WHO working document for the development of an action plan to strengthen the implementation of the Global Strategy to reduce the harmful use of alcohol

WHO Working document
for development of an action plan to
strengthen implementation of the
Global Strategy to Reduce the Harmful
Use of Alcohol
14th
November 2020
WORKING DOCUMENT
© World Health Organization 2020
All rights reserved. The information contained in this document may be freely used and copied
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drugs-and-addictive-behaviours
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the expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries.
This document serves as background information for a web based consultation and for regional
technical consultations with the WHO Member States in the process of development of an action
plan (2022-2030) to effectively implement the Global Strategy to reduce the harmful use of
alcohol. The World Health Organization does not warrant that the information contained in this
publication document is complete and correct and shall not be liable for any damages incurred
as a result of its use.
The information in this document does not necessarily represent the stated views or policies of
the World Health Organization. The responsibility for the interpretation and use of the material
lies with the reader.
CONTENT
SETTING THE SCENE………………………………………………………………………………………………………………… 1
The Global Strategy to Reduce the Harmful Use of Alcohol …………………………………………………….. 1
Additional international guidance………………………………………………………………………………………. 1
Implementation of the Global Strategy since its endorsement ………………………………………………… 2
CHALLENGES IN IMPLEMENTATION OF THE GLOBAL STRATEGY………………………………………………………………….. 3
OPPORTUNITIES FOR REDUCING THE HARMFUL USE OF ALCOHOL……………………………………………………………….. 5
SCOPE OF THE ACTION PLAN……………………………………………………………………………………………………. 6
GOAL OF THE ACTION PLAN …………………………………………………………………………………………………….. 7
PROPOSED OPERATIONAL OBJECTIVES FOR THE ACTION PLAN, GUIDING PRINCIPLES AND KEY AREAS
FOR GLOBAL ACTION………………………………………………………………………………………………………………. 7
ACTION AREA 1: IMPLEMENTATION OF HIGH-IMPACT STRATEGIES AND INTERVENTIONS ……………… 11
GLOBAL TARGETS FOR ACTION AREA 1…………………………………………………………………………………………… 11
Proposed actions for Member States ………………………………………………………………………………… 12
Proposed actions for the WHO Secretariat…………………………………………………………………………. 12
Proposed actions for international partners and non-State actors …………………………………………. 12
ACTION AREA 2: ADVOCACY, AWARENESS AND COMMITMENT …………………………………………………. 13
GLOBAL TARGETS FOR ACTION AREA 2…………………………………………………………………………………………… 13
Proposed actions for Member States ………………………………………………………………………………… 13
Proposed actions for the WHO Secretariat…………………………………………………………………………. 14
Proposed actions for international partners and non-State actors …………………………………………. 14
ACTION AREA 3: PARTNERSHIP, DIALOGUE AND COORDINATION……………………………………………….. 15
GLOBAL TARGETS FOR ACTION AREA 3…………………………………………………………………………………………… 15
Proposed actions for Member States ………………………………………………………………………………… 15
Actions for the Secretariat ………………………………………………………………………………………………. 16
Proposed actions for international partners and non-State actors …………………………………………. 16
ACTION AREA 4: TECHNICAL SUPPORT AND CAPACITY-BUILDING ……………………………………………….. 17
GLOBAL TARGETS FOR ACTION AREA 4…………………………………………………………………………………………… 17
Proposed actions for Member States ………………………………………………………………………………… 17
Actions for the Secretariat ………………………………………………………………………………………………. 18
Proposed actions for international partners and non-State actors …………………………………………. 18
ACTION AREA 5: KNOWLEDGE PRODUCTION AND INFORMATION SYSTEMS…………………………………. 18
GLOBAL TARGETS FOR ACTION AREA 5…………………………………………………………………………………………… 19
Proposed actions for Member States ………………………………………………………………………………… 19
Actions for the Secretariat ………………………………………………………………………………………………. 20
Proposed actions for international partners and non-State actors …………………………………………. 20
ACTION AREA 6: RESOURCE MOBILIZATION……………………………………………………………………………… 21
GLOBAL TARGETS FOR ACTION AREA 6…………………………………………………………………………………………… 21
Proposed actions for Member States ………………………………………………………………………………… 21
Actions for the Secretariat ………………………………………………………………………………………………. 22
Proposed actions for international partners and non-State actors …………………………………………. 22
ANNEX 1: INDICATORS AND MILESTONES FOR ACHIEVING GLOBAL TARGETS……………………………….. 23
ANNEX 2: WHO EXECUTIVE BOARD DECISION EB146(14) …………………………………………………………… 28
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SETTING THE SCENE
The Global Strategy to Reduce the Harmful Use of Alcohol
The Global Strategy to Reduce the Harmful Use of Alcohol was endorsed by the Sixty-third World
Health Assembly in May 2010 (Resolution WHA63.13). The consensus reached on the Global
Strategy and its endorsement by the Health Assembly was the outcome of close collaboration
between WHO Member States and the WHO Secretariat. The process that led to the development
of the Global Strategy included consultations with other stakeholders, such as nongovernmental
organizations (NGOs) and economic operators. The Global Strategy and Health Assembly
Resolution WHA63.13 build on several WHO global and regional strategic initiatives and represent
the commitment by WHO Member States to sustained action at all levels. The strategy contains a
set of principles that should guide the development and implementation of policies at all levels,
setting out priority areas for global action and recommending target areas for national action. The
strategy gives a strong mandate to WHO to strengthen action at national, regional and global
levels. The vision behind the Global Strategy is improved health and social outcomes for
individuals, families and communities, with considerably reduced morbidity and mortality due to
the harmful use of alcohol and the ensuing social consequences. The Global Strategy was
developed to promote and support local, regional and global actions to prevent and reduce the
harmful use of alcohol (Box 1).
Box 1. Purpose, vision and aims of the Global Strategy to Reduce the Harmful Use of
Alcohol (WHO, 2010)
Purpose: to support and complement public health policies in Member States, including national
and local efforts.
Vision: improved health and social outcomes for individuals, families and communities, with
considerably reduced morbidity and mortality due to harmful use of alcohol and their ensuing
social consequences.
Aims: to give guidance for actions at all levels; to set priority areas for global action; and to
recommend a portfolio of policy options and measures that could be considered for
implementation and adjusted as appropriate at the national level, taking into account national
circumstances, such as religious and cultural contexts, national public health priorities, as well as
resources, capacities and capabilities.
Additional international guidance
Since the endorsement of the Global Strategy in 2010, Member States’ commitment to reducing
the harmful use of alcohol has been further strengthened by the adoption of the political
declarations emanating from high-level meetings of the United Nations General Assembly on
noncommunicable diseases (NCDs). This included the declaration in 2011 and subsequent
adoption and implementation of the WHO Global Action Plan for the Prevention and Control of
NCDs 2013−2020. In 2019 the World Health Assembly (in Resolution WHA72.11) extended the
NCD global action plan to 2030, ensuring its alignment with the 2030 Agenda for Sustainable
Development. The NCD global action plan lists the harmful use of alcohol as one of four key risk
factors for major NCDs. The action plan enables Member States and other stakeholders to identify
and use opportunities for synergies to tackle more than one risk factor at the same time, to
strengthen coordination and coherence between measures to reduce the harmful use of alcohol
and activities to prevent and control NCDs, and to set voluntary targets for reducing the harmful
use of alcohol and other risk factors for NCDs.
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Furthermore, target 3.5 of the Sustainable Development Goals (SDGs) 2030 includes the objective
of strengthening the prevention and treatment of substance abuse, including harmful use of
alcohol. This reflects the broader impact of harmful alcohol use on health beyond NCDs – in areas
such as mental health, violence, road traffic injuries and infectious diseases.
Evidence on the cost-effectiveness of alcohol policy options and interventions was updated in a
revision of Appendix 3 to the NCD global action plan, and this appendix was endorsed by the Health
Assembly in Resolution WHA70.11 (2017). This resulted in a new set of enabling and
recommended actions to reduce the harmful use of alcohol. The most cost-effective actions, or
“best buys”, include increasing taxes on alcoholic beverages, enacting and enforcing bans or
comprehensive restrictions on exposure to alcohol advertising across multiple types of media, and
enacting and enforcing restrictions on the physical availability of retailed alcohol. By prioritizing
the most cost-effective policy measures, the Secretariat and partners launched the SAFER
initiative. The primary objective of SAFER is to support Member States in reducing the harmful use
of alcohol by enhancing ongoing implementation of the Global Strategy and other WHO and
United Nations strategies. The SAFER initiative also aims to protect public health-oriented policy-
making against interference from commercial interests, to establish strong monitoring systems to
ensure accountability, and to track progress in the implementation of SAFER policy options and
interventions.
Implementation of the Global Strategy since its endorsement
Since the endorsement of the Global Strategy, its implementation has been uneven across WHO
regions. The number of countries with a written national alcohol policy has steadily increased and
many countries have revised their existing alcohol policies. However, the presence of written
national alcohol policies continues to be most common in high-income countries and least
common among low-income countries, with written national alcohol policies missing from most
countries in the African Region and the Region of the Americas. The disproportionate prevalence
of effective alcohol control measures in higher-income countries raises questions about global
health equity; it underscores the need for more resources and greater priority to be allocated to
support the development and implementation of effective policies and actions in low- and middle-
income countries.
