Background/Aims Social Development Goal 3.5.2 calls for a 10% reduction in harmful alcohol use. We began evaluating efforts to achieve this goal in Alexandra, South Africa; Brasilia, Brazil; Columbus, Ohio; Jiangshan, China; Leuven, Belgium; and Zacatecas, Mexico by estimating baseline harm.

Methods Following the Global Burden of Disease (GBD), we measured alcohol-attributable burden in Years of Healthy Life (YHLs) lost. GBD estimates harmful alcohol use from a jurisdiction’s alcohol consumption and diagnosis-specific relative risk distributions. We assessed alcohol consumption and alcohol-involved violence through surveys of 1500 adults per city and, except in Columbus, 1500 youth. We combined those data with GBD’s relative risk curves and accessible police-reported road crash data to estimate the baseline. We incorporated the financial effects of health problems into the baseline by converting them to YHL-equivalents. For use in conversion. we defined a standardized YHL as the average year of life expectancy lost to a crash death or homicide.

Results Violence – physical assault, sexual assault, drink-driving crashes, and suicide -- comprised 84% of the burden in Alexandra, 74% in Zacatecas, 65% in Leuven, and 56%-59% elsewhere. Physical and sexual assault alone comprised 32%-72%. Drink-driving comprised 10%-21%.

Conclusions Achieving this SDG goal will require creating effective violence prevention programs. Our physical assault estimates greatly exceed GBD’s estimates. GBD’s assault incidence sets a high severity threshold for qualifying cases. Its alcohol-attributable fractions for physical assault average one third of the estimates in widely respected multi-national studies. GBD 2017 also attributed no sexual violence to harmful alcohol use.