Alcohol Policy Progress Reveals Global Gaps

ALCOHOL policy preparedness improved globally between 2010 and 2019, but progress varied widely across policy areas and regions, according to an analysis of 141 countries.

While gains were strongest in alcohol taxation and monitoring, fewer than 25% of countries had a comprehensive national alcohol plan by 2019, highlighting continuing gaps in efforts to reduce alcohol-related harm.

Alcohol use is a leading contributor to morbidity and mortality worldwide, causing an estimated 2.6 million deaths each year and contributing to more than 200 diseases and injuries. It is a recognised cause of alcohol-associated liver disease, hepatocellular carcinoma, cardiovascular disease and six other cancers, making effective alcohol control policies a key public health priority.

Alcohol Policy Preparedness Shows Uneven Progress

Researchers updated the Alcohol Preparedness Index (API), a validated measure of national alcohol policy environments, to assess changes between 2010 and 2019. The index evaluates five domains: national policy frameworks; production, pricing and taxation; marketing and availability; drink-driving countermeasures; and monitoring and surveillance.

The median API increased from 57.0 in 2010 to 67.8 in 2019, indicating an overall improvement in alcohol policy preparedness across participating countries. Although the median score appeared higher in 2016 than in 2019, the researchers noted this was likely influenced by the imputation of missing 2019 data using 2016 values rather than reflecting a true decline.

The strongest progress was seen in production, pricing and taxation, with the proportion of countries achieving strong performance rising from 27% in 2010 to 78% in 2019. Monitoring and surveillance also strengthened, reaching 47.5%.

National Alcohol Plans Continue to Lag

Despite these gains, fewer than 25% of countries had both a written national alcohol policy and a formal implementation plan by 2019, while 40% had no national plan at all. Regional trends also differed, with Europe and the Western Pacific showing broader improvements, the Americas remaining relatively stable, Africa recording gains, and the Eastern Mediterranean showing little change.

Larger population size was linked to smaller improvements in API scores, whereas Human Development Index and alcohol per capita consumption did not explain changes in preparedness.

Policy Presence Does Not Guarantee Implementation

The authors cautioned that the API measures the existence of policies rather than how consistently they are enforced. Data were available for only 141 of 194 WHO member states, with countries missing from the analysis disproportionately located in Africa, potentially underestimating the extent of weak alcohol policy preparedness globally.

The findings suggest that strengthening implementation, alongside expanding evidence-based measures aligned with the WHO SAFER framework, could help address persistent policy gaps and support efforts to reduce alcohol-associated disease.

Reference

Gu H et al. Global trends in national alcohol control policies between 2010-2019. JHEP REP. 2026;DOI:10.1016/j.jhepr.2026.101938.

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