Between 2010 and 2018 no tangible progress was made in reducing total global alcohol
consumption per capita; the figures for people aged 15 years and over rose from 5.5 litres of pure
alcohol in 2005 to 6.3 litres in 2010 and remained relatively stable at 6.2 litres in 2018. The highest
levels of consumption per capita were observed in countries in the European Region. Although
consumption per capita remained stable between 2010 and 2018 in the Region of the Americas
and the African and Eastern Mediterranean regions, it decreased in the European Region –
surpassing the target set in the global monitoring framework for NCDs. Consumption of alcohol
per capita increased, however, in the South-East Asia and Western Pacific regions.
The number of drinkers declined across all WHO regions between 2010 and 2016. More than half
of the global population aged 15 years and older abstained from drinking alcohol during the
previous 12 months. In 2016, alcohol was consumed by more than half of the population in three
of the six WHO regions: the Americas, European and the Western Pacific regions. Some 2.3 billion
people are current drinkers. Age-standardized prevalence of heavy episodic drinking (defined as
60 or more grams of pure alcohol on at least one occasion at least once per month) decreased
globally from 20.6% in 2010 to 18.5% in 2016 among the total population but remained high
among drinkers, particularly in parts of Eastern Europe and in some sub-Saharan African countries
(more than 60% among current drinkers). There is emerging evidence of an increase in alcohol
consumption in some population groups during the COVID-19 pandemic, at least in the early
stages of the pandemic.
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In all WHO regions, higher alcohol consumption rates and higher prevalence rates of current
drinkers are associated with the higher economic wealth of countries. However, the prevalence of
heavy episodic drinking is equally distributed between higher- and lower-income countries in most
regions. The two exceptions to this are the African Region (where rates of heavy episodic drinking
are higher in lower-income countries than in higher-income countries) and the European Region
(where, conversely, heavy episodic drinking is more frequent in high-income countries).
Despite some improvements in the number of age-standardized alcohol-attributable deaths and
disability-adjusted life years (DALYs) in all regions except South-East Asia, the overall burden of
disease attributable to alcohol consumption remains unacceptably high. In 2016, the harmful use
of alcohol resulted in some 3 million deaths (5.3% of all deaths) worldwide and 132.6 millionDALYs
(5.1% of all DALYs). Mortality from alcohol consumption is higher than from diseases such as
tuberculosis, HIV/AIDS and diabetes. In 2016, an estimated 2.3 million deaths and 106.5 million
DALYs among men globally were attributable to alcohol consumption. For women, the figures
were 0.7 million and 26.1 million, respectively. Worldwide, in 2016, alcohol was responsible for
7.2% of all premature mortality (in persons aged 69 years or less). Younger people were
disproportionately affected by alcohol; 13.5% of all deaths among 20–39-year-olds in 2016 were
attributed to alcohol.
In 2016, the age-standardized alcohol-attributable burden of disease and injury was highest in the
African Region, whereas the proportions of all deaths and DALYs attributable to alcohol
consumption were highest in the European Region (10.1% of all deaths and 10.8% of all DALYs)
followed by the Region of the Americas (5.5% of deaths and 6.7% of DALYs). Approximately 49%
of alcohol-attributable DALYs are due to NCDs and mental health conditions, and about 40% are
due to injury.
According to the latest WHO global estimates, 283 million people aged 15 years and older – 237
million men and 46 million women – live with alcohol use disorders (AUD), accounting for 5.1% of
the global adult population. Alcohol dependence, as the most severe form of AUD, affects 2.6% of
the world’s adults, or 144 million people.
The impact of the harmful use of alcohol on health and well-being is not limited to health
consequences; it incurs significant social and economic losses relating to costs in the justice sector,
costs from lost workforce productivity and unemployment, and costs assigned to pain and
suffering. The harmful use of alcohol can also result in harm to others, such as family members,
friends, co-workers and strangers. The harms to others may be concrete (e.g. injuries or damages)
or may result from suffering, poor health and well-being, and the social consequences of drinking
(e.g. being harassed or insulted, or feeling threatened).
Overall – despite some decreasing trends in alcohol consumption in some segments of the
population, improvements in some indicators of the disease burden attributable to alcohol
consumption, and alcohol policy developments at national level – the implementation of the
Global Strategy has not resulted in considerable reductions in alcohol-related morbidity and
mortality and the ensuing social consequences. Globally, the levels of alcohol consumption and
alcohol-attributable harm continue to be unacceptably high. The impact of the COVID-19
pandemic on the levels and patterns of alcohol consumption and related harm worldwide still
need to be assessed.
Challenges in implementation of the Global Strategy
Considerable challenges remain for the development and implementation of effective alcohol
policies. These challenges relate to the complexity of the problem, differences in cultural norms
and contexts, and the intersectoral nature of cost-effective solutions and associated limited levels
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of political will and leadership at the highest levels of governments, as well as the influence of
powerful commercial interests in policy-making and implementation. These challenges operate
against a background of competing international economic commitments. Responsibility for
dealing with these various challenges is dispersed between different entities – including
government departments, different professions and technical areas – which complicates
coordination and cooperation at all levels.
The drinking of alcoholic beverages is strongly embedded in the social norms and cultural
traditions of many societies. Prevailing social norms that support drinking behaviour and mixed
messages about the harms and benefits of drinking may encourage alcohol consumption, delay
appropriate health-seeking behaviour and weaken community action. The accumulated evidence
indicates that alcohol consumption is associated with inherent health risks, although these risks
vary significantly in magnitude and health consequences among drinkers. Awareness and
acceptance of the overall negative impact of alcohol consumption on a population’s health and
safety is low among decision-makers and the general public. This is influenced by commercial
messaging and poorly-regulated marketing of alcoholic beverages which deprioritize efforts to
counter the harmful use of alcohol in favour of other public health issues.
The production of alcoholic beverages has become increasingly concentrated and globalized in
recent decades, particularly in the beer and spirits sectors. A significant proportion of alcoholic
beverages is consumed in heavy drinking occasions and by people affected by AUD, illustrating the
inherent contradiction between the interests of alcohol producers and public health. Strong
international leadership is needed to counter interference of commercial interests in alcohol
policy development and implementation in order to prioritize the public health agenda for alcohol
in the face of a strong global industry and commercial interests.
Competing interests across the whole of government at the country level, including interests
related to the production and trade of alcohol and government revenues from alcohol taxation
and sales, often result in policy incoherence and the weakening of alcohol control efforts. The
situation varies at national and subnational levels and is heavily influenced by the commercial
interests of alcohol producers and distributors, religious beliefs, and spiritual and cultural norms.
However, general trends towards deregulation in recent decades have often resulted in a
weakening of alcohol controls, to the benefit of economic interests and to the expense of public
health and welfare.
Alcohol remains the only psychoactive and dependence-producing substance that exerts a
significant impact on global population health that is not controlled at the international level by
legally-binding regulatory instruments. This absence limits the ability of national and subnational
governments to regulate the distribution, sale and marketing of alcohol within the context of
international, regional and bilateral trade negotiations, as well as to protect the development of
alcohol policies from interference by transnational corporations and commercial interests. This
prompted calls for a global normative law on alcohol at the intergovernmental level, modelled on
the WHO Framework Convention on Tobacco Control, and discussions about the feasibility and
necessity of such a legally binding international instrument.
Informally and illegally produced alcohol account for an estimated 25% of total alcohol
consumption per capita worldwide and, in some jurisdictions, exceed half of all alcohol consumed
by the population. Informal and illegal production and trade are different in nature and require
different policy and programme responses. Informal production and distribution of alcohol are
often embedded in cultural traditions and socioeconomic fabrics of communities. Illicit alcohol
production is associated with significant health risks and challenges for regulatory and law
enforcement sectors of governments. The capacity to deal with informal or illicit production,
distribution and consumption of alcohol, including safety issues, is limited or inadequate,
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particularly in jurisdictions where unrecorded alcohol makes up a significant proportion of all
alcohol consumed.
Satellite and digital marketing present a growing challenge for the effective control of alcohol
marketing and advertising. Alcohol producers and distributors have increasingly moved to
investing in digital marketing and using social media platforms, which are profit-making businesses
with an infrastructure designed to allow “native advertising” that is data-driven and participatory.
Internet marketing crosses borders with even greater ease than satellite television and is not easily
subjected to national-level control. In parallel with the greater opportunity for marketing and
selling alcohol through online platforms, delivery systems are rapidly evolving, imposing
considerable challenges on the ability of governments to control alcohol sales.
Limited technical capacity, human resources and funding hinder efforts in developing,
implementing, enforcing and monitoring effective alcohol control interventions at all levels.
Technical expertise in alcohol-control measures is often absent at national and subnational levels
and sufficient human and financial resources for the provision of essential technical assistance and
compilation, dissemination and application of technical knowledge into practice have been grossly
insufficient in WHO at all levels. Few civil society organizations prioritize alcohol as a health risk or
motivate governments into action compared to organizations that support tobacco control. In the
absence of philanthropic funding, and with limited resources in WHO and other intergovernmental
organizations, there has been little investment in capacity-building in low- and middle-income
countries.
The lack of sufficiently developed national systems for monitoring alcohol consumption and the
impact of alcohol on health reduces the capacity of advocacy for effective alcohol-control policies
and for monitoring their implementation and impact.
