Less alcohol, lower risk: in conversation with Rafn M. Jónsson

Alcohol has been part of social and cultural life across Europe for generations, from celebrations and traditions to everyday social occasions. At the same time, its effects on health are well established. Alcohol is linked to cancer, cardiovascular disease, liver disease, injuries, mental health harms and wider impacts on families and communities.

The prevention message is straightforward: less alcohol means lower risk. But alcohol-related harms are not determined by individual choices alone. Price, physical availability, marketing, social norms, commercial interests and access to support all influence the pattern of consumption and who is most affected.

The recently launched JA PreventNCD prevention campaign builds on this approach. Its aim is to provide clear, accessible, and evidence-based guidance on prevention while recognising that better health depends on both individual action and the conditions in which choices are made. The campaign therefore provides practical information for the general public on how drinking less can support health and wellbeing, alongside evidence-based guidance for policymakers on the measures that can reduce alcohol-related harm across the population.

To explore what this means in practice, we spoke with Rafn M. Jónsson, Project Manager at the Directorate of Health, Iceland, and Thematic Coordinator for Alcohol in JA PreventNCD, about alcohol and health, what we already know works, the conditions that shape alcohol consumption, and how Europe can strengthen prevention.

Alcohol is so normalised in many European societies that its health effects can sometimes be overlooked. What is the most important thing you would like people to understand about alcohol and health?

I think it is important to start with the known fact and to remind us that alcohol is no ordinary commodity. Its availability and consumption should be limited as much as possible. So, the important message is a simple one: less alcohol means lower risk.

There can be a tendency to think about alcohol-related harm mainly in terms of very heavy drinking or alcohol dependence. These are important issues, but they are not the whole picture. Alcohol is linked to a wide range of health harms, including several types of cancer, cardiovascular and liver disease, injuries and mental health problems. When it comes to cancer, there is no level of alcohol consumption that is completely without risk.

It is also important to understand that the type of drink does not remove that risk. Beer, wine and spirits all contain alcohol, and alcohol itself contributes to health risk. Messages suggesting, for example, that some alcoholic drinks are inherently good for health can create confusion and distract from the more straightforward evidence that alcohol is harmful and reducing alcohol consumption reduces risk.

Some people do not drink, some would like to drink less, and others may need support to reduce or stop.

The role of public health is to make sure people have clear and reliable information about risk, that healthier choices are supported, and that help is available when people need it.

Alcohol prevention can be politically and socially challenging. But do we actually know what works, and how quickly can effective policies make a difference?

Yes. This is an important point because the complexity of alcohol policy should not be confused with uncertainty about what works.

The evidence base is strong. The World Health Organization has identified a set of highly cost-effective interventions for preventing and controlling NCDs, known as the Best Buys. For alcohol, these include increasing excise taxes, restricting exposure to alcohol advertising, and reducing the physical availability of retailed alcohol, for example through limits on hours of sale.

Other recommended measures include drink-driving policies, brief interventions to support people in reducing alcohol use, minimum-age restrictions, reduced outlet density, restrictions on promotions and sponsorship, health warnings, and access to treatment and care.

More recently, a 2025 analysis by researchers from WHO/Europe and academic partners introduced the concept of “Quick Buys”: cost-effective NCD interventions where measurable population-health effects can be seen within five years. The idea adds another consideration for policymakers, who often need to demonstrate progress within relatively short political cycles.

Alcohol provides a particularly striking example. The analysis found evidence of immediate effects on alcohol consumption from increasing excise taxes, restricting alcohol advertising and reducing the physical availability of alcohol.

This matters because there can sometimes be an assumption that prevention means investing now and waiting many years before seeing results. In reality, some of the measures we already know are effective can begin producing measurable change very quickly.

Of course, that does not mean they are necessarily easy to implement. The Quick Buys authors make an important distinction: quick does not mean easy. These are interventions capable of producing rapid population benefits, but they may still require difficult political decisions and effective implementation.

So increasingly, the central challenge is not identifying what might work. We already have strong evidence and established policy tools. The challenge is implementation, enforcement and sustaining the political commitment to use them.

