Esa Österberg

Alcohol: No ordinary commodity research and public policy

From a public health perspective, alcohol is a major contributor to morbidity and mortality. This book describes recent advances in alcohol research which have direct relevance for the development of effective alcohol policies at the local, national and international levels. The central purpose of the book is to empower those responsible for public health and social welfare.

A scale of formal alcohol control policy in 15 European countries

Thomas Karlsson & Esa Österberg: A scale of formal alcohol control policy in 15 European countries As part of the alcohol control policy analysis of the ECAS project, this article reviews and discusses previous attempts to measure the strictness of alcohol control policies and to conduct a similar analysis in the ECAS countries. Based on the knowledge gathered from previous studies, we have created a scale of our own to measure the strictness of alcohol control policies and have applied it to the countries included in the ECAS project. The scales reviewed in this article and the scale we have constructed only measure the strictness of formal alcohol control. Drawing on the results of the ECAS scale, it seems that formal alcohol control in the EU member states has become stricter during the second half of the twentieth century. In the 1950s only three of the 15 countries were classified as having “high alcohol control”. In the year 2000 the number of high alcohol control countries had increased to six. The number of countries with low alcohol control had decreased from nine to zero between 1950 and 2000. Comparing the scores in the different countries or the average scores in all the ECAS countries over time is, however, problematic because the changes in these numbers reflect two different trends. On the one hand, there has been a decrease in the control of production and sales of alcoholic beverages or the regulation on alcohol availability. On the other hand, alcohol control measures targeted at demand or alcohol-related problems have become more prevalent. This means that alcohol control policies have become more similar in the ECAS countries in the second half of the twentieth century. Because of the limitations of the scale, however, we have to make certain reservations about the results and be very careful not to draw too far-reaching conclusions based solely on the results and rankings on the ECAS scale or any other scale for that matter. The scale and the results should therefore be considered as yet another attempt to quantify and rank alcohol control policies according to their strictness and not as an attempt to provide a perfect solution to a mission impossible.

Alcohol : No Ordinary Commodity – a summary of the second edition

This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn). The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America. In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services. Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective. Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.

Explaining change and stasis in alcohol consumption

The term ‘saturation’ has often been used when alcohol consumption in a region stays the same despite there having been reason to expect an increase, e.g. after a decrease of taxation. However, the term ‘saturation’ has been used only descriptively, and in different ways. We therefore propose a wider-ranging framework for understanding and explaining trends in alcohol consumption, illustrating the operation of the factors with historical or contemporary examples. In the framework, we include not only taxes and other alcohol controls, but also situational and other norms on drinking and intoxication, competing responsibilities and attractions that demand or favour sobriety, structural changes, external influences and the range of societal or cultural responses to alcohol problems.

Contextual Determinants of Alcohol Consumption Changes and Preventive Alcohol Policies: A 12-Country European Study in Progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.

Scaling alcohol control policies across Europe

Aim: One of the tasks in the Bridging the Gap (BtG) project was to create a scale to measure the strictness of alcohol control policies in Europe. The countries included were all the current EU member states as well as three applicant countries plus Norway and Switzerland (BtG countries). Methods: Alcohol control measures were divided in seven subgroups. The weights in scoring different alcohol policy measures were based on the evidence of effective alcohol policy. In order to validate the scores given to different alcohol policy measures a kind of Delphi technique was used. The data for the scale was gathered from the country information provided by the BtG Alcohol Policy Network, and from other relevant sources, as for instance the WHO Alcohol Control Database. Findings: According to the BtG scale alcohol control policies are most strict in Northern European countries. Countries with low alcohol control include wine-producing countries. A common feature for these countries is that none of them have instituted a positive excise duty for wine. Central European beer-preferring countries and the new EU member states from Eastern Europe belong to medium alcohol control countries. Conclusions: The scale offers an easy instrument for comparing different countries. At the same time it is a simplistic tool, which should be used cautiously.