Opportunities for reducing the harmful use of alcohol
Uneven and insufficient progress with implementation of the Global Strategy can be addressed by
actions which are built on existing and emerging opportunities for reducing the harmful use of
alcohol.
In recent years, alcohol consumption among young people has decreased in many countries
throughout Europe and in some other high-income societies, with the exception of some
disadvantaged groups. The decline seems to be continuing into the next age group as the cohort
ages. Capitalizing on this trend offers a considerable opportunity for public health policies and
programmes. There is also a trend towards an increase in the proportion of former drinkers among
people aged 15 years and above. One contributory factor is the increasing awareness of negative
health and social consequences of the harmful use of alcohol, and alcohol’s causal relationships
with some types of cancer, liver and cardiovascular diseases, as well as its association with
increased risk of infectious diseases such as tuberculosis and HIV/AIDS. Increasing the health
literacy and health consciousness of the general public provides an opportunity for strengthening
prevention activities and scaling up screening and brief interventions in health services.
While recognizing its negative influences and effects, social media also provides new opportunities
for changing peoples’ relationship with alcohol through increased awareness of the negative
health consequences of drinking, and new horizons for communication and promotion of
recreational activities as an alternative to drinking and intoxication. At the same time, social media
can serve as a powerful source of marketing communication and brand promotion for alcoholic
beverages.
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Alcohol use and its impact on health have been increasingly recognized as factors in health
inequality. Within a given society, adverse health impacts and social harm from a given level and
pattern of drinking are greater for poorer individuals and societies. Increased alcohol consumption
can exacerbate health and social inequalities between genders as well as social classes. Policies
and programmes to reduce health inequalities and promote sustainable development need to
include sustained attention to alcohol policies and programmes.
The body of evidence for the effectiveness and cost-effectiveness of alcohol control measures has
been significantly strengthened in recent years. The latest economic analysis undertaken under
the auspices of WHO demonstrated high returns on investment for “best buys” in alcohol control.
Every additional United States dollar invested in the most cost-effective interventions per person
per year will yield a return of US$ 9.13 by 2030, a return that is higher than a similar investment
in tobacco control (US$ 7.43) or prevention of physical inactivity (US$ 2.80).
The COVID-19 pandemic and measures to curb virus transmission (lockdowns, stay-at-home
mandates) have had a significant impact on population health and well-being, as well as on
patterns of alcohol consumption, alcohol-related harms and the effectiveness of existing policy
and programme responses. The COVID-19 outbreak has underscored the importance of
developing appropriate alcohol policy responses, alcohol-focused activities and interventions
during public health emergencies. This will have important implications for reducing not only the
harmful use of alcohol at national, regional and global levels, but also the alcohol-related health
burden and demand for health service interventions during the pandemic.
SCOPE OF THE ACTION PLAN
The Global Strategy to Reduce the Harmful Use of Alcohol was recognized by WHO Member States
at the 146th session of the Executive Board (2020) (Annex 2) as continuing to be relevant (a report
on a review of the Global Strategy will be submitted in 2030), but resources and capacities for its
implementation in WHO and some Member States do not correspond to the magnitude of the
health and social burden. Alcohol marketing, advertising and promotional activities of alcoholic
beverages are of deep concern, including those implemented through cross-border marketing,
and targeting young people and adolescents. The development of an action plan (2022−2030) was
requested by the decision of the WHO Executive Board to implement the Global Strategy as a
public health priority. When endorsing the Global Strategy in 2010, the World Health Assembly
affirmed that it aims to give guidance for action at all levels and to set priority areas for global
action. The Strategy also provides a portfolio of policy options and measures that could be
considered for implementation at the national level at the discretion of each Member State,
depending on national contexts, priorities and resources. As stated in paragraph 59 of the Global
Strategy, its successful implementation requires concerted actions by Member States, effective
global governance and appropriate engagement of all relevant stakeholders. Hence, the proposed
scope of key elements for developing the action plan includes specific actions and measures to be
implemented at global level, in line with key roles and components of global action as formulated
in the Global Strategy. The action plan will also include proposed actions for Member States,
international partners and non-State actors to be considered for implementation at the national
level. The action plan contains specific targets, indicators and proposed actions for all
stakeholders, developed on the basis of lessons learned from implementation of the Global
Strategy over the last 10 years, and with a timeline extended to 2030 in line with the timeline of
the 2030 Agenda for Sustainable Development. The action plan is linked to and aligned with other
relevant global action plans, including the Mental health action plan, the Global action plan for
prevention and control of NCDs, the Global action plan on the public health response to dementia,
and the Global plan of action to address interpersonal violence.
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WHO aims to ensure that by 2023 1 billion more people enjoy better health and well-being, 1
billion more people are better protected from health emergencies and a further 1 billion more
people benefit from universal health coverage. These goals indicate strategic directions for WHO
in protecting and promoting population health worldwide. In the context of reducing the harmful
use of alcohol, these goals can be translated into the objectives of: 1) increasing the proportion of
populations that are protected from the harmful use of alcohol by effective alcohol control
policies; 2) increasing the capacity of countries to address the harmful use of alcohol during health
emergencies (such as the COVID-19 pandemic) by appropriate policy and programme responses;
and 3) increasing the proportion of people with AUD and comorbid conditions benefitting from
universal health coverage.
GOAL OF THE ACTION PLAN
The goal of the action plan is to boost effective implementation of the Global Strategy as a public
health priority and considerably reduce morbidity and mortality due to alcohol use – over and
above general morbidity and mortality trends – as well as associated social consequences.
Effective implementation of the action plan at regional levels may require development or
elaboration and adaptation of region-specific action plans. Emphasis is also needed on
coordination within the Secretariat so that all actions aimed at reducing the harmful use of alcohol
are in line with the Global Strategy and the action plan to strengthen its implementation.
PROPOSED OPERATIONAL OBJECTIVES FOR THE ACTION PLAN,
GUIDING PRINCIPLES AND KEY AREAS FOR GLOBAL ACTION
The proposed operational objectives of the action plan 2022−2030 and the proposed action areas
are based on the objectives of the Global Strategy (Box 2) and the four key components of global
action to reduce the harmful use of alcohol effectively (Box 3). However, the proposed operational
objectives of the action plan are not identical to those of the Global Strategy. This reflects the
action-oriented nature of the action plan, as well as more recent goals and objectives of other
relevant global strategies and action plans, and lessons learned in implementing the Global
Strategy since its endorsement.
Box 2. Objectives of the Global Strategy to Reduce the Harmful Use of Alcohol (WHO, 2010)
(a) Raised global awareness of the magnitude and nature of the health, social and economic
problems caused by harmful use of alcohol, and increased commitment by governments to act to
address the harmful use of alcohol;
(b) strengthened knowledge base on the magnitude and determinants of alcohol-related harm
and on effective interventions to reduce and prevent such harm;
(c) increased technical support to, and enhanced capacity of, Member States for preventing the
harmful use of alcohol and managing alcohol use disorders and associated health conditions;
(d) strengthened partnerships and better coordination among stakeholders and increased
mobilization of resources required for appropriate and concerted action to prevent the harmful
use of alcohol;
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(e) improved systems for monitoring and surveillance at different levels, and more effective
dissemination and application of information for advocacy, policy development and evaluation
purposes.
It is widely acknowledged that implementation of the Global Strategy is uneven, and the overall
burden of disease and injuries attributable to alcohol consumption remains unacceptably high.
Substantial progress with attainment of the goal and objectives of the Global Strategy can be
achieved only through implementation of high-impact cost-effective alcohol control measures
from the 10 target areas recommended in the Global Strategy for national policies and
interventions (Box 4) at the national level. These target areas are not only supportive of and
complementary to each other, but are strongly interlinked with the four components for global
action.
Box 3. Global action: key components (Global Strategy to Reduce the Harmful Use of
Alcohol. WHO, 2010)
1. Public health advocacy and partnership. International public health advocacy and
partnership are needed for strengthened commitment and abilities of the governments
and all relevant parties at all levels for reducing the harmful use of alcohol worldwide.
2. Technical support and capacity-building. Many Member States need increased capacity
and capability to create, enforce and sustain the necessary policy and legal frames and
implementation mechanisms. Global action will support national action through the
development of sustainable mechanisms and the provision of the necessary normative
guidance and technical tools for effective technical support and capacity-building, with
particular focus on developing and low- and middle-income countries.
3. Production and dissemination of knowledge. Important areas for global action will be
monitoring trends in alcohol consumption, alcohol-attributable harm and the societal
responses, analysing this information and facilitating timely dissemination. Available
knowledge on the magnitude of harmful use of alcohol, and effectiveness and cost-
effectiveness of preventive and treatment interventions should be further consolidated
and expanded systematically at the global level, especially information on epidemiology
of alcohol use and alcohol-related harm, impact of harmful use of alcohol on economic
and social development and the spread of infectious diseases in developing and low- and
middle-income countries.
4. Resource mobilization. The magnitude of alcohol-attributable disease and social burden
is in sharp contradiction with the resources available at all levels to reduce harmful use of
alcohol. Global development initiatives must take into account that developing and low-
and middle-income countries need technical support – through aid and expertise – to
establish and strengthen national policies and plans for the prevention of harmful use of
alcohol and develop appropriate infrastructures, including those in health-care systems.
