor for premature death and disability causing considerable public health problems.

Estimates for 2002 show that at least 2.3 million people died worldwide of alcoholrelated causes accounting for 3.7% of global mortality. Alcohol consumption was responsible for 4.4% of the global burden of disease (see Table 1).

The impact of alcohol consumption is greater in younger age groups of both sexes - 3.7% of all deaths in all age groups (6.1% in men, 1.1% in women) and 5% of deaths under the age of 60 (7.5% in men, 1.7% in women). Fatal injuries occur relatively early in life.

Harmful use of alcohol is the third leading contributor to disease burden in developed countries, the first for men in developing countries in which mortality rates are low, and eleventh in developing countries with high mortality rates.

Neuropsychiatric disorders, mainly from alcohol use and including alcohol dependence, account for more than a third (34%) of the burden of disease and disability attributable to alcohol, followed by unintentional injuries like road traffic crashes, burns, drowning and falls (altogether 26%), intentional injuries including suicide (11%), cirrhosis of the liver (10%), cardiovascular diseases (10%) and cancer (9%) (seeTable 2). When only alcohol related deaths are considered, unintentional injuries (25%), cardiovascular diseases (22%) and cancer (20%) are the three biggest categories.

The disease burden estimates reflect the harm attributable to alcohol after the protective effects of alcohol, particularly for ischaemic heart disease, have been taken into consideration. Any threshold for harmful use of alcohol is difficult to define even though evidence suggests that low or moderate alcohol consumption can reduce mortality and morbidity in a few diseases and for certain age groups. For many diseases, such as breast cancer, the risk increases with the amount of alcohol drunk,with no evidence of a threshold effect.

The global economic cost of the harmful use of alcohol in 2002
(Cost in US$)

This has been estimated to be between 210,000 million and 665,000 million:

  • Illness 50,000–120,000 million
  • Premature mortality 55,000–210,000 million
  • Drink-driving 30,000–55,000 million
  • Absenteeism 30,000–65,000 millio
  • Unemployment 80,000 million
  • Criminal justice 30,000–85,000 million
  • Criminal damage 15,000–50,000 million

The total equates to between 0.6% and 2.0% of global gross domestic product.

The WHO assessment cautions that “due to current trends both in availability of alcohol and increases in alcohol consumption the detrimental impact of alcohol is expected to increase in the future if further interventions are not introduced.”

WHO Expert Committee Report

The expert group emphasised the fact that their recommendations were built on an evidence base of alcohol policies which is globally relevant.Their recommendations included among other things that WHO:

  • should continue to play a leading role in continuing a global response to the global nature of alcohol problems
  • liaise with inter-governmental agencies at regional level, to seek inclusion of alcohol policies in relevant social and development agendas
  • support governmental bodies at national and subnational levels and in particular to low and middle income countries to give high priority to the prevention of the harmful use of alcohol; to formulate, develop and implement adequately financed action plans on alcohol and implement and evaluate evidence-based policies.

In recognising the role that non-governmental organizations can play in supporting alcohol policy, the Committee recommended that WHO should strengthen its processes of consultation and collaboration with non-governmental organizations that are free of a potential conflict of interest with the public health interest.

With regard to the alcohol industry, the Committee recommended that WHO continue its practice of no collaboration with the various sectors of the alcohol industry. “Any interaction should be confined to discussion of the contribution the alcohol industry can make to the reduction of alcohol-related harm only in the context of their roles as producers, distributors and marketers of alcohol, and not in terms of alcohol policy development or health promotion”

The Committee recognised that with alcohol being a special commodity in terms of its toxicity and dependence properties, there was need for WHO to protect the public health interest concerning alcohol in trade, industrial and agricultural decisions.

In considering the detrimental effects of alcohol marketing measures on young people, the Committee recommended thatWHO support and assist governments:

  • to effectively regulate the marketing of alcoholic beverages, including effective regulation or banning of advertising and of sponsorship of cultural and sports events, in particular those that have an impact on younger people;
  • to designate statutory agencies to be responsible for monitoring and enforcement of marketing regulations;
  • to work together to explore establishing a mechanism to regulate the marketing of alcoholic beverages, including effective regulation or banning of advertising and sponsorship, at the global level.