Comparing Alcohol Policies Between Countries: Science or Silliness?

I t seems self-evident that it would be useful to have a way of comparing alcohol policies between countries. A metric to compare countries would enable improvements or changes to be monitored; create benchmarks for comparative purposes; and potentially improve policy effi ciency and effectiveness. Indeed, the World Health Organization (WHO) in its alcohol policy report notes that " …it would be useful to develop a scientifi c way to measure and to evaluate overall policy comprehensiveness " [1]. But it seems that the endeavour is fraught. The multiplicity of problems— conceptual, methodological, and political—lead some researchers and policy makers to conclude that the effort is not worth pursuing. For those brave or foolhardy enough to persist, including Brand and colleagues who now report their fi ndings in PLoS Medicine [2], there are a number of different ways of approaching a common metric. Inputs (such as government spending), outcomes (such as consumption or harm), and policy statements can all be measured and compared. Each of these different approaches has strengths and weaknesses, without a clear front-runner. Government spending. The " inputs " approach is best characterised by government spending estimates. Measuring government expenditure is one clear way of comparing countries. Indeed, such comparative work has been reported in the literature [3–6]. Interestingly, this work has largely been conducted in the area of illicit drugs, not in the area of alcohol. Drug budgets are a " useful partial description of a nation's drug policy " [5]. The national drug budget can be used to calculate what proportion of a country's gross domestic product is spent on drug policy, enabling country comparisons. And the development of a shared methodology across research teams and countries means that this comparative work is now more sophisticated [6]. However, it has its limitations—for example there is no agreement as to what aspects of government spending should be included [6]. Cost-of-illness. The greatest criticism of the government spending approach is that it is merely measuring " inputs " , not the consequences of the policies. An alternate approach is that termed cost-of-illness, where the societal cost consequences of drug use (alcohol, tobacco, and/or illicit drugs) are calculated. Again there are a number of methodological stumbling blocks, but much work has been performed internationally to establish agreed-upon methodological standards for the conduct of such studies. In 2003, the WHO published the " International Guidelines for Estimating the Costs …