Box 4. Recommended target areas for policy measures and interventions at the national level
(Global Strategy to Reduce the Harmful Use of Alcohol. WHO, 2010)
Area 1. Leadership, awareness and commitment
Area 2. Health services’ response
Area 3. Community action
Area 4. Drink-driving policies and countermeasures
Area 5. Availability of alcohol
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Area 6. Marketing of alcoholic beverages
Area 7. Pricing policies
Area 8. Reducing the negative consequences of drinking and alcohol intoxication
Area 9. Reducing the public health impact of illicit alcohol and informally produced alcohol
Area 10. Monitoring and surveillance
Operational objectives of the action plan:
1. Increase population coverage and implementation of high-impact policy options and
interventions to reduce the harmful use of alcohol worldwide for better health and well-
being.
2. Strengthen multisectoral action through effective governance, enhanced political
commitment and leadership, dialogue and coordination of multisectoral action.
3. Enhance prevention and treatment capacity of health and social care systems for disorders
due to alcohol use and associated health conditions as an integral part of universal health
coverage and aligned with the 2030 Agenda for Sustainable Development and its health
targets.
4. Raise awareness of risks and harms associated with alcohol consumption at all levels as
well as of effectiveness of different policy options to reduce consumption and related
harm.
5. Strengthen information systems and research for monitoring alcohol consumption,
alcohol-related harm and policy responses at all levels with dissemination and application
of information for advocacy, policy development and evaluation purposes.
6. Significantly increase mobilization of resources required for appropriate and sustained
action to reduce the harmful use of alcohol at all levels.
Operational principles for global action:
The Global Strategy includes guiding principles for the development and implementation of
alcohol policies at all levels (Box 5). The guiding principles listed in the Strategy can be
complemented by operational action-oriented principles to be included in the global action plan.
The following principles and approaches are presented here for consideration:
• Multisectoral action
• Universal health coverage
• Life course approach
• Protection from commercial interests
• Evidence-based approach
• Equity-based approach
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• Human rights approach
• Empowering of people and communities
Box 5. Guiding principles (Global Strategy to Reduce the Harmful Use of Alcohol. WHO,
2010)
Principle 1 Public policies and interventions to prevent and reduce alcohol-related harm
should be guided and formulated by public health interests and based on clear
public health goals and the best available evidence.
Principle 2 Policies should be equitable and sensitive to national, religious and cultural
contexts.
Principle 3 All involved parties have the responsibility to act in ways that do not undermine
the implementation of public policies and interventions to prevent and reduce
harmful use of alcohol.
Principle 4 Public health should be given proper deference in relation to competing
interests and approaches that support that direction should be promoted.
Principle 5 Protection of populations at high risk of alcohol-attributable harm and those
exposed to the effects of harmful drinking by others should be an integral part
of policies addressing the harmful use of alcohol.
Principle 6 Individuals and families affected by the harmful use of alcohol should have
access to affordable and effective prevention and care services.
Principle 7 Children, teenagers and adults who choose not to drink alcoholic beverages
have the right to be supported in their nondrinking behaviour and protected
from pressures to drink.
Principle 8 Public policies and interventions to prevent and reduce alcohol-related harm
should encompass all alcoholic beverages and surrogate alcohol.
Key areas for global action:
To achieve the above-mentioned goal and objectives, the following key areas are proposed for
action by Member States, the WHO Secretariat, international and national partners and, as
appropriate, other stakeholders:
Action area 1: Implementation of high-impact strategies and interventions
Action area 2: Advocacy, awareness and commitment
Action area 3: Partnership, dialogue and coordination
Action area 4: Technical support and capacity-building
Action area 5: Knowledge production and information systems
Action area 6: Resource mobilization.
Page 11
The first action area, focusing on implementation of high-impact, cost-effective interventions
summarized in the WHO SAFER technical package, is the key for successful achievement of the
global action plan goal: to reduce considerably morbidity and mortality due to alcohol use over
and above general morbidity and mortality trends.
ACTION AREA 1: IMPLEMENTATION OF HIGH-IMPACT STRATEGIES
AND INTERVENTIONS
Limited global progress achieved so far in reducing the harmful use of alcohol (or no progress at
all in some parts of the world) can be explained by insufficient uptake, implementation and
enforcement of the most effective and cost-effective alcohol policies and interventions. The goal
of considerably reducing morbidity and mortality due to alcohol use over and above general
morbidity and mortality trends and associated social consequences can be achieved by increasing
population coverage and strengthening implementation of measures with proven effectiveness
that can be implemented in countries with different levels of available resources.
The WHO-led SAFER initiative is based on effective and cost-effective policy options and
interventions which are summarized in Appendix 3 of the Global Action Plan for the Prevention
and Control of NCDs and endorsed by the 70th
World Health Assembly. The SAFER initiative
includes the following policy options and interventions:
• Strengthen restrictions on alcohol availability
• Advance and enforce drink-driving countermeasures
• Facilitate access to screening, brief interventions and treatment
• Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship and
promotion
• Raise prices on alcohol through excise taxes and other pricing policies.
Global targets for Action area 1
Global target 1.1: By 2030, 75% of countries have introduced and/or strengthened and sustainably
enforced implementation of high-impact policy options and interventions.1
Global target 1.2: At least a x% relative reduction in alcohol per capita (among those aged 15
years and older) consumption by 2025 and a x% relative reduction by 2030.2
Global target 1.3: By 2030, 80% of the world’s population are protected from the harmful use of
alcohol by sustained implementation and enforcement of high-impact policy options with due
consideration of national contexts, priorities and available resources.
1
Included in the SAFER technical package.
2
The target figures for this indicator are to be defined on the basis of analysis of the WHO data on
alcohol consumption.
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Proposed actions for Member States
Action 1. Based on the evidence of effectiveness and cost-effectiveness of policy measures, to prioritize
sustainable implementation, continued enforcement, monitoring and evaluation of high-impact policy
options included in the WHO SAFER technical package.
Action 2. Ensure that development, implementation and evaluation of alcohol policy measures are based on
public health goals and the best available evidence and are protected from interference from
commercial interests.
Action 3. Strengthen or develop national systems to monitor implemented alcohol policy measures and
interventions in conjunction with monitoring alcohol consumption and related harm to assess the
impact of implemented policy measures and interventions.
Action 4. Build or strengthen and support broad partnerships and intragovernmental and intergovernmental
mechanisms for collaboration across different sectors for implementation of high-impact policy
options.
Proposed actions for the WHO Secretariat
Action 1. Provide policy guidance, advocacy and, as required, technical assistance for the development,
implementation and evaluation of effective and cost-effective policy options, and continue to lead
implementation of the SAFER initiative in collaboration with WHO partners.
Action 2. Periodically review the evidence of effectiveness and cost-effectiveness of alcohol policy options and
interventions and formulate and disseminate recommendations for reducing the harmful use of
alcohol.
Action 3. Further develop and strengthen broad international partnerships on reducing the harmful use of
alcohol and support international mechanisms for intersectoral collaboration with United Nations
entities, civil society, academia and professional organizations.
Action 4. Maintain dialogues with representatives of economic operators in the area of alcoholic beverage
production and trade on how they can best contribute to the reduction of alcohol-related harm within
their core roles.
Action 5. Strengthen global monitoring of implementation of the Global Strategy and the proposed action plan
to reduce the harmful use of alcohol with a focus on high-impact strategies and interventions and
report periodically on progress achieved.3
Proposed actions for international partners and non-State actors
Action 1. Major partners within the United Nations system and intergovernmental organizations are invited to
increase collaboration and cooperation with WHO on the development, implementation and
evaluation of high-impact policy measures, and by joining the WHO-led SAFER initiative.
Action 2. Civil society organizations and academia are invited to strengthen advocacy and support for
implementation of high-impact policy options by creating enabling environments, promoting the
SAFER initiative, strengthening global and regional networks and action groups, developing and
strengthening accountability frameworks, and monitoring activities and commitments of economic
operators in alcohol production and trade.
Action 3. Economic operators in alcohol production and trade are invited to focus on their core roles as
developers, producers, distributors, marketers and sellers of alcoholic beverages, and refrain from
activities that may prevent, delay or stop the development, enactment and enforcement of high-
impact strategies and interventions to reduce the harmful use of alcohol. Economic operators in
alcohol production and trade, as well as economic operators in other relevant sectors (such as retail,
advertisements, social media and communication), are encouraged to contribute to the elimination
of marketing and sales of alcoholic beverages to minors and targeted commercial activities towards
other high-risk groups.
3
Proposed indicators for monitoring implementation of high-impact interventions are included in
Annex 1.
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ACTION AREA 2: ADVOCACY, AWARENESS AND COMMITMENT
Strategic and well-developed international communication and advocacy are needed to raise
awareness about alcohol-related harm and the effectiveness of policy measures among decision-
makers and the general public in order to increase their support for faster implementation of the
Global Strategy. Special efforts and activities are needed to mobilize different stakeholders for
coordinated actions to protect public health and foster broad political commitment to reduce the
harmful use of alcohol.
