This document summarizes Marion DEVAUX's presentation on assessing alcohol policy in an international context. It shows that overall alcohol consumption in Europe has slightly declined but binge drinking has increased in some groups. Younger people are initiating drinking and getting drunk at younger ages. Correcting for self-report bias leads to estimates of higher rates of hazardous drinking. Modeling shows that brief interventions and policies like pricing and advertising regulations can significantly reduce alcohol consumption and related harms in a cost-effective manner. An international alcohol policy model is being developed to evaluate policies across multiple countries.

1. ASSESSING ALCOHOL POLICY
IN AN INTERNATIONAL CONTEXT
Marion DEVAUX, Health Policy Analyst, OECD
RARHA Expert Meeting, Helsinki, 17 February 2016

2. • OECD report “Tackling Harmful
Alcohol Use”, May 2015
• OECD health working papers
No. 79 and 80
• «Social disparities in hazardous
alcohol use: self-report bias may
lead to incorrect estimates »,
Devaux M and Sassi F, Eur J Pub
H, 2015
OECD recent work on Alcohol

3. Overall, Alcohol Consumption Has
Slightly Declined in Europe
5,0
7,5
10,0
12,5
15,0
17,5
20,0
1980 1985 1990 1995 2000 2005 2010
Litresofpurealcoholpercapita,15+
Finland France Sweden Germany Italy Ireland Belgium OECD-Europe
Source: OECD Health Statistics database, 2015

4. 20%
30%
40%
50%
60%
70%
80%
2001-02 2005-06 2009-10
Shareofpeopleaged15orlessin
OECD
Time (years)
People are Initiating Drinking and Get
Drunk at Younger Ages
Age of first drink ≤15
Age of first drunkenness ≤15
Boys
Girls
Girls
Boys
Source: OECD estimates based on HBSC data

5. Heavy episodic drinking has
increased in young women
0%
2%
4%
6%
8%
10%
12%
14%
16%
1995 2000 2005 2010
New Zealand
Germany Canada
Italy*
France
Finland*
Japan*
Australia
US
10%
15%
20%
25%
30%
35%
40%
1995 2000 2005 2010
England
Ireland
HED at least once a month in Japan and once a year in Italy; crude weighted rates in Finland (age-standardised elsewhere)
Women aged 18-24
5
Source: OECD estimates on national survey data.

6. Highly educated women more likely to
drink hazardously, while inverted in men
ProbabilityofHazardousDrinking
0%
5%
10%
15%
20%
25%
Low education Medium education High education
0%
5%
10%
15%
20%
25%
Women
Selected European countries
Men
Source: Tackling Harmful Alcohol Use, OECD, 2015; OECD estimates based on national survey data

7. 0%
25%
50%
75%
100%
Shareoftotalalcohol
20% of Population Drinking the Most
Consumes the Largest Share of Alcohol
Source: Tackling Harmful Alcohol Use, OECD, 2015; OECD estimates based on national survey data
66%

8. Survey-based Estimates and Sales Data
Differ Widely
8
205 195 200
239
222
197
169
191
63
36
82
34
60
38
71 70
0
50
100
150
200
250
Grams of pure alcohol per week, per capita
Recorded + unrecorded consumption Survey-based consumption
* Survey-based data refer to England only.
Source: Devaux and Sassi, Eur J Pub H, 2015

9. Correcting for Self-Report Bias in Drinking
• Triangulation of self-reported survey data with
aggregate WHO data (Rehm et al. 2009)
 To shift the distribution of alcohol consumption to
the aggregate data average .
• Assume the same degree of bias for all
population groups, although differences may
exist across SES groups or categories of drinkers.
9

10. Correcting for Self-Reporting Leads to
Higher Porportion of Hazardous Drinkers
10
21%
5%
16%
9%
12% 13%
37%
41%
30%
47%
42%
36%
0%
10%
20%
30%
40%
50%
England
2002
France 2008-
2010
Germany
2009
Hungary
2009
Ireland 2007 Spain 2006
% hazardous drinkers in total male population
Survey-based estimates Corrected estimates
Source: OECD estimates based on survey data.

11. What Policy-Makers Need to Know
• Does a policy improve health?
• Does it reduce health expenditure?
• Does it reduce health inequalities?
• Is it cost-effective?
• When will desired effects show up?

