Alcohol or alcoholic beverages contain ethanol, a psychoactive and toxic substance that can cause dependence. In 2019, approximately 2.6 million people died worldwide from alcohol consumption. Of these, 1.6 million were from noncommunicable diseases, 700,000 from injuries, and 300,000 from communicable diseases. Alcohol-attributable deaths were highest in men in 2019, accounting for 2 million deaths compared with 600,000 in women. An estimated 400 million people, or 7% of the world's population aged 15 years and older, are living with an alcohol and drug use disorder. Of these, 209 million people (3.7% of the world's adult population) are living with alcoholism. Although alcohol consumption can pose health risks even at low levels, most alcohol-related harm results from high and intermittent alcohol consumption or high and continuous alcohol consumption. Effective alcohol management interventions exist and should be more utilized, but at the same time, it is important that people are aware of the risks associated with alcohol consumption and take individualized actions to protect themselves from its harmful effects.
overview
Alcohol and alcoholic beverages contain ethanol, a psychoactive and toxic substance that produces dependence. Alcohol has been widely used in many cultures for centuries, but carries significant health risks and harms.
In 2019, 2.6 million deaths were attributable to alcohol consumption worldwide, of which 2 million were men and 0.6 million were women. The WHO European and African Regions had the highest alcohol-related deaths per 100,000 people, at 52.9 and 52.2 per 100,000, respectively.
Young people (20-39 years old) are disproportionately affected by alcohol consumption, with this age group having the highest alcohol-attributable death rate (13%) in 2019.
According to 2019 data on global alcohol consumption, an estimated 400 million people aged 15 and over have an alcohol use disorder, and an estimated 209 million have alcohol dependence.
Some progress has been made: between 2010 and 2019, the number of alcohol-related deaths per 100,000 people globally fell by 20.2%.
The number of countries developing national alcohol policies has steadily increased. Nearly all countries have implemented alcohol excise taxes. However, countries report continued interference from the alcohol industry in policy development.
According to 2019 data, around 54% of the 145 reporting countries had national guidelines/standards for specialised treatment services for alcohol use disorders, but only 46% had legal regulations to protect the confidentiality of people in treatment.
Access to screening, brief interventions and treatment for people with hazardous alcohol use and alcohol use disorders remains very low, as does access to medication for alcohol use disorders. Overall, the proportion of people with alcohol use disorders receiving treatment services varies from less than 1% to 14% or less across all countries where such data are available.
Health risks of alcohol consumption
Alcohol consumption is known to contribute to over 200 diseases, injuries and other health conditions. However, although there is scientific evidence on the impact of alcohol consumption on the onset, occurrence and outcome of diseases and injuries, the global burden of disease and injury attributable to alcohol consumption can only be quantified for 31 health conditions.
Alcohol consumption is associated with an increased risk of developing non-communicable diseases such as liver disease, heart disease and various types of cancer, as well as mental health and behavioral disorders such as depression, anxiety and alcohol use disorder.
An estimated 474,000 deaths from cardiovascular disease were attributed to alcohol consumption in 2019.
Alcohol is a proven carcinogen and alcohol consumption increases the risk of a variety of cancers, including breast, liver, head and neck, esophageal and colorectal cancer. In 2019, 4.4% of diagnosed cancers and 401,000 cancer deaths worldwide were attributable to alcohol consumption.
Alcohol consumption causes significant harm not only to the drinker but also to others. The majority of the disease burden attributable to alcohol comes from injuries such as road traffic accidents. In 2019, of the 298,000 alcohol-related road traffic deaths, 156,000 were due to someone else's drinking.
Other injuries include falls, whether intentional or unintentional, drowning, burns, sexual assault, intimate partner violence, and suicide.
There is a well-established causal relationship between alcohol consumption and the incidence and outcome of infectious diseases such as tuberculosis and HIV.
Drinking alcohol during pregnancy increases the risk of having a child with a fetal alcohol spectrum disorder (FASD), the most severe form of which is fetal alcohol syndrome (FAS), which is associated with developmental disabilities and congenital abnormalities. Drinking alcohol during pregnancy may also increase the risk of premature birth complications, such as miscarriage, stillbirth, and premature birth.