Alcohol tax changes and the use of alcohol in Europe

INTRODUCTION AND AIMS Different motives in determining the level and structure of alcohol taxes lead to greatly varying alcohol excise duty levels. The aim of this paper is to look at alcohol excise duty rates in European Union (EU) and the mechanisms affecting them. Also the trends in alcohol prices and alcohol consumption will be discussed. MATERIAL Material concerning alcohol taxes and consumption comes from available statistics and published literature. RESULTS This paper shows that despite many attempts the EU has not been able to harmonise alcohol excise duty rates in its member states. The importance of alcohol taxes as an alcohol control measure has decreased as the real value of alcohol excise duty rates has decreased in most EU countries during the last decades. DISCUSSION In most European countries the share of alcohol taxes of the price of alcoholic beverages is quite low. Therefore, increasing alcohol excise duty rates would in most countries lead to increased alcohol tax revenues to the public sector. Consequently, increasing alcohol excise duty rates would serve both the fiscal and the health and social policy interests of the state.

Explanations and Implications of Concurrent and Diverging Trends: Alcohol consumption and alcohol-related harm in the Nordic countries in 1990–2005

Aims This paper summarizes and discusses the trends in alcohol consumption and various types of alcohol related-harm in the five Nordic countries—Denmark. Finland, Iceland, Norway and Sweden. Results and Conclusions The development in alcohol consumption versus alcohol-related harm is mixed. In some cases the trends are fairly parallel whereas in other cases they are diverging. This article lays out the different potential methodological and substantive explanations for the diverging trends. as well as discussing their likely explanatory value. Although we have observed that trends in alcohol consumption are not necessarily followed by similar trends in all indicators of alcohol-related harm, we conclude that there is still in general reason to assume that a significant change in total alcohol consumption in a Nordic country is—all other things being equal—likely to be followed by a change in the same direction in various alcohol-related harms in that population.

Potential consequences of replacing a retail alcohol monopoly with a private licence system: results from Sweden.

AIM To examine the potential effects of replacing the Swedish alcohol retail system with a private licensing system on alcohol consumption and alcohol-related harm. DESIGN Two possible scenarios were analysed: (1) replacing the current alcohol retail monopoly with private licensed stores that specialize in alcohol sales or (2) making all alcohol available in grocery stores. We utilized a multiplicative model that projected effects of changes in a set of key factors including hours of sale, retail prices, promotion and advertising and outlet density. Next, we estimated the effect of the projected consumption increase on a set of harm indicators. Values for the model parameters were obtained from the research literature. MEASUREMENTS Measures of alcohol-related harm included explicitly alcohol-related mortality, accident mortality, suicide, homicide, assaults, drinking driving and sickness absence. FINDINGS According to the projections, scenario 1 yields a consumption increase of 17% (1.4 litres/capita), which in turn would cause an additional 770 deaths, 8500 assaults, 2700 drinking driving offences and 4.5 million sick days per year. The corresponding figures for scenario 2 are a consumption increase of 37.4% (3.1 litres/capita) leading to an additional annual toll of 2000 deaths, 20 000 assaults, 6600 drinking driving offences and 11.1 million days of sick leave. CONCLUSIONS Projections based on the research literature suggest that privatization of the Swedish alcohol retail market would significantly increase alcohol consumption and alcohol-related harm.

A New Alcohol Environment: Trends in alcohol consumption, harms and policy: Finland 1990–2010

■ AIMS This article reports developments in the Finnish alcohol field from 1990 to 2010, focusing on changes and trends in alcohol consumption, drinking habits and alcohol-related harm. We pay special attention to changes in alcohol availability and alcohol policy and look at the factors behind changes in alcohol policies. The article will also discuss the current status and future prospects of alcohol policy and alcohol control as well as differences between Finland and the situation in the neighbouring countries with a similar alcohol monopoly. ■ METHODS Routinely collected statistical data on alcohol consumption and related harm as well as repeated cross-sectional representative population surveys will be reviewed, as will changes in alcohol policy and availability. ■ RESULTS Apart from the economic recession in the early 1990s, alcohol consumption and related harm have increased in Finland. Changes in alcohol consumption are mostly explained by changes in consumer incomes and alcohol policy measures. However, EU membership has restricted tightened alcohol control and given more room for private alcohol industry to affect alcohol policy. ■ CONCLUSIONS While increased alcohol-related harm has stopped the Finns from moving toward a more liberal alcohol policy, EU membership and private alcohol interests have made it considerably more difficult to combat alcohol-related harm with alcohol control measures.