Nordic-Baltic region has both highest and lowest levels of per capita alcohol consumption. In Nordic countries we have a strict alcohol regulation and Baltic countries struggle due to weak and slow policy process. Still, changes are taking place and few last years have seen important developments in alcohol policy. This first NordAN report on alcohol is bringing you an overview of the recent changes and also the drivers and reasons behind them. Enjoy and share!
The civic society as well as policy makers, they need facts, they need figures, they need arguments. So I think it is important to put together figures and data on alcohol use and alcohol related harm in the Nordic and the Baltic countries. Now, you can say that these figures are available. You can look at the report from the OECD, WHO etc.
But figures are not always easy to find and perhaps easily comparable. And we want also an aid to figures, aid to data through this report. What is new and what we have good capacity for in the NordAN, is the capacity to do very nice presentations. So this report will be a mix of data, hard facts but also points of view, policy views from various Nordic and Baltic countries. And we hope that this will make it more lively, more user friendly.
What we put on this website will of course be freely available, so you are welcome to steal, lend, borrow and reuse for your own purpose in your country.
Professor Peter Allebeck, president of Nordic Alcohol and Drug Policy Network (NordAN)
Alcohol policy is an ongoing process, as it should be. States have to address new challenges, for instance the way media is functioning these days. We are speaking now about “new media”, online resources that have elevated the usual advertising from traditional 30-second TV clips to something that is everywhere and where people are not only targets but function also as part of marketing through sharing and recommending these materials to their friends and followers.
This is one urgent area where different countries are taking steps adopting new regulations. Finland has shown the way, Lithuania and Estonia are discussing and making plans.
In 2016, we are living in a situation where there is no EU Alcohol Strategy and with the end of this year, the EU Alcohol Action Plans finds its end as well. That means that individual governments have even bigger responsibility making sure that their citizens are protected from alcohol related harms.
We have update our country reports and keep on doing that as new changes and developments emerge.
Lauri Beekmann, secretary general of NordAN
Peter Allebeck, president of NordAN, is professor of Social Medicine at the Department of Public Health Sciences KI, and also has a position at CES, Stockholm County Council . His main area of research is Mental Health and in particular epidemiology of alcohol and substance use. Dr Allebeck works also as a Secretary General for FORTE, Swedish Research Council for Health, Working Life and Welfare.
Finland and Sweden – biggest Nanny States in Europe?
Institute of Economic Affairs (IEA) along with the European Policy Information Centre published the so called Nanny State Index that puts Finland and Sweden in top defining these Nordic countries as the “worst places in the European Union to eat, drink, smoke and vape.”
“The Nanny State Index is concerned with policies that have an adverse impact on consumers. Policies are given different weights to reflect the extent to which consumers are negatively affected, from relatively minor inconveniences to heavy taxes or outright prohibition.” The Index includes any policy that is designed to deter consumption of legal products.
Nanny State Index? Its a list that does´nt just rank countries based on the level of existing regulations but that translates that into being “worst places to eat, drink, smoke…”. Would be interesting to add the overall satisfaction index from these countries. There are some indexes that might give a hint of how local people feel about their countries situation and the way their states are run. The ability to draw these conclusions is of course limited but the same goes with the conclusion that if the country has a retail monopoly (like Finland and Sweden) it must be bad for people. For instance in 2012 71% of Swedes supported the strict monopoly system Systembolaget. And that support has grown from around 50% in the beginning of 2000. In Norway, a non EU country that would definitely top the Nanny State Index, a 2013 TNS Gallup poll showed that 74% of the population wanted to keep the monopoly while only 22% wanted to dissolve it. So one of the aspects that makes alcohol policy very different in Finland and Sweden compared to all other countries is clearly supported by local people.
But lets look at these other indexes as well. And for a comparison lets focus on Finland and Sweden, two countries that are positioned as the top Nanny States and Czech Republic, Slovakia and Portugal, three countries that are ranked as the least Nanny States and should be thus be best places “to eat, drink, smoke and vape”.
How does the ability to do these things affect the level of happiness? According to the World Happiness Report both Nordic countries are in the top 10. Finland on 5th and Sweden in 10th position. Czech Republic is on 27th place, Slovakia on 45th and Portugal 94th. Now of course, happiness is much more than just ability to consume different products. But at least it shows that the strict regulation that Nordic countries have, does´nt ruin that happiness. I should also mention that two other Nordic countries (that are not part of EU) that have even stronger regulations, Iceland and Norway, are placed even higher – 3 and 4 in the World Happiness Report.
Lets also look at the Happy Planet Index (HPI). The HPI measures what matters: the extent to which countries deliver long, happy, sustainable lives for the people that live in them. The Index uses global data on life expectancy, experienced well-being and Ecological Footprint to calculate this. HPI Score for:
Sweden is 46.2 and for Experienced well-being 7.5.
Finland – 42.7 and 7.4.
Czech Republic – 39.4 and 6.2
Slovakia – 40.1 and 6.1
Portugal – 38.7 and 4.9
Then there is The Family Life Index that ranks countries according to their results in these subcategories: availability of childcare and education, costs of childcare and education, quality of education, family well-being, as well as childcare and education options. Services that are mentioned here are directly linked also to the country´s tax policies and can give some light to how the quality of life is influenced by the level of taxes.
In this index Finland ranks nr 2 and Sweden nr 3. Czech Republic, Slovakia and Portugal were not included into that list.
Report STATE OF THE WORLD’S MOTHERS 2015 gives the Mothers Index that shows where mothers and children living in urban areas face the least and the greatest hardships regarding women’s and children’s health and economic well-being, among other aspects. The world’s best countries for mothers to raise children are less of a surprise: Norway, Finland and Iceland. Sweden is on the 5th position. Czech Republic – 25, Slovakia – 34, Portugal 16.
These different indexes place Finland and Sweden among the best or even the very best in the world. The Nanny State Index is no exception, they are on top again but it is translated as being bad. “”Unless you are a teetotal, non-smoking vegetarian, my advice is to go to Germany or the Czech Republic this summer,” said the reports author Christopher Snowdon to the Independent. So if you want to have a rowdy vacation, Czech Republic might be a good place for that. But what if you live in that country, you consume lots of alcohol, smoke and eat fast food and you will have lifestyle related health issues, what happens then? How well can the society as a whole manage these problems?
True, Sweden and Finland are not free from alcohol problems. The Nanny State Index even “concluded that countries with heavy alcohol regulation do not have lower rates of drinking.” With countries we have been focusing in here, the correlation does exist. Per capita (15+) consumption in Finland is 11.2 litres and in Sweden as low as 9.4 litres. Czech Republic – 13.0; Slovakia – 13.0; Portugal – 12.9 litres.
To have even clearer understanding on how the “Nanny State” status influences alcohol consumption, we should include Norway and Iceland into that comparison. Per capita consumption in Iceland is 7.06 and in Norway 6.22 litres. On the other hand you may ask why did I choose Czech Republic, Slovakia and Portugal as examples of the “free” societies? Why not focus on Italy for example where the consumption level is similar to Norway but which is in the yellow zone (freer) in the Nanny State Index (still on the 17th position compared to Czech Republic´s 28th)? When we look at individual countries we have to understand the details that are behind different developments. Italy is very different case, which cannot be understood without including the historical and cultural story behind it. Please read closer from here: http://nordan.org/nordic-alcohol-policy-challenged-by-italian-experience/
Finland on the other hand is another peculiar country where you have to know and understand some important facts to be able to judge the situation correctly. Being a part of Nordic countries with restrictive alcohol policies, Finland does stand out with the highest alcohol consumption compared to other Nordic countries. So why does´nt these regulations work in Finland as well as in Sweden, Norway and Iceland? There is one very clear reason and that is a small southern neighbour, Estonia which has much lower level of regulations including several times lower prices. Finland is unique for being one of the richest countries which in its door step has a faucet where you can get alcohol almost for free. And because of that more alcohol is sold in Estonia per capita than in any other state in the world. Estonia, with its low prices, is a clear obstacle for Finland to effectively implement its alcohol policies.
Nordic countries overall, have, as it is called, the Nordic welfare model, which it builds upon the general organisational principles of Nordic social and welfare policy. “The social security net is central to the Nordic welfare model. It is rooted in the basic principle of universal rights, i.e. everybody has the individual right to assistance from the public sector if they are unable to look after themselves. As a point of departure, these rights are the same for all, regardless of factors such as income and assets. One crucial way in which the Nordic system differs from other welfare models is that rights are not acquired on the basis of previous payments (e.g. national insurance payments) or status (e.g. employment). Welfare is funded collectively via taxation, and the individuals’ rights are not linked to their tax history.” (Nordic Council)
Tax policy and health related policies are closely linked to that Nordic Welfare Model. And that model helps to get Nordic countries in the top of these different indexes stating clearly that it is good to live there.
The Nanny State Index could be useful for bachelor parties which search for a cheap and easy locations to have limitless fun, but it does´nt say anything useful for countries that are struggling with alcohol, smoking and obesity and which have´nt found the political will to do much about it.
Secretary General of the Nordic Alcohol and Drug Policy Network (NordAN)
Tax policy and health related policies are closely linked to that Nordic Welfare Model which helps them to get in the top of these different indexes stating clearly that it is good to live there.
Finland and Sweden – biggest Nanny States in Europe?
Nordic alcohol policy challenged by Italian experience
Which is the best practice country when we think of alcohol policy and reducing alcohol consumption? Is it Norway, where alcohol availability is lowest in Europe or is it Italy where similar results have been reached with different influences?
In both countries the per capita alcohol consumption is around 6 litres. Estonia, for instance, has it at 12 litres. So, which one should be an example to a small Baltic country which has long struggled with alcohol related harm?
Nordic alcohol policy challenged
As you may have heard Estonia is discussing about a new alcohol bill that would limit alcohol advertising and availability. The Ministry of Justice sent few weeks ago a letter to the Ministry of Social Affairs (the author of the bill) stating that Nordic countries are not best example for a country like Estonia. “Retail alcohol monopoly is the reason why Nordic countries and Estonia cannot be seen as similar examples when it comes to alcohol policy. The number of selling points in Estonia, Finland, Norway and Sweden cannot be compared, because Estonia has made a choice in favour of free enterprise. While Northern European countries have one of the toughest alcohol policies in Europe, it have´nt helped them reach their goals, but in Italy, on the other hand, where there are free market rules in alcohol trade, alcohol consumption has decreased for a long time.”
I will not stop longer to discuss Ministry of Justices subjective view on Nordic countries success in reaching (or not reaching) their goals in alcohol policy. But I will focus on the comparison of these two extremes – Nordics versus Italy. Nordic countries, Norway as the best example, are following WHO´s global strategies action plan by setting attention to price, availability and marketing. Nordic countries (Iceland, Norway, Sweden and Finland) have the special measure in monopoly systems which has reduced remarkably the availability of alcohol. But at the same time in Italy – it seems that policy measures have not played that important role, if at all. Wine, for instance, is not taxed at all. And still, during the last decades, Italy has experienced a serious decline in alcohol consumption. Which means they have reached very positive results without restrictive policy measures. Why should´nt we try to copy Italy, instead of Nordic countries?
How experts explain Italian reduction in alcohol consumption
Diving into Italian experience I have asked for comments from three distinguished Italian alcohol policy experts. Tiziana Codenotti is president of the European Alcohol Policy Alliance Eurocare, Ennio Palmesino is the delegate for European affairs for the European Mutual-Help Network for Alcohol Related Problems (EMNA) and professor Emanuele Scafato is the vice-president of European Federation of the Societies on Addiction. Our Italian experts are explaining that behind these developments in Italy are these specific keywords – wine culture associated with long lunches, globalisation and also alcohol policy.
“The REAL mediterranean style was represented, 40-50 years ago, by people (mainly men) who used to drink huge volumes of wine every day, during every meal, 3-4 glasses for lunch and 4-5 glasses for dinner,” Ennio Plamesino explained the tradition of daily long lunches and dinners. “What happened in Italy afterwards, without any alcohol policy from the top, was globalisation. Which means living a hectic life, running the whole day and having very short time for lunch. The typical, slow-motion Italian lunch break disappeared, and so magically half of the daily consumption disappeared.”
The majority of reduction in Italian alcohol consumption is in wine drinking. Beer and spirits have played much smaller part over there anyway. “What we do not drink anymore for lunch, has not been replaced by evening drinking, which does not fit our traditions,” Palmesino added.
With a change in a daily lifestyle the wine consumption decreased drastically and was´nt replaced with anything else, at least not in most cases. This is the main change in Italian alcohol consumption.
The Nordic consumption model has been different. The choice of drinks has been either beer or spirits and not in the meal context but in the evening and during weekends. The end goal is too often drunkenness and way to get there – binge drinking. In Italy they drink different drinks, in different ways and with a different goal. It is illogical to hope that by trying to imitate Italian experience we could achieve similar results. It should be stressed once again that the change in Italy was´nt so much because of a certain intervention. Reminding Ennio Plamesinos explanation: “The typical, slow-motion Italian lunch break disappeared, and so magically half of the daily consumption disappeared.”
Tiziana Codenotti from Eurocare brings up the importance of alcohol treatment services that were started within the National Health Service in the beginning of eighties. “Before that people with alcohol related problems did not have any place to go. At the same time the multifamily communities of the Clubs of Alcoholic in Treatment and other self-help groups started their activities. The implementation of recovery programs necessarily implied abstinence or a major reduction in consumption for a great number of people,” Codenotti explained.
These family groups are especially effective in Italy thanks to tradition again. The importance of family and connection between different generations is clearly bigger in Italy than in Nordic countries, where is much higher percentage of single parent families for instance. According to Eurostat 2008 data in comparison of 27 European countries Latvia had the biggest portion of single parents, Estonia was on third place and Italy on 19th. As expected, Nordic countries were all in the first part of that list and southern-European countries in the latter part. We could dream that these interventions could be as effective in our societies but it does´nt seem to be logical again.
Alcohol policies role
Codenotti does´nt agree also with a view that alcohol policy measures does´nt play any role in Italy. “Starting from 2001 when the first comprehensive law on alcohol was passed, many policy developments have happened, I am thinking of drink driving (0.50 long time ago, and the more recent “zero tolerance” for professional drivers and new drivers) or legal age limits for instance. I am fully aware that we do have a problem with policy enforcement, but at the same time these policy changes have contributed to raise awareness of the risks related to alcohol consumption in the general population.”