If the evidence is this strong, why can effective alcohol policy still be so difficult to implement?

One reason is that public health objectives and commercial incentives do not always point in the same direction.

We know, for example, that reducing the physical availability of alcohol is an effective population-level measure. This can mean where alcohol is sold, when it is sold and how easily it can be purchased. WHO identifies restrictions on availability as one of its Best Buys for alcohol prevention, and the evidence shows that changes in availability can affect alcohol consumption quickly.

At the same time, commercial developments can move in the opposite direction. New business models and ways of marketing may make alcohol increasingly convenient to obtain, for example through expanded sales channels, online purchasing or delivery directly to people's homes. From a commercial perspective, increasing convenience and availability can increase sales. From a public health perspective, however, we need to consider what that greater availability means for consumption and alcohol-related harm.

This does not mean that every new way of selling alcohol should automatically be treated in exactly the same way. But it does mean that policymakers should assess these developments against the evidence we already have rather than assuming that greater convenience is neutral from a public health perspective.

The same tension exists with price and marketing. Public health evidence supports measures that reduce affordability and exposure to promotion, while commercial actors naturally have an interest in keeping their products attractive, visible, accessible and competitive. JA PreventNCD's prevention guidance specifically identifies pricing, retail availability, marketing, sponsorship, lobbying and public narratives as commercial factors shaping alcohol consumption and policy.

This is where the commercial determinants of health become important. Alcohol policy is not developed in a vacuum. Governments are making decisions in an environment where businesses, consumers, public health authorities and other stakeholders may have different priorities and interests.

The role of public health policy should therefore be to keep the evidence and the protection of population health at the center of decision-making. We already know that price, availability and marketing matter. The challenge is ensuring that new commercial practices and market developments do not gradually undermine measures that have been shown to reduce harm.

Protecting children and young people is a clear priority. What is JA PreventNCD learning about the gap between alcohol laws on paper and what happens in practice?

This is an area where work within JA PreventNCD has produced some very tangible findings.

In Slovenia, a mystery-shopping study looked at whether age restrictions on alcohol and tobacco sales were actually being respected. The results were concerning: 70% of underage mystery shoppers were able to buy alcohol in physical stores, while nearly 90% successfully purchased alcohol from online retailers.

That tells us something very important. Having legislation is necessary, but legislation only protects young people if it is implemented and enforced.

We have seen the same implementation question explored in Cantabria, Spain. Following work with students, 13% of the minors surveyed reported that they had purchased alcohol from commercial establishments while underage. The local JA PreventNCD team responded by working with municipalities and retailers to reinforce compliance with the law and make the responsibility of sellers more visible.

These examples show different sides of prevention. We need strong rules, but we also need monitoring, enforcement and community involvement.

Online sales deserve particular attention because they can create additional challenges around age verification and access. This connects directly with the wider question of availability we have just discussed. In addition, home delivery can extend the drinking time and the amount of alcohol consumed.

Protecting young people therefore cannot rely simply on telling them not to drink. Public authorities, retailers, policymakers, communities and families all have responsibilities for creating environments in which existing protections actually work.

Alcohol is described as a cross-cutting theme in JA PreventNCD. What does that mean in practice?

Alcohol is a very good example of why prevention cannot be contained within one intervention or one part of a public health project.

Within JA PreventNCD, different areas approach alcohol from different perspectives. Our work on regulation and taxation includes alcohol regulation, e-commerce and online sales, fiscal policy, warning labels, advertising and digital marketing. Our work on healthy living environments looks at how settings and communities can reduce exposure to unhealthy products such as alcohol.

Our work on Health in All Policies considers alcohol beyond the health sector and examines how policies and decisions elsewhere in government can support or undermine prevention. There are also important perspectives on social inequalities and identifying individuals at risk, because population-level measures need to work alongside approaches for people and groups experiencing greater harm or requiring more individualised support.

That means JA PreventNCD addresses alcohol both at the societal and individual level, and through strategies aimed at the whole population as well as people at higher risk.