12. The CDP-Alcohol Model
Abstainer Drinker
Quantity
Pattern
Drinks per week
(continuous)
Regular drinker
Binge drinker
Dependent drinker
Source: Tackling Harmful Alcohol Use, OECD, 2015
Entry
• Birth
• Inward
migration
Population
• Gender
• Age
• Drinking
status
Diseases and
injuries
• Incidence
• Prevalence
• Remission
• Fatality
• Risk
Exit
• Death
• Outward
migration

13. Included Alcohol-related Conditions
Average
volume
Pattern of
drinking
Breast
cancer
Mouth and
pharynx ca
Liver
cancer
Oesophag
us cancer
Cirrhosis
of the liver
Epilepsy
Stroke
IHD
Injuries
AUDs
Age
Gender
Socioeconomic
status
Source: Tackling Harmful Alcohol Use, OECD, 2015

14. Alcohol Policy Options Assessed
Price
policies
Regulation /
enforcement
Education Health care
All
consumption
Tax
increase
Regulation
advertising
Heavy use /
dependence
Minimum
pricing
School-based
programmes
Brief
Intervention
Drug /
psychosocial
therapy
Workplace
programmes
Injuries
Drink drive
enforcement
Limit
opening
hours
Source: Tackling Harmful Alcohol Use, OECD, 2015

15. No effect on drinking modelled for drink-driving enforcement and limit opening hours
Source: OECD, 2015
Prevention Decreases Dependency and
Harmful and Binge Drinking, Germany
-12%
-10%
-8%
-6%
-4%
-2%
0%
main analysis further analysis
Decreaseinprevalence
Hazardous/harmful drinkers Heavy episodic drinkers Dependent drinkers

16. Prevention Saves Lives and Keeps
in Good Health, Germany
**
**
**
**
**
**
**
**
**
**
**
**
**
**
**
**
**
ns
0 25 000 50 000 75 000 100 000 125 000 150 000
Brief interventions
Tax increase
Advertising regulation
Opening hours regulation
Drink-drive restrictions
Treatment of dependence
Minimum price
Worksite interventions
School-based programmes
DALYs Life Years
Source: Tackling Harmful Alcohol Use, OECD, 2015

17. Many Interventions Are Cost-
Saving, Germany
-600
-400
-200
0
200
400
600
800
main analysis further analysis
Yearlycost(millionUSDPPPs)
Intervention costs Health expenditure
Source: Tackling Harmful Alcohol Use, OECD, 2015

18. Preventing Alcohol Consumption is an
Efficient Investment
Further analyses as dotted lines
0
10 000
20 000
30 000
40 000
50 000
60 000
70 000
80 000
5 10 15 20 25 30 35 40
CEratio(USDPPP/DALY)
Time (years)
Brief interventions Drink-drive restrictions
Treatment of dependence Worksite interventions
Cost-saving interventions
Minimum price
School-based programmes
Opening hours regulation
Tax increase
Advertising regulation (7 years)
Source: Tackling Harmful Alcohol Use, OECD, 2015

19. Key Policy Implications
• Alcohol consumption is decreasing, overall, but with
social & geographical disparities and a rise in binge
drinking in some groups
• Brief interventions and price and regulation policies
provide large health gains
• Alcohol policies produce significant reductions in
health care expenditure. Many interventions are cost
saving
• All policies become cost-effective soon after
implementation

20. International Alcohol Policy Model
(RAND/OECD/WHO)
• New project funded by NIH for 2015-2019
• 3 types of policy:
Price
Drink driving enforcement
Health care policy
• 8 countries: USA, Canada, Mexico, Chile,
UK, Finland, Russia + France
• Modelling, Evaluation, Diffusion

21. Contact: Marion.Devaux@oecd.org
Read more about our work Follow us on Twitter: @OECD_Social
Website: http://www.oecd.org/health/health-systems/economics-of-
prevention.htm
Newsletter: http://www.oecd.org/health/update
Thank you

22. This presentation was produced for a meeting organized within Joint Action
on Reducing Alcohol Related Harm (RARHA) which has received funding
from the European Union, in the framework of the Health Programme (2008-
2013).
The content of this presentation represents the views of the author/s and it
is their sole responsibility; it can in no way be taken to reflect the views of
the European Commission or of the Consumers, Health, Agriculture and
Food Executive Agency or any other body of the European Union. The
European Commission and the Executive Agency do not accept
responsibility for any use that may be made of the information it contains.