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.

Explanations and Implications of Concurrent and Diverging Trends

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.

Upward Trends in Alcohol Consumption and Related Harm in Finland

Aim

Our aim was to study whether the development in the rates of harm still follows the development in per capita alcohol consumption, and to clarify the relationship between alcohol consumption and related harms by paying attention to third factors affecting this relationship.

Data

Statistics on alcohol consumption and alcohol-related harm associated with the maintenance of public order and safety alcohol-related deaths and hospitalizations, and treatment for alcohol problems in the period 1990–2004.

Analysis

In the last 15 years, alcohol consumption in Finland first decreased during the economic recession of the early 1990s, and then increased almost constantly. Some harm series roughly followed these consumption trends, and for some others the connection with alcohol consumption became obvious when the effect of some third factor was taken into account. Harm rates also increased in 2004 when alcohol consumption increased by 10% after a decrease of alcohol excise duty rates of 33% on average.

Conclusions

In Finland changes in alcohol consumption are still today followed by changes in rates of alcohol-related harm.

The Nordic Borders are not Alike

Aim

To pinpoint the most important and interesting border trade areas for alcoholic beverages in the Nordic countries and to investigate patterns of routes and directions of border trade with alcoholic beverages in these areas.

Data & Methods

Travellers' alcohol imports in general and border trade in alcoholic beverages in particular are studied in Denmark, Finland, Iceland, Norway and Sweden, paying special attention to different borders and border areas in the Nordic countries.

Results

The main motive for border trade in alcohol is differences in the prices of alcoholic beverages. The greater the price difference the higher the volume of border trade in alcoholic beverages, ceteris paribus. However, differences in alcohol prices are by no means the only factors affecting the volume of border trade in alcohol. In the Nordic countries the volume of cross-border trade in alcoholic beverages is currently especially significant in five geographic areas.

Conclusions

Not only factors derived from the basic economic theory of consumer behaviour, but a mixed variety of intervening factors, as for instance manmade hindrances or geographical circumstances, markedly influence cross-border trade in alcoholic beverages in the Nordic countries.

Does Beverage Type Matter?

The purpose of this article is to review the associations of different beverage types with different types of harm and discuss their likely causes. The key issue is whether alcohol policy can influence the occurrence of harms by affecting consumers' beverage choices. This is dependent on the following questions addressed in this article:

1) Does beverage choice affect alcohol-related harm if quantity of alcohol is equal? 2) Does beverage choice impact the quantity of alcohol consumed? 3) Can beverage choice influence the nature of the drinking situation and thereby quantities and harm?

The literature review did not reveal great differences between different beverages with regard to harm if equal amounts are drunk, although it seems that spirits are somewhat more closely associated with alcohol poisonings and aggressive behaviour. Our results showed that spirits have a prominent role in Finnish binge drinking: the proportion of spirits consumed increases in direct proportion to the amounts of alcohol consumed on individual drinking occasions. we conclude that it would be unwise to encourage consumers to favour spirits. Currently, the difference in taxes on spirits and mild alcoholic beverages in Finland is larger than the corresponding difference in harm per litre of ethyl alcohol. However, an equal rate of taxes would make spirits much cheaper per litre of ethyl alcohol than other beverages. Based on our review, this situation would in all probability lead to an increase in alcohol-related harm.

Estimating Alcohol Consumption: Measurement and Policy Issues Related to Legal and Illegal Sources of Alcohol

There are several challenges to obtaining an accurate estimate of alcohol consumption and per capita consumption in a jurisdiction. There are difficulties in estimating the extent of illegal production and fraudulent transportation activities. In some jurisdictions there is extensive home production, which is difficult to estimate. There are challenges to estimating the amount of alcohol that is brought into a country or is taken out, primarily by individuals. This includes “slippage” between official and unofficial production and consumption. As drinking preferences change and stronger or weaker brands are marketed, the conventional conversion factors from beverage to absolute alcohol volumes need to be adjusted. Finally, in light of extensive international travel there are challenges in determining the appropriate denominators in calculating some rates of consumption or damage. The eight papers in this special issue of Contemporary Drug Problems address a number ofthe challenges related to measurement issues and to estimating “unrecorded” consumption, and they note the underlying social and political dynamics and the applications of estimates. They also point to the need forfurther research on the reasons for gaps between different estimation methods, consequences ofhigh rates ofsmuggling or use ofillegal alcohol, and impacts ofvarious interventions to curtail illegal consumption.

Unrecorded Alcohol Consumption in Finland in the 1990s

This paper discusses different categories of unrecorded alcohol consumption and the data sources used in estimating their magnitude and developments. It also gives a brief overview of the developments and importance of different categories of unrecorded alcohol consumption in Finland in the post Second World War period until the 1990s, and a more detailed analysis of the developments in the 1990s. One of the main findings is that travelers' alcohol imports have gained in importance, especially during the 1990s. However, drinking of non-beverage alcohol or surrogates has almost disappeared on the Finnish alcohol scene. In the second half of the 1990s homemade alcohol was also on the decrease. At the end of the 1990s about one-fifth of all alcohol consumed was unrecorded alcohol. More than half of the unrecorded alcohol consisted of travelers' alcohol imports. The next important categories were consumption outside Finland, homemade alcohol, and smuggled alcohol.