It is necessary to raise awareness among decision-makers and the general public about the risks
and harms associated with alcohol consumption. Appropriate attention should be given to
preventing the initiation of drinking among children and adolescents and protecting people from
pressures to drink, especially in societies with high levels of alcohol consumption where heavy
drinkers are encouraged to drink even more. An international day of awareness on the harmful
use of alcohol or a “World no alcohol day” could help to focus and reinforce public attention on
the problem. Public health advocacy is more likely to succeed if it is well supported by evidence
and based on emerging opportunities, and if the arguments are free from moralizing. The
international discourse on alcohol policy development and implementation should not be limited
to NCDs but should be expanded to include other areas of health and development such as injuries,
violence, infectious diseases and a “harm to others” perspective. Modern communication
technologies and multimedia materials are needed for successful advocacy and behavioural
change campaigns, including social media engagement.
Such awareness, along with the development and enforcement of alcohol policies, needs to be
protected from interference by commercial interests. Appropriate mechanisms that involve
academics and civil society must be set up to systematically monitor such interference and
activities of the industry.
Global targets for Action area 2
Global target 2.1: By 2030, 75% of countries have developed and enacted a written national
alcohol policy that is based on best available evidence and supported by legislative measures for
effective implementation of high-impact strategies and interventions.
Global target 2.2: By 2030, 50% of countries are periodically producing national reports on alcohol
consumption, alcohol-related harm and effective policy responses targeting decision-makers and
the general public.
Proposed actions for Member States
Action 1. Based on evidence of the nature and magnitude of alcohol-attributable public health problems,
advocate for the development and implementation of high-impact strategies, interventions and other
actions to prevent and reduce alcohol-related harm. This includes a special emphasis on protecting at-
risk populations and those affected by the harmful drinking of others, preventing initiation of drinking
among children and adolescents, and reducing the levels of alcohol consumption among drinkers.
Action 2. Develop, strengthen and update as necessary and implement national alcohol policies with legislative
measures to support high-impact strategies and interventions.
Action 3. Advocate for appropriate attention, congruous with the magnitude of related public health problems,
to reducing the harmful use of alcohol in multisectoral policies and frameworks as well as in national,
economic, environmental, agricultural and other relevant policies and action plans.
Action 4. Include a commitment to reduce the harmful use of alcohol and its impact on health and well-being in
high-level national developmental and public health strategies, programmes and action plans, and
support the creation and development of advocacy coalitions.
Action 5. Regularly produce national reports on alcohol consumption and alcohol-related harm targeting
decision-makers and the general public with information on alcohol’s contribution to specific health
Page 14
and social problems and dissemination of information through available modern communication
technologies.
Action 6. Increase awareness of the health risks of alcohol use and related overall impact on health and well-
being through strategic, well-developed and long-term communication activities, including an option
of a national alcohol awareness day to be implemented by public health agencies and organizations
and involving countering misinformation and using targeted communication channels, including social
media platforms.
Action 7. Ensure appropriate consumer protection measures through development and implementation of
labelling requirements for alcoholic beverages which display essential information on ingredients,
caloric value and health warnings.
Action 8. Support education, training and networking activities on reducing the harmful use of alcohol for
representatives of authorities at different levels, health professionals, civil society organizations and
the media.
Proposed actions for the WHO Secretariat
Action 1. Raise the priority given to the alcohol-attributable health and social burden and effective policy
responses in the agendas of high-level global, regional and other international forums, meetings and
conferences of international and intergovernmental organizations, professional associations and civil
society groups, and seek inclusion of alcohol policies in relevant social and development agendas.
Action 2. Continue monitoring the magnitude of public health problems caused by the harmful use of alcohol by
collecting relevant information from Member States, international agencies and other information
sources, and supporting estimates of alcohol-attributable disease burden at global, regional and
subregional levels.
Action 3. Develop and implement an organization-wide communication plan to support actions to reduce the
harmful use of alcohol reflecting emerging challenges (such as the COVID-19 pandemic), targeting
different population groups and using different communication channels.
Action 4. Prepare and disseminate every 4−5 years global status reports on alcohol and health to raise
awareness of the alcohol-attributable burden and advocate for appropriate action at all levels.
Action 5. Develop, test and disseminate technical and advocacy tools for effective communication of consistent,
scientifically sound and clear messages about alcohol-attributable health and social problems and
effective policy and programme responses. Review, update and disseminate WHO nomenclature and
definitions of alcohol-related terms, particularly in the area of alcohol policy and monitoring.
Action 6. Develop the international standards for labelling of alcoholic beverages to inform consumers about
the content of the products and the health risks associated with their consumption.
Action 7. To facilitate dialogue and information exchange regarding the impact of international aspects of the
alcohol market on the alcohol-attributable health burden, advocate for appropriate consideration of
these aspects by parties in international trade negotiations and seek international solutions within the
WHO’s mandate if appropriate actions to protect the health of populations cannot be implemented.
Proposed actions for international partners and non-State actors
Action 1. Major partners within the United Nations system and intergovernmental organizations are invited to
include activities for reducing the harmful use of alcohol in their agendas and ensure support for
policy coherence between health and other sectors in international multisectoral policies, strategies
and frameworks, as well as proper deference of public health interests in relation to competing
interests.
Action 2. Civil society organizations, professional associations and academia are invited to scale up their
activities in support of global, regional and national awareness and advocacy campaigns, as well as in
countering misinformation about alcohol use and its associated health risks. They are also invited to
motivate and engage different stakeholders, as appropriate, in the implementation of effective
strategies and interventions to reduce the harmful use of alcohol, and to monitor activities which
undermine effective public health measures.
Action 3. Economic operators in alcohol production and trade as well as operators in other relevant sectors of
the economy are invited to take concrete steps, where relevant, towards eliminating the marketing
and advertising of alcoholic products to minors, refrain from promoting drinking, eliminate and
prevent any positive health claims, and ensure, within co-regulatory frameworks, the availability of
easily-understood consumer information on the labels of alcoholic beverages (including composition,
age limits, health warning and contraindications for alcohol use).
Page 15
ACTION AREA 3: PARTNERSHIP, DIALOGUE AND COORDINATION
New partnerships and the appropriate engagement of all relevant stakeholders are needed to
build capacity and support implementation of practical and focused technical packages that can
ensure returns on investments within a “Health for All” approach. Increased coordination between
health and other sectors such as finance, transport, communication and law enforcement is
required for implementation of effective multisectoral measures to reduce the harmful use of
alcohol. The new WHO-led SAFER initiative and partnership to promote and support
implementation of “best buys”, alongside other recommended alcohol-control measures at the
country level, can invigorate action in countries through coordination with WHO’s partners within
and outside the United Nations system. Effective alcohol control requires a “whole of
government” and “whole of society” approach with clear leadership by the public health sector
and appropriate engagement of other governmental sectors, civil society organizations, academic
institutions and, as appropriate, the private sector. There is a need to strengthen the role of civil
society in alcohol policy development and implementation.
Global and regional networks of country focal points and WHO national counterparts for reducing
the harmful use of alcohol, as well as technical experts, will facilitate country cooperation,
knowledge transfer and capacity-building. The technical networks and platforms should focus on
particularly challenging technical areas and situations such as the control of digital marketing,
social media advertising or reducing the harmful use of alcohol during health emergencies such as
the COVID-19 pandemic.
The continuing global dialogue with economic operators in alcohol production and trade should
focus on the industry’s contribution to reducing the harmful use of alcohol in their roles as
developers, producers and distributors/sellers of alcoholic beverages. This dialogue should also
aim for implementation of comprehensive restrictions or bans on traditional, online or digital
marketing (including sponsorship), as well as on sales, e-commerce, delivery, product formulation
and labelling, and data on production and sales. The dialogue should engage, as appropriate,
economic operators in other sectors of the economy directly involved in distribution, sales and
marketing of alcoholic beverages.
Global targets for Action area 3
Global target 3.1: x%4
of countries have established and functioning national and subnational
multisectoral coordination mechanisms for implementation and strengthening of effective alcohol
control measures.
Global target 3.2: 75% of countries are engaged in and contribute to the work of the global and
regional networks of WHO national counterparts for international dialogue and coordination on
reducing the harmful use of alcohol.
Proposed actions for Member States
Action 1. Encourage mobilization and active and appropriate engagement of all relevant entities and groups in
reducing the harmful use of alcohol, and also by advocating for appropriate coordination mechanisms,
4
A target figure to be defined on the basis of reanalysis of the WHO global SDG health target 3.5
survey implemented in 2019−2020.
Page 16
strategies and action plans in the context of the 2030 Agenda for Sustainable Development, taking into
consideration any stakeholder conflicts of interests.
Action 2. Ensure effective national governance and coordination of activities of all relevant stakeholders in the
implementation of national strategies, action plans and policies to reduce the harmful use of alcohol.
Action 3. Collaborate with the WHO Secretariat on implementation of the Global Strategy and through
representation in WHO’s global and regional networks of national counterparts and (technical)
contributions to their working mechanisms, processes and structures.
Action 4. Document and share experiences and information on the development, implementation and
evaluation of multisectoral actions to reduce the harmful use of alcohol at national and subnational
levels.
Actions for the Secretariat
Action 1. Liaise and cooperate with major partners within the United Nations system and intergovernmental
organizations, and coordinate and develop collaborative activities through the functioning of
interagency working mechanisms on reducing harmful use of alcohol, including those established for
Mental Health and Noncommunicable Diseases.
Action 2. To provide support to the global and regional networks of WHO national counterparts and their
working mechanisms and procedures by ensuring regular information exchange and their effective
functioning. This includes the working groups or task teams addressing priority areas for reducing the
harmful use of alcohol.
