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.

Source: http://www.landlaeknir.is/servlet/file/store93/item22830/Framkvaemdaskyrsla_2012_loka.pdf. Pages 119-124.

After the financial crises of 2008, alcohol consumption decreased, probably due to decreased purchasing power and increased alcohol taxes. Alcohol consumption is now slowly increasing again peaking in 2015 and with a slight decrease in 2016.

Looking at a longer period alcohol consumption has risen quite a significantly. According to  Statistics Iceland consumption of alcoholic beverages based on sales figures in Iceland was 2,015 thousand litres of pure alcohol in 2016 compared with 1,324 thousand litres in 2000 and 716 thousand in 1980.

The figures on quantity do not take into account alcohol imported by ship and aircraft crews and tourists entering the country, alcohol exported by the ÁTVR and others or alcohol sold to the Duty Free Store at Keflavík Airport.

Source: Statistics Iceland (21 June 2017)

Alcohol policy in Iceland, being one of the strongest in the western world, has seen fierce opposition in the recent years. Several political initiatives have threatened to weaken the traditional Nordic alcohol policy, from abolishing retail monopoly system to allowing alcohol and tobacco advertising.

In February 2017 four parties – the ruling coalition of the Independence Party, the Reform Party and Bright Future, in addition to the Pirate Party – introduced a bill to parliament that aimed to permit the sale of alcohol in private shops, starting at the beginning of 2018. Doctors, public health officials and NGOs protested the change. And even domestic microbreweries came out in opposition to the bill, arguing that abolishing the state monopoly stores Vínbúðin, would only benefit larger breweries while hurting small producers.

Icelanders have supported the monopoly system and a new poll published by Kjarninn (conducted by Zenter in February 2017) affirmed that once again. Poll results showed that 61.5% of respondents were opposed to the sale of alcohol in private shops, with only 22.8% supporting the measure but 15.7% having no opinion.

Iceland´s alcohol policy was strongly supported also by the international public health community when NordAN, supported by European Alcohol Policy Alliance Eurocare and a list of different national and international organisations, sent a letter to Parliament members in Iceland urging them to “drop the bill proposing abolition of a public monopoly on sales of alcohol and of the alcohol advertising ban.”

On May 31, 2017, NordAN board member from Iceland, Arni Einarsson, informed the network that “the alcohol bill will not be taken to a final discussion in the Parliament. Today is the last working day of the present session. Now we will see if they start again next autumn when the next Parliament session starts.”

Elections 2017
On 15 September 2017, the three-party coalition government collapsed after the departure of Bright Future over a scandal involving Prime Minister Bjarni Benediktsson’s father. Parliamentary elections were held in Iceland on 28 October 2017. Though many opinion polls in the run-up to the election indicated an increase in support for the Left-Green Movement, the Independence Party retained its position as the Althing’s largest party. Following the election, four-party coalition talks led by the Left-Greens ensued; however, after the Progressive Party rejected the possibility, a three-party coalition led by the Left-Greens including the Independence Party and Progressive Party was negotiated. After formally receiving the mandate to form a coalition on 28 November, Left-Green leader Katrín Jakobsdóttir was designated Prime Minister to lead the new government on 30 November. (Source: Wikipedia)

Homebrewing
New parliament continued with alcohol issues and started from homebrewing, which is currently illegal in Iceland, but a bill (March 2018) proposing its legalisation was reintroduced in parliament. Backed by 10 MPs from the Pirate Party, Independence Party, Social Democratic Alliance, and the Reform Party, the bill proposed legalising home brewing for personal consumption. Ívar J. Arndal, CEO of the State Alcohol and Tobacco Company of Iceland, released a statement on the bill where he urged the government to consider public health and social responsibility in reviewing the bill, but did not express direct opposition. He added that the bill has not made a distinction between the home brewing of beer and wine and stronger liquor, which is contrary to similar legislation in most countries in the region, such as England and Denmark.

In April 2018 Iceland´s Ministry of Education and Culture was considering lifting the ban on advertising alcohol and tobacco products. A majority of the committee on independent media proposed the change, publishing a report on the matter this past January. The committee stated the advertisements could present a large source of income for independent media in Iceland. Again, the plan met strong opposition from public health community from home and abroad.

In June 2018 Arni Einarsson, the NordAN board member from Iceland, reported: “It is now clear that the bill on allowing the sale of alcohol in ordinary stores and abolition of the advertising ban on alcohol will not pass the Parliament this time, once again. It never reached the level of being discussed in the Parliament. It is a relief but it does not mean that it will not appear once again next fall when the next Parliament session starts. The same fate faced the bill on allowing farm sale of alcohol. It was not processed in the Parliament.”

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. Latest alcohol tax increase – 2% – was done in January 1, 2018.

