Table 1
Recommendations for alcohol use by target groups.
| TARGET GROUP | WHAT IS THE RECOMMENDATION? | JUSTIFICATION FOR RECOMMENDATION |
|---|---|---|
| People living with cardiovascular diseases and other chronic illnesses | Abstinence | Alcohol increases the risk for hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, and strokes. It is attributed in many other infectious and non-infectious diseases as well. |
| Pregnant women or those who are breastfeeding | Abstinence | Consumption of alcohol during pregnancy has been linked with Foetal Alcohol Syndrome [29], which is a combination of physical, behavioural and learning abnormalities in the new-born child. For mothers who are breastfeeding, no level of alcohol is safe for their babies. |
| Children and young people | Abstinence | Heavy drinking during adolescence and young adulthood is associated with lower neuro-cognitive functioning during the young adult years and particularly with impairment of attention and visio-spatial skills [30]. Early onset of alcohol use increases the risk of poor health outcomes, poor academic outcomes, and other problems during adolescence as well as a risk of developing an alcohol use disorder later on in life. The brain of an individual develops until the age of 25 years and alcohol use during this period negatively affects the brain [30]. |
| Adults with no underlying health conditions | For abstainers: Not advised to start drinking For drinkers: There are no safe recommended levels of alcohol consumption – those who drink are advised to reduce their consumption for overall health. | Alcohol consumption negatively affects mental and physical health and is also linked with poorer quality of life and poverty. Even in smaller quantities, alcohol consumption can increase the risk of breast cancer. It can cause more severe motor and cognitive dysfunction in women at much lower levels of consumption than men. |
| National societies and organizations must play a central role in advocating for stricter alcohol control measures. The voices of public evidence-based, public health-oriented agents are essential to ensuring the achievement of the Sustainable Development Goals and ultimately health equity. To begin with, all such actors should uniformly indicate the evidence on alcohol consumption and heart health. Ministries should implement strict regulatory measures to dissuade direct and indirect impacts of alcohol use (see Table 2). Finally, national cardiology societies and foundations can play the following roles for ensuring reduction in alcohol use and its related harms:
|  |
Table 2
Alcohol Policy – Best Practices.
| MEASURE | WHY IMPLEMENT IT? | COUNTRY BEST PRACTICE | |
|---|---|---|---|
| WHO SAFER Best Buys [31] | Strengthen restrictions on alcohol availability | Restrictions on availability of unhealthy substances have proven to be cost-effective best-buy interventions for non-communicable disease prevention. | South Africa’s Liquor Amendment Bill prohibits licensed distributors from selling alcohol to unlicensed establishments [33]. |
| Advance and enforce drink driving countermeasures | Road traffic injuries are a rising and major cause of death and disability, especially among young adults. In high income countries, 20% of fatally injured drivers were found with excess blood alcohol content, and 33%-69% of road traffic fatalities in low-income countries were attributed to alcohol use. | A cluster of best practices were identified in Lithuania, where policies such as increase in excise taxes on alcoholic products, increase in legal minimum purchasing and drinking age, and a full ban of alcohol advertisements led to a decrease in road traffic injuries over time [34]. | |
| Facilitate access to screening, brief interventions, and treatment | Evidence indicates that imparting brief advice within primary care settings is a successful intervention to reduce alcohol use and prevent or mitigate progression to alcohol use disorder and addiction. Behavioural and pharmacological therapies have shown to be effective treatments for alcohol use disorder. | A randomized control trial conducted in South Africa showed a positive effect of alcohol screening and intervention using health education leaflets at the beginning of anti-tuberculosis treatment in primary care setting [35]. In the Russian Federation, the Federal Law on Healthcare includes the provision of primary specialised care to people at risk of alcohol abuse, as well as those who indulge in harmful use of alcohol. The law was amended to include a focus on both prevention and treatment. With the recent revision of the law in 2019, the country offers ‘narcology’ specialists in primary healthcare facilities and strict anonymity to patient [36]. | |
| Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion | Restricting alcohol advertisement is important to decrease the incidence of alcohol use, considering the impact of these advertisement on adolescents and young people. Advertising bans will prevent adolescents and young adults from being exposed to alcohol and will prevent the alcohol industry from influencing social norms through wrongful depictions in their advertisements. | France’s Loi Evin (Evin’s Law) is a partial ban and includes comprehensive regulation of alcohol advertising, promotion, and sponsorship [37]. Finland is one of the first countries to ban alcohol advertisements on social media [33]. | |
| Raise prices on alcohol through excise taxes and other fiscal policies | Increasing taxes on harmful substances increases their selling cost and subsequently decreases the affordability of such substances. Increasing taxes has been shown to be strongly associated with decrease in alcohol consumption and alcohol-related harms. | In South Africa, the taxation structure has changed from unitary taxes (based on the volume of the alcoholic beverage) to specific volumetric taxes (based on the ethanol content of the alcoholic beverage). As a result, there has been a shift in advertising to low-alcohol beers as they become more profitable to produce [38]. | |
| Other Good Practices | Establish and enforce a uniform minimum legal drinking age | Increase in legal age to drink alcohol has been found to lead to less drinking in adolescence and subsequently moderate drinking patterns and less frequent harmful drinking patterns as adults. | The increase in the minimum legal drinking age in the USA has been associated with reduced suicide mortality and reduced night-time road traffic fatalities among 18–20 year olds by 17% [39]. |
| Mandate prominent health warnings on alcohol products | Studies have shown that putting health warnings on alcohol products was associated with an increase in perceptions of health risks of consuming alcohol, as well as greater intentions to reduce and quit alcohol consumption. | The Eurasian Economic Union’s technical regulation mandates provision of an ingredients list, health information, and an additional message of ‘recommendatory nature’ to be put on all types of alcoholic beverages intended for human use [40]. |