Action 3. To facilitate dialogue and information exchange on the impact of international aspects of the alcohol
market on the alcohol-attributable health burden and advocate for appropriate consideration of these
aspects by parties in international trade negotiations.
Action 4. To support international collaboration and information exchange among public health-oriented NGOs,
academic institutions and professional associations, with a special focus on facilitating multisectoral
collaboration, ensuring policy coherence (with due consideration of differences in cultural contexts),
and support for strengthening the contributions of civil society organizations to alcohol policy
development and implementation.
Action 5. Every second year organize an international forum on reducing the harmful use of alcohol within the
WHO Forum on alcohol, drugs and addictive behaviours (FADAB) with participation of representatives
of Member States, United Nations entities and other intergovernmental and international
organizations, civil society organizations and professional associations, and support broader
representation of civil society organizations from low- and middle-income countries.
Action 6. Organize regular (each year or every second year, as required) global dialogues with economic
operators in alcohol production and trade focused on and limited to the industry’s contribution to
reducing the harmful use of alcohol within their roles as developers, producers and distributors/sellers
of alcoholic beverages.
Proposed actions for international partners and non-State actors
Action 1. Major partners within the United Nations system and intergovernmental organizations are invited to
include, as appropriate, implementation of the Global Strategy in their developmental strategies and
action plans, and to develop horizontal multisectoral programmes and partnerships to reduce the
harmful use of alcohol as a public health priority, in line with the guiding principles of the Global
Strategy.
Action 2. Civil society organizations, professional associations and academia are invited to prioritize and
strengthen their activities on reducing the harmful use of alcohol, by motivating and engaging their
stakeholders in implementation of the Global Strategy within existing partnerships or by developing
new collaborative frameworks, and by promoting and supporting, within their roles and mandates,
intersectoral and multisectoral collaboration and dialogue while monitoring and countering undue
influences from commercial vested interests that undermine attainment of public health objectives.
Action 3. Economic operators in alcohol production and trade are invited to focus on their core roles as
developers, producers, distributors, marketers and sellers of alcoholic beverages, and abstain from
interfering with alcohol policy development and evaluation.
Page 17
ACTION AREA 4: TECHNICAL SUPPORT AND CAPACITY-BUILDING
There is a need to increase the capacity and capability of countries to create, enforce and sustain
the necessary policy and legislative frameworks, develop infrastructure and sustainable
mechanisms for their implementation at national and subnational levels, and ensure that
implemented strategies and interventions are based on the best available scientific evidence and
best practices of their implementation accumulated in different cultural, economic and social
contexts. Implementation of alcohol policy measures at the country level according to the national
contexts, needs and priorities may require strong technical assistance, particularly in less-
resourced countries and in technical areas such as taxation, legislation, regulations for digital
marketing and their enforcement, or consideration of health protection from alcohol-related harm
in trade negotiations.
Global targets for Action area 4
Global target 4.1: 50% 5
of countries have increased capacity and infrastructure for
implementation of high-impact strategies and interventions to reduce the harmful use of alcohol.
Global target 4.2: 50%6
of countries have increased capacity to provide prevention and treatment
interventions for health conditions due to alcohol use in line with the principles of universal health
coverage.
Proposed actions for Member States
Action 1. Develop or strengthen technical capacity and infrastructure, including involvement of public health
civil society organizations, for implementation of high-impact strategies and interventions to reduce
the harmful use of alcohol and, when appropriate, collaborate with the WHO Secretariat on testing,
dissemination, implementation and evaluation of WHO technical tools, recommendations and training
materials.
Action 2. Document and share, in collaboration with WHO, good practices and examples of policy responses and
implemented measures to reduce harmful use of alcohol in different socioeconomic and cultural
contexts according to the 10 recommended target areas for policy options and interventions included
in the Global Strategy.
Action 3. Develop or strengthen the capacity of health professionals in health and social care systems to prevent,
identify and manage hazardous drinking7 and disorders due to alcohol use, and develop the capacity
of health and social care systems to ensure universal health coverage for people with alcohol use
disorders and comorbid health conditions.
Action 4. Support capacity-building of health professionals, public health experts and representatives of civil
society organizations, including mutual help groups and associations of affected individuals and their
family members, to advocate for, implement, enforce and sustain implementation of effective
measures to reduce the harmful use of alcohol, including support of education and training
programmes.
5
This figure is indicative and subject to adjustment after reanalysis of data from the relevant WHO
surveys. The baseline for this indicator is the year of endorsement of the action plan.
6
This figure is indicative and subject to adjustment after reanalysis of data from the relevant WHO
surveys. The baseline for this indicator is the year of endorsement of the action plan.
7
In ICD-11 “hazardous alcohol use” is defined as a “pattern of alcohol use that appreciably
increases the risk of harmful physical or mental health consequences to the user or to others to
an extent that warrants attention and advice from health professionals” (WHO, 2019).
Page 18
Actions for the Secretariat
Action 1. Collect, compile and disseminate through WHO information channels at global and regional levels
good practices and examples of policy responses and implemented measures to reduce the harmful
use of alcohol in Member States from around the world according to the 10 recommended target areas
for policy options and interventions, including legislative provisions; and develop and maintain global
and regional repositories of good practice and examples.
Action 2. Foster and strengthen global and regional networks of national technical counterparts by developing
capacity-building platforms in partnership with academia and civil society organizations with a focus
on particularly challenging areas such as: 1) digital marketing and social media advertising; 2)
protecting alcohol control within the context of supranational regulatory and legislative frameworks;
3) strengthening health service and social care responses; and 4) building up national monitoring
systems on alcohol and health.
Action 3. Develop, test and disseminate global evidence-based and ethical recommendations, standards,
guidelines and technical tools, including a protocol for comprehensive assessment of alcohol policies;
propose, as deemed necessary and according to WHO procedures, other normative or technical
instruments to provide normative and technical guidance on effective and cost-effective prevention
and treatment interventions in different settings; and provide support to Member States in
implementing the Global Strategy according to the 10 recommended target areas for policy options
and interventions.
Action 4. Develop the global country support network of experts and strengthen global coordination of relevant
activities of the WHO collaborating centres in order to increase the Secretariat’s capacity to respond
to Member States’ requests for support of their efforts to develop, implement and evaluate strategies
and programmes to reduce the harmful use of alcohol.
Action 5. Develop a global programme of training activities on priority areas for global action and target areas
for action at national level, and implement this programme by organizing and supporting global,
regional and intercountry workshops, seminars (including web-based seminars), online consultations
and other capacity-building activities.
Action 6. Support and conduct capacity-building projects and activities on planning and implementing research
and dissemination of research findings with a particular focus on alcohol policy research in low- and
middle-income countries, and data generation to produce reliable estimates of alcohol consumption,
alcohol-related harm and treatment coverage for alcohol use disorders.
Action 7. Reconvene the WHO Expert Committee on Problems Related to Alcohol Consumption for a
comprehensive review of the accumulated evidence on feasible and effective measures to address the
harmful use of alcohol, and provide recommendations on the way forward to strengthen
implementation of the Global Strategy.
Proposed actions for international partners and non-State actors
Action 1. Major partners within the UN system and intergovernmental organizations are invited to prioritize
technical assistance and capacity-building activities for accelerating implementation of the Global
Strategy in their developmental assistance and country support activities and plans.
Action 2. Civil society organizations, professional associations and research institutions are invited to develop
capacity-building activities at national and, if appropriate, international levels within their roles and
mandates. They are invited to contribute to capacity-building and provide technical assistance
activities undertaken by Member States, WHO or other international organizations in line with the
objectives and principles of the Global Strategy.
Action 3. Economic operators in alcohol production and trade are invited to implement capacity-building
activities within their sectors of alcohol production, distribution and sales, and refrain from
engagement in capacity-building activities outside their core roles that may compete with the activities
of the public health community.
ACTION AREA 5: KNOWLEDGE PRODUCTION AND INFORMATION
SYSTEMS
Production and dissemination of knowledge facilitates advocacy, policy prioritization and
evaluation, and supports overall global actions to reduce the harmful use of alcohol. International
collaborative research and knowledge production should focus on the generation of data that are
Page 19
highly relevant to the development and implementation of alcohol policies. Effective monitoring
of levels and patterns of alcohol consumption in populations and of alcohol-related harm,
including alcohol-attributable disease burden, is of utmost importance for monitoring progress of
implementation of the Global Strategy at national, regional and global levels, and should be
conducted in conjunction with monitoring implementation of alcohol policy measures. Effective
monitoring of alcohol consumption, alcohol-related harm and policy responses requires
streamlined data generation, collection, validation and reporting procedures that will allow
regular updates of country-level data at 1–2-year intervals with minimized time lags between data
collection and reporting. Effective monitoring of treatment coverage for alcohol use disorders not
only requires these actions but better methods of monitoring treatment coverage, all within the
framework of universal health coverage.
Significantly more resources are required for investment in international research on alcohol
policy development and implementation in low- and middle-income countries, on the reasons for
uneven implementation of alcohol policy measures in different jurisdictions, with quantitative and
qualitative analyses of barriers, enabling factors and the impact of different policy options, as well
as in different population groups.