In September 2008 the due of for a calculated centiliter of the alcohol spirit in wine was 52,8 ISK. In 2017 (with additional raise of 4.7 percent) it was 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.
Source: Alko

Icelanders support retail monopoly system
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 have permitted 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 continued in the Parliament and was (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. As with earlier attempts, it didn´t go through and was stopped in the process.

In February 2017 four parties – the ruling coalition of the Independence Party, the Reform Party and Bright Future, in addition to the Pirate Party – introduced a bill to parliament that aimed to permit the sale of alcohol in private shops, starting at the beginning of 2018.

A new poll published by Kjarninn (conducted by Zenter in February 2017) showed that 61.5% of respondents were opposed to the sale of alcohol in private shops, with only 22.8% supporting the measure but 15.7% having no opinion.

On May 31, 2017, NordAN board member from Iceland, Arni Einarsson, informed the network that “the alcohol bill will not be taken to a final discussion in the Parliament. Today is the last working day of the present session. Now we will see if they start again next autumn when the next Parliament session starts.”

 

Alcohol Law (Áfengislög) states that “all advertising and marketing is banned.” In addition, The Law on Media states that commercial messages and teleshopping for alcohol are forbidden. It is also prohibited to show consumption or
any other usage of alcohol in advertising or for information on any other commodity or service. Law on
radio broadcasting states that radio programs may not be sponsored by entities that are forbidden to advertise their product or service.

While article 20 of the current alcohol law has a total ban on alcohol advertising, 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 a 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 arenas, especially football areas.

As mentioned earlier in April 2018 Iceland´s Ministry of Education and Culture was considering lifting the ban on advertising alcohol and tobacco products. A majority of the committee on independent media proposed the change, publishing a report on the matter this past January. The committee stated the advertisements could present a large source of income for independent media in Iceland. The plan met strong opposition from the public health community from home and abroad and was subsequently removed from the agenda.

According to a study conducted by MMR (Market and Media Research) in April 2018 the majority of Icelanders were also opposed to allowing alcohol and tobacco ads. Over 60% of respondents reported being opposed to such marketing and 42% reported being “very opposed.” Only 18% of respondents were in favor of the ban on alcohol and tobacco ads being lifted.

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.

The policy also emphasizes the necessity of public health perspectives when decisions are made concerning alcohol and drugs and the importance of activating the whole society in awareness and solidarity for actions taken regarding alcohol and drugs.
Source: http://www.velferdarraduneyti.is/media/rit-og-skyrslur-2014/Stefna-i-afengis–og-vimuvornum-desember-2013.pdf

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.
Source: http://www.landlaeknir.is/servlet/file/store93/item22838/Talnabrunnur_mars_2014.pdf

The semi-continental Danish lifestyle is the least healthy in the Nordics. And this shows in the country’s life expectancy, concludes 2017 report “Intoxicants in Norway 2016“, which surveyed Nordic health habits with a focus on drinking and smoking. Researchers from all the Nordic countries conducted the study.

Denmark stands out from the study as the Nordics’ least healthy nation. One in five Danish adults (21%) are regular smokers, and the average Dane drinks alcohol 2.5 times per week.

As a result, Danish women have the shortest life expectancy (82.5) in the Nordics, and in Western Europe as a whole (WHO, 2015).

Danish men have the second shortest lives (78.6) among Nordic men, after Finns (78.3).

Source: Business Insider Nordic

The Danish population is living longer than a decade ago, but not all of these additional years are spent in good health. The Danish health system generally provides good access to high-quality care, with comparatively low levels of unmet need for medical care. Challenges remain to tackle essential risk factors for health, such as excessive alcohol consumption and rising obesity rates.

37% of Danish adults report regular heavy alcohol consumption, the highest in the EU. Almost 40% of Danish adolescents report being drunk at least twice in their life.

Although the amount of alcohol consumed per capita in 2014 was slightly below the EU average, 37% of adults in Denmark reported regularly engaging in heavy alcohol consumption, the highest proportion among all EU countries.

A substantial gender gap exists in the proportion of adults reporting such heavy alcohol consumption, with the rate among Danish men reaching 47% compared with 28% among Danish women. A much greater proportion of Danish adolescents also report having been drunk more than once in their life than in other EU countries – this proportion reached almost 40% among 15-year-olds in 2013–14 (38% among 15-year-old girls and 39% among boys), also the highest level among EU countries.

Excessive alcohol consumption and alcohol-related deaths in Denmark are much higher than in most other EU countries. More than 1 200 people died from preventable alcohol-related diseases in Denmark in 2014, and this number does not include those who died from alcohol-related accidents or violence.

‘HEALTHIER LIFE FOR ALL’ POLICY FRAMEWORK

A key objective of the Danish 2014 ‘Healthier life for all’ prevention policy framework is to cut the number of people who engage in harmful alcohol consumption by a third. The government financially supports two partnerships to help with achieving this target.

