2011-08-12
Summary of a publication in Swedish.
This sub-report address es developments concerning alcohol consumption and related harms in Sweden with a focus on the period 2004-2009 and discusses the measures implemented to reduce hazardous and harmful alcohol consumption. Proposals of future measures are also made. This report contains more proposed measures than the five prioritised proposals recommended in the Public Health Policy Report 2010.
The area of alcohol has had a predominantly positive development since the publication of the Public Health Policy Report 2005. Total alcohol consumption has decreased, although it has done so from a historically high level, and intoxicative drinking has decreased. The structure of prevention work has become increasingly better and more long term throughout Sweden and the use of preventive measures that have scientific support has become more common. Supervision under the Alcohol Act at the regional and local levels slowly improved during the period, and cooperation increased between authorities and other actors to prevent alcohol-related crime and harm. During the period, a number of major prevention efforts in the alcohol area also achieved their widest spread in Sweden, in many different arenas and among several different target groups. The Government’s long-term approach in the 2000s was a crucial success factor in this regard. The greater focus on alcohol on the part of the authorities went hand in hand with greater interest in the issue in the population and a more restrictive view towards alcohol. The population’s support of the alcohol retail monopoly, for instance, reached its highest point in 2009 and 2010 since measurements began in 2001.
At the same time, average annual alcohol consumption has risen in Sweden in the past 15 years (from 1996 up to the present) from 8.1 litres to 9.2 litres of pure alcohol per resident aged 15 or older. Since 2004, alcohol has become substantially more accessible, with falling real retail prices on alcoholic beverages and rising purchasing power, virtually unlimited personal imports for travellers and permitted Internet sales. In addition, the number of on-premise serving licences has successively increased at the same time that the level of regional and local alcohol supervision is still far too low. Marketing of alcoholic beverages increased sharply during the period. All of this set very high requirements on the drug prevention work in
municipalities and county administrative boards, requirements that many of those who work for better public health find frustrating. The fact that we, despite all of this, note decreasing total consumption nationwide, less intoxicative drinking,
fewer personal imports, less smuggling, fewer adolescents who drink and more restrictive attitudes to alcohol in the population indicates that the collective prevention efforts in the alcohol area have had a significant effect.
The picture of alcohol harms in the period 2004 to 2009 is not clear cut, but nonetheless generally indicates a stabilisation – and in many cases a decrease – following an increase of many years. The number of alcohol-related deaths among men is decreasing. The number of alcohol-related deaths among those over the age of 50, which has exhibited a sharp increase for quite some time, may also be stabilising now. The number of drivers who have died with alcohol in their bodies appears to be decreasing and the number of DUIs has decreased since 2008. Decreasing numbers of adolescents are being treated for alcohol poisoning, but the number of alcohol poisonings is still increasing among men, as is the number of alcohol-related care instances among women over the age of 50. Altogether, the number of alcoholrelated diseases, injuries and deaths indicates that the situation is still serious, and we cannot view the decrease of certain indicators over the past three years as stable. It is possible that we are seeing a greater polarisation in society, in which drinking is on the rise in some groups while the majority of the population has adopted healthier living habits that include reduced consumption of alcohol. Consequently, it is important to better survey and pay more attention to the risk groups in future, at the same time that efforts to reduce total alcohol consumption and harmful drinking behaviour are redoubled. The collective view of alcohol-related harms nonetheless indicates that the trend can be influenced.
The measures implemented during the period were focused on norms, laws, illegal activities, accessibility, attitudes and behaviour, but were unable to prevent greater accessibility to alcohol. Prices should periodically be increased in order to reduce pressure on the prevention efforts of the municipalities and increase the cost-effectiveness of prevention measures in the future. For the same reasons, we should implement measures that increase control of the Internet trade and limit the marketing of alcohol. Support among the population was probably never higher throughout the 2000s than it is today. Price increases and marketing restrictions automatically has the consequence that the Government must more actively work in the EU for higher minimum levels of duties on alcohol, for lower personal import quotas and against unlimited alcohol advertising. Our other recommendations of measures also concern the central aspects of an effective alcohol policy:
• Combat illegal handling of alcohol, particularly to reduce adolescent access to alcohol. Crime-fighting authorities should undertake both long and short-term measures to reduce the illegal trade in alcohol.
• Review the alcohol supervision procedures of county administrative boards and municipalities as well as the issuance of licences by municipalities. In addition, work should be ensured on effective methods to limit access, such as Responsible
beverage service (STAD method).
• Increase the quality of the breathalyser tests that are carried out annually through greater randomness of the controls and better information-gathering for more effectively targeted controls.
• Develop and distribute the measures to influence attitudes and behaviour that have provided good results during the period, such as information to parents of teenagers in conjunction with early identification and brief intervention in healthcare to influence the drinking habits of the adult population. In addition to these central aspects, it has become apparent that the monitoring of alcohol-related harm and alcohol policy needs a clearer division of responsibilities. We also identified a need for knowledge development in a few strategically important areas for future Swedish alcohol policy in the EU. Health warnings on
alcoholic beverage packaging are one such area. Sweden’s prevention efforts against the harms of alcohol are extensive by international comparison and are an expression of the fact that the area is highly prioritised in Sweden. Still, in relation to the costs that these drugs cause society, these efforts are nearly marginal. The cost-effectiveness of the prevention measures motivates a broader endeavour. Because a long-term approach is so important in efforts to prevent the harms of alcohol, future measures should build on the chosen path of knowledge-based prevention, but should be reinforced by more effective limits to
accessibility and price increases in the next five-year period.
updated Friday, August 12, 2011