Research, including international research projects, is needed on the role of alcohol consumption
in the transmission, progression and treatment outcomes of some infectious diseases, on harm to
others from drinking, on the impact of the harmful use of alcohol on child development and
maternal health, as well as on the consumption of informally and illegally produced alcohol and
its health consequences. International studies are needed on effective ways to increase the health
literacy of people who consume alcohol. Studies on the costs and benefits of alcohol control
measures and development of investment cases can help to overcome resistance to effective
alcohol control measures in view of financial and other revenues associated with alcohol
production and trade.
Global targets for Action area 5
Global target 5.1: By 2030, 75% of countries have data generated and regularly reported at the
national level on alcohol consumption, alcohol-related harm and implementation of alcohol
control measures.
Global target 5.2: By 2030, 50% of countries have a core set of indicators and national data for
monitoring progress on attainment of universal health coverage for alcohol use disorders and
major health conditions due to alcohol use.
Proposed actions for Member States
Action 1. Support the generation, compilation and dissemination of knowledge on the magnitude and nature of
public health problems caused by the harmful use of alcohol and effectiveness of different policy
options, and undertake activities for informing the general public about health risks associated with
alcohol consumption.
Action 2. In coordination with relevant stakeholders, develop or strengthen national monitoring systems for
monitoring alcohol consumption, its health and social consequences, and respective policy responses,
in line with the SDGs and WHO indicators and their definitions.
Action 3. Establish national monitoring centres or other appropriate institutional entities with responsibility for
collecting and compiling national data on alcohol consumption, alcohol-related harm and policy
responses, as well as monitoring trends and reporting regularly to WHO’s regional and global
information systems on alcohol and health.
Action 4. Include alcohol modules in data collection tools used in population-based surveillance activities at
national and subnational levels to facilitate international comparisons.
Action 5. Collaborate with the WHO Secretariat on global surveys on alcohol and health by collecting, collating,
validating and reporting the required information, and including relevant questions on alcohol
consumption and alcohol-related harm in national surveillance tools and activities.
Page 20
Action 6. Document, collate and disseminate practical experiences with the implementation of alcohol policy
measures and interventions, and support and promote evaluation of their effectiveness, cost-
effectiveness and impact on alcohol-attributable harm in order to document feasibility, effectiveness
and cost-effectiveness of policy measures in different contexts.
Actions for the Secretariat
Action 1. Maintain and further develop the WHO Global Information System on Alcohol and Health (GISAH) and
regional information systems by developing and integrating indicators for monitoring implementation
of the Global Strategy, further operationalization and standardization of GISAH indicators,
coordination of data collection activities at all levels, and bringing together information on the
effectiveness and cost-effectiveness of policy measures and interventions to reduce the harmful use
of alcohol and public health problems attributable to alcohol.
Action 2. Support capacity-building for research, monitoring and surveillance on alcohol and health by
establishing and supporting global and regional research networks, training and supporting data
collection, analysis and dissemination.
Action 3. Prepare and implement during the period 2022-2030 at least three waves of data collection on alcohol
consumption, alcohol-related harm and alcohol policies from Member States through the WHO Global
Survey on Alcoholand Health (tentatively in 2022, 2025 and 2028) and from other relevant information
sources. Also, use computerized data collection tools and web-based data collection platforms, and
disseminate information through GISAH, regional information systems and global and regional status
reports on alcohol and health. Whenever necessary, organize data consensus workshops for improving
the quality of data.
Action 4. Constantly review, analyse and disseminate emerging scientific evidence on the magnitude and nature
of public health problems attributable to alcohol consumption as well as on the effectiveness and cost-
effectiveness of policy measures and interventions. This includes meetings of the technical advisory
group on alcohol and drug epidemiology.
Action 5. Continue to generate comparable data on alcohol consumption, alcohol-related mortality and
morbidity, and estimates of alcohol-attributable burden within the comparative risk assessment and
global burden of disease estimates.
Action 6. Continue and further develop collaboration with international and United Nations agencies on data
collection and analysis as well as continue dialogue and information exchange with alcohol producers
and industry-supported research groups and organizations to improve the coverage and quality of data
on alcohol consumption and availability of alcoholic beverages at global, regional and national levels.
Action 7. Promote and support priority setting for international research on alcohol and health as well as specific
international research projects in low- and middle- income countries with a particular focus on the
epidemiology of alcohol consumption and alcohol-related harm, evaluation of policy measures and
interventions in health services, comparative effectiveness research, and the relationship between
harmful use of alcohol and social and health inequities. Initiate and implement in selected low- and
middle-income countries international research projects on harm to other than drinkers, including
research on fetal alcohol spectrum disorders.
Action 8. Develop methodology, core indicators, computerized data collection tools and support generation of
comparable data on implementation of effective policy measures at national level using the system of
indices and scores, and support information and experience sharing among countries, particularly with
similar socio-economic and cultural contexts.
Proposed actions for international partners and non-State actors
Action 1. Major partners within the United Nations system and intergovernmental organizations are invited to
support knowledge generation and monitoring activities on alcohol and health at all levels, including
alcohol policy research, to work with WHO on harmonization of indicators and data collection tools,
and to support national monitoring capacities in line with reporting commitments for the major
international monitoring frameworks.
Action 2. Civil society organizations, professional associations and research institutions are invited to support
WHO efforts on data collection and analysis to improve the coverage and quality of data on alcohol
consumption, alcohol-related harm, policy responses and treatment coverage for alcohol use
disorders at global, regional and national levels, and to support countries in their efforts to build and
strengthen research and monitoring capacities in this area.
Action 3. Economic operators in alcohol production and trade are invited to disclose, with due regard of
limitations associated with confidentiality of commercial information, data of public health relevance
that can contribute to improvement of WHO estimates of alcohol consumption in populations, such as
data on production and sales of alcoholic beverages and data on consumer knowledge, attitudes and
preferences regarding alcoholic beverages.
Page 21
ACTION AREA 6: RESOURCE MOBILIZATION
Lack of resources presents a primary barrier to introducing or accelerating global and national
actions to reduce the harmful use of alcohol. Adequate resources need to be mobilized at all levels
for implementation of the Global Strategy, namely for: 1) development, implementation and
monitoring of alcohol policies in low- and middle-income countries; 2) international collaboration
and research in this area; and 3) civil society engagement at the international level to reduce
harmful use of alcohol. Such resources are not limited to funding, although this is a priority, but
also include human resources and workforce capacity, appropriate infrastructures, international
cooperation and partnerships.
The lack of resources to finance alcohol control measures, as well as programmes and
interventions for prevention and treatment of substance use disorders, requires innovative
funding mechanisms if the related targets of the Sustainable Development Goals are to be met.
Several innovative approaches that combine evidence-based knowledge with more unorthodox
ideas have been reported across countries and at the international level. There are existing
examples of revenues from taxes on alcoholic beverages being used to fund health-promotion
initiatives, health coverage of vulnerable populations, prevention and treatment of alcohol and
substance use disorders and, in some cases, support to international work in these areas. In some
jurisdictions, earmarked funding for the prevention and treatment of alcohol use disorders and
related conditions is provided with funds generated from state-owned retail monopolies, a levy
on profits across the value chains for alcoholic beverages, taxing alcohol advertising, or fines for
noncompliance with alcohol regulations. Consideration should be given to an intergovernmental
commitment to a global tax on alcohol to support this effort, with the use of the money raised to
be governed internationally.
Global targets for Action area 6
Global target 6.1: 50% of countries8
have increased available resources for reducing the harmful
use of alcohol and increasing coverage and quality of prevention and treatment interventions for
disorders due to alcohol use and associated health conditions.
Global target 6.2: An increased number of countries with earmarked funding from alcohol tax
revenues for reducing the harmful use of alcohol and increasing coverage and quality of
prevention and treatment interventions for disorders due to alcohol use and associated health
conditions.
Proposed actions for Member States
Action 1. Increase allocation of resources, including international and domestic financial resources generated
by new or innovative ways and means to secure essential funding, for reducing the harmful use of
alcohol and increasing coverage and quality of prevention and treatment interventions according to
the scope and nature of public health problems caused by harmful use of alcohol.
Action 2. Consider the development and implementation of earmarked funding or contributions from alcohol
tax revenues or other revenues linked to alcohol beverage production and trade for reducing the
harmful use of alcohol and increasing coverage and quality of prevention and treatment interventions
for disorders due to alcohol use and associated health conditions.
Action 3. Increase the resources available for implementation of the Global Strategy and action plan by
mainstreaming alcohol policy options and interventions in public health and developmental activities
8
The baseline for this indicator is the year of endorsement of the action plan.
Page 22
in other areas such as maternal and child health, violence prevention, road safety and infectious
diseases.
Action 4. Participate in and support international collaboration to increase resources available for accelerating
implementation of the Global Strategy and action plan to reduce the harmful use of alcohol and
support provided to low- and middle-income countries in developing and implementing high-impact
strategies and interventions.
Action 5. Promote and support resource mobilization for implementation of the Global Strategy and action plan
to reduce the harmful use of alcohol in the framework of broad developmental agendas such as the
2030 Agenda for Sustainable Development and responses to health emergencies such as the COVID-
19 pandemic.
Action 6. Share experiences at the international level, including with the WHO Secretariat and other
international organizations, of good practice in financing policies and interventions to reduce the
harmful use of alcohol.
Actions for the Secretariat
Action 1. Collect, analyse and disseminate experiences and good practices in financing policies and interventions
to reduce harmful use of alcohol and implement new or innovative ways and means to secure
adequate funding for implementation of the Global Strategy at all levels.
