Restricting alcohol availability in practice: evidence from selected countries.

Abstract

THE PROBLEM: RESTRICTING THE AVAILABILITY OF ALCOHOL Alcoholic beverages contain ethanol, an established psychoactive and toxic substance that can cause dependence and is associated with public health challenges. Harm caused by alcohol consumption may extend beyond individual drinkers, affecting families and communities through increased rates of violence, road crash injuries and health-care expenditure. Policy measures that restrict alcohol availability have proven to be effective at reducing alcohol consumption, shaping consumption patterns and mitigating harm. However, the implementation and enforcement of these policy measures varies across countries, limiting their impact. Country evidence and data on the specific measures applied remain sparse and prevent global guidance. THE EVIDENCE: COUNTRY POLICY MEASURES TO RESTRICT ALCOHOL AVAILABILITY Analysis of a selection of 30 countries with licensing systems showed that the most common feature was categorizing the types of outlets and alcohol sold. Countries prohibit alcohol sales at some locations, commonly at educational premises, health facilities, houses of worship and sport sites. Fewer countries establish a minimum required distance between alcohol outlets and sensitive locations, such as alcohol treatment centres and houses of worship. Required distances ranged between 100 and 500 metres. Only a few countries have an alcohol outlet density policy that establishes a population quota with varying thresholds of one outlet for every 300, 450, 600 or 1000 inhabitants. Only one third of countries regulated the days of sale, and more than half restrict the hours of sale. Licensing renewals are commonly set at one-year intervals, with 40% of countries including instructions for communities on how to protest during the application and renewal phase. The most common minimum legal purchase age is 18 years. Remote sale and delivery of alcohol is largely unregulated. Only a few countries require age verification at the point of sale or delivery. Fines are the most common implemented penalty. Other penalties include administrative points and suspending or cancelling the licence and reducing hours. THE KNOW-HOW: COUNTRY CASE STUDIES Policy measures that restrict the availability of alcohol can be used to address public health concerns in specific contexts. Botswana applied minimum distance standards to address young people’s alcohol consumption, including its effects on HIV transmission, disease progression and reduced medication adherence. Burundi regulated availability to tackle the high prevalence of alcohol use, also among pregnant women. Malawi and Uganda banned alcohol sachets to address early initiation to alcohol consumption. Alcohol-related mortality declined in Lithuania after the introduction of a series of policy measures including stricter regulations on alcohol outlet density and hours of sale. Thailand pioneered a ban on alcohol delivery to reduce alcohol consumption among young people. Viet Nam banned the consumption and sale of alcohol near sensitive facilities to tackle a dramatic rise on per capita alcohol consumption. THE WAY FORWARD A coordinated, multisectoral approach is needed to address the challenges of restricting alcohol availability. Governments should focus on adopting clear and enforceable policy measures tailored to their unique social, cultural and economic contexts with an emphasis on limiting the proliferation of alcohol outlets and addressing unregulated markets. Engaging civil society organizations and community leaders in developing and implementing policy can enhance public support and compliance. In addition, fostering international knowledge exchange and investing in policy-relevant research will provide the tools necessary to bridge evidence gaps and inform global alcohol policy efforts.