The ‘Partnership for a responsible alcohol culture’ involves industry stakeholders (beverage companies, hotels, restaurants, the Danish Chamber of Commerce and the Danish Merchants Association) and focuses on compliance with age limits on the sale of alcohol and on initiatives to change the alcohol culture in bars. The ‘Partnership for youth and alcohol’ involves municipalities and civil society organisations, with the aim to reduce underage drinking by initiating local activities for young people in collaboration with local authorities and civil society (OECD, 2015).

Source: State of Health in the EU. Denmark. Country Health Profile 2017

In 2017 every Dane aged 15 years or more bought on average 9,1 litres of pure (100%) alcohol.

The sale of alcohol in Denmark is significantly higher than sales in the other Nordic countries except Finland.

The consumption figures were only calculated from 2000-2010 after that only sales data is available. Data on cross-border trade came from The Danish Ministry of Taxation but is no longer included in the statistics.

According to WHO´s Global status report on alcohol and health, alcohol consumption in 2016, when also adjusted for tourist consumption, was 10.4 litres.

Figures from 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 per cent. Usage amongst girls has gone from 19 to 31 per cent over the same time.

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)

A new report in 2018 by the Danish Cancer Society and TrygFonden charities show that Danes between the ages of 15 and 25 drink less than in previous years. Four out of five people in that age range do not get drunk each weekend. The percentage of young people who get drunk every weekend has fallen from 27 per cent in 2014 to 12 per cent in 2017, according to the report produced by the two organisations.

The survey, carried out by Epinion on behalf of the two charities, is based on data collected from 1,000 people between the ages of 15 and 25. (Source: The Local)

According to the Global Burden of Disease Study 2016, Denmark had the highest proportion of drinkers (97.1 per cent of men and 95.3 per cent of women).

That is contradicting though to WHO´s Global status report on alcohol and health which claims for instance that 10.7% of Danes are lifetime abstainers and 35.8% of women haven´t drunk alcohol the last 12 months.

Alcohol is one of the individual factors that have the most significant impact on public health in Denmark. Heavy drinking increases the risk of many diseases.

37% of Danish adults report regular heavy alcohol consumption, the highest in the EU. Almost 40% of Danish adolescents report having been drunk at least twice in their life.

According to estimates, over 30% of the overall disease burden in Denmark in 2015 could be attributed to behavioural risk factors, including smoking, alcohol use, diet and physical inactivity, with smoking and metabolic risks (e.g. obesity and high cholesterol) contributing the most (IHME, 2016).

A substantial gender gap exists in the proportion of adults reporting such heavy alcohol consumption, with the rate among Danish men reaching 47% compared with 28% among Danish women.

Source of the graph: OECD Country Health Profile 2017

Excessive alcohol consumption and alcohol-related deaths in Denmark are much higher than in most other EU countries. More than 1 200 people died from preventable alcohol-related diseases in Denmark in 2014, and this number does not include those who died from alcohol-related accidents or violence.

 

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.

Alcohol laws in Denmark are different for spirits compared to beer and wine. The age limit for buying beer and wine in Denmark is 16 years in shops and 18 years in bars and restaurants. For buying alcohol with a percentage higher than 16.5%, the legal age in Denmark is 18 everywhere. Danish Regions, the interest organisation for the five regions in Denmark, suggested in April 2017 that this should be extended to shops, supermarkets and kiosks – in other words, the same as in many other European countries. (Source: CPH Post)

“The first age restriction (15 years) on buying alcohol from retail outlets was imposed in 1998. This was raised to 16 years in 2004 and again to 18 years for drinks stronger than 16.5% vol. in 2010.”

Until 2003 there was a legal ban on alcohol advertising on Danish TV and radio channels, but has since been rescinded. The self-regulatory code governing content accepted in 2000 follows the usual advertising guidelines that state that such adverts may not be targeted towards minors, suggest that alcohol is healthy or improves mental or physical abilities. This code also bans the association of alcohol and sports, sponsoring of sports events and sorts fields by alcoholic beverages brands, as well as advertising in sports magazine.

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 per cent and above can have their vehicles confiscated on the spot, as can drivers stopped with a BAC of 0.12 per cent who have a previous drunk driving infraction within the past three years. (Source: The Local)

Drinking in public in Denmark is legal in general. The law forbids “disturbing of the public law and order”. Thus general consumption is accepted. Several cafes have outdoor serving in the same zones.

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)

Prenatal alcohol exposure

In January 2017 The Lancet published a systematic review and meta-analysis estimating national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome. The analysis found that Denmark (45.8%) had one of the highest estimated prevalence of alcohol use during pregnancy, behind only Ireland (60.4%) and Belarus (46.6%). “Alarmingly, about a quarter of women in the general population of Europe drink alcohol during pregnancy, which, as one would expect, is mirrored by also having the highest FAS prevalence—a prevalence that is 2.6 times higher than the global average.”

The study also found that Denmark has one of the highest rates of children born with alcohol syndrome – 68 per 10,000 children per year. Denmark placed 6th in the international comparison.