Action 2. Develop and disseminate technical tools and information products in support of efforts to increase the
resources available for reducing the harmful use of alcohol and increasing coverage and quality of
prevention and treatment interventions for disorders due to alcohol use and associated health
conditions.
Action 3. At global and regional levels, monitor allocation of resources for the implementation of the Global
Strategy and action plan.
Action 4. Promote and support pooling of resources and their effective use by better coordination and
intensified collaboration between different programme areas within WHO, United Nations agencies
and other international partners.
Action 5. Promote allocation of resources for alcohol policy development and implementation of the Global
Strategy and action plan in bilateral and other cooperation agreements with donor countries and
agencies.
Action 6. Intensify fundraising efforts to support implementation of the Global Strategy in low- and middle-
income countries by organizing donor conferences and meetings of interested parties.
Proposed actions for international partners and non-State actors
Action 1. Major partners within the United Nations system and intergovernmental organizations are invited to
mainstream their efforts to reduce the harmful use of alcohol in their developmental and public health
strategies and action plans and to promote and support financing policies and interventions to ensure
the availability of adequate resources for accelerated implementation of the Global Strategy while
maintaining independence from funding from alcohol producers and distributors.
Action 2. Civil society organizations, professional associations and research institutions are invited to promote
and support new or innovative ways and means to secure required funding and to facilitate
collaboration of the finance and health sectors to ensure mobilization, allocation and accountability of
the resources necessary to reduce the harmful use of alcohol and accelerate implementation of the
Global Strategy at all levels.
Action 3. Economic operators in alcohol production and trade are invited to allocate resources for
implementation of measures that can contribute to reducing the harmful use of alcohol within their
core roles, and to refrain from direct funding of public health and policy-related research to prevent
any potential bias in agenda-setting emerging from the conflict of interest, and cease sponsorship of
scientific research for marketing or lobbying purposes.
Page 23
ANNEX 1: INDICATORS AND MILESTONES FOR ACHIEVING GLOBAL
TARGETS
Global targets Indicators Milestones Comments
1.1. 75% of countries have
strengthened and
sustainably enforced
implementation of high-
impact policy options and
interventions.
Composite indicator for
monitoring
implementation of high-
impact policy options and
interventions (to be
developed).
2019
2022
2023
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
1.2. At least x% relative
reduction in alcohol per
capita (15 years and older)
consumption achieved by
2025 and x% relative
reduction by 2030.9
Total alcohol per capita
consumption defined as
the total (recorded plus
estimated unrecorded
alcohol) alcohol per capita
(aged 15 years and older)
consumption within a
calendar year in litres of
pure alcohol, adjusted for
tourist consumption.
2010
2016
2019
2022
2023
2024
2028
2030
Annual WHO
estimates produced
on the basis of data
submitted by
Member States and
generated through
WHO global and
regional monitoring
and surveillance
activities.
1.3. By 2030, 80% of the
world population are
protected from the harmful
use of alcohol by sustained
implementation and
enforcement of high-impact
policy options with due
consideration of national
contexts, priorities and
available resources.
The size of the world
population (as a
percentage of the world
population) living in
countries which have
enacted and enforced
effective and cost-
effective strategies and
interventions to reduce
the harmful use of
alcohol. Full
operationalization of the
indicator to be developed.
2016
2019
2022
2023
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
9
The target figures for this indicator are to be defined on the basis of analysis of the WHO data on
alcohol consumption.
Page 24
2.1: By 2030, 75% of
countries have developed
and enacted a written
national alcohol policy that is
based on best available
evidence and supported by
legislative measures for
effective implementation of
high-impact strategies and
interventions.
Number of countries (as a
percentage of all WHO
Member States) with a
written and enacted
national alcohol policy,
supported by required
legislative measures.
2019
2022
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health and the
WHO NCD country
capacity survey.
2.2: By 2030, 50% of
countries produce periodic
national reports on alcohol
consumption, alcohol-
related harm and effective
policy responses targeting
decision-makers and the
general public.
Number of countries (as a
percentage of all WHO
Member States)
producing at least two
national reports within
the last 8-year period on
alcohol consumption,
alcohol-related harm and
written national alcohol
policy, including legislative
measures.
2022
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
3.1: x%10
of countries have
established and functioning
national and subnational
multisectoral partnerships
for implementation of
effective alcohol control
measures.
Number of countries (as a
proportion of all WHO
Member States) with
established and
multisectoral partnerships
for implementation of
effective alcohol control
measures (including the
number of countries
implementing the SAFER
initiative). Full
operationalization of the
indicator to be developed.
2022
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
10
The figure is to be defined on the basis of reanalysis of data from the relevant WHO surveys.
Page 25
3.2: 75% of countries are
engaged in the work of the
global and regional
networks of WHO national
counterparts for
international dialogue and
coordination on reducing
the harmful use of alcohol.
Number of countries (as a
proportion of all WHO
Member States) actively
represented in the global
and regional networks of
WHO national
counterparts.
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Information from
WHO regional
offices and
Headquarters
collated on the
annual basis.
4.1: 50% of countries have
increased capacity and
infrastructure for
implementation of high-
impact strategies and
interventions to reduce the
harmful use of alcohol.
Number of countries (as a
proportion of all WHO
Member States) that have
increased capacity and
infrastructure for
implementation of high-
impact strategies and
interventions to reduce
the harmful use of alcohol
(including the number of
countries implementing
the SAFER initiative).
Composite indicator with
operationalization to be
developed.
The baseline for this
indicator is the year of
endorsement of the action
plan.
2022
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
The figure is
indicative and
subject to
adjustment after
reanalysis of data
from the relevant
WHO surveys.
4.2: 50% of countries have
increased capacity to
provide prevention and
treatment interventions for
health conditions due to
alcohol use in line with the
principles of universal
health coverage.
Number of countries (as a
proportion of all WHO
Member States) that have
increased capacity to
provide prevention and
treatment interventions
for health conditions due
to alcohol use in line with
the principles of universal
health coverage. The work
on this indicator as a
proxy measure for
treatment coverage for
alcohol use disorders and
related health conditions
is currently in progress.
The baseline for this
indicator is the year of
2019
2022
2025
2028/9
Data collected
through WHO global
survey on progress
towards attainment
of SDG health target
3.5 on prevention
and treatment of
substance abuse.
This figure is
indicative and
subject to
adjustment after
reanalysis of data
from the relevant
WHO surveys.
Page 26
endorsement of the action
plan.
5.1: By 2030, 75% of
countries have data
generated and regularly
reported at the national
level on levels and patterns
of alcohol consumption,
alcohol-related harm and
implementation of alcohol
control measures.
Number of countries (as a
proportion of all WHO
Member States) that
generate and report
national data on per
capita alcohol
consumption, alcohol-
related harm and policy
responses.
2019
2022
2025
2028/9
Passive literature
surveillance and
data collected
through WHO global
surveys on alcohol
and health and
progress with
attainment of SDG
health target 3.5;
data collected
through activities
undertaken for SDG
3.5.2 monitoring.
5.2: By 2030, 50% of
countries have a core set of
indicators and national data
generated at national level
for monitoring progress
with attainment of universal
health coverage for alcohol
use disorders and major
health conditions due to
alcohol use.
Number of countries (as a
proportion of all WHO
Member States) that have
a core set of agreed
indicators and generate
and report national data
on treatment coverage
and treatment capacity
for alcohol use disorders
and related health
conditions, alcohol-
related harm and policy
responses.
2019
2022
2025
2028/9
Passive literature
surveillance and
data collected
through WHO global
survey on progress
towards attainment
of SDG health target
3.5; data collected
through activities
undertaken for SDG
3.5.1 monitoring.
6.1: 50% of countries have
increased or ensured
appropriate levels of
available resources for
reducing the harmful use of
alcohol and increasing
coverage and quality of
prevention and treatment
interventions for disorders
due to alcohol use and
associated health
conditions.
Number of countries (as a
proportion of all Member
States) that have
increased or ensured
appropriate levels of
available resources to
finance alcohol control
measures and
interventions for reducing
the harmful use of alcohol
and increasing coverage
and quality of prevention
and treatment
interventions for disorders
due to alcohol use and
associated health
conditions.
The baseline for this
indicator is the year of
endorsement of the action
plan.
2022
2025
2028/9
Data collected
through WHO global
survey on alcohol
and health, SAFER
monitoring and
other relevant
activities
undertaken at the
global and regional
levels.
Page 27
6.2: An increased number of
countries with earmarked
funding from alcohol tax
revenues for reducing the
harmful use of alcohol and
increasing coverage and
quality of prevention and
treatment interventions for
disorders due to alcohol use
and associated health
conditions.
Number (absolute) of
countries that have
introduced earmarked
funding from alcohol tax
revenues for reducing the
harmful use of alcohol and
increasing coverage and
quality of prevention and
treatment interventions
for disorders due to
alcohol use and associated
health conditions.
2022
2025
2028/9
Data collected
through WHO global
surveys on alcohol
and health and
progress towards
attainment of SDG
health target 3.5;
data collected
through activities
undertaken for SDG
3.5.1.
Page 28
ANNEX 2: WHO EXECUTIVE BOARD DECISION EB146(14)
EXECUTIVE BOARD EB146(14)
146th session 7 February 2020
Agenda item 7.2
Page 29