Young people are disproportionately affected by the harmful effects of alcohol consumption, with the highest proportion of alcohol-attributable deaths (13%) in 2019 occurring among people aged 20-39.
In the long term, harmful and dangerous levels of alcohol consumption can lead to social problems such as family problems, problems at work, financial problems, and unemployment.
Factors influencing alcohol consumption and alcohol-related harm
There is no risk-free way to consume alcohol, and even consuming small amounts of alcohol can be harmful and pose some risk.
The level of risk depends on several factors, including the amount of alcohol consumed, how often it is consumed, your personal health, age, sex, other personal characteristics, and the circumstances surrounding your alcohol consumption.
Some vulnerable or at-risk groups and individuals may be more susceptible to the toxic, psychoactive and dependence-inducing effects of alcohol, whereas individuals who adopt lower-risk alcohol consumption patterns do not necessarily face a significantly increased risk of adverse health or social consequences.
Social factors that influence levels and patterns of alcohol consumption and related problems include cultural and societal norms, availability of alcohol, level of economic development, and implementation and enforcement of alcohol policies.
The impact of alcohol consumption on chronic and acute health outcomes is determined primarily by the total amount of alcohol consumed and the drinking pattern, particularly in relation to drinking frequency and binge drinking episodes. Most alcohol-related harm results from episodic or sustained heavy drinking.
Context plays an important role in the occurrence of alcohol-related harm, particularly as a result of alcohol intoxication: alcohol consumption can affect not only the incidence of illness, injury and other health conditions, but also their outcomes and how they change over time.
Alcohol consumption and alcohol-related mortality and morbidity rates vary between men and women. In 2019, 52% of men were current drinkers, while only 35% of women had drunk alcohol in the past 12 months. On average, men consumed 8.2 liters of alcohol per capita, compared with 2.2 liters for women. In 2019, alcohol consumption was responsible for 6.7% of all deaths in men and 2.4% of all deaths in women.
WHO response
The Global Alcohol Action Plan 2022-2030, endorsed by WHO Member States, aims to reduce the harmful use of alcohol through effective, evidence-based strategies at country, regional and global levels. The plan outlines six key areas of action: high-impact strategies and interventions, advocacy and awareness-raising, partnerships and coordination, technical support and capacity-building, knowledge generation and information systems, and resource mobilization.
The implementation of the Global Strategy and Action Plan will accelerate global progress towards achieving the alcohol-related targets under Sustainable Development Goal 3.5 on strengthening the prevention and treatment of substance abuse, including drug abuse and harmful use of alcohol.
Achieving this requires global, regional and national action on the levels, patterns and contexts of alcohol consumption and the broader social determinants of health, with a particular focus on implementing effective and cost-effective interventions.
It is crucial to address factors influencing the acceptability, availability and affordability of alcohol consumption through multi-sectoral, comprehensive and integrated policy measures, as well as to achieve universal health coverage for people with alcohol use disorders and other health conditions resulting from alcohol use by strengthening health system response and developing comprehensive and accessible systems of treatment and care for those in need.
The SAFER Initiative, launched by WHO and partners in 2018, supports countries to implement effective, cost-effective interventions proven to reduce harm from alcohol consumption.
WHO's Global Information System on Alcohol and Health (GISAH) presents data on alcohol consumption levels and patterns around the world, alcohol-attributable health and social consequences, and policy responses.
Reducing the harmful use of alcohol in line with the targets contained in the Global Alcohol Action Plan, the SDG 2030 Agenda and the WHO Global Surveillance Framework for Noncommunicable Diseases requires concerted country action and effective global governance.
Public policies and interventions to prevent and reduce alcohol-related harm should be based on the public health interest, with clear public health goals and the best available evidence.
Engagement of all relevant stakeholders is essential, but before engaging, potential conflicts of interest, particularly with the alcohol industry, should be carefully assessed. Economic actors should refrain from activities that may impede, delay or halt the development, enactment, implementation and enforcement of high-impact strategies and interventions to reduce the harmful use of alcohol.
By working together and exercising due diligence and avoiding conflicts of interest, we can effectively reduce the adverse health and social impacts of alcohol.