As a cross-cutting theme coordinator, part of the role is to help connect those different perspectives and identify where work taking place in different areas of the Joint Action can reinforce one another.

The value is in seeing the whole picture: what shapes alcohol consumption, what policies can change those conditions, who experiences the greatest harm, whether the regulations are actually working in practice, and what additional support people may need.

No single intervention can address all of that, which is why coordination matters.

Alcohol-related harm is not distributed equally. How should equity influence prevention policy?

Alcohol can affect people across society, but its consequences are not distributed equally.

People facing social and economic disadvantage can experience greater alcohol-related harm, even at similar or sometimes lower levels of consumption. Income, working conditions, mental health, family circumstances, social environments and access to healthcare and support can all influence both risk and outcomes.

This is why we should be careful about framing alcohol-related harm simply as the result of irresponsible individual behavior. That can increase stigma while overlooking the conditions that influence people's lives.

An equitable approach asks questions such as: Who is most exposed to alcohol marketing? Where are cheap products most readily available? Who has access to early advice or treatment? Which communities experience the greatest consequences of alcohol harm? And will a new policy reduce or increase existing inequalities?

Population-wide policies are important because they can change the environment for everyone. But they should be combined with accessible and proportionate support for people and communities experiencing greater harm.

The objective is not simply only to reduce alcohol consumption on average. It is to reduce preventable harm, fairly and without blaming or stigmatising the people who need support most.

Where does support for individuals fit alongside these population-level policies?

The two approaches should complement one another rather than be presented as alternatives.

Population-level policies can reduce exposure and risk across society, but there will always be people who want to reduce their alcohol consumption or who need additional support.

For some people, relatively small changes can make a difference. Alcohol-free days, smaller servings, alcohol-free alternatives or changing social routines can all help. The important message is that people do not need to wait until alcohol has become a severe problem before deciding to drink less or stop drinking.

For others, brief advice from a health professional may be useful, while people experiencing alcohol dependence or more serious alcohol-related problems may need treatment and longer-term support.

Services need to be accessible, respectful and free from stigma. Seeking support should not be treated as a personal failure.

This is another reason we need both individual and structural prevention. It is easier to drink less when alcohol-free choices are normal, health risks are clearly communicated, marketing exposure is reduced, workplaces and social occasions do not automatically revolve around alcohol, and appropriate support is easy to access.

The aim is to give people both the information and the conditions they need to reduce risk.

Looking ahead, what would meaningful progress on alcohol prevention in Europe look like?

For me, progress would mean first of all becoming more confident about implementing the measures we already know can reduce alcohol-related harm. Europe needs to step up and put public health before commercial interest.

It would mean alcohol pricing and taxation better reflecting public health objectives, effective limits on availability, stronger protection from marketing and digital promotion, clearer health information including cancer-risk information, and better enforcement of rules designed to protect children and young people.

It would also mean accessible support for people who want or need to drink less, with prevention designed to reduce rather than reinforce health inequalities.

But perhaps one of the most important changes would be in how we think about the issue. Alcohol prevention should not be framed as a choice between individual responsibility and government action. Both matter, but they operate at different levels.

People can make choices about their own alcohol consumption. Policymakers have responsibility for the conditions in which those choices are made, including price, availability, marketing, information and access to support.

JA PreventNCD gives us an opportunity to connect work across these different levels, learn from implementation in different European contexts and strengthen cooperation between countries. Alcohol is relevant across the Joint Action precisely because its harms, and the approaches needed to prevent them, cut across sectors, policies and populations.

Ultimately, I think success would be a Europe where people understand the risks associated with alcohol, drinking less or not at all is easier and more socially accepted, children and young people are better protected, people who need help can access it, and policymakers have the confidence to implement the evidence-based measures we already know work.

Alcohol prevention illustrates a central message of JA PreventNCD's prevention campaign: we can support individuals to reduce their risk while also changing the conditions that shape alcohol use and alcohol-related harm.

The evidence gives us a strong foundation. The challenge now is to translate what we know into sustained actions that protects health, reduces inequalities and make lower-risk choices easier and more realistic across Europe.