It is also important to note that even though wine is not taxed, other alcohol taxes in Italy are unique in one special way. In 2009 Rand Europe wrote a report “The affordability of alcoholic beverages in the European Union” to European Commission which among other things came to following conclusion: “The affordability of alcoholic beverages has increased in all countries examined, apart from Italy; that is, in nearly all countries examined alcohol has become more affordable over the last twelve years. In six countries (Lithuania, Estonia, Latvia, Finland, Slovakia and Ireland) affordability of alcohol increased by 50% or more.” http://ec.europa.eu/health/ph_determinants/life_style/alcohol/documents/alcohol_rand_en.pdf
Alcohol related harm in Italy
Even though the consumption level has decreased significantly and there are more people in Italy who drink in moderation than in most countries in Europe, it does´nt mean that they dont have alcohol problems. Professor Emanuele Scafato states that there are 8 million heavy drinkers in Italy. “And among those there are 400 000 male harmful drinkers and more than 320 000 female harmful drinkers. Harmful drinkers and alcohol dependants are in need for treatment in order to stop harm progression.”
Italy is also facing a bigger problem than expected with alcohol related birth defects. According to 2011 study done in near Rome area Fetal Alcohol Spectrum Disorders (FASD) was found in 2.3% to 6.3% of the children. “These rates are substantially higher than previous estimates of FAS (Fetal Alcohol Syndrome) and overall FASD for the general populations of Western Europe and the U. S., and raise questions as to the total impact of FASD on mental deficit in mainstream populations of Western Europe and the United States where the majority are middle class and are not believed to be characterized by heavy episodic drinking,” researchers concluded. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3138028/
Italian example is very interesting and important. But unfortunately there is almost nothing for us to learn from that. Even the definition of alcohol consumption is different compared to ours. They have drank alcohol in a different way (in a long lunch context) and different beverages (majority of alcohol in wine). As Italian alcohol experts are implying, reduction of alcohol consumption in Italy is not a result of an informed liberal alcohol policy or through moderate alcohol consumption campaigns. Main reasons are in an overall change in lifestyle and globalisation but also alcohol policy measures. Long historical tradition of having long meals was interrupted by the way world changed and nothing has replaced that lost part of alcohol consumption.
Our context (in Estonia) is much more similar to Northern countries (I´m including here also other Baltic nations, Russia and Great Britain) where binge drinking is much more common and getting drunk is often the desired end goal. Our nations drink in the evenings and during weekends. We tend to prefer beer and spirits.
Norway, also Iceland and Sweden, have managed to put a stop to this historical alcohol tradition. Of course, the problem is still there but through effective and evidence based alcohol policies a very different and violent alcohol consumption has been brought down to the lowest levels in Europe.
Secretary General for the Nordic Alcohol and Drug Policy Network (NordAN)
Italian example is very interesting and important. But unfortunately there is almost nothing for us to learn from that.
Nordic alcohol policy challenged by Italian experience
Surveys on alcohol consumption show no major changes in recent years except for youth alcohol consumption which has declined extensively and Iceland has been ranked amongst the lowest adolescent consumers of alcohol in Europe, according to studies.
In 1998, 42% of 15 to 16 year old Icelanders had become drunk during the past 30 days whereas in 2014 only 6% of students report the same. Daily smoking and the use of cannabis has also decreased dramatically.
Source: UNGT FÓLK 2014 – GRUNNSKÓLAR: Menntun, menning, félags, – íþrótta- og tómstundastarf, heilsa, líðan og vímuefnaneysla unglinga í 8., 9. og 10. bekk á Íslandi. Pages 69-76.
Surveys on adult drinking show no major change. In 2007, 94,9% said in a survey that they had sometime during their lifetime used alcohol, whereas in 2012 the ratio was 95,9%.
Frequent drinking and binge drinking has declined slightly during these years, but number of occasional drinking increased a little instead.
After the financial crises in 2008, alcohol consumption decreased, probably due to decreased purchasing power and increased alcohol taxes. Alcohol consumption is now slowly increasing again.
There are no available surveys which indicate any changes in the attitudes of the people during this period except for people’s unwillingness to make alcohol available in grocery stores.
Alcohol consumption of pure alcohol in litres per capita 15 years and older. Red bars indicate alcohol sale by the State Alcohol Monopoly. Blue bars indicate estimated total consumption based on alcohol sold by the State Alcohol Monopoly.
There is a fairly good political acceptance of the present alcohol policy in the country. Governmental and parliamentarian policy papers introduced and/or adopted in recent years rank alcohol among major health and social issues which should be tackled and no laws have recently been adopted which undermine or weaken the basic cornerstones of present policy.
The only threat is the parliamentary bill currently in the system proposing the abolition of the State’s monopoly on sales of alcohol and extending the right to sell alcohol to all retail outlets. The bill has found an extensive opposition from civil society and also from different institutions like for instance the Ombudsman for Children. “Many studies have shown that freer access to alcohol increases consumption, which in turn has significant negative consequences for children, their families, and society as a whole,” reads the Ombudsman’s official feedback on the bill.
The tax on alcohol has increased several times since 2008. The first tax rise came when alcohol tax was put up by 12.5 percent from December 15th 2008, then by 15 percent from May 29th 2009 and by a further 10 percent from January 1st 2010. This time, there was an additional four percent tax charged on beer and wine and one percent more on spirits. The tax was also raised by 5, 1% (average) January 1st 2012 and 3% in beginning of 2014.
In September 2008 the due of for a calculated centiliter of the alcohol spirit in wine was 52,8 ISK. According to the state budget for 2017 (with additional raise of 4.7 percent) it will become 106,8 ISK, which results in a 102% raise.
The tax system explained with an example of Vodka looks like this: It is ISK 7,300 (USD 65, EUR 62), 94 percent of which goes to the Icelandic state. Only ISK 434, goes to the producer or the importer. The rest is divided as follows: alcohol tax is ISK 5,419; bottle deposit is ISK 20; Vínbúðin, the state-run liquor store, gets ISK 705; and value added tax is ISK 724.
Sources: Iceland Review and Ice News
According to a survey conducted in May 2013, 56% were satisfied with the current system of alcohol sales in Iceland.
A survey from October 2014, carried out by Fréttablaðið newspaper, reveals that 67 per cent of Icelanders are opposed introducing new laws that allow sale of wine and beer in grocery stores; 30 per cent are in favor.
The ground for the survey was a MP bill submitted to parliament (Alþingi) in September 2014. The bill, if passed, would permit the sale of alcohol beverages in private shops instead of only in The State Alcohol and Tobacco Company of Iceland (ÁTVR) stores in the country as it is now. Similar bills have been submitted and ,,killed“ six times before.
In 2016 a new poll, conducted by Fréttablaðið, Vísir and Stöð 2, showed that some 62% of Icelanders are against alcohol being sold in private shops and grocery stores, while 38% were in favour. When all responses are taken into account, 35% said they supported the sale of beer and wine in food stores, while 56% were opposed, and 9% were undecided. The results show a distinct change from the last time a poll was done on the subject, last November, when 47% of respondents were against the sale of alcohol in private shops, while 41% supported the idea, and 12% had no position on the matter. Source: The Reykjavik Grapevine.
In October 2015, NordAN General Assembly adopted a resolution stressing that the monopoly system is an important corner-stone of Iceland´s effective alcohol policy. NordAN “strongly urges members of the Icelandic Parliament, Alþingi, to veto the bill proposing the abolition of a public monopoly on sales of alcohol and authorizing the right to sell alcohol at all retail outlets which is now being dealt with by the Parliament.”
The bill continues in the Parliament and was lastly (March 2016) approved by a majority of members of the Icelandic Parliament (‘Alþingi’) General Affairs Committee. The bill received the endorsement of a cross-party majority of committee MPs and moved on to Alþingi for further legislative processing.
“It did not surprise that the majority of the Committee of Judicial Affairs and Education approved the „alcohol bill“,” said Arni Einarsson, NordAN board member from Iceland. “The committee consists of nine members, thereoff are four of them among the movers of the proposal. It is of course a matter of question why all the evidence based information and arguments provided against the bill and the strong opposition on behalf of all those working in the field of public health, health promotion, prevention and child and youth affairs has so little weight in the minds of these “public servants“. In addition all recent polls show that a majority of Icelanders do not want to change the system regarding retail sale of alcohol.”
Marketing and advertising
While article 20 of the current alcohol laws bans totally advertisement of alcohol beverages, the alcohol industry has found and uses loopholes regarding beer – for example by advertising low alcohol content versions with same firm brand and trademarks. Advertising was common in newspapers but when police put focus on editors instead of the industry they have decreased but increased in TV instead. Are also not uncommon as sponsors on radio programs and are seen in sports arena, especially football areas.
Alcohol policy strategy
There is available a comprehensive policy on alcohol- and drug prevention until 2020 adopted by the government in 2014. The first alcohol action plan based on this policy was supposed to be introduced in 2014. It has not yet been launched.
Main topics of the policy are:
To limit access to alchol and other drugs
Protect vulnerable groups against negative influences caused by alcohol and other drugs
Prevent young people from starting to use alcohol and other drugs
Reduce number of those who develop harmful use of alcohol and other drugs
To ensure integrated service based on best knowledge and quality for people with alcohol and drug problems
To reduce number of deaths caused by alcohol and drugs.
In addition to this there are clear cornerstones in alcohol policy in Iceland confirmed by laws and regulations like:
Monopoly for off-premise sales for strong beer, wine and spirits;
20 years minimum legal age limits for on- and off-premise sales for beer / wine / spirits,
High alcohol tax;
Maximum 0,05 promille legal blood alcohol concentration (BAC) when driving a vehicle;
Ban on alcohol advertising.
Recent policy papers concerning or including alcohol related issues show no indications of changing these cornerstones, except a MP bill submitted to the parliament in September 2014 which has not been passed yet.
Iceland has a long history and tradition of non-governmental non-profit organizations working in various fields. Many are engaged in health and social welfare, sports and education. Some have formed coalitions or networks around certain issues to strengthen their efforts and position. One of these networks is Cooperation Council for Alcohol and Drug Prevention in Iceland – Samfo. Samfo is a cooperative platform for more than twenty national NGO‘s in Iceland. The aim of the cooperation is to activate and strengthen cooperation between non-governmental organizations which support an active alcohol and drug control policy in the country. Policy that has public interest and public health promotion as a goal.
Samfo has launched and executed some national prevention projects in the field of alcohol and drugs. Every year the network organizes so-called Week 43; awareness week with focus on prevention and the role of NGO’s in the society.
There is great interest among the member organizations to strengthen this network and deepen their cooperation.
In a survey by the Medical Directorate of Health in Iceland, conducted in November/December 2013, about 47% of the respondents said that relative(s) or someone in their closest social environment had drunk too much once or more often during the last 12 months; about 60% said this had had negative impact on them. 30% said they had been harassed by drunken people in bars, restaurants or private parties during the last 12 months. 13% said so in a similar survey conducted in 2001. Young people were more exposed than the older ones. 25% had been annoyed by drunken people in the streets or other open public places; 22% said this had scared them. Young people and people living in the capital area were more likely to complain about this.
Interview with Arni Einarsson, Managing Director of FRAE. "Alcohol policy NGO-s and funding".
Alcohol related harm
Alcohol is one of the factors having the greatest impact on public health in Denmark.
Not only the alcohol plays a role in the development of a variety of diseases, such as certain types of cancer, severe liver disorders, gastrointestinal, lung – and musculoskeletal diseases.
Alcohol also causes premature death. In addition, the accidents that happens because of alcohol, and the other consequences of alcohol can have even for non-drinkers.
After the late 1990´s, the sale of alcohol in Denmark declined steadily, albeit with some fluctuations.
Over the past 10 years, the annual sales of alcohol fell by approximately 2 liters of pure (100%) of alcohol per capita (15 and over).
Cross- border shopping is quite stable and is approximately 20% of total alcohol consumption.
In 2013 every Dane aged 15 years or more bought on average 9,4 liters of pure (100%) alcohol.
The sale of alcohol in Denmark is significantly higher than sales in the other Nordic countries except Finland.
From 2010 to 2013 shows a general decline in the Danish alcohol consumption.
. A smaller proportion of low risk drinking limit
. A smaller proportion of high risk drinking limit
. A smaller proportion has drunk alcohol in the last week
. Development is particularly acute for young men
. The development is particularly women who drink alcohol at pregnancy has declined markedly over the last 15 years.
In 2013, 12 % of the population do not drink alcohol regularly.
Thus, 10 % men and 14 % women not drinking alcohol in a typical week.
From 2010 to 2013 seen in all age groups a growing proportion who do not drink alcohol in a typical week and it applies to both men and women.
The development is particularly significant for the young men and women, where the proportion has increased significantly from respectively 11, 7 % to 17. 5 % among young men and from 13, 3% to 17% among young women.
In 2013 8% men and 16% women say that they had drunk alcohol in the past year.
In the period 2011- 2013 there was an increase in the proportion of men aged 16 – 64 years and the increase is significant among men aged 25- 34 years and 45 – 54 years.
The proportion of men over 64 who have not drunk alcohol in the past year has however fallen.
For women, only in the age range 16-24 years, there is a significant increase in the proportion who have not drunk alcohol in the past year.
The proportion of older women aged 65 and older who have not drunk alcohol in the past year, has declined significantly from 2010- 2013.
The figures for 2014 are not yet available.
New figures (July 2015) from the Danish National Institute of Public Health show that cannabis use is up among high school students while drinking is down. According to a survey from the Danish National Institute of Public Health (Statens Institut for Folkesundhed), cannabis use has increased significantly amongst teenaged Danes. Since 1996, the number of male high school students who have experimented with cannabis has grown from 26 to 50 percent. Usage amongst girls has gone from 19 to 31 percent over the same time period.
While cannabis use is growing in popularity, excessive drinking is on the decline. Concrete numbers on alcohol use are expected to be part of the Danish National Institute of Public Health’s full report that is due to be released next month. (Source: The Local)
Burden of disease
Alcohol is one of the individual factors that has the greatest impact on public health in Denmark. Heavy drinking increases the risk of many diseases.