Katrine Strandberg-Larsen, a lecturer at the department of public health at Copenhagen University, claims the Canadian researchers based their calculations on 20-year-old data, which does not correctly reflect today’s reality.

Strandberg-Larsen argues that recent data collected in 2012-2013 in fact shows that only 3 percent of Danish women drink alcohol during pregnancy, and of them, about 2.6 percent have just one glass per week. (Source: Copenhagen Post). Read dr Strandberg-Larsens full article HERE.

Dr Svetlana Popova, the lead author of the meta-analysis responded: “With respect to the comment of Strandberg-Larsen and colleagues from Denmark, the authors question our finding that the prevalence of alcohol use during pregnancy in the WHO European Region was estimated to be the highest among the six WHO regions. According to the latest Global Status Report on Alcohol and Health 2014,2 however, almost all major alcohol indicators such as prevalence and level of consumption, rates of chronic and heavy episodic drinking, and alcohol use disorders are the highest in this region. Thus, the high prevalence of alcohol use during pregnancy and FAS in the WHO European Region, which exceed global levels, should not come as a surprise.”

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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 permitted them 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 thinks 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 per cent) 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 per cent when only looking at young people aged 18-29.

2018 study (König et al) found that, in Denmark, an environment with high levels of alcohol availability and alcohol consumption, students aged 15 to 16 years who are at risk of high alcohol consumption and risky drinking are more likely to be in a peer group that drinks alcohol and to be experiencing problems with friends and at home. They are not likely to be performing poorly at school or to come from socio-economically deprived backgrounds. The study results indicate the likely importance of legal and cultural contexts; while alcohol consumption at the age of 15 years is not legal in Denmark, it is widespread, and students have very high exposure to alcohol.

Danish research: Ground rules can halt youth drinking

When parents set firm ground rules for drinking as kids, their children drink less than their counterparts, according to new Danish research published in March 2018.

One of the other trends discovered in the results was that alcohol consumption habits that were established during teenage years often persist through the start of adulthood. “There is a specific reason to be aware of teenagers who drink the most. They seem to maintain their leading drinking position up into adulthood,” study authors concluded.

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.

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. By 2015, 82 per cent of the population reported drinking at least once in the last year. 36 percent said they had been drinking each week.

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 “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)

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. Turnover at Norwegian airports (duty-free) was 0.59 liters of pure alcohol per capita in 2014, down to 0.52 liters by 2015.

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.

The following figure shows that for the whole population, the proportion engaging in heavy episodic drinking was stable at around 18 per cent from 2012 to 2016. The figure also includes separate lines for the 16-30 and 31-79 age groups. These two groups exhibited slightly different trends. For the 16-30 age group, the proportion fell from 34 per cent to 28 per cent, while for the 31-79 age group, the proportion remained stable at around 13 per cent. Source: The Norwegian Institute of Public Health

 

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.

Tax is levied on all alcoholic beverages containing more than 0.7 percent by volume of alcohol that are either imported into Norway or produced in Norway. Tax is also levied on beverage packaging.

In May 2018 Government proposed to reduce alcohol tax on beer with an alcohol content of 3.7 to 4.7% by volume, with a turnover of up to 200,000 liters of beer. The purpose is to improve the conditions for the small breweries.

The Norwegian Directorate of Health on the other hand proposed in August 2018 ten suggestions to improve the health of Norwegians and one of these proposals was to increase alcohol price through tax increase.

 

 

 

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. The border between Norway and Sweden is 1,640 km long, with almost 80 crossing points between the two countries. Increases in cross border shopping and particularly taxfree sales will put further pressure on Norwegian pricing 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.

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According to the cost of living aggregator Numbeo (March 2018), which keeps track of the prices of various consumer goods in major cities around the world, Oslo is the most expensive city in Europe to buy the standard size of a “large beer” (0,5 litres). The average price for a large domestic beer in Oslo is 8,38 EUR. In the global ranking of beer prices, Norway and Iceland come in third and fourth place, respectively, as the top two spots are occupied by Qatar and the United Arab Emirates. A large beer in Qatar costs 8,91 EUR, and 8,83 EUR.

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.

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/

Support for Vinmonopolet, the state monopoly system, has increased in recent years, and customer satisfaction is among the ten highest in Norway. 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 tax-free 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.

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.

Find more also from EUCAM

Read also The Association of Norwegian Wine and Spirits Suppliers report (September 2018) which states that “There is a broad political consensus that we should have a strict ban on alcohol advertising in Norway, and this is also something the largest industry organisations in the alcohol sector support.”

