It’s been a bad week for booze lovers. An Oxford study estimated that in 2005, alcohol caused over 30 000 UK deaths, costing the NHS over £3 billion. 6% of deaths and 10% of all “ill-health” (as measured by "disability-adjusted life years”) are caused by alcohol. To put it in context, the same researchers showed last month that smoking caused 19% of all deaths and 12% of ill health, costing over the NHS £5 billion per year.

The President of the Royal College of Physicians, Dr Ian Gilmore, has made no secret of his desire to raise the profile of alcohol-related disease as a problem that can no longer be ignored. Writing in this week’s British Medical Journal, he speaks of “many factors that are deeply embedded in society and individual behaviours that influence how, why, and how much people drink. Previous public health campaigns, such as weekly alcohol limits, have been unsuccessful in reducing binge-drinking. On the other hand, the alcohol industry spends £800 million annually on marketing (about a quarter of what their product costs the NHS per year). A report commissioned by the British Medical Association shows that existing controls on alcohol advertising are inadequate, especially in young people, and as Gilmore says, “We should have learnt from tobacco that voluntary partnerships with the relevant industry do not work”. Calls are being made to curb merchandising, sponsorship of sporting events, competitions and loyalty schemes.

A systematic review of 13 studies of almost 40 000 young people found good evidence to support the impact of media exposure and alcohol advertising on subsequent alcohol use, including initiation of drinking and heavier drinking among existing drinkers. The UK is the only country in Europe with no restrictions on alcohol advertising and this method has been shown to work in other countries. Therefore, a Europe-wide ban on alcohol advertising has been recommended as a cost-effective health policy.

However, research and policy will have to be more innovative than simple bans if we are to change the current drinking behaviour of young people. For example, measures to change behaviours of college or university students were found to be more effective if they were web-based, compared with mail-based feedback.

Cost effectiveness is flavour of the week, whether in relation to the NHS, global health or politics. It makes sense to optimise use of limited resources, particularly public goods (e.g. taxpayers’ money). The Gates Foundation (GF) has changed the global health landscape both in terms of scale of funding and policy agenda. This week’s Lancet focused on the GF’s efficiency, based on an analysis of its funded projects [1-3]. It awarded 1094 global health grants over the last decade: a massive US$8·95 billion, of which $5·82 billion (65%) was shared by only 20 organisations. 40% of all funding was given to “supranational” organizations such as the World Health Organisation. Of the remaining amount, 82% went to recipients based in the USA. Just over a third ($3·27 billion) of funding was allocated to research and development (mainly for vaccines), or to basic science research [1].