Finland: increases in alcohol availability and consumption

This article briefly describes the changes that Finland has undergone during the 1960-2012 period with regards to societal changes, alcohol control policies, alcohol-related harms, and alcohol consumption, after which the findings of the analyses made by Allamani and his colleagues in the AMPHORA project are discussed. It seems that despite the changes in the alcohol field, the strong and comprehensive control policy measures still have a solid footing in the Finnish society. It is also evident that the policy changes implemented over the course of the last decades have affected the development of the total alcohol consumption to a large degree in both positive and negative directions, depending on the kind of measure implemented.

Alcohol Retailing in Canadian and Nordic Contexts: Challenges and Opportunities in Balancing Trade and Prevention Agendas

This article involves a comparison of the Nordic alcohol-monopoly countries with Canadian provinces that have a tradition of off-premise alcohol retail monopolies. The aim of the article is to shed light on recent developments in Canadian and Nordic alcohol-retailing systems, and to propose a way forward for alcohol-control policy that involves balancing alcohol trade and damage-reduction agendas. The article first considers developments over the past three decades in alcohol production, marketing, and retailing involving a concentration of production, and an expansion and increased sophistication of alcohol marketing and retailing, and the underlying international and national pressures. Next, it examines examples of recent alcohol policy making in Canada and the Nordic countries, noting the challenges of controlling total alcohol consumption and high-risk drinking in a market-oriented environment. Third, it offers several steps forward that will facilitate a better balance of alcohol trade and problem-prevention agendas in the context of off-premise alcohol-retail-control systems.

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 2008 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.

Psychological Factors in Irritable Bowel Syndrome: a Population-based Study of Patients, Non-patients and Controls

BACKGROUND

It has been suggested that psychopathology in irritable bowel syndrome (IBS) patients is a function of patient status rather than of the disease. Although there are many studies comparing IBS patients, IBS non-patients, and controls with each other, no previous study has recruited all three groups from a representative community sample and had all subjects diagnosed by a physician. In the present study we aimed to compare psychological factors in IBS patients, IBS non-patients, and normal controls in a sample recruited from the population.

METHODS

Subjects aged 18-45 years were recruited from a random sample of the normal population. Seventeen (2 M and 15 F) IBS patients were matched by sex and age with IBS non-patients and normals. Measures of personality traits, interpersonal distress, and temporary psychological distress were used. A physician diagnosed all 51 subjects in order to exclude possible gastrointestinal diagnoses other than IBS.

RESULTS

Controls often differed from IBS non-patients and patients on the personality, interpersonal, and psychological distress measures, while IBS non-patients and patients very rarely differed from each other. All three groups were non-alexithymic.

CONCLUSIONS

The results indicate that there are psychopathological differences between normals and IBS persons (patients and non-patients), but they could not confirm that psychopathology was a function of patient status. Whether this psychopathology is a vulnerability factor for IBS, or a consequence of it, remains to be studied.

Article

Øyvind Horverak & Esa Österberg: Trends in alcohol taxation and prices in the Nordic countries in the 1990s

This article provides a comparative description of alcohol taxation in the Nordic countries today. In addition, it looks at how the duty system and the level of duties have changed since the early 1990s. With the exception of Denmark all distilled spirits and wine and partially also beer were sold in state owned monopoly liquor stores.

There have been major changes over the past decade in the way that alcohol is taxed in the Nordic countries. Nowadays both the Nordic EU members states, Denmark, Finland and Sweden as well as Island and Norway which participate in the European Economic Area agreement have adopted their alcohol taxation systems to EU standards. The most important change has been that the alcohol duty is no longer connected in any way to the price of the products but only with their alcohol content inside different beverage categories. In a 1992 directive on the harmonisation of the structure of excise duties on alcohol and alcoholic beverages, the EU Commission set out its guidelines concerning the allocation of different alcoholic beverages into different beverage categories. A distinction was made between four product groups: beer, wine, intermediate products and distilled spirits, with definitions based primarily on customs tariff bands.

In 1991 the level of alcohol excise duties in Denmark was markedly lower than in the other Nordic countries, whereas the duties in Finland and Sweden were more closely in line with the figures recorded for Iceland and Norway. Te n years ago the Nordic countries could most appropriately be divided into two different tax regimes, with Denmark representing one and the remaining Nordic countries the other. During the study period alcohol excise duties have been lowered in Denmark, Finland and Sweden whereas they have been kept about the same in Iceland and been increased somewhat in Norway. Therefore, today it is fair to say there are three different alcohol tax regimes in the Nordic countries: the Danish version, the Finnish-Swedish regime and the Icelandic-Norwegian one.

As can be expected the lowest prices for alcoholic beverages in the Nordic countries are to be found in Denmark, which also has the lowest alcohol excise duties. As a rule alcohol prices are the higher the higher the alcohol excise duties. However this is not true across the board and without exception, in fact the prices of wine in Sweden are at the same level as in Denmark. This means that the Swedish Systembolaget, from the consumer's point of view, is a more efficient distributor of alcohol than are the Danish markets. This is even more clearly seen when we look at alcohol prices without taxes. Then we notice that with the exception of the sparsely populated and remote Iceland, prices of wine and distilled spirits are lower in the Nordic monopoly countries than in Denmark. With respect to beer the Danish market is the most effective. Overall our examination of price trends indicates that there are no grounds to argue that the system of alcohol retail monopoly means consumers have to pay more for their drink. On the contrary it seems that quite the opposite is true, that retail monopolies help to reduce prices of alcohol.

Article

Mika Alavaikko & Esa Österberg: Increased power of alