Public health policies and alcohol-related liver disease

Abstract

Alcohol-related liver disease (ALD) represents a major public health problem worldwide. According to the World Health Organization, the highest levels of per capita alcohol consumption are observed in countries of the European Region. Alcohol consumption is also alarmingly increasing in developing countries. ALD is one of the main contributors to the burden of alcoholattributable deaths and disability. In the United States, severe forms of ALD such alcoholic hepatitis have increased in the last decade and in the United Kingdom, three-quarters of liver-related mortality results from alcohol consumption. Besides genetic factors, there is strong evidence that the amount of alcohol consumed plays a major role in the development of advanced ALD. Establishing effective public health policies is therefore mandatory to reduce the burden of ALD. Since the 90s, major public health institutions and governments have developed a variety of policies in order to reduce the harm caused by excessive drinking. These policies encompass multiple factors, from pricing and taxation to advertising regulation. Measures focused on taxation and price regulation have been shown to be the most effective at reducing alcohol-related mortality. However, there are few studies focused on the effect of public policies on ALD. This review article summarises the factors influencing ALD burden and the role of different public health policies.

Global and regional impacts of alcohol use on public health: Emphasis on alcohol policies

“…9 Alcohol is the cause of 60% of all liver cirrhosis in developed countries (Europe and North America), and the mortality and morbidity due to alcohol-related liver cirrhosis presents an increasing trend. 18 In the Asia-Pacific region, one-quarter of deaths due to cirrhosis and other chronic liver diseases are attributable to alcohol use. 19 Digestive disease deaths due to alcohol are highest in Africa (16.9 deaths per 100,000 people) and the Western Pacific regions (10.8 deaths per 100,000 people).…”

“…9 Alcohol consumption is deeply affected by many factors at the individual and population levels. 15,18 Identifying those factors is important. Of those factors, three stand out as the most important: religion (especially Islam), economic development, and the implementation of alcohol policies.…”

“…Of those factors, three stand out as the most important: religion (especially Islam), economic development, and the implementation of alcohol policies. 15,18 The wealth of a country is associated with higher alcohol consumption and a higher prevalence of current drinkers across all WHO regions. 9 Historically, in many European countries, industrialization of alcoholic beverages was an early aspect of the indus-trial revolution, and the rates of heavy alcohol drinking and alcohol-related harm rose steeply as the relative alcohol price dropped and alcoholic beverages became more widely available in many European empires and their colonies.…”

“…9,36,37 These WHO recommended interventions, so-called 'best buys', include increased taxation on alcoholic beverages, enforced restrictions on the physical availability of alcohol and comprehensive restrictions or bans on advertising alcoholic beverages (Table 2). 9,18 It has been suggested that the most effective measure is a combination of various alcohol policies, especially in countries with high alcohol-related burdens. 18 The ultimate goal is to design a package of population-based alcohol policies considering the specific characteristics of a country to have the highest impact on both alcohol consumption and the alcohol-related burden.…”

“…9,18 It has been suggested that the most effective measure is a combination of various alcohol policies, especially in countries with high alcohol-related burdens. 18 The ultimate goal is to design a package of population-based alcohol policies considering the specific characteristics of a country to have the highest impact on both alcohol consumption and the alcohol-related burden. 18,38…”