In December 2018 Norway Parliament agreed on a new alcohol strategy. It was the Christian Democrats (KrF) who proposed this – one of the representatives was the Chair of the Health Committee – Olaug Bollestad, and also the party chairman, Knut Arild Hareide. The official name of the proposal is ‘Proposal for a proactive alcohol policy based on solidarity’ (Representantforslag om en offsensiv og solidarisk alkoholpolitikk). They got the support from the opposition, labour (AP), left (SV) and the farmers (SP), and together got the majority in Parliament.
Find more from HERE

The proposal has several decision points and asking among other things for:
– Asking the Government to present a national alcohol strategy for the Parliament, going in detail on how they want to achieve the aim of reduced alcohol consumption (Norway has adopted a decision that we shall reduce the harmful alcohol consumption by 10 % by 2025 (I believe…).
– Asking the Government to establish an export group to assess the cost to society (work, society, individual health and families)
– Asking the Government to propose to the Parliament proper labelling of the ingredients of alcoholic beverages
– Asking the Government to include health information with a warning of the risk of alcohol in pregnancy and driving

These days, KrF is in discussions with the government to be included in the government. So the decision on the alcohol strategy could be a mechanism on how the new government should address alcohol policy. But that would be too early to say.

Civil society, Actis, IOGT etc, have been asking for this for long time.

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. Alcohol in the work life will probably be an area for more activity in the years to come.

The report Rusmidler i Norge (Alcohol and drugs in Norway, 2016) provides an overview of the alcohol and drugs situation in Norway.

Evaluation of Norway’s action plan for the alcohol and drugs field 2016-20. First status report, baseline analysis 2016. By independent social science research foundation Fafo.

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 the 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 per cent of the population thinks it is okay for pregnant women to have a glass of wine for dinner.

In January 2019 BMC Public health published a case study on “The handling of evidence in national and local policy making: a case study of alcohol industry actor strategies regarding data on on-premise trading hours and violence in Norway”. The study concluded: “Alcohol industry actors employed various strategies to shape perceptions and use of evidence to advance their interests. The particular strategies and arguments changed over time as new data and research became available, and also varied between the national and the local levels, and by categories of industry actors.

General elections were held in Sweden on Sunday 9 September 2018 to elect the 349 members of the Riksdag. Regional and municipal elections were also held on the same day. The incumbent minority government, consisting of the Social Democrats and the Greens and supported by the Left Party, won 144 seats, one seat more than the four-party Alliance coalition, with the Sweden Democrats winning the remaining 62 seats. The Social Democrats’ vote share fell to 28.3 per cent, its lowest level of support since 1911, although the main opposition, the Moderates, lost even more support. The Sweden Democrats made gains, though less than anticipated.

Following the elections, Prime Minister Stefan Löfven lost a vote of no-confidence on 25 September, forcing a parliamentary vote on a new government. In the meantime, his government remained in power as a caretaker government.

After several failed negotiations, Löfven was finally re-elected as prime minister on January 18, 2019. Löfven was elected Prime Minister with 115 Riksdag members voting for him and 77 members who abstained (total of 192 votes). Due to the low number of yes votes Löfven received, he has the third weakest government since the end of World War II as at the time of his election.

In the new government agreement, a 73-point long settlement between the four parties (Social Democratic Party, Green Party, Centre Party, Liberal Party), point 23 opens a door for farm sales: “An investigation into farm sales of alcoholic beverages should be carried out. A prerequisite is that Systembolaget’s monopoly is secured.”

It is primarily the Center Party that has repeatedly pushed for small-scale alcohol sales directly on farms and Skåne region wants to start trials. At the same time, at least two state investigations have previously concluded that this would collide with Sweden’s exemption in the EU to keep Systembolaget’s monopoly for public health reasons (parallel sales on Swedish farms would be interpreted as discrimination against foreign alcohol producers).

Alcohol researchers reacted to farm sales plan by pointing out that it would threaten Systembolaget’s monopoly and allowing alcohol in the grocery trade would increase sales significantly and lead to over 1400 more deaths annually.

“It appears to be both worrying and unnecessary because two previous state investigations found that farm sales are not compatible with Systembolaget’s monopoly,” writes scientists Sven Andréasson, professor of social medicine, Karolinska Institutet, Johanna Gripenberg, head of STAD and KI researcher, Thor Norström, professor in sociology at Stockholm University, and Mats Ramstedt, associate professor and KI researcher.

They were all co-authors of a new study “Estimating the public health impact of disbanding a government alcohol monopoly: application of new methods to the case of Sweden” that was published in December 2018 at BMC Public Health. The study concluded: “There would be substantial adverse consequences for public health and safety were Systembolaget to be privatised. We demonstrate a new combined approach for estimating the impact of alcohol policies on consumption and, using two alternative methods, alcohol-attributable harm. This approach could be readily adapted to other policies and settings. We note the limitation that some significant sources of uncertainty in the estimates of harm impacts were not modelled.”

If alcohol could be sold in grocery stores, alcohol consumption would increase 31 per cent in Sweden and lead to increased health injuries and more than 1,400 more deaths per year, (including 29 per cent more alcohol-related cancer deaths). Also, health days and social costs would increase, as well by 34 per cent more abuse cases and 58 per cent more drunk driving.