It´s about more than 200 diseases, including cancer, gastrointestinal disease, lung disease, liver disorders, muscle- skeleton diseases, fetal abnormalities and addiction.
In addition, alcohol increases the risk of dying prematurely and to getting into an accident.
In 2013 about 2.900 deaths were related to alcohol out of a total of 52.182 deaths in Denmark.
The alcohol related deaths correspond to 5, 5 % of all deaths in Denmark.
The proportion of deaths related to alcohol has declined slightly over the past year from 6, 0 % in 2008 to 5, 5 % in 2013.
Board of Health´s recommendations – Adults
# Women no more than 7 drinks per week
# Men no more than 14 drinks per week
# Maximum 5 drinks at the same time.
More and more large companies have in recent years introduced alcohol policy at workplaces.
Industry downplays effect, but alcohol advertising is playing an important role in the Danish heavy alcohol consumption.
Alcohol advertising in public spaces is a very strong marketing method claiming that alcohol is a harmless product comparable with all sorts of other products.
It helps to support the notion that alcohol is a fun product and not something that may cause cancer.
Beginning July 1st 2014, tougher laws on driving under the influence will allow police to confiscate the vehicles of first-time offenders. Motorists caught driving with a blood alcohol content (BAC) of 0.21 percent and above can have their vehicles confiscated on the spot, as can drivers stopped with a BAC of 0.12 percent who have have a previous drunk driving infraction within the past three years. (Source: The Local)
Harm to others
Danish women are increasingly being subjected to domestic violence, physical attacks, stalking and sexual harassment. According to a study of 42,000 women in 28 EU countries published (March 2014) by the EU Agency for Fundamental Rights (FRA), Denmark is at the top end of the scale in almost every parameter when it comes to violence against women.
Some 52 percent of the Danish women surveyed said they had been victims of physical or sexual violence – well above the EU average of 33 percent. Meanwhile 37 percent of Danish women indicated they have been subjected to sexual harassment within the last year, and 32 percent said they have been the victims of physical or sexual violence at the hands of their partner.
The report concluded that the “more dominant an alcohol culture a country has, the higher the level of violence against women”. (Source: The Copenhagen Post)
Blue Cross Denmark campaign “Alcohol affects other than yourself”
According to the report “Alcohol habits of young people in Denmark in 2014” (2014) that has been created by the Danish Cancer Society and TrygFonden’s alcohol campaign with the Danish title, ”Fuld af liv”, majority of young people aged 15-25 have tried alcohol, and eight out of ten have been drunk.
Six out of ten young people aged between 15-25 state that their parents had given them permission to drink alcohol before they were 16 years old. Fewer young people aged 15-20 than those aged 21-25 were allowed to drink alcohol before they were 16 years old.
By far the majority of young people aged 15-25 are aware of the age restrictions on the purchase of alcohol in Denmark. 27% of young people aged 15-25 believe that purchasing alcohol should be banned for those aged under 18. Among those aged 15-17, who would personally be affected by an age limit of 18, barely one in four (23%) support an age limit of 18 for the purchase of alcohol.
The respondents were also asked about the illness they believe heavy alcohol consumption can lead to. The majority mention liver disease (85%). One in four believe that heavy alcohol consumption can lead to heart disease, while 16% believe that it can lead to alcohol dependence and alcohol poisoning. Furthermore, 16% believe that heavy alcohol consumption can lead to cancer and finally 15% believe that it can lead to brain and/or nerve damage.
According to another survey, almost a quarter (24 percent) of all Danes over 18 who drink alcohol have felt pressured to drink more alcohol than they’ve wanted to. The survey, compiled by YouGov for Metroxpress newspaper, also showed that the figure shoots up to 42 percent when only looking at young people aged 18-29.
The political system of Denmark is that of a multi-party structure, where several parties can be represented in Parliament at any one time. Danish governments are often characterised by minority administrations, aided with the help of one or more supporting parties. This means that Danish politics is based on consensus politics. Since 1909, no single party has had the majority in Parliament.
Since 28 November 2016, the Government has consisted of the Liberal Party (Venstre), Liberal Alliance and the Conservative Party (Det Konservative Folkeparti). Lars Løkke Rasmussen from the Liberal Party is the Prime Minister.
The sale of alcohol in Denmark is significantly higher than sales in the other Nordic countries except Finland.
Registered alcohol consumption in Norway has stabilised or even declined slightly after a steady increase in the period from the early 1990s to 2008. The major shift in Norwegian consumption patterns over the last decades is the strong increase in wine consumption. Studies indicate that Norwegians still tend to binge drink, but have also adopted more continental habits with more frequent consumption.
Men still drink considerably more than women, but long term trends indicate that women’s consumption has increased significantly. We also see increasing consumption among older age groups as new cohorts take their drinking habits into old age.
Interestingly, there seems to be a decrease in youth alcohol consumption, despite relatively high consumption levels among adults. This decrease is found in a number of studies and is also seen in other countries.
A national study published in February 2016 showed that while most Norwegian seventh graders have never tried alcohol, there is a a “worrisome” amount who have. Among Norwegian 12-year-olds, every tenth boy reports drinking at least one serving of alcohol within the past month and three percent say that they have been drunk. On the positive side, the survey concluded that most Norwegian seventh-graders have never tried alcohol – 69 percent of boys and 83 percent of girls. But nine percent of the boys and four percent of the girls said that within the previous month they had had at least one glass of beer, wine or spirits.
In addition, 3.1 percent of boys and 0.8 percent of girls said they had been drunk which the study defined as having at least five alcoholic drinks in one sitting. (Source: The Local)
Registred alcohol consumption the last four years:
Litres of pure alcohol >15 years
(Source: SIRUS and Statistics Norway)
The recent decline comes after a long period of increase, and is still relatively high in a historical perspective. Moreover, some of the reduction in consumption may be offset by increasing taxfree sales, particularly in the period after the increase in travellers’ allowance in 2014. Taxfree sales figures are unfortunately not included in the official consumption statistics.
Unregistered consumption SIRUS does give an estimate for the unregistered consumption. In 2012, alcohol consumption was 6.21 litres of pure alcohol per inhabitant over 15 years of age. In addition, there is unregistered consumption from cross-border trade in Sweden and duty-free sales at Norwegian airports, which is estimated to be 1.6 litres (SIRUS, Drug statistics). Unregistered consumption also includes other «tourist import», alcohol consumption while abroad, home brewing of beer, wine and spirits, and smuggling. Source: FHI.no
Studies indicate that support for restrictive alcohol policies such as the state monopoly, taxation, age limits, closing times and advertising ban has increased in recent years. People’s beliefs in the effectiveness of the policies and the connection between alcohol consumption and alcohol related harm seem to influence their attitudes towards policies.
There was considerable interest in the alcohol policies of the current Conservative-Progress Party coalition government as it gained power in 2013. Both parties are ideologically on the liberal side, and alcohol policy has been a symbolically important issue particularly for the Progress Party.
However, despite a somewhat liberal ideology, the Conservative Party has historically been relatively moderate when in power. Furthermore, the current minority coalition needs the support of the Christian Democrats and the Liberal Left party to get a majority in Parliament. In the agreement between the coalition and the two Parliamentary partners it was stated that the main features of Norwegian alcohol policy should remain fixed.
However, ”the main features” were never explicitly defined, although it can reasonably be interpreted as a combination of a state retail monopoly, high excise duties on alcohol and limited availability through age limits, restrictions on opening hours and licencing.
The policy initiatives from the Government so far have not been radical, although most proposals tend to liberalise regulations, such as
Increasing taxfree allowances (implemented)
Increasing sales days for the state monopoly, such as New Year’s Eve, election days etc. (implemented)
Allowing farm sales of alcohol (suggested)
Relaxing regulations on commercial communication/advertising (suggested)
Lowering taxes on beer (suggested)
Individually, these changes may not be dramatic, but critics have argued that in sum, they may affect alcohol consumption and related harm, and even weaken some of the key instruments of Norwegian alcohol policy.
Alcohol policy is relatively high on the political agenda in Norway and is among the issues that could cause conflicts between the coalition government and their partners in Parliament. More recently, labelling and taxfree sales have been on the political agenda.
In February, Parliament voted on a proposal to introduce health labelling on alcohol. Labelling has been mentioned in national alcohol strategies for almost a decade, and many parties supported the policy in principle. However, the proposal still failed, because the majority wanted to wait for the outcome of the EU-process on the issue.
The increase in taxfree alcohol allowances sparked new interest in the issue of taxfree sales. Researchers have long pointed out that taxfree is the main source of unregistred alcohol in Norway, and as travel becomes more common and allowances increase, taxfree sales are expected to grow. As the share of alcohol sold through taxfree stores increases, the share sold in state monopoly stores decreases. This undermines the monopoly status of the state monopoly. The state monopoly has already reported a decrease in sales since the allowance increase.
Furthermore, aggressive sales practices that guided travellers through the wine and spirits shelves on arrival also led to protests. Several parties suggested that the state monopoly should take over taxfree sales to ensure more responsible sales practices and to strengthen the state monopoly. However, many NGOs, newspapers and politicians wanted to go further and abolish taxfree sales of alcohol altogether. The health committee of the biggest party, the Labour party, supported this proposal, but it was defeated at their annual congress.
The Government will have to produce a report on the future of taxfree sales during their time in office.
Many observers were surprised that the coalition government actually increased alcohol taxes in their first revised national budget. The reason given was that projections for inflation had been adjusted and the increase was necessary to maintain the real tax level on alcohol.
Tax levels are a balancing act between the need to protect public health and to increase revenue on the one hand and the need to limit cross-border shopping and taxfree sales on the other.
Norway is influenced by alcohol prices in neighbouring countries, and particularly in periods with favourable currency exchange rates. Changes in exchange rates affect all product categories and therefore makes it more or less profitable to buy goods – including alcohol – on the other side of the border. Increases in cross border shopping and particularly taxfree sales will put further pressure on Norwegian princing policies.
Recently the Conservative party proposed a reduction in taxes on beer. The purpose of this tax reduction is to shift consumption from high-alcohol beverages to lower-alcohol beverages. It is also intended to help small, local producers and breweries. The size of the reduction and the effects of changes in the taxation system remain to be seen.
Changes in media coverage
It is difficult to assess changes in the media coverage of alcohol. On the one hand there is considerable attention to alcohol related harm, perhaps specifically the issue of harm to families and children. On the other, several media outlets focus extensively on wine journalism, reviews of alcoholic drinks etc.
Alcohol policy issues are frequently debated in Norway, and newspaper commentators often support restrictive policies. A recent case where a Norwegian elite skier was arrested for drink driving showed massive support for strict regulations across Norwegian media. In early 2015, several political parties discussed abolishing the tax free system for travellers, and most major newspapers came out in support of the proposal.
Support for Vinmonopolet, the state monopoly system, has increased in recent years1, and customer satisfaction is among the ten highest in Norway2. Threats to the monopoly at this time come mainly from developments that undermine the dominant position of the Vinmonopolet.
One of the factors that weaken the position of the monopoly is the share of alcohol that goes through other channels, such as cross border shopping and particularly taxfree. The last government increased travellers’ allowance slightly (from 3 to 4 bottles of wine), and in a surprise move the current government decided to let travellers trade their tobacco allowance for alcohol, so that travellers now can buy 6 bottles of wine tax free. This increased the taxfree sales of alcohol, and the state monopoly argued that this caused a small dip in their sales.
The government has also promised to open up for farm sale of locally produced alcohol over 4,75 %. The reasoning behind this proposal is to stimulate local farming, industry and tourism. However, alcohol over 4,75% has so far been reserved for the alcohol monopoly, and competition from local outlets may challenge the monopoly status of the alcohol monopoly under EEA rules.
Marketing and advertising
Norway has had a ban on alcohol advertising since 1975. The ban applies to all media and covers all commercial messages that target a Norwegian audience, with some minor exceptions to advertising in trade magazines etc. Historically, there have been some cases before the courts to determine the boundaries of advertising, but on the whole, the courts have upheld a strict interpretation of the advertising ban.
The advertising ban does not apply to editorial coverage of alcoholic products. Many Norwegian media outlets have focused on wine journalism, with reviews of alcoholic products and extensive coverage of new products in the monopoly stores. Clearly, this kind of journalism is an important tool for producers and importers to communicate with their customers, and it is frequently reported that good reviews in major newspapers translate into higher sales in the state monopoly stores.1
In recent years, Norwegian brewers have complained that they are not allowed to provide neutral information about their products on their websites. They point out that such information is provided on the wine monopoly webshop and argue that this creates an unfair disadvantage for low alcoholic strength products like beer. However, the reason for this differential treatment is that the wine monopoly webshops sells to consumers, whereas the breweries sell to retailers.
Norwegian brewers have set up a website www.drikkeglede.no (”drinking enjoyment”) to provide product information. However, the Norwegian Directorate of Health intervened and all information and pictures on the website are now censored.
The Government has signalled that they will allow neutral product information and images on producers’ websites, on restaurant menus and other channels aimed at consumers. It is not yet clear how this new policy will be designed, but there is some worry that it will be difficult to draw the line between ”neutral description” and sales promotion. Furthermore, the new policy cannot only apply to Norwegian producers, but will also apply to global producers.
Alcohol policy strategy
The national alcohol policy strategy is embedded in the white paper on alcohol and drug problems. The white paper takes a public health approach to alcohol that ranges from effective prevention and early intervention to treatment, and that also acknowledges harm to others. The white paper emphasises prevention, reducing availability, reducing demand and accessible services for users and for those affected by other people’s use of alcohol or drugs.
The white paper emphasises the need for a comprehensive and coordinated policy to combat alcohol and drug related harm. It does not signal any major deviations from Norwegian alcohol policy. However, it does introduce a strong emphasis on ”passive drinking”, i.e. harm to others from alcohol and drugs.
Actis and member organisations are the main actors in civil society advocacy in the alcohol field. The past year, NGOs have focused on labelling, tax free sales and local licencing policies, including a more uniform system for control and sanctions of violations. Leading up to the local elections in 2015, NGOs will focus on local alcohol policies. Alcohol in the work life will probably be an area for more activity in the years to come.
The report Rusmidler in Norge (Alcohol and drugs in Norway) provides an overview of the alcohol and drugs situation in Norway.
