Research project DR/96 (Research action DR)
Substance use, including alcohol, tobacco, and illicit drugs, remains a major public health challenge, contributing to premature mortality and significant social and economic costs. Globally, alcohol use ranked as the eleventh leading risk factor for Disability-Adjusted Life Years (DALYs) in 2023 (Hay et al., 2025), accounting for around 2% of total DALYs and deaths (Institute for Health Metrics and Evaluation (IHME), s. d.). Tobacco use continues to have an even greater impact, responsible for 9.7% of all deaths and 5.8% of DALYs worldwide (Hay et al., 2025; Institute for Health Metrics and Evaluation (IHME), s. d.). In Belgium, in 2023, 17.6% of the population aged 15 years and older smoked, one out of seven young people engaged in risky single occasion drinking weekly (Drieskens et al., 2025), and 2.6% were at risk of gambling addiction (Boone et al., 2025). The growing use of e-cigarettes and other nicotine products, particularly among younger adults, further highlights the changing landscape of substance use (Health Status Report 2023).
To address these challenges, the Interministerial Conference on Public Health has adopted several interfederal strategies and action plans targeting tobacco, alcohol, illicit drugs, and gambling. However, Belgium currently lacks an integrated system of indicators to evaluate and monitor the implementation and impact of these plans. The five-year interval of the Belgian Health Interview Survey (BHIS) limits timely policy evaluation, and no comprehensive framework yet exists to predict potential health impacts before policy implementation. International organizations such as the WHO and CDC stress the importance of continuous monitoring and evaluation within the policy cycle to support evidence-based decision-making (CDC, n.d.; WHO 2023).
The IMPACT project aims to co-create, implement and evaluate an integrated indicator framework to enable the routine monitoring and evaluation of policies addressing substance use and related behaviours in Belgium. The project combines quantitative and qualitative approaches and is built around two interconnected cycles: a policy cycle, encompassing design, implementation and evaluation, and an indicator cycle, focused on developing and validating metrics for predicting and assessing policy impacts. Together, these cycles create a dynamic system linking policy development with rigorous, data-driven evaluation, fuelled by active stakeholder engagement.
Methodologically, IMPACT builds on a multi-step approach: first, existing action plans and data sources will be analysed to develop a comprehensive list of potential indicators, drawing on international evidence and national surveys. Through stakeholder mapping and a structured Delphi process, consensus will be reached on a core set of indicators for monitoring and evaluation. These indicators will then be mapped to existing Belgian data to identify gaps and inform the development of new data collection tools where needed. In parallel, the project will initiate the development of a modelling framework to predict the potential health and economic impacts of policies using Health Impact Assessment (HIA) principles, contributing to the integration of predictive policy evaluation into the Belgian National Burden of Disease Study (BeBOD).
Sustainability and impact are central to IMPACT. The framework will be designed for long-term use, adaptable to new policies and supported by synergies with existing initiatives such as HealthyBelgium.be and BeBOD. The project will actively engage policymakers and stakeholders throughout its course to ensure practical uptake and policy relevance. Attention will also be given to gender differences in substance use and policy effects, ensuring balanced representation and analysis.
Knowledge translation and stakeholder engagement are at the heart of the IMPACT project, ensuring that scientific evidence is effectively transferred into policy and practice. The project’s outcomes will provide Belgian health authorities with an integrated, sustainable framework to routinely evaluate and predict the effects of policies on substance use and related behaviours, ultimately strengthening evidence-based public health policymaking.