The four researchers also see problems with today’s approach and want rules against distance selling of alcohol from abroad to be tightened and recommend the government to introduce minimum unit pricing for alcohol, already introduced in Ireland and Scotland, to protect vulnerable groups.

The Swedish total consumption of alcohol per capita over 15 years or older was 9 litres of pure alcohol in 2017, out of which 2 litres was unrecorded consumption. The wine was the most commonly consumed beverage.

According to OECD report “State of Health in the EU (2017)” “Overall alcohol consumption per adult has increased and one-fifth of adults report heavy alcohol consumption on a regular basis.”

Regardless of that developments, alcohol consumption among Swedish adults is the lowest in the EU with adults consuming 7.2 litres per capita in 2015, although this is up from 6.2 litres in 2000. Alcohol consumption among 15-year-olds is also among the lowest in the EU, with 18% of girls and 15% of boys reporting having been drunk at least twice in their life (compared to an EU average of 23% among girls and 27% among boys). However, there remains a challenge in reducing regular binge drinking among a sizeable proportion of adults. Over 20% of adults in Sweden (12% of women and 29% of men) report heavy alcohol consumption on a regular basis, which is slightly higher than the EU average.

Sweden’s low levels of preventable deaths for causes such as lung cancer (third lowest mortality rate in the EU), alcohol-related deaths (eighth lowest) and road traffic accidents (second lowest) can partly be explained by strong public health policies. Public awareness campaigns and high taxes on tobacco and alcohol, a long tradition in Sweden, have contributed to restricting consumption. The alcohol control policy is characterised by a state retail monopoly that limits access to dedicated stores with restricted opening hours. It also imposes a minimum age limit of 20 years to buy liquor.

 

Source: CAN

Advertising of alcohol containing no more than 15 vol. % is allowed under certain conditions in printed media. Up until 2003, alcohol advertising was banned in all shapes and forms.

Alcohol commercials must apply special moderation and cannot target young people under the age of 25. Printed ads must carry warning texts. A white paper on alcohol marketing in digital media (in Swedish but with a summary in English) was presented to the Swedish  Government in January 2018, which might be the first step towards stricter regulation for online marketing in the future.

Swedish public white papers, shortened SOU, usually precede any legislative proposal and carry a lot of clout in the legislative process. The white paper on alcohol marketing in digital media had the specific tasks of investigating how children and young people could be better protected from alcohol marketing online. It was carried out by a government-appointed committee of specialists on public health and media law, led by Ingeborg Simonsson, District Court Judge and one of Sweden’s leading experts on competition law.

The white paper cites the strong scientific evidence of the adverse effects of alcohol marketing on drinking behaviours, especially for children and young people. It also looks into the specificities of online alcohol marketing on the Swedish market. Although it does not find examples of more predatory types of advertising, it recognises that online alcohol marketing is nonetheless very prevalent. According to numbers cited in the paper, 68 per cent of 16-24 year-olds had been exposed to alcohol advertising online in 2013, a higher exposure rate than those aged 25-34. The white paper thereby concludes that there is a need for statutory restrictions to alcohol marketing online and puts forward the proposal to ban commercial advertising on social media.

Sweden/UK case

Since the 80’s/90’s a significant amount of alcohol marketing have been coming into Sweden from channels broadcasting from abroad (but in Swedish, with Swedish programmes and Swedish targeted advertising). Because of the country-of-origin principle, Swedish authorities have not been able to enforce these laws.

In February 2018 the European Commission has decided, on the basis of the Audiovisual Media Services Directive (AVMSD), that the Swedish intention to impose their ban on alcohol advertising on two broadcasters based in the UK and broadcasting in Sweden is not compatible with EU law.

“The AVMSD is based on the principle of the country of origin, according to which broadcasters are subject solely to the rules of the Member State where they are established, including when they broadcast to other EU countries. The AVMSD does not prohibit alcohol advertising but allows the Member States to apply stricter rules, including a full ban, on broadcasters under their jurisdiction. Such a ban exists in Sweden,” European Commissions decision states. “In order to impose such a ban on the UK broadcasters, Sweden should have demonstrated, under the specific procedure contained in Article 4 of the AVMS directive, that the broadcasters in question established themselves in the UK in order to circumvent such rules. The burden of proof lies with the Member State and the Commission found in this case that Sweden failed to prove circumvention on the part of the two broadcasters.”

The Swedish Alcohol Retailing Monopoly, Systembolaget, has the sole right to retail alcoholic beverages in Sweden. The purpose is to minimize alcohol-related problems by selling alcohol in a responsible way, without profit motive.

Systembolagets monopoly rights cover all alcoholic beverages stronger than 2.25 vol. %, with one exception: Beers with max 3.5 vol. % (“Folköl”) which can be sold in grocery stores.

