Managing Alcohol in Europe Peter Anderson MD, PhD, MPH Fort Myers 5 January 2007

1. Managing Alcohol in Europe Peter Anderson MD, PhD, MPH Fort Myers 5 January 2007

2. Alcohol is no ordinary commodity • Alcohol is an important health determinant • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

3. Alcohol is no ordinary commodity • Alcohol is an important health determinant in Europe • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

4. is a toxin that can harm almost any system or organ of the body, leading to more than 60 different acute and chronic disorders; • can exacerbate pre-existing mental and physical disorders, adversely interact with other prescribed and illicit drugs, and contribute to a wide range of social problems; • can pose a significant risk to third parties, including the foetus;

5. can weaken the immune system and thus may increase the risk for communicable diseases such as TB, HIV/AIDS or different forms of hepatitis; • can lead to a higher risk of unsafe sex thereby increasing the risk of sexually transmitted diseases;

6. shows wide individual variation in the toxic effects of consuming a given amount; has no threshold below which consumption can be regarded as entirely risk free; produces a state of dependence, CNS depression and stimulation, ill effects, and abuse liability.

8. Alcohol is no ordinary commodity • Alcohol is an important health determinant • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

9. Prevalence of abstention in World 2002 Rehm 2006

10. Adult per capita consumption (L pure alcohol) 2002 Rehm 2006

11. Alcohol-attributable global burden of disease 2002

12. 28% of all male deaths at age 15-29 years are due to alcohol 11% of all female deaths at age 15-29 years are due to alcohol

13. Alcohol is no ordinary commodity • Alcohol is an important health determinant • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

14. Although there are individual examples of the beneficial impact of school-based education, systematic reviews and meta-analyses find that the majority of well-evaluated studies show no impact even in the short-term.

15. The impact of 2 education sessions [] on binge drinking in 13-15 year olds The impact of 2 education sessions [] on binge drinking in 13-15 year olds

16. Educational programmes should not be implemented in isolation as an alcohol policy measure, or with the sole purpose of reducing the harm done by alcohol, but rather as a measure to reinforce awareness of the problems created by alcohol and to prepare the ground for specific interventions and policy changes.

17. Alcohol is no ordinary commodity • Alcohol is an important health determinant • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

19. Alcohol is no ordinary commodity • Alcohol is an important health determinant • Education not an alternative to regulating the alcohol market • Brief advice complements but does not replace regulating the alcohol market • Options for regulating the alcohol market • Price • Availability • Advertising

20. Options for regulating the alcohol market • Increasing the price of alcohol reduces alcohol-related harm, particularly amongst younger and heavier drinkers • Increasing the availability of alcohol increases alcohol-related harm • Both the content and volume of alcohol advertising need to be regulated in order to reduce young people’s drinking

21. Options for regulating the alcohol market • Increasing the price of alcohol reduces alcohol-related harm, particularly amongst younger and heavier drinkers • Increasing the availability of alcohol increases alcohol-related harm • Both the content and volume of alcohol advertising need to be regulated in order to reduce young people’s drinking

22. Principles of EU tax policy: • Taxes should be shifted from labour to social costs to contribute to the EU goals of increasing employment and reducing negative health impacts in a cost-effective way

23. Increases in alcohol taxes: • cirrhosis death rates • road traffic accidents and fatalities • intentional and unintentional injuries • workplace injuries • sexually transmitted disease rates • rapes and robberies • homicides • crime • child abuse • wife abuse

24. Alcohol taxes have a greater impact: • Younger drinkers • Heavier drinkers • Poorer drinkers

25. Before alcopop tax After alcopop tax

26. Principles of EU tax policy: • New revenues can be allocated to specific funds to be used for financing measures to lessen or offset external costs

27. Levy introduced on alcohol (>3% strength) to fund a community programme, with restricted availability, and improved education and treatment Northern Territories, Australia Control region, Australia Acute alcohol deaths/100,000 Chronic alcohol deaths/100,000

28. Acute alcohol Chronic alcohol deaths/100,000 deaths/100,000

29. Options for regulating the alcohol market • Increasing the price of alcohol reduces alcohol-related harm, particularly amongst younger and heavier drinkers • Increasing the availability of alcohol increases alcohol-related harm • Both the content and volume of alcohol advertising need to be regulated in order to reduce young people’s drinking

32. Finnish studies have found an overall impact on alcohol consumption from changes in the number of outlets. The most dramatic change was observed in 1969, when beer up to 4.7% alcohol was allowed to be sold by grocery stores, and it also became easier to get a restaurant license. The number of off-premise sales points increased from 132 to about 17,600, and on-premise sales points grew from 940 to over 4000.

33. In the following year: • alcohol consumption increased by 46%. • In the following five years: • mortality from liver cirrhosis increased by 50% • hospital admissions for alcoholic psychosis increased by 110% for men and 130% for women • arrests for drunkenness increased by 80% for men and 160% for women.

34. Mean

38. In England, since 1980: Bars and nightclubs  10% Licensed hotels and restaurants  68% Off licences  100% Licence applications  145% Alcohol 54% more affordable than in 1980 Manchester capacity  250% 1996-2000

39. Rickards et al, 2004, Deehan and Saville, 2003, Anderson and Hughes, 2006; Fuller, 2005

40. Office for National Statistics, 2006

44. Spanish 15-29 year olds

45. Spanish 30-64 year olds

46. Homicide rate/million 18/mn 10/mn 14/mn

47. Homicides due to alcohol (%) 50% 55% 61%

48. Options for regulating the alcohol market • Increasing the price of alcohol reduces alcohol-related harm, particularly amongst younger and heavier drinkers • Increasing the availability of alcohol increases alcohol-related harm • Both the content and volume of alcohol advertising need to be regulated in order to reduce young people’s drinking

49. Ellickson et al.: Exposure to in-store beer displays predicts drinking onset; exposure to alcohol ads in magazines or beer concession stands at sports or music events predicts greater frequency of drinking. (Addiction 2005)

50. Stacy et al.: One standard deviation increase in viewing television programs containing alcohol commercials in seventh grade (11-12 year-olds) associated with an excess risk of beer use (44%), wine/liquor use (34%), and 3-drink episodes (26%) in eighth grade (12-13 year-olds). (Am J Health Behav 2004)