Themes that have been explored in other studies include attitudes to alcohol policies, alcohol in the workplace and alcohol in nightlife settings. Other notable studies have assessed the number of people with risky alcohol consumption and revisited the collectivity of drinking cultures.
According to a 2016 July survey one in ten pregnant women drink during pregnancy. Women with higher education are most liberal to official recommendation on total abstinence. Nine out of ten women completely stopped drinking when they discovered that they were pregnant. The survey was conducted by TNS Gallup for Actis.
Women under 30 and those with more than four years of higher education are most open to drink during pregnancy. The survey also shows that 13 percent of the population thinks it is okay for pregnant women to have a glass of wine for dinner.
"Interestingly, there seems to be a decrease in youth alcohol consumption."
6.06 litres per capita
In September 2014 a new political situation was created after the general election. In the election campaign there were few, maybe zero, discussions on alcohol and other drug issues. These themes are very low prioritized. The new government, Social democrats and The Green Party, plan to continue with a long term, possibly 4 years, strategy, and it will probably be decided on during this year.
The expectations are not so very high. The message so far from the government is that farm sales of alcohol will still be prohibited.
There was also a strong parliamentarian agreement to raise the tax with 5% and that was in function from 1st of January. Bad enough some of the importers decreased their price to the alcohol monopoly, to reduce the effect of the political action. The industry is not to trust! There is no increase of the alcohol tax in the budget for next year.
The law which regulate the license to serve alcohol in restaurants and bars are since twenty years liberalized and the numbers has raised from ca 3000 to 12 000. That means in reality that most restaurants and cafés who want sell alcohol are allowed to do it.
The government have not acted to clarify the law to stop commercial activities in Sweden in connection with so called internet sales of alcohol and state that they are waiting for the opinion of the European Court of Justice in the Finnish so called Alkotaxi-case. In the meantime some of the “e-trade-companies” have attracted new capital and are increasing their marketing activities.
The state financial support to NGOs is on the same level for many years, but there has been some new organisations so in reality the amount has decreased.
The situation regarding narcotic drugs in Sweden was stable for many years, both in terms of data on use and in the political debate. In international comparison misuse was at a quite low level generally speaking and there was a consensus, more or less, among the political parties on what to do. Lately there has been a change of scene.
Most important is that drug related deaths have risen sharply over some years which has gotten a lot of attention during 2015. Some people argue in the debate that this is a consequence of the restrictive policy that Sweden has and therefore it should be replaced. The long term goal a drug-free society should give way for harm reduction as a goal. Other voices in the debate link the high death rates to the increased prescription of methadone and buprenorphine, based on data from Toxreg, a register over drug related deaths from Karolinska Institute.
The new red and green Government has been in place for less than a year and has so far been quite passive in this debate. The only action announced is that the Government plans to make it easier to start syringe exchange programs. As of today there are only a few programs running in Sweden. Also the Minister in charge, Gabriel Wikström, has ordered an inquiry to analyze why so many die from drugs. The report from the inquiry is to be presented during spring next year.
When it comes to data on prevalence the figures are still low. The latest data for lifetime prevalence for 16-yearolds is 8% for boys and 5% for girls. A small reduction from the year before.1
Swedish NGOs have a big interest in EU. But last year the Swedish organisations, together with other European organisations, left the Alcohol and Health Forum, organized by the Commission. The reason was that in this Forum also the alcohol industry was a stakeholder and the discussion wasn´t all the time meaningful. A meeting with the commissioner Andriukaitis is planned at the beginning of November 2015.
3. Sweden has a tradition of a strong influence from NGOs. The temperance movement is still active as well in national as in the local areas and act sometimes as a watch dog. In the Parliament has the numbers of member interested in alcohol issues reduced but there is still two associations, one for those who are interested in policy issues and one where you also have to be an abstainer.
Important work has been done by MHF, Abstaining Motorist, to reduce drink driving of truck drivers coming by ferries. Automatic sobriety checkpoints with breath analyzer test of the driver are in use in the Stockholm port “Frihamnen”. The test period has shown that there are a lot of drivers drinking in the ferry that later try to drive. There is a political support for these sobriety checkpoints to be established at all international ferry terminals in Sweden.
Another long term working project is a notification on alcohol advertisements on TV broadcasted from Great Britain to Sweden. Alcohol advertisement is not allowed on TV or radio according to Swedish law. The notification is done by IOGT-NTO and the issue, after two years, seems to be at a stand-still.
There is a strong support for the alcohol monopoly. Most of the parties in the parliament says officially that Sweden shall keep a restrictive alcohol policy. But there is difference between PMs what they really mean by restrictive.
Very good is that young people drink less today than earlier. The school surveys made by CAN show that 58% of students in 9th grade (ca 15 years of age) have not consumed alcohol in the last twelve months, which is the lowest figure since the surveys started in 1971.
According to figures from CAN the total consumption decreased by 4% during 2014 compared to 2013. In 2014 the consumption per capita 15 years and older was 9..28 litre 100% alcohol. During the last 10 years the consumption has more of less stabilized but has decreased with 11%. In 2015 the slow decrease continued, as consumption was 9.17 liters of pure alcohol, a decrease of just over 1% compared with 2014 (9.28).
Source: Alkoholkonsumtionen i Sverige 2015
58% of students in 9th grade have not consumed alcohol in the last 12 months
Changes in total alcohol consumption in Finland
Unlike most countries in Western Europe, in Finland the total consumption of alcohol continued to increase after the mid-1970s. The economic recession of the early 1990s reduced consumption for a few years. However, in the mid-1990s, the recession abated and alcohol became more easily accessible at the same time: mild alcohol beverages became available in kiosks and at service stations, the opening hours of stores and licensed bars and restaurants were extended, and quotas for travellers’ tax-free imports of alcohol were increased. The ‘booze rally’ escalated at the Eastern border and in Tallinn, and in 1995 the total consumption increased by 10 per cent compared with the previous year. (THL 2013)
In order to reduce alcohol imports by travellers, time limits for minimum stay outside Finland in order to be allowed to import tax-free alcohol were reintroduced in May 1996 for travel between Finland and non-EU countries, such as Russia and Estonia. (THL 2013)
In 2004, the availability of alcohol again changed significantly, as quotas for travellers’ tax-free imports of alcohol from other EU countries were abolished and Estonia joined the EU. Finland anticipated the growth of travellers’ alcohol imports by cutting alcohol taxes by one third on average. This reduced travellers’ imports, but total consumption and alcohol-related harm started to increase rapidly. The total alcohol consumption reached its highest point in 2005, being 10.5 litres in 100% alcohol per capita. (THL 2013)
As a result of the considerable increase in alcohol-related harm, Finns adopted a stricter attitude towards alcohol consumption. Requests for abolishing alcohol regulation became less common. In order to reduce consumption and alcohol-related harm, the Government increased the alcohol tax five times between 2008 and 2014. By the end of 2014, the increases reduced the total consumption to 9.3 litres of 100% alcohol per capita, which means 11.1 litres for each Finn 15 years and older.
The total consumption of alcoholic beverages decreased in 2015. According to the National Institute for Health and Welfare (THL), the decline has continued since 2008. The reduction amounted to 3.6 percent more than the previous year (2014). The total consumption of pure alcohol was 10.8 litre for every person aged 15 or over.
The total consumption of alcohol, according to statistics, was 8.5 litre per person. The rest was unrecorded consumption, such as alcohol imports by individuals. (Source: Finland Times; Päihdetilastollinen vuosikirja 2016)
(Finland has started applying the model used by the WHO, in which persons 15 years and older are included in the calculation.) (THL 2014a)
Figure 1: Total alcohol consumption from 1965 to 2013 in litres of 100% alcohol per capita, 15 years and older
Reference THL 2014a
Development of drinking habits
In fifty years, Finns have quintupled their alcohol consumption. During this time, the percentage of alcohol-consuming Finns, the number of instances of consumption and the amount of alcohol consumed at a time have increased.
Women’s alcohol consumption has sextupled from 1968 to 2008 and men’s consumption has doubled over the same period of time (THL 2010). In 2013, 13 per cent of men and 14 per cent of women abstained from alcohol. (THL 2014) However, men still consume twice as much alcohol as women. According to estimates, there are 250,000 heavy consumers of alcohol in Finland, but the estimate is probably too low. (THL 2013). A considerable percentage of heavy users and alcoholics go to work. (TTL 2010)
At the turn of the millennium, a change was seen in the alcohol consumption habits of minors: in this millennium, abstinence from alcohol has become much more common among minors, while binge drinking has decreased. (THL 2013). However, recent research data do not suggest that future generations would consume less alcohol than their predecessors. Even though minors are drinking less than before, binge-drinking at the age of 18 is just as common as in earlier decades, and among young women it is even more common than before. So, being drunk is not becoming less popular in our culture! (Lintonen et al 2015)
Alcohol tax and the booze rally
The questions and challenges related to alcohol imports by travellers also concern Sweden and, indirectly, Norway (an EEA country). In Finland, however, taxation policies have been much more inconsistent compared with those countries.
Until recent years, Nordic and Finnish alcohol policies have strongly relied on taxation, but in Finland the situation has changed in a short while. Fear of increasing alcohol imports, particularly from Estonia, has restrained decision-makers’ desire to further increase alcohol taxation. However, from 2008 to 2012, imports by travellers remained on a stable level, despite four alcohol tax increases. In 2013, imports by travellers increased. In consequence of this, the alcohol tax increase in 2014 was only half of that planned. In 2014, imports by travellers started to decrease slightly. (THL 2014b)
Figure 2: Development of imports by travellers by beverage type from 5/2004 to 8/2014, million litres of 100% alcohol
The month shown is the month in which the rolling 12-month period ends. For example, ‘8/14’ indicates imports by travellers from 09/13 to 08/14.
Reference: THL 2014b
In their advocacy work, the Federation of the Brewing and Soft Drinks Industry, which represents the brewing industry, and other players in the field of alcohol industry emphasise imports by travellers as a critical threat to their industry. In public debate, alcohol imported by travellers has become the main theme of the Finnish alcohol policy. Tax increases, for example, are strongly criticised. Tax increases have been successful in decreasing both the total consumption and the costs of alcohol-related harm. In addition, tax increases bring a multiple amount of tax income compared with possible increased imports by travellers from Estonia.
The value of the Finnish alcohol market (retailing and licensed serving of alcohol) is EUR 4.5 billion (THL 2014a). According to the estimate of the Finnish Ministry of Finance, the value of imports by travellers is EUR 200–300 million. Despite the concerns raised by the Federation of the Brewing and Soft Drinks Industry, a considerable percentage of the beer consumed in Finland is bought in Finnish stores, kiosks and service stations. It should also be kept in mind that a large proportion of brewery products imported from ferries or Estonia is produced by Finnish breweries or their Estonian subsidiaries.
Climate change in the alcohol policy
After the rapid increase in total alcohol consumption and alcohol-related harm starting in 2004, the Finnish alcohol policy climate remained very peaceful for years. Most Finns have been satisfied with the current alcohol policy and regulation. Stricter regulation has even been preferred to deregulation. During the 2007–2011 term of government, the Finnish Parliament demanded that image advertising of alcohol be prohibited. The Parliament referred to strong research-based evidence on the effects of alcohol advertisements, particularly on children and adolescents.
In recent years, requests for deregulation have once again increased, and the alcohol policy debate has become more heated. During the Parliamentary election campaign in spring 2015, a considerable number of candidates on candidate election machines expressed views related to the liberalisation of the Finnish alcohol policy.
The new restrictions to alcohol advertising that came into effect in January 2015 stirred vigorous public debate in autumn 2014. What actually had been decided was often obscured in the debate. The restriction of advertising was seen as a Finnish innovation, and Finland was referred to as ‘Bureauslavia’. The public debate culminated in the so-called Whiskygate. The false information according to which the authorities had prohibited the use of the word ‘whisky’ raised a storm, particularly in social media. Some members of parliament who had voted for the restrictions publicly demanded that the decisions should be cancelled. Some elements of the alcohol policy debate started to resemble hate speech. The government, the Ministry of Social Affairs and Health, the National Institute for Health and Welfare and substance abuse organisations were in the firing line.
In the 2011–2015 term of government, the objective was to implement a complete revision of the Finnish alcohol legislation and the Temperance Work Act, the latter of which regulates the prevention of harmful effects of substance abuse. The revision of the Alcohol Act was prepared from the perspective of public health and harm reduction. However, in connection with the change of Prime Minister, the idea of a complete revision of the Alcohol Act was given up. Instead, the revision of the Temperance Work Act was completed, and on 12 March 2015 the Parliament passed the law on the organisation of preventive substance abuse work.
The change in the alcohol policy climate has already been described above. Right before the parliamentary election held in April 2015, no political party had the courage to identify itself as an advocate for an alcohol policy that is based on the promotion of public health. The Centre Party, which became the Prime Minister party following the election, did not dare to defend its policy definitions, made only two years ago, aiming for the promotion of public health and the reduction of alcohol-related harm.
In the public debate and the statements of some politicians, the Finnish alcohol policy is portrayed as a world of over-strict regulation. This is not the whole truth about Finnish opinions on alcohol policy, but those opposed to restrictions are the loudest and most active voices in the debate. All of the most significant parties published their own norm dissolution programmes before the parliamentary election. Government and bureaucracy are believed to be oversized and the cause of Finland’s economic problems.
Economic questions, the sustainability gap and prolongation of working careers were at the core of the election debate in spring 2015. The officials in the Finnish Ministry of Finance have calculated that the public economy needs adjustments of EUR six billion during the next parliamentary term. Even though the estimated direct and indirect costs of alcohol harms in Finland amount to six or seven billion euros a year, reducing them has not made it to the agenda.
Once the term of government begins, we will know whether alcohol and other substance abuse questions return to the agenda. For example, will the overall revision of the Alcohol Act be carried out?
Changes in media coverage
Alcohol and alcohol policy are much discussed in the media. The media has highlighted substance abuse effects at the workplace, and the Finnish Broadcasting Company has even produced reality TV shows in which the participants try to abstain from alcohol. At the same time, the media has very colourfully analysed the Finnish alcohol policy. Instead of the perspectives of public health and harm reduction, the media focuses on criticising regulation and on the supervision of the interests of alcohol industries.
The latest alcohol tax increase was implemented at the beginning of 2014. It was only half of the originally planned increase. This was explained to be due to the possible increasing effect of the tax increase on travellers’ alcohol imports. The price of spirits increased by 2.2 per cent on average and the price of wine by 2–2.5 per cent. The prices of middle products, such as fortified wine and mulled wine, increased by 3.7 per cent on average. For the first time, the tax increase was implemented as an equal increase in relation to pure alcohol. The increase was EUR 2.15 per litre of pure alcohol. As a result of this, the tax increase varied from five to 8.6 per cent, depending on the beverage category. Previous tax increases were implemented by increasing the tax by 10 or 15 per cent in all beverage categories.
Estonia’s recent decision to increase alcohol tax was received positively among decision-makers and experts. At the same time, however, it was stated that the planned increases will not stop the booze rally, as the price level of alcohol in Estonia will still be low.
The majority of Finns support the alcohol monopoly. Recently, however, particularly expectations on allowing grocery stores to sell wine have increased. This has not happened for some time. As regards spirits, the monopoly system enjoys strong support. In practice, maintaining the monopoly system only as the sales channel for spirits is an unlikely option, simply because of the cost structure: selling would require government subvention. Even now, estate wines can be sold outside the monopoly system. Small breweries wish to have the same opportunity. In public debate, it has been difficult to clearly communicate the fact that from the viewpoint of the EU Commission, such a change is hardly possible any more if Finland wants to keep its monopoly system. Instead, it is now easier for small breweries to sell their beers through Alko.
Alcohol policy strategy
The previous, and only, Government Resolution on alcohol policy guidelines is from 2003. Its implementation has been supported with national alcohol programmes. At the moment,
a new action plan is being prepared to support the implementation of the new law on preventive substance abuse work. It will replace the current alcohol programme. An extra appropriation has been granted for this preparation work for 2014–2016.
The frame of reference for the action plan is the WHO’s strategy and action plan for the reduction of alcohol harm and the UN/WHO’s action plan for the reduction of national diseases. National objectives for alcohol and tobacco will be derived from these. Thus, the revision serves the enforcement of new laws. International undertakings and recommendations will be taken into account and made visible. Alcohol, tobacco, drugs and gambling will be integrated into preventive substance abuse work and this extensive approach will be included in the name of the programme.
Figure 3: Recommendations for action included in the WHO’s programme for the reduction of national diseases
The Finnish Association for Substance Abuse Prevention EHYT has launched the Network for Preventive Substance Abuse Work. It includes the 35 most important Finnish expert organisations focusing on preventive substance abuse work. The network was launched in 2012 and it combines resources for efficient work. The goal is a society with more well-being and less substances.
The network aims to
•promote work for stronger social influence
•make citizens’ voices heard
•provide a forum for discussion
•support small organisations
•strengthen a collective culture of preventive substance abuse work
•improve the quality of preventive substance abuse work and increase its appreciation.
The network is currently updating its strategy.
Even though it is a young organisation launched in 2012, EHYT has quickly found its place. The stakeholder questionnaire carried out after the first year of operations indicated that the organisation has become a popular partner for co-operation. EHYT works with children, adolescents and working-age and ageing population. The organisation works mainly on the collective (schools, workplaces) and individual levels. However, advocacy work on alcohol policy has become emphasised in the organisation’s public profile, which is not completely attributable to the organisation itself. In its work, EHYT aims to reduce harm caused by alcohol, tobacco, drugs and gambling. As for alcohol, EHYT is aiming for a 20 per cent reduction in total consumption. This would mean returning approximately to the level of the mid-1990s and the current level of Sweden, for example.
Any major reports in alcohol research, statistics and related harm in 2014/2015?
The law reform that came into effect on 1 January 2015 prohibits the advertising of mild alcoholic beverages in public places, such as bus stops, public transportation vehicles and billboards. An exception to this rule is that alcohol can still be advertised at public events, such as sports events and concerts. Furthermore, advertising in the current manner is allowed on ships in international traffic and in locations where alcoholic beverages are served and sold. Outside these locations, the names and prices of alcoholic beverages may be advertised.
The current limit for showing alcohol commercials on TV will be moved from 9 p.m. to 10 p.m. In future, this limitation will also apply to radio commercials.
In future, such advertising and marketing of mild alcoholic beverages that involves consumers’ participation in a game, lottery or competition will be prohibited. In addition, content produced or shared by consumers, such as writing, photos, video clips or commercial films, must not be used for advertising. This affects alcohol advertising on social media but does not apply to citizens’ own communication. In other words, the new restrictions to alcohol advertising only limit the rights of producers and sellers to advertise their products on the street or on social media. Consumers are still allowed to praise their favourite drinks as much as they please.
Advertising of spirits continues to be prohibited. According to the current Alcohol Act, spirits can be shown only on printed price lists. In future, retail price lists (Alko, airlines and shipping companies) may be published also on the internet.
Substance abuse organisations pursued a solution similar to the French Loi Evin, so that alcohol advertising would be limited to product information and any lifestyle advertising would be banned. The restrictions to outdoor advertising are considered good as such, but allowing advertising at sports events and other public events undermines the efficiency of the restrictions.
Some representatives of the media, advertising and marketing players and, particularly, representatives of the brewing industry have strongly opposed the new restrictions in public, questioning the effects of advertising on children and adolescents.
At the moment, total prohibition of advertising has no chance of success; it is opposed by decision-makers and the general public alike.
The majority of Finns support the alcohol monopoly.
Estonia has been one of the leading countries when it comes to alcohol consumption. In 2007 the per capita consumption level (from birth to death) was 12.7 litres. With a combination of introduction of different alcohol policy measures (tax raises, ban of night time sale, advertising restrictions) and the economic crises that started in 2008, alcohol consumption started to fall until it reached 10.0 litres in 2013 (all residents).
“Converted into liters of absolute alcohol, 13.8 liters of legal alcohol per resident were sold in Estonia last year.
Deducting tourist consumption and accounting for some degree of consumption of illegal alcohol (0.5 liters per person) brought the total amount of alcohol consumption, as measured in absolute alcohol, to 8.7 liters per resident, or 10.3 liters per adult. Thus alcohol consumption in Estonia decreased for the third year in a row.
Compared to the year before, alcohol consumption per adult resident decreased by 0.8 liters.
Compared to 2007, however, which saw the past decade’s highest level of annual alcohol consumption, consumption in 2015 had decreased by a whole 4.5 liters, down from 14.8.” Source: ERR News
It is impossible to say what have been the main influences behind that decline but it is clear that the economic crises played an important part in this change. And as Estonia is still lacking a comprehensive alcohol policy, current situation is unstable. This was also stated at 2011 paper by Taavi Lai and Jarno Habicht. “Alcohol consumption in Estonia has decreased moderately since 2008, while the alcohol policy has strengthened since 2005. Estonia lacks a comprehensive alcohol policy that could be used to coordinate action against harmful alcohol consumption. The need for such a policy is among other things underlined by the fact that some of the important alcohol policy changes were based on national fiscal policy concerns or adaptation of EU agreements, and public health concerns were addressed only in second order.” http://alcalc.oxfordjournals.org/content/46/2/200
National Institute for Health Development has declared that countries goal is to reach 8 litres level per inhabitant. The current government coalition agreement goes even further and says that alcohol consumption should be halved by 2030. While it is an important development hinting that the government is interested in having a long term goal concerning alcohol consumption and related harm it is still rather unclear how government plans to reach that goal and of course the current coalition does´nt have a direct responsibility on what happens in 2030.
The society seems to be growing in understanding the depth of the alcohol related problem. When 10 years ago a large part of Estonian population was in denial and did´nt recognize the size of the problem, now we have evolved to level where the discussion is about what works and what does´nt in preventing that harm.
Estonian Reform Party is liberal political party in Estonia. The party is led by Taavi Rõivas, the current Prime Minister of Estonia, and has 30 members in the 101-member Riigikogu, making it the largest party in the legislature. The Estonian Reform Party has participated in the government of Estonia for all but three years since its foundation in 1994.
As the Reform Party has participated in most of the government coalitions in Estonia since the mid-1990s, its influence has been significant, especially regarding Estonia’s free market and low taxes policies.
Ideologically, the Reform Party has consistently advocated market liberalism. The Reform Party is the most economically liberal in the political landscape of Estonia.
As the Reform Party has been partner (if not the leading party) in most of the governments in Estonia, most alcohol policy developments have also taken place under their governance. Even though they are opposing to most of the stronger alcohol policy measures (alcohol advertising bans, strong limitations in availability), developments that have taken place have been either their initiatives or together with their support. Until now, the Ministry of Social Affairs have been ruled by the Reform Party. In the current government the Minister of Health and Labour is Social Democrat Jevgeni Ossinovski.
In 2011 the Ministry of Social Affairs initiated an alcohol policy “Green Book” process which was supposed to serve as the basis for government action. Both public health NGO-s and alcohol industry were involved in different working groups. Paper was adopted by the Government in February 2014. Coalition agreement in 2015 commits to introduce some of the principles from the green paper. Until this day, Estonia does´nt have an Alcohol Strategy.
Ossinovski´s alcohol bill
In October 2015 minister Ossinovski introduced a bill that would set tougher regulations on alcohol ads and turn flashy commercials into concise notices. The bill will also limit the sale of alcohol in gas stations and ban happy hour offers. According to social ministry’s plan, alcohol ads can no longer include audio and visual design elements. All outdoor advertising will be banned. In other words, alcohol commercials will be limited to a monochrome still picture and a short audio cue with product information and a health warning. Adverts will can only entail the name, type and producer of the alcoholic beverage they promote, country of origin, alcohol content by volume, image of the packaging, and descriptions like color, scent and taste of the product. In addition, no alcohol commercials will be aired before 22:00, instead of the current 21:00 watershed.
According to the bill, alcoholic drinks must be separated from other products in shops. Starting from January 1, 2018 they can only be sold in an area detached from the rest of the floor space by non-transparent walls. Small shops can get around this rule by selling alcohol over the counter only.
From 2017 onward, gas stations will no longer be allowed to sell alcohol.
Moreover, catering establishments will not be allowed to offer happy hour deals of two for one or any similar discounts.
During the following months the bill received both strong support from the civil society and harsh criticism from the economic operators and different political parties. The minister of economic affairs and infrastructure, Kristen Michal (Reform Party) and Justice Minister Urmas Reinsalu (Pro Patria and Res Publica Union) withheld their consent for the proposed changes. The Ministry of Justice supports the bill’s objective to protect public health from the risks of alcohol consumption, but the objective should be achieved in a way that burdens the society the least and is the most cost-effective, Reinsalu said.
Minister Reinsalu´s opposition is especially unexpected as Pro Patria and Res Publica Union has been one of the main supporters of stronger regulation in alcohol policy. At least partly the reason appears to be a personal one between political figures.
After these interventions, the bill has been slightly modified and a stronger stand on internet advertising was added.
The bill is expected to go back to the governments agenda early this fall.
Looking at the recent alcohol policy discussion, pricing has been one of the main topics. State has twice the reason to consider tax raise as in addition to public health benefit it also promises to increase the state income.
An important period in alcohol taxation was around the beginning of the economic crises. Compared with the 2004 level, excise tax increased 45% by the beginning of 2010. The highest tax increases (30% altogether) occurred in 2008 when the economic crisis started to affect the Estonian economy. This was the first occasion when affordability of alcoholic beverages decreased after many years.
In 2010, the revenue from alcohol excise duty was 165.21 million euros, which accounted for a quarter of total state revenue from excise duties. Since 2000, receipts of alcohol excise duty have decreased by about 11 percentage points. In 2010, alcohol excise duty accounted for 4.1% of Estonia’s total tax revenue.
Estonia has lower excise duty rates than Finland and Sweden. Although the excise duty rates in Estonia are higher than the EU minimum rates, there is enough room for improvement. The excise duty rate for strong alcoholic beverages in Estonia is 25.31 euros lower than in Finland and 35.02 euros lower than in Sweden. The difference in duty rates is justified, since Estonian consumers have a lower ability to pay tax.
In the 4th quarter of 2010, average monthly wages in Estonia were 814 euros according to Statistics Estonia, and the average monthly wages in Finland were 2,600 euros according to the Finnish Working Life Information Point.
After the Parliament elections in March 2015 the new government has searched for new income sources and alcohol taxes have always been on the table. After long discussions the decision is to raise the excise duty for alcohol in 2016 for 15%. Alcohol tax will also rise by 10 per cent in 2017, 2018, 2019 and 2020, except for the excise duty on wine which will rise by 20 per cent. The rate of excise duty on fermented beverage will also be raised by 20 per cent, so that it would be equal with the rate of excise duty on wine.
According to the Estonian Alcohol Producers and Alcohol Importers Association by the end of May 2016, 10% of the Estonian market for strong alcohol had moved to Latvia and estimates suggest that at the end of the year 2016 Estonian consumers will buy 20% of strong alcohol at stores situated on the Latvian side of the Estonian-Latvian border. Producers have demanded that further tax raises would be canceled.
Commenting the issue the Estonian Tax and Customs Board (MTA) has said that their focus is on smuggling and smugglers, and that bringing alcohol across the border from Latvia for one’s own consumption is a lawful activity. Ministry of Finances commented that this is a small problem and the excise duties are coming in as planned.
Reducing alcohol availability has´nt seen any real changes in recent years. The last major change took place in 2008 when retail sale was restricted after 10:00 p.m. and allowed again from 10:00 a.m.
According to Estonian Institute of Economic Research the baseline is following. There are 195 alcohol sales points per 100,000 population in Estonia compared with only 6.5 in Finland, 5.1 in Norway and 4.5 in Sweden.
A single bigger change reducing alcohol availability in Estonia came from Tallinn municipality. The law that came in force July banned the sale of beverages with alcohol content higher than 22 percent in gas stations, shops smaller than 150 square meters and shops less than 50 meters from primary, secondary and vocational schools.
Tallinn also attempted to ban all alcohol sales on Sundays, but that was overturned by a court although no final ruling has been made yet.
Drinking in public places
The Estonian Parliament (Riigikogu) voted in December 2014 for amendments to the law enforcement act which will prohibit drinking alcohol in public. This came just six months after Parliament passed a law that permitted public drinking in the country.
The act provides for a general prohibition of alcohol consumption in public places, including non-food substances that can cause intoxication like cleaning liquids or perfumery.
Alcoholic beverages can be consumed in a place where they are being sold for consumption on the spot, such as establishments providing catering and accommodation, performing arts institutions, etc. Alcoholic beverages can also be consumed at public events or in limited areas where the local government has allowed the retail of alcoholic beverages for consumption on the spot.
Local municipalities will have the right to identify places where alcohol consumption is allowed. But drinkers will not be permitted to consume alcohol in a way that disturbs others.
An absolute ban on the consumption of alcohol will stay in force in certain places, such as around childcare centres and playgrounds, health authorities, on public transport and at stops, and local authorities will not be able allow the consumption of alcohol in these areas. (Source: The Baltic Times)
The next big step would be adopting the alcohol bill and with that ban alcohol sale in gas stations and limit the availability in grocery stores by moving alcohol to special areas, surrounded by walls.
Marketing and advertising
At the moment, alcohol can be advertised in TV and Radio starting from 9.00 PM to 7. AM.
Health minister Jevgeni Ossinovski has acted by introducing a comprehensive bill that addresses also alcohol marketing. More precisely, the bill proposes following:
– Alcohol ads may only contain regarding the drink its 1) name 2) type 3) name of producer 4) trademark 5) country of origin 6) geographical region 7) ethanol content percentage 8) image of sales package 9) description of characteristics (colour, aroma, taste). The information contained in alcohol ad must be presented on single colour background, and without sound and visual design elements.
– Also to be banned is the thus far allowed open air ads of low-alcoholic beverages (strong alcohol is already banned).
– In TV the allowed time for alcohol ads will be pushed further into the night by one hour to 10 pm.
– It will be prohibited for stores to hold degustation events for alcohol, and eateries will have to go without the so-called happy hours where at certain times alcohol is cheaper of offered two for the price of one.
Civil society projects and reports
In 2014-2015 Norway Grants programme “Public Health Initiatives” is funding different civil society projects. Estonian Temperance Union is running a media campaign introducing the term „Passive drinking“ and changing attitudes and behaviour regarding alcohol abuse. http://passiivnejoomine.ee/
There are 195 alcohol sales points per 100,000 population in Estonia compared with only 6.5 in Finland, 5.1 in Norway and 4.5 in Sweden.
Alcohol policy strategy
Since the previous Program for Reduction of Alcohol Consumption and Restriction of Alcohol Addiction for 2005-2008 ended in 2008, there was a need to continue the implementation of common alcohol policy, which would result in a decrease of the use of alcoholic beverages and the reduction of health care burden caused by alcohol related diseases.
The Ministry of Health, as the Secretriat of The National Council for Prevention of Alcoholism (hereinafter- Council), which has been an advisory institution on issues related to alcohol harm reduction in the country since 1995, and which is chaired by the Minister of Health, prepared the initial proposals for the new action plan. Draft proposals were first discussed on February 2, 2011 during the meeting of the Council, where representatives of the Council expressed their support for the new action plan. On October 5, 2011 Public Health Strategy 2011-2017 was adopted where, according to the task set forth in Action 2, Sub-paragraph 2.1, the Ministry of Health was dedicated to develop and implement the Alcoholic Beverage Consumption Reduction and Alcoholism Restriction Action Plan 2012-2014 (hereinafter- Plan).
Action Plan 2012-2014 The Plan was a short-term policy planning document and has already finished. The Plan aimed to provide planned, harmonised and coordinated actions to promote the reduction of the harmful effects of alcohol consumption on public health. Four key action areas proposed to achieve the target include the restriction of and control over the offering of alcoholic beverages, the reduction of demand for alcoholic beverages, the reduction of the dangerous and harmful use of alcoholic beverages and monitoring of indicators of alcohol consumption and its effects, and public information. It is expected that these actions will promote the reduction of activities related to the trade of illegally produced alcoholic beverages and criminal activities. It is also expected to change the acceptability of alcohol as the social norm in society, especially among young people and children. The Plan was also aimed to reduce health problems related to the harmful use of alcohol in society. Alcohol-related information monitoring and analysis of data is also one of the strategically important issues covered by the Plan.
The time frame starting from the conception leading to the adoption of the Plan was 2 years. Tough discussions with stakeholders on action areas and specific activities led to a very long adoption period and as a result the plan was adopted only on December 19, 2012. As the most challenging issues were retail and advertising restrictions and issues related to the taxation of alcoholic beverages, no agreement was reached with trader NGOs, the Ministry of Economics, the Ministry of Agriculture, and the Ministry of Finance. Quite a difficult issue was also the determination of responsibility for sobering-up stations. While only few measures under the Plan were carried out through financial resources from European Structural Funds, there were no additional resources allocated for the implementation of the whole Plan.
Results of the Action Plan During the action plan the obligation to show ID during the purchase of the alcohol for the persons of 25 years old and younger was introduced in the legislation. Also the new legislation, which allows to involve minors in the control purchases of alcohol and tobacco was introduced.
During the plan, interactive map on the police website was developed, which allows people to warn about the places where alcohol is sold illegally.
Ban on alcohol outdoor advertising was introduced in 2014. Tough discussions where about the possibility to introduce ban on advertising of special offers and discounts outside the sales premises, as well regarding the prohibition to show persons in alcohol adverts and ban alcohol adverts on radio and television during daylight hours (6 am- 10pm). Since no agreement was reached between different sectors in the government, the draft legal act has been withdrawn.
Report on implementation has been prepared.
Currently (December 2016) the Ministry of Health works on new 3 years action plan.
Important argument for alcohol excise raises has been Governments need for additional revenues. Excise taxes have been raised for alcohol in August 2015. For spirits +1,7%, wine +9,3%, intermediate products + 10,4%, beer +22,6%. For ciders with absolute alcohol under 6% excise has not been raised. Money was used to finance free meal for 4 th grade pupils.
Outdoor advertising has been banned. Draft law regarding advertising hours limitations in tv and radio, as well as draft law regarding restrictions on advertising of special offerings have struggled in the government. Restrictions on using persons in alcohol adverts also are in the package.
37 percent of economically active residents of Latvia have admitted to purchasing illegal alcohol at least once in their lives, with many also admitting that the State Police is not doing enough to combat the sale of illegal alcohol, according to a survey carried out by the market, social and media research company “TNS Latvia” and the LNT television channel’s news program “900 Seconds”.
The highest proportion of those who have purchased illegal alcohol are residents of Latgale and Vidzeme provinces, males, and persons from lower income households.
At the same time, 60 percent of respondents admitted that they have personally never purchased illegal alcohol. The highest proportion of those who have never purchased illegal alcohol are residents of Riga and the surrounding area, females, as well as persons with a university degrees.
Furthermore, 80 percent of economically active residents of Latvia believe that the State Police is not doing enough to combat the sale of illegal alcohol, while only 13 percent believe that the police is doing enough. (Source: Latvian News)
Health Minister Guntis Belevics (Greens/Farmers) said in March 2015 that Health Ministry’s Latvian Health Platform is intended to to reduce the percentage of the population who smoke and (ab)use alcohol or drugs to 1% by 2065. He also said that by 2065 he will make sure the average lifespan in Latvia be 90 years. In 2013, the average lifespan in Latvia was 74 years, which is one of the lowest in the European Union.
According to the plan the number of healthy life years for both women and men will be 75, which is 16 to 20 years more than in 2012. In order to achieve this, the Health Ministry, in collaboration with the Center for Disease Prevention and Control, will focus on four pillars of the health platform – healthy food, addiction treatment, preventive healthcare, and physical activity.
Healthy food will help reduce the number of people who are overweight or obese. In 2012, the proportion of Latvian residents who were overweight was 32%, those suffering obesity – 18%. By 2065, the Health Ministry plans to reduce the number of overweight people to 10%, but obese people – to 5%. The ministry also wants to increase the proportion of people who engage in physical activity.
Reducing the number of residents who smoke and use alcohol or drugs to one percent of the population is possible, however, it requires educating people at a very early age, as well as implementing radical amendments to the law, commented Astrida Stirna, the head of the Latvian Association of Narcologists. In order to achieve this, there has to be a clear plan of action, says Stirna. The law has to be amended, and the availability of alcohol and tobacco restricted. “This is a complicated process,” the expert stresses. Alcohol producers are currently focusing on aggressive advertising which influences the youth, and it would be necessary to limit it in order to reduce the demand, the medic adds. (Source: The Baltic Course)
Minister of Health was changed on June 16, 2016 and current minister is Anda Čakša. The long-term plan is currently not in the agenda.
Alcohol related harm
Latvia loses nearly 20 thousand years of life and EUR 80 million annually because of problems caused by alcohol: premature deaths, disabilities and all kinds of illnesses, says Marcis Tapencieris, researcher of the Philosophy and Sociology Institute of the University of Latvia and NordAN board member.
Measures to reduce availability of strong alcoholic drinks especially apply to the demographic of young people in the country, because alcohol consumption has the largest negative impact on youngsters’ health. It is also the leading cause of death among young people. This includes alcohol overdose and drunk driving. Habitual consumption of alcohol also causes serious health problems, including cancer. (Source: Baltic News Network).
The most patients treated by the Narcology Centre are insolvent and are usually released after the first day after receiving treatment. According to Astrida Stirna, patients are quickly released because they cannot afford treatment. There is no compensated medicine for adult patients of this kind. This makes their treatment even more difficult.
Stirna notes that even if a doctor prescribes medicine, patients often simply cannot afford it. This is often detrimental to the final result of the treatment.
Latvian Medical Association mentions circulation of alcohol among schoolchildren as one of the main problems in Latvia. Statistical data shows that 84% of schoolchildren have consumed alcohol at one point or another. On top of that, teenagers often do not have any problems in procuring alcohol. Approximately one-third of schoolchildren have tried alcohol more than 40 times, which points to the problem of alcoholism. (Source: Baltic News Network).
Longterm goal: Reducing the number of alcohol (ab)users to 1% by 2065.
Alcohol consumption per capita (15+) in the population is calculated and publicly reported by the Lithuanian Department of Statistics, based on retail sales data. In Lithuania consumption of legal alcohol has increased 1.5 times over the period of past 15 years (from approximately 9.7 litres per capita in 2000, to 14 litres in 2015). There was a significant, but brief reduction as a reaction to financial crisis of 2008, but in 2011 has reached the pre-crisis levels and plateaued at an alarmingly high level, despite a slight decline in 2014. Average per capita consumption according to WHO Global report on alcohol and health (2014) in Lithuania between 2008 and 2010 was 15,4 litres of pure alcohol (including legal and illegal alcohol). Such indicator places Lithuania among top three in the world.
Source: Lithuanian department of statistics
In 2016, after a focused pressure from the combined alcohol related industries lobby, the Statistics Lithuania methodology for estimating alcohol consumption was changed and retrospectively applied towards consumption estimates from 2010 and several previous years. The change in methodology involved inclusion of tourist effect and exclusion of duty free alcohol sales. This update resulted in slight decline of pure alcohol consumption estimate in years where the reestimation was applied.
Attitude estimation is quite difficult, due to lack of studies and surveys on this issue in Lithuania. There are general attitude trends that can be gleaned from the number of opinion-articles in mass media, statements from politicians. One of such trends is favoring harsher punishments against drinking and driving among the general public, especially after recent accidents involving drunk drivers. Harsher punishments have also been publicly promoted by politicians and civil servants.
Conflicting data is produced by public surveys, regarding population attitude towards advertising ban, however more people seem to favor full advertising ban. A positive attitude among the electorate, however that is not acted upon by politicians.
2009 Eurobarometer studies have shown that Lithuanians are similarly aware of the alcohol harm on health, and similarly to populations in other Eastern European countries were more inclined to agree that price increases would change their purchasing behavior.
A population survey conducted in 2008, determined that over half of the respondents thought that in Lithuania people drink too much and too often and agreed that alcohol should be used only on special occasions. These attitudes are however divergent from drinking behavior prevalent in population.
Current Government is formed by center left coalition, with the leading Lithuanian Social Democratic Party (LSDP). The party has conflicting record on alcohol control, with positive initiatives taken under leadership of V. Andriukaitis (current EU Health Commissioner) when serving as healthcare minister, while the party itself consistently sides with alcohol industry, rather than supports public health interests. Overall alcohol control issue is highly politicized and currently dominated by numerous, uncoordinated and contradictory proposals for new legal amendments, arising from different individual politicians and parties. Some of the proposals attempt to introduce minor, but evidence based alcohol control measures, while others lack any scientific or empirical evidence of their effectiveness. Last quarter of 2015 and first months of 2016 alcohol lobby mounted a strong campaign to revoke alcohol sales ban in fuel stations (came into force 1st of January, 2016). Somewhat surprisingly these efforts were not successful.
Alcohol control efforts originating in the state institutions have been uncoordinated and controversial, since they do not include WHO best buys, focus on promises about the future and do not inspire trust regarding implementation.
In Lithuania there is a legal provision allowing public initiatives to be mandatorily considered by the Parliament, when new proposals are backed by more than 50 thousand valid signatures. In March, 2016 a campaign by a group of Lithuanian activists was announced to introduce specific amendments to the Alcohol Control Law to be presented for the Parliamentary deliberation procedure. The campaign has formally fulfilled all requirements, collected over 61,000 signatures, was accepted by the Central Electoral Commission as a valid legal proposal and registered in the Parliament. The initiative included amendments to ban all alcohol advertising, introduction of specialized alcohol-only shops, increase of the legal drinking age and other. Current Government provided a negative review of all the proposals prior to upcoming voting in the Parliament autumn session.
Currently there is an open lack of political will to engage in consistent and strategic activities in the field of alcohol control, due to upcoming Parliament elections in October 2016. The topic of alcohol control for now has become a tool of political rivalry and agitation
Besides the instrument for assessment of the Republic of Lithuania MPs voting patterns regarding alcohol and tobacco control policy has been developed and implemented during six sessions of the 2012-2016 Parliamentary periods. Results of the analysis were published in journal Health Policy and Management (in Lithuanian language). Methodology is publicly available. Assessment of the MP voting patterns has revealed large differences between individuals belonging to the same political party, therefore general assessments for political fractions were more negative. Over half of the MPs were assessed negatively, which partially was due to their non-attendance of the Parliamentary voting rounds.