Systembolaget’s mandate from the Swedish state is to help limit the medical and social harm caused by alcohol and thereby improve public health. For Systembolaget this means:

# Restricting availability through the number of stores, opening hours and retail rules
# Not attempting to maximise our profit
# Not promoting additional sales
# Being brand-neutral
# Providing a high standard of customer service
# Being financially efficient

There are 440 Systembolaget-stores and 457 order points all across Sweden, and goods can be ordered online and delivered to monopoly shops or order points, or – in special trial areas – straight to the customer’s home address. The most common opening hours in 2017 was 50 hours a week, 10-19 on weekdays and 10-15 on Saturdays. The age limits for purchasing alcohol in Systembolaget is 20 both for strong and mild beverages, and 18 for on-premise sales in restaurants and bars.

Systembolaget’s market share was 62.8% in 2017, and half of all sales within the monopoly was beer.

The minimum legal age for purchasing alcoholic beverages in Sweden on off-premise retail sale is for all alcoholic beverages 20 years. For on-premise retail sale, the minimum legal age is 18. The age limit for “Folköl” (beer containing between 2.8 and 3.5 vol. %) is 18 years.

77.8% of Swedes support the monopoly according to a Kantar SIFO survey. Customer satisfaction rate in Systembolaget is 84.2%.

Find further information from Alko report “INFORMATION ON THE NORDIC ALCOHOL MARKET 2018“.

 

The Nordic alcohol monopoly companies follow the principles of impartiality and transparency in pricing. The suppliers are informed in advance of the rules applied to the pricing of retail sale products. The retail price of an alcoholic beverage is composed of the beverage’s purchase price, the alcohol monopoly sales margin and the potential deposit, excise duty on alcohol, any potential environmental or beverage package tax, and value added tax. The prevailing pricing practice in the Nordic alcohol monopolies uses a coefficient principle. The sales margin is included in the prices by the so-called pricing coefficient. The coefficient is directed to the purchase price of the beverage, though in Finland, Norway and Sweden, it excludes the beverage package tax. In Iceland and the Faroe Islands the coefficient is directed to the purchase price and includes the beverage package tax. The sales margin consists of ordinary selling costs in addition to the required management expenses and business profit.

Source: Alko.fi

 

 

 

 

 

 

 

 

 

 

 

 

In February 2016 the Swedish Government adopted a new coherent strategy for alcohol, narcotics, doping and tobacco (ANDT) for the period 2016–2020. In the new strategy, the Government takes further steps to increase activity in this area to achieve the objective set by the Riksdag: A society free from narcotic drugs and doping, with reduced alcohol-related medical and social harm and reduced tobacco use.

Swedish ANDT policy covers both legal (alcohol and tobacco) and illegal (narcotics and doping substances) drugs. This means that the conditions vary, but one common starting point in ANDT policy is the right of each and every person to have the best possible physical and mental health. This is also stated in the United Nations International Covenant on Economic, Social and Cultural Rights.

ANDT policy is also part of Swedish welfare and rests on solidarity. This means that restrictions to personal freedom can be accepted in order to protect public health, which is expressed, for example, in strong support for the Swedish alcohol monopoly, age limits for the purchase of alcohol and tobacco, and the criminalisation of narcotics and doping.

For everyone to have the chance of maintaining good health, general measures need to be supplemented with targeted measures to people living in socially vulnerable situations as a result of substance abuse or addiction.

There are six objectives that, combined, are to help achieve the overarching objective:

# Access to alcohol, narcotics, doping substances and tobacco must be reduced.
# The number of children and young people who start to use narcotics, doping substances and tobacco or who have an early alcohol debut must be progressively reduced.
# The number of women and men, as well as girls and boys, who become involved in the harmful use or abuse of or dependence on alcohol, narcotics, doping substances or tobacco must be progressively reduced.
# Women and men, as well as girls and boys, with abuse or addiction problems must be given greater access to good-quality care and support on the basis of their circumstances and needs.
# The number of women and men, as well as girls and boys, who die or are injured as a result of their own or others’ use of alcohol, narcotics, doping substances or tobacco must be reduced.
# An EU and international approach to ANDT that is based on public health.

Under the Swedish Social Services Act, the municipalities are to prevent and combat the abuse of alcohol and other addictive substances. This applies in particular to abuse among children and young people. Municipalities must also offer measures to people with abuse or addiction problems.

The regional level consists of 21 county councils or regions responsible for health and medical care. County councils must work preventively, and highlight and offer care and treatment for people with abuse or addiction problems.

At central government level there are a number of national agencies that help in various ways to implement ANDT policy. The Public Health Agency of Sweden and the National Board of Health and Welfare are central agencies that with their expertise support those working in the area at local and regional level. The Public Health Agency of Sweden is also responsible for following up public health policy and the ANDT strategy. In the new strategy, the Agency is given a stronger and clearer role in supporting the implementation of the ANDT strategy.

