Alcohol policies in low- and middle-income countries: Do they work?

Background: With much of the evidence for the effectiveness of alcohol policies coming from high-income countries (HICs), there is a paucity of research that evaluates the effectiveness of alcohol policies in low- and middle-income countries (LMICs). Since alcohol use may pose greater health risks in LMICs (especially in emerging economies) than in HICs, it is important to improve understanding of what specific policies might be effective.

Methods: Alcohol policy data compiled by the World Health Organization and individual-level alcohol consumption data collected in 15 LMICs in the Gender, Alcohol, and Culture: An International Study (GENACIS) study were used. Using multi-level modeling, we investigated whether alcohol consumption in LMICs was inversely associated with more restrictive alcohol policies in four policy domains.

Results: Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a government monopoly or licensing system for off-premise alcohol retail sales, were the most consistent predictors of alcohol consumption in LMICs. The high level of aggregate relative alcohol prices was also inversely associated with all drinking outcomes. Restrictions on alcohol advertising were inversely associated with three outcomes, current drinking, usual frequency and total drinking volume. Restrictions on motor vehicles operation were associated only with current drinking in the opposite direction than hypothesized.

Conclusions: Some alcohol policies found effective in HICs, particularly those that regulate the physical availability of alcohol, may also work in LMICs. Public health infrastructures to develop and implement comprehensive alcohol policies in LMICs are needed.