The WHO has declared war on alcohol. In January last year, it declared there is 'no level of alcohol consumption is safe': publishing its position in The Lancet.
While alcohol had generally previously been accepted as a drink that could be consumed in moderation, the WHO has brought forward data that indicates half of all alcohol-attributable cancers in Europe are caused by 'light' or 'moderate' drinking. That's defined as less than 1.5 liters of wine a week or less than 3.5 liters of beer - equating to around two bottles of wine, or around 7 pints of beer, a week.
Then there's also the calories that come with alcohol; the fact it can be a dependence-producing substance; and the risks of injury caused as a result of binge drinking.
And this year, the WHO has singled out alcohol as one of the four most harmful industries in Europe (alcohol, ultra-processed foods, tobacco and fossil fuels contribute to 24.5% of all deaths, according to its research).
If governments echo the WHO's position, what regulations does the alcohol industry need to be ready for and how have we seen these play out so far?
Pricing
Minimum unit pricing sets a minimum price each unit of alcohol can be sold for. That's done to stop the sale of very cheap (and therefore very accessible) alcohol.
Scotland introduced Minimum Unit Pricing in 2018, becoming the first country in the world to do so. The legislation sets a minimum 50 pence per unit price as a measure to help tackle damage caused by cheap, high strength alcohol.
But it was not an easy journey: taking six years to get through domestic and European courts against industry opposition. One of the main arguments was that MUP distorts competition by penalizing efficient low-cost producers of alcohol.
A study carried out by researchers from Public Health Scotland and the University of Glasgow suggested a 13% reduction in deaths from alcohol consumption in the two years and eight months following the implementation of the policy.
Citing the success of the policy, the Scottish government is now set to raise this to 65 pence per unit.
That not only raises the policy to make up for inflation, but also ups the minimum unit price in the hope of further reducing hospital admissions and deaths.
A shake-up of drinking guidelines?
Last year, a report from the Canadian Centre on Substance Abuse and Addiction (CCSA), funded by Health Canada, made headlines with its recommendation to bring drinking guidelines down to just two drinks per week (down from the current recommendations of 15 drinks a week).
Why the change? Research and knowledge has developed since the guidelines were developed in 2011, says the CCSA.
"Science is evolving, and recommendations about alcohol use need to change."
Taxes
Alcohol taxes are, says the WHO, ‘the least implemented and yet one of the most effective policies for alcohol control in the region’.
A 2017 study shows taxes that increase alcohol prices by 50% would help avert more than 21 million deaths globally over 50 years and would generate nearly $17 trillion in additional revenues. That’s equivalent to the total government revenue of eight of the world’s largest economies in one year.
Countries like Lithuania, which increased alcohol tax in 2017 to drive down consumption, have decreased deaths from alcohol related diseases. Lithuania increased alcohol tax revenue from 234 million euros in 2016 to 323 million euros in 2018 and saw alcohol-related deaths drop from 23.4 per 100 000 people in 2016 to 18.1 per 100 000 people in 2018.
The WHO recommends excise tax should apply to all alcoholic beverages: releasing an alcohol tax manual in December 2023.
WHO does not hold back on alcohol harms
Global Burden of Disease estimates suggest that 3.84% of deaths are attributable to alcohol. That’s some way behind tobacco (10.37%), but along way ahead of sugary drinks (0.14%).
And that might even be an underestimate: the WHO now warns that 8.8% of deaths could be attributable to alcohol use, given that alcohol use is complex and linked to a number of diseases.
"Alcohol is a toxic, psychoactive, and dependence-producing substance and has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer decades ago – this is the highest risk group, which also includes asbestos, radiation and tobacco," reads the WHO's advice.
"Alcohol causes at least seven types of cancer, including the most common cancer types, such as bowel cancer and female breast cancer.
"The risk of developing cancer increases substantially the more alcohol is consumed."
Alcohol labeling
In Europe, alcohol is exempt from the Food Information to Consumers (FIC) regulation. That means they are not required to carry the same basic information on ingredients and energy values (such as calorie counts) as are required on non-alcoholic drinks.
While an EU-wide self-regulator scheme was proposed and put forward to the EU in 2018, no standardized, sector-wide label was every produced.
Separate sectors (such as beer and spirits) have introduced their own initiatives, while wine is now subject to European regulations (more on this complex set-up here)
And the US is paying also increasing attention to how nutrition and ingredients information should be provided to consumers, with the TTB reviewing more than 5,000 comments from both public health and industry experts on the subject as it seeks to find a way forward.
Spotlight on Europe
Globally, the WHO European Region has the highest alcohol consumption level and the highest proportion of drinkers in the population.
Europe is home to 5 of the world’s largest alcohol manufacturers, and the alcohol market value is estimated at €200bn – equating to 20% of the global alcohol market.
In its latest report on the Europe market, the WHO does not shy away from blaming the alcohol industry for holding up progress in introducing health policies for alcohol.
Health warnings
Labeling alcohol with health warnings – as is set to come into effect in Ireland – can help consumers become more conscious of the dangers.
“However, implementing these policies has faced significant delays and challenges at the regional and national level,” says the WHO.
In Ireland, the labels will include warnings about alcohol and cancer, liver disease and drinking in pregnancy; as well as information on the energy and alcohol content of the product alongside a link to a public health website.
Signed into law in 2023, a three-year implementation period means labels will be introduced in May 2026.
Much of the delay in bringing the law about in Ireland came down to arguments from the alcohol industry, who said this set a bad precedent for the EU’s single market, with particular concerns for the costs for small producers.
But the WHO claims something of a victory in the introduction of health warnings.
“Increasingly, the provision of statutory health information labelling is happening in different contexts with visible pregnancy warnings now mandatory on alcohol products in Australia and New Zealand, and countries such as Norway planning to introduce cancer warnings.
“Ireland’s success in this area can help to accelerate this process across Europe and globally.”
Restricting alcohol marketing
The main of alcohol marketing restrictions are to stop children and young people from being exposed (and tempted) by alcohol marketing.
Many countries have guidelines that set out guidelines for responsible marketing for alcohol. That means ensuring alcohol does not appeal to children, or encourage excessive or dangerous drinking.
France’s ‘Loi Evin’ was enacted in 1991 to regulate the advertising and promotion of alcoholic beverages, particularly those targeting youth and vulnerable populations.
The law mandates all promotional messages for alcohol must be accompanied by a health warning and provides a list of where alcohol can be promoted (such as printed press, radio at certain times and billboards). What that means is alcohol cannot be promoted through other media and settings – such as on television or via sponsorship of sporting events.
While considered pioneering regulation, legislative reforms over time have weakened the policy, says the WHO.
“Legislative reforms over time have expanded the list of media where alcohol marketing may be allowed, thereby eroding the scope and potential effectiveness of the law,” says the WHO.