Find more from the Government Offices of Sweden

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?

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.

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
•find synergies
•share information
•provide a forum for discussion
•eliminate overlaps
•support small organisations
•improve cost-efficiency
•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.

Reports

Any major reports in alcohol research, statistics and related harm in 2014/2015?

Yearbook of alcohol and drug statistics 2014:
http://www.julkari.fi/bitstream/handle/10024/125383/URN_ISBN_978-952-302-295-9.pdf?sequence=1

Specific statistics and publications related to the consumption, sales and imports of alcohol (in Finnish):
https://www.thl.fi/fi/tilastot/tilastot-aiheittain/paihteet-ja-riippuvuudet/alkoholi

Thomas Karlsson (2014): Nordic Alcohol Policy in Europe. The Adaptation of Finland’s, Sweden’s and Norway’s Alcohol Policies to a New Policy Framework, 1994 – 2013:
https://www.julkari.fi/bitstream/handle/10024/116940/URN_ISBN_978-952-302-307-9.pdf?sequence=1

Thomas Karlsson et al (ed.)(2013): Alkoholi Suomessa. Kulutus, haitat ja politiikkatoimet (Alcohol in Finland. Consumption, harms and policy measures)
https://www.julkari.fi/bitstream/handle/10024/104455/URN_ISBN_978-952-245-896-4.pdf?sequence=1

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.

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.

The difference in wages is more than threefold, but the difference is excise duty rates is slightly smaller. http://www.stat.ee/dokumendid/70132

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.

At the moment, alcohol can be advertised in TV and Radio starting from 9.00 PM to 7. AM.

Current goverments coalition agreement states: “we will allow providing only neutral information in alcohol advertisements, and will ban so-called lifestyle ads”. https://valitsus.ee/sites/default/files/content-editors/failid/coalition-policy-agreement-may2015.pdf

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.

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/

NGO Terve Eesti is doing a public awareness campaign Joome poole vähem (“Lets drink half as much”). http://www.xn--poolevhem-02a.ee/

Ministry of Internal Affairs is running a “Wise Parent” project that counsels on parenting issues, including on children´s alcohol and drug related questions and problems. http://tarkvanem.ee/#

Estonian Institute of Economic Research have published its latest annual report “Alcohol market, consumption and harms in Estonia. Yearbook 2014”. http://www.ki.ee/publikatsioonid/valmis/Alkoholi_aastaraamat_2014.pdf

Yearbook 2015. https://www.sm.ee/sites/default/files/content-editors/Ministeerium_kontaktid/Uuringu_ja_analuusid/Tervisevaldkond/144774789351_alkoholi_turg_2015.pd.pdf

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.

Additional tax raises have been planned until 2018. Source: Ministry of Finance

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.

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).

Addiction treatment

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).

 

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.

Source: Global report on alcohol and health, WHO 2014

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.

2017
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.

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.
Link: http://talpykla.elaba.lt/elaba-fedora/objects/elaba:8606783/datastreams/MAIN/content
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.
Link: http://vddb.library.lt/fedora/get/LT-eLABa-0001:E.02~2014~D_20140904_150421-41383/DS.005.0.01.ETD
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.

Annual report 2014 of Drug, Tobacco and Alcohol Control Department. Narkotikų, tabako ir alkoholio kontrolės departamentas. 2014, ISSN 1822-1181.
Link:
http://www.ntakd.lt/files/informacine_medzega/0-NTAKD_medziaga/1-MP/2014_LT.pdf
About: Annual report provides the latest data on prevention, control and policy of psychoactive substances in Lithuania.

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.
Link: http://onlinelibrary.wiley.com/doi/10.1111/add.12495/abstract
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.

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.

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):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Source: Ice News

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.

Sweden
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/ 

Finland
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.
Opening hours:
Mon–Thu 9–20 or 9–18
Fri 9–20
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.

Norway
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/

Iceland
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.
Opening hours:
Monday -Thursday: 10 (mostly 11 or later) – 18 (some until 20)
Friday: 10-20 (many less)
Saturday: 11-18 (many less, many closed)
Sunday: 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.

Estonia
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

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.

NORWAY

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.

The official advice is given by the Norwegian Directorate of Health and can be found on https://helsenorge.no/gravid/gravid-og-alkohol

DENMARK

1 unit = 12 gr of pure alcohol.

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.

ICELAND

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:
http://www.landlaeknir.is/servlet/file/store93/item2535/3370.pdf

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.

Our guidelines for pregnancy is no alcohol.

http://www.landlaeknir.is/servlet/file/store93/item10668/afe_vim_medganga.pdf

FINLAND

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

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

Lithuania has no official guidelines.

ESTONIA

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.

Source: ESPAD

As a precautionary measure related to methodological issues the comparability of the Latvian data has been considered limited.
Source: ESPAD 2015 Country Summaries

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