During past few years negative media coverage on effective alcohol policies decreased, there is less ridiculing evidence based measures and personal attacks on control advocates. There are more public articles and events where alcohol harm is publicly stated.Due to relevant problem of suicides, harmful consumption and dependence is discussed more often, yet major information outlets too often ignore and sometimes block articles focusing on evidence based control policies. There is a tendency to whitewash and discreetly hide evidence – e.g. photos of politicians having a beer with alcohol industry lobbyist have been removed. Articles were denied publication, when clearly stating the need to ban advertising. However there is an increase in attention from opinion-makers, celebrities and politicians discussing alcohol harm in media, more high profile journalists cover those issues in their programs on TV and radio.
Minor increases in excise tax have been achieved, despite constant inhibitions by industry lobby. However despite that, affordability of alcohol has steadily increased since the end of economic crisis in 2010. In comparison to 2010 (2010 = 100 per cent) the affordability index of alcohol beverages in 2012 was 113 percent, in 2013 – 118 percent and in 2014 – 122 percent. The main driver for such trend was the increase of average net salary in Lithuania (from 450 EUR in 2010 to 527 EUR in 2014). This trend also fuels consumption and related harm.
After government changed in October 2016, new coalition has a very different view on alcohol regulation. Before Christmas 2016, Lithuanian Parliament with overwhelming majority adopted legal changes which will substantially increase alcohol tax from March 2017. All groups of alcoholic beverages will be affected – while excise tax for beer and wine will increase up to 112%, for strong alcohol it will be only 23%.
Tax increases will have to be addressed next year as well, since the planned automatic scheduling of tax increases was abandoned.
Alcohol availability changes are quite difficult to measure, because of faulty licensing system of alcohol. Alcohol licenses are issued for unlimited time and vendors do not carry responsibility to inform authorities about full or temporary discontinuation of activities. According to the Drug, Tobacco and Alcohol Control Department data, number of issued alcohol licenses increased by 27 percent in 13 years (picture 3).
Picture 3. Dynamics of Issued licenses to sell alcoholic beverages in 2003-2015
Currently there are relatively few restrictions regarding location of alcohol sale. Alcohol accessibility for underaged to buy alcohol is high, majority report that they do not encounter difficulty in buying alcohol: NTAKD survey in 2012 has demonstrated that only 9 perc. of adolescents aged 14-17 experience that to buy alcohol is very difficult or rather difficult. About 50 perc. of respondents report buying alcohol themselves, high proportion is provided alcohol by adult friends and parents or relatives.
Ban in petrol stations – January 1, 2016
Efforts to reduce alcohol consumption are continuing in the country – a specific goal to reduce per capita annual consumption down to the level of the European average was adopted in 2014 as part of the National Health Program. Yet there still appears to be ambivalence of politicians in power towards effective alcohol control measures in Lithuania, as evidenced by the newest attempt at the end of 2015 to overturn the ban on alcohol sale in petrol stations. Learning from previous experience of 2011, this latest attempt was anticipated by public health advocates.
In November 10 (2015) Parliament rejected this proposal to extend the permit to sell alcoholic beverages in petrol stations until 2019. The proposal to reject extension was supported by 50 MPs, with 9 votes against and 16 abstentions.
The process was counteracted with more effective resistance, focusing on early monitoring of the legal process and instant publication of events by creating a publicly available event chronology. That document mapped parliamentary processes, as well as the persons involved, and was followed attentively by the media. Success was a result of vigorous, time-consuming efforts by the anti-alcohol lobby, combined with growing public support in response to some tragic and very public alcohol-related deaths. This restriction on alcohol availability has now been in force since January 2016 and has helped to eliminate nearly 600 points of alcohol sale.
Eurocare, NordAN and APYN sent a support letter to the Parliament of Lithuania urging Parliament members to vote in favor of the alcohol sale ban at petrol stations. Estonia is now following Lithuania´s example when Ministry of Social Affairs introduced a bill on October 19 and part of that bill is also a ban for alcohol sales at petrol stations.
In the past years rights of municipalities to legally regulate availability and accessibility have been broadened: determine legal distance between alcohol outlets and schools, places of worship, etc., possibility to ban sale of alcohol in public events. There are new attempts by municipalities to reduce availability of alcohol by introducing limited sales restrictions for specific public events, local celebrations and similar. However no funding and additional resources are available to control the implementation of these local decisions yet.
Marketing and advertising
In 2014 (January-August) beer was among top ten product groups in advertising volume and has increased since 2013. In major internet based media alcohol advertising is pervasive.There is an increase in more opaque and unmarked advertising, through social media, special articles, distribution of mascots and brand souvenirs. There is a spread of hidden advertising using other products, especially products for sports-fans.
There is an additional focus on home brew, increase in advertising for beer making equipment.
The new and deliberately strengthened channel for advertising is use of non-alcoholic beer to avoid all advertising restrictions that are currently provided within legislation. The non-alcoholic beer advertisements have been extensively used during basketball events and in 2015 have been prevalent in most running events (marathons, half-marathons, etc.), distributed even to children. It is also advertised as a healthy drink in association with these events. Beer industry is audaciously exploiting a current loophole, and also aware of it.
The focus of NTAKK this year is to build support among the politicians and decision makers in a very unstable political environment which is preparing for the election next year. We are cooperating with the Drug, Tobacco and Alcohol Control department supporting their proposed control measures on alcohol advertising restrictions, involved in activities against unethical alcohol advertising. Continuing to work in raising awareness on the issue among the public nationally and internationally.
There is no national alcohol control strategy in Lithuania, however there is comprehensive Alcohol Control Law and provisions for alcohol control in other legal acts. Alcohol control law sets a strategic goal – to decrease alcohol consumption and related harm. Constitutional Court of Lithuania of 26th of January, 2004 has contributed with a strategic decision stating that “alcohol consumption can have harmful consequences for physical, psychological and social well-being of individuals, their groups and even society as a whole, therefore exceptional regulation procedures for alcohol production, import, trade and other supply provisions should be implemented by the state.
The restrictive alcohol control measures are Prevention and control policy is mostly shaped according to Lithuanian Health Programme 2014-2025 and related documents, some of which have already expired, such as Alcohol and Tobacco control programme 2012-2014 (interinstitutional action plan). Overall both documents provide relevant objectives and goals, but their implementation is weak. Too little funding is earmarked for implementation of these programmes. Also there is an enduring problem of missing cooperation between governmental institutions responsible for these issues, and often lacking expertise. There are severely limited funds for smaller NGO projects, and of these small funds most is spent on primary prevention in schools, rather than increasing focus on evidence based policy measures, engaging society in advocacy or empowering to implementation of evidence based alcohol control.
After previous Health minister V.P.Andriukaitis became EU commissioner, in July 2014 new minister of Health was appointed. This slowed down many alcohol control policy processes, reduced cooperation, and changed networks. Overall judgement – it is more difficult to implement evidence based alcohol control policy now than before and political will is simply lacking.
Drug, Tobacco and Alcohol Control Department has been under threat for the second time during 2014-2015. Lithuanian Government, supported by the Lithuanian Health Ministry had once again initiated process of weakening alcohol and tobacco control policy in Lithuania by restructuring Drug,Tobacco and Alcohol Control Department and distributing their control functions to other institutions. State Food and Veterinary Service would become responsible for the alcohol control and State non Food products inspectorate would get tobacco control functions. Drug, Tobacco and Alcohol Control Department is the only public institution in Lithuania that systematically works towards evidence based policies, fully supports WHO Alcohol policy best buys and has effectively collaborated with NGO. This is the key institution in implementing, overseeing and coordinating all areas of psychoactive substance control. For Lithuania it is crucial that this institution remains in full functionality and continues it’s activities. The final decision on this will have to be made by the Parliament of the Republic of Lithuania.
Lithuanian Tobacco and Alcohol Control Coalition and its’ member organisations continue to be the main advocacy force in the field of control for alcohol and other psychoactive substances. Past several years NGOs had to combat different state and municipal initiatives to weaken alcohol policy.
In 2015 Lithuanian MPs initiated the amendment to revoke the ban on alcohol sale in petrol stations. Civil society reacted to this by launching an experiment and providing proof how easily underaged can buy alcohol in petrol stations. The viral video released as part of the action has helped to make public more aware of the harmful amendments.
Overall feeling is that there is less tolerance in society towards harmful alcohol use, sale of alcohol to underaged persons, but so far media major appears to be selectively blocking the messages by NGOs and activists exposing the role of industry and advocating for the evidence based measures.
The recent continuous activity initiated by the Health Research Institute in partnership with Lithuanian Tobacco and Alcohol Control Coalition is the ranking of Members of Parliament (MPs) based on to their votes for or against laws improving the public health in Lithuania in the fields of alcohol and tobacco. The ranking is updated twice a year where each MP (as well as political factions in the Parliament) gets graded from 0 to 10 according to the publicly available voting statistics. More on this may be found in Lithuanian Tobacco and Alcohol Control Coalition’s webpage (http://www.ntakk.lt/politika/reitingai/).9
Grabauskas V, Klumbiene J, Petkeviciene J, Sakyte E, Kriaucioniene V, Veryga A, et al. (2015) Health behaviour among Lithuanian adult population, 2014. Kaunas: Lithuanian University of Health Sciences. 145 p.
About: Health behaviour among Lithuanian adult population, 2014 gives the overall review on Lithuanian adult population health behaviours. Report includes information on such health behaviours like smoking, alcohol and drug use, physical activity, vegetables, fruits.
PhD Dissertation: Mindaugas Štelemėkas. Alkoholio vartojimo socialinė ir ekonominė žala Lietuvoje [Social and economic harm of alcohol in Lithuania]: doctoral dissertation: biomedical sciences, public health (09B). Lithuanian university of health sciences. Medical academy. Kaunas. 2014. 212 p.
About: Study evaluates social and economic harm of alcohol in Lithuania in 2003-2011. Alcohol-attributable mortality, morbidity and disabilities are estimated. Study also evaluates alcohol related violations of law and presents alcohol-attributable economic costs in Lithuania in 2010.
Paukštė E, Liutkutė V, Štelemėkas M, Goštautaitė Midttun N, Veryga A. Overturn of the proposed alcohol advertising ban in Lithuania. Addict Abingdon Engl. 2014 May;109(5):711–9.
About: In response to the dramatic increase in alcohol-related problems in Lithuania, policy measures, including alcohol advertising and availability restrictions combined with taxation increase, were implemented in 2007–08. Simultaneously, a full alcohol advertising ban was adopted to take effect from 1 January 2012. Therefore, the alcohol industry responded with extensive lobbying aiming to revoke this ban, and ultimately they succeeded at the end of December 2011. The policy study analyses actions of stakeholders and events during the alcohol advertising ban cancellation process in Lithuania.
Current consumption is highest ever.
As a network Nordic Alcohol and Drug Policy Network (NordAN) advocates for the prevention and reduction of alcohol- and drug related harm through effective evidence based alcohol- and drug policy in the Nordic and Baltic countries and in the entire Northern dimension region of Europe.
NordAN was established in September 2000 as a network of non governmental, voluntary organizations who all worked to reduce the consumption of alcohol and other drugs and who supported a restrictive alcohol and drug policy and who did not receive contributions from the commercial alcohol industry.
Acting on these principles NordAN today have grown to have 90 non-governmental, voluntary member organisations in all the eight Nordic and Baltic countries (Denmark, Estonia, Finland, Iceland, Latvia, Lithuania, Norway and Sweden), all active in the alcohol and drug field.
Nordic Alcohol Policy Report 2015
NAPR2015 is NordAN´s first report on alcohol policy developments in Nordic-Baltic region. The report attempts to give the latest data and information on consumption trends and policy developments. In addition the report gives from the ground input from civil society and alcohol policy experts on different reasons why and how different changes have taken place. This is an alcohol policy report from a NGO perspective.
Editor in chief – Lauri Beekmann, Secretary General of NordAN
Editorial team (responsible for different chapters) – Peter Allebeck, Árni Einarsson, Stig Erik Sørheim, Kristiina Hannula, Kjell-Ove Oscarsson, Marcis Trapencieris, Jona Hansen, Alise Krumina, Aurelijus Veryga, Nijole G. Midttun, Vaida Liutkute.
NAPR2015 is funded by Stiftelsen Ansvar för Framtiden.
"NAPR2015 is an alcohol policy report from a NGO perspective."
Transatlantic Trade and Investment Partnership
TTIP – Transatlantic Trade and Investment Partnership
TTIP is a big news, but it is not in the headlines. TTIP refers to a trade deal negotiated between European Union and the United States. But TTIP is not so much about trade in the traditional sense, but more about corporate rights, investment guarantees and deregulation.
TTIP could have far-reaching and seriously harmful effects on the wellbeing of the people and the environment. TTIP would change dramatically what kind of alcohol and tobacco policies countries can fulfill. As TTIP would be an “all-inclusive” deal (with only small exceptions) also public services would be affected.
It is now crucial that we who defend heath and wellbeing, raise debate about TTIP as well as about CETA (agreement with Canada) and TiSA (trade deal concerning services). In democracy, people need to know about these huge deals and their possible impacts.
TTIP is big news, but it is not in the headlines.
Transatlantic Trade and Investment Partnership
NordAN women section
Interview with KSAN/WOCAD General Manager Leena Haraké
What do you consider to be main problem when you think women and alcohol-drug related issues? Gender blind policies, programs and lack of services targeting women´s needs. There is a traditional expectation that women do not/should not drink/ and if they do, they have to recover on their own or accept male treatments. Second best is not good enough.
When you think 3-5 years back, has the situation improved?
No. I think it is worse. Poly-drug use among women. Lack of services, targeted marketing, tailored things for women, looks, happiness, slim and sick. High mortality rates of women in overdoses i Sweden. Ill health, failing support for other life circumstances for women in drugs. Violence.
What are the main obstacles?
Lack of political and professional will to focus and budget for genderspecific services. Stigma, mother, shame on you!
What decisions member countries (possibly EU) should take right away to help solve these problems?
Include women´s issues in alcohol and other drugs policy making.
Nordic countries have one of the best alcohol policy models, yet at the same time violence against women seems to be one of the highest.How can you explain that? It seems to be an odd contradiction?!
Shaming and blaming women, they are held responsible for/even deserving being violated because of alcohol/drugs. Despite 2015 they are still given structural quilty trips.
Could you bring couple of individual examples from any of the Nordic-Baltic countries that show the magnitude of women and alcohol related problem?
We have started a process of discussing these issues within the women´s section at NordAN and I just finished our report from the Nordiskt Forum 2014 with views from Norway, Finland, Iceland and Sweden. Norway Retretten has thousands of persons in self help before and probably even after treatment, Iceland has also addressed the sexual abuse issues in a radicakl way – from darkness to light. Women´s issues are very hurting ones, since girls are small, a whole life can be destroyed by perpetrators that often are people children trust.
What are the main areas and topics KSAN (and NordAN´s womens section) has been and is working with?
Raise awareness, build networks, develope methods, Prevention, advocacy, methods to prevent and empower, both alkohol and other drugs in all ages, policy, network, inspiring, cooperation, pressure on the government and authorities to take notice on women´s needs and offer services with quality. EU Civil Society Forum on Drugs, BellaNet International.
You have been targeting also Ukraine and Russia? How is that going?
Belarus and Russia. We have an ongoing project in Belarus with NGO Mothers Against Drugs and that is an awesome activity that we never ever could imagine would wortk so well, Our partner is Mothers like tigers! Russia – Womens council in Novodvinsk – a great issue, too. Women fighting against poverty, alcohol, violence, bad attitydes, and empowering disabled children to be part of the society, not hidden in cellars, and we are a partner for St Petersburgs Drug prevention centre in a very ambitiuous plan written by Andrei Nevskii, to EU- also focusing on girls and women. And there is a cooperation between us and NGO´s from Vilnius & Riga focusing on girls 2020 in Baltikum. I call this part BellaBaltikum because we are going to train girl groups leaders in this project financed by the NCM.
What are the main needs for KSAN as a organisation and a network? Long term resources to finance our work and enable network meetings and joint ventures for better health for girls and women without alcohol and other drugs.
NordAN´s womens section was formed in 2006 by Sweden’s KSAN (Women’s Organisations Committee on Alcohol and Drugs Issues) and Finland’s Naistenkartano R.y (Women Together Against Addictions).
NordAN women section
The amount of alcohol-related harm in any society tends to rise and fall in line with changes in the total or average level of consumption. The more alcohol is consumed by a society, the higher its level of alcohol-related harm is likely to be. The lower its level of consumption, the lower its level of harm. Alcohol consumption is defined as annual sales of pure alcohol in litres per person aged 15 years and over. Still, different countries have different methods and also capabilities for measuring alcohol use. Some publish per capita use, divided among population from birth to death. The methodology to convert alcoholic drinks to pure alcohol may differ across countries. Official statistics do not include unrecorded alcohol consumption, such as home production. Italy reports consumption for the population 14 years and over, Sweden for 16 years and over, and for Japan 20 years and over. In some countries (e.g. Luxembourg), national sales do not accurately reflect actual consumption by residents, since purchases by non-residents may create a significant gap between national sales and consumption.
Alcohol is no ordinary commodity and as such its production, sale and marketing is regulated. Though, in some countries more than in others. Research shows that the exposure of young people to alcohol marketing hastens the drinking debut and increases alcohol consumption among those people who already drink. Legislation that imposes restrictions on advertising of alcohol is a well established preventative measure that is used by authorities in many parts of the world, despite opposition from the alcohol sector.
There are countries in the NordAN region with total ban on alcohol advertising – Iceland, Norway and also Faroe Islands. Sweden has a ban on TV advertising and Finland has introduced a ban on alcohol advertising in social media. In Lithuania a full alcohol advertising ban was adopted to take effect from 1 January 2012. Alcohol industry responded with extensive lobbying aiming to revoke this ban, and ultimately they succeeded at the end of December 2011. Estonia has introduced an amendment (October 2015) according to which alcohol commercials will be limited to a monochrome still picture and a short audio cue with product information and a health warning. Ads will can only entail the name, type and producer of the alcoholic beverage they promote, country of origin, alcohol content by volume, image of the packaging, and descriptions like color, scent and taste of the product.
Excise duty levels
The tax rates are very different in Baltic countries compared to much richer Nordic countries. Nordic countries are famous for their high alcohol taxes. For instance beer tax in Sweden is 3.3 times higher than in Estonia. Spirits tax is 2.76 times higher in Finland compared to Estonia.
But how these differences compare when we put the tax rates into national context. Lets take teachers salaries.
Difference in teachers salaries between Sweden and Estonia is 2.8 times. Difference in teachers salaries between Finland and Estonia is 3.08 times.
The spirits excise tax rate in Denmark is only 1.2 times higher than in Estonia while teachers salaries in Denmark are 3.8 times higher than in Estonia.
In Iceland and Norway tax principles are different compared to EU countries. The alcohol tax on alcoholic beverages in Iceland is proportionate to the alcohol content as follows, on each cl. of alcohol in each litre:
a. Of ale (beer) containing more than 2.25% alcohol – for each centilitre in excess of 2.25 centilitres = 93,14 ISK
b. Of wine and fermented beverages – for each centilitre in excess of 2.25 centilitres = 83,78 ISK
c. Other alcohol (spirits) = 114,08 ISK
In Norway (2015) – Spirits-based beverages in excess of 0.7 pct. alcohol by volume, NOK per pct. alcohol and per litre – 7.13. Other alcoholic beverages from 4.7 to 22 pct.alcohol by volume, NOK per pct. alcohol and per litre – 4.64.
Actual prices compare like this (in the Nordic alcohol monopoly companies from 2 June 2015 in euro):
An alcohol monopoly is a government monopoly retailing of some or all alcoholic beverages, such as beer, wine and spirits. They exist in all Nordic countries except mainland Denmark (only on the Faroe Islands). Nordic alcohol monopolies are namely Systembolaget in Sweden, Alko in Finland, Vínbúð in Iceland, Rúsdrekkasøla Landsins in the Faroe Islands and Vinmonopolet in Norway.
The alcohol monopoly was created in the Swedish town of Falun in 1850, to prevent overconsumption and reduce the profit motive for sales of alcohol. It later went all over the country in 1905 when the Swedish parliament ordered all sales of vodka to be done via local alcohol monopolies.
Following the prohibition of alcohol in Norway in 1919, the wine-producing nations demanded a reflexive policy regarding the goods exported from Norway, and Vinmonopolet was established in 1922, as a response to a deal with France, which allowed Norwegians to buy as much table wine of any kind as they wanted. When prohibition was lifted on fortified wine in 1923 and spirits in 1926, Vinmonopolet assumed sales of these goods as well.
Systembolaget is a government owned chain of liquor stores in Sweden. It is the only retail store allowed to sell alcoholic beverages that contain more than 3.5% alcohol by volume.
To buy alcoholic beverages at Systembolaget one has to be 20 years of age or older. At Swedish restaurants and bars the legal age to buy alcoholic beverages is 18 years (though bars and clubs may voluntarily set an age limit higher than 18 if they prefer).
Mainly Systembolaget stores open between 10-18, but some stores are open until 19.00 and some until 20 – most of them in situated in Stockholm area. Saturdays maximum until 15. Sundays stores are closed.
“Systembolaget exists for one reason: To minimize alcohol-related problems by selling alcohol in a responsible way, without profit motive.” –https://www.systembolaget.se/
Alko is the national alcoholic beverage retailing monopoly in Finland. It is the only store in the country which retails beer over 4.7% ABV, wine (except in vineyards) and spirits. There were 352 Alko shops in 2016.
Mon–Thu 9–20 or 9–18
Sat 9–18 or 9–16
All stores are closed on Sundays, religious holidays, Easter Saturday and Christmas Eve. Exceptions
Some stores are open at 10:00, and the opening hours of certain stores in Lapland vary depending on the season.
A 20-year-old can buy all alcoholic beverages. 18–19-year-olds can buy alcoholic beverages with a maximum 22% alcohol content.
Vinmonopolet is a government-owned alcoholic beverage retailer and the only company allowed to sell beverages containing an alcohol content higher than 4.75% in Norway.
Outlets, located across the country from cities to smaller communities, typically close business earlier than other shops, normally weekdays at 18:00 and Saturdays at 15:00.
“Although alcohol policy involves complex possibilities and dilemmas, all countries with a more liberal sales structure than Norway have substantially higher per capita consumption – often as much as double. Greater use of alcohol carries higher costs in the form of ill-health and social damage. Vinmonopolet is accordingly an important instrument for making wine, spirits and strong beer available in a form acceptable for society and public health.” – http://www.vinmonopolet.no/
Vínbúð is a chain of 46 stores run by the Icelandic alcohol and tobacco monopoly ÁTVR, locally called ríkið. It is Iceland’s sole legal vendor of alcohol for off-premises consumption.
Monday -Thursday: 10 (mostly 11 or later) – 18 (some until 20)
Friday: 10-20 (many less)
Saturday: 11-18 (many less, many closed)
Lithuania Off-premise alcohol sale is allowed in all licensed shops from 8-22. For on-premise alcohol sale there are no time restrictions.
All alcoholic beverages can be sold also in gas stations. According to current legislation alcohol sale at gas stations should be banned starting from 2016-01-01.
Since February 2008 alcohol can be purchased (off-premise) only between 10 a.m. and 10 p.m. New restrictions were also introduced in regard to minors. The previous provision, which allowed juveniles to carry alcohol in closed containers, was repealed, and a ban on carrying alcohol by those who are under 18 years of age was imposed. The law obligates a guardian or custodian of a minor to ensure that he has no alcoholic beverages in his immediate possession. However, the handling of alcohol by minors within the course of their employment is allowed. Tallinn, the capital of Estonia, passed a law in November 2014, banning the sale of beverages with alcohol content higher than 22 percent in gas stations, shops smaller than 150 square meters and shops less than 50 meters from primary, secondary and vocational schools. The law came to force in July 2015.
Tallinn also attempted to ban all alcohol sales on Sundays, but that was overturned by a court although no final ruling has been made yet.
Alcohol unit is defined differently in different countries. 1 unit is 12 grams of pure alcohol in Denmark and Sweden. 10 grams in Finland and Estonia. And 8 grams in UK.
Sweden has following drinking guidelines for risk consumption:
Men: 14 units/week
Women: 9 units/week
(1 unit = 12g pure alcohol). If you drink the above amount or more AND/OR binge at least once a month you are considered a risk consumer.
Issuing institution: The Swedish Public Health Agency
A proposal is being discussed at the national level to change the guidelines so there is no gender differences, to 9 units/week for men as well as for women.
In Sweden the recommendations for pregnancy is to avoid alcohol consumption completely. To be on the safe side even trying to get pregnant.
So far Norway has not had any official drinking guidelines – apart from a very general advice that less is better.
The official advice on drinking during pregnancy is that pregnant women should avoid alcohol and preferably also when trying to conceive.
There are two limits:
Low risk limit: women/men= 1/2 units per drinking occasion
High risk limit: women/men= 2/3 units per drinking occasion
The official advice on drinking during pregnancy is that pregnant women should avoid alcohol and preferably also when trying to conceive.
Issuing institution: National Board of Health.
Officially there is no recommendations or drinking guidelines. Iceland have followed WHO´s recommendations: Less is better.
However in the Clinical guidelines for alcohol treatment in primary health care, based on Scottish guidelines there are some definitions or guidelines. They are as follows:
Risky alcohol consumption:
21 units for male and 14 units for female in one week.
Pdf version here:
Issuing institution: Directorate of Health.
If we look at SÁÁ, the main alcohol treatment centre they have newer version of moderate drinking. Male 20-65 should not drink more than two drinks per day. Never more than 5 drinks in single occasion.
Female (and male older than 65) should not drink more than one drink per day. Never more than 4 drinks in single occasion.
High risk drinking levels are defined as 23-24 units for men and 12-16 units for women in a week.
Moderate risk levels are 14 units for men and 7 units for women in a week.
And low risk levels are defined as 0-2 units for men and 0-1 units for women per day.
Issuing institution: Working group appointed by the Finnish Society of Addiction Medicine
According to Finnish Nutrition Recommendations (published in 2014 by the National Nutrition Council) women should´nt drink more than 10 grams (1 unit) of alcohol per day and men no more than 20 grams (2 units) per day.
Latvia don´t have official guideliens.
Center for disease prevention and control has issued a leaflet on how to count how much you drink. http://www.spkc.gov.lv/file_download/304/Buklets_alkohola_devas.pdf
In the leaflet one unit is 12 grams of pure alcohol.
Lithuania has no official guidelines.
Every week should have at least 3 alcohol-free days.
Men should not drink more than 4 units per day (16 units per week).
Women should not drink more than 2 units per day (8 units per week).
Alcohol unit is defined as 10 grams of pure alcohol.
Issuing institution: National Institute for Health Development.
Smoking and drinking among 15–16-year-old school students are showing signs of decline, but there are concerns over challenges posed by new drugs and new addictive behaviours. And while overall illicit drug use is stable in this group after previous increases (1995–2003), it continues at high levels. These are among the findings released today in the latest report from the European School Survey Project on Alcohol and Other Drugs (ESPAD). The study, published in collaboration with the EU drugs agency (EMCDDA), is based on a 2015 survey in 35 European countries, including 24 EU Member States.
Alcohol use among adolescents in Europe remains high, but here also, time trends since 1995 show some positive developments. Lifetime use of alcohol decreased from 89% to 81% between 1995 and 2015 and last-30-day use from 56% to 47%, with a marked decrease seen in both patterns after a peak in 2003.
The prevalence of ‘heavy episodic drinking’ has remained unchanged over the 20 years, with values in 2015 similar to those in 1995. However, after progressive increases from 1995, the prevalence values decreased clearly from 2011 to 2015 (for boys 44% to 37%; for girls 38% to 33%) in some countries. Less positively, every third student (35%) reported heavy episodic drinking in the past month in the latest survey. Over three-quarters of respondents (78%) reported relatively easy access to alcohol.
As a precautionary measure related to methodological issues the comparability of the Latvian data has been considered limited.
Source: ESPAD 2015 Country Summaries
Number of retail shops
Calculations in Nordic countries are based to the number of retail outlets as of 1.01.2015, in Latvia as of 9.09.2015 and in Estonia to the number of registered retail outlets with alcohol sales as of 20.05.2015
Sources: Alko; Latvian Ministry of Health; Register of Economic Activities, Ministry of Economic Affairs and Communications; Statistics Estonia
How Nordic-Baltic countries compare from different aspects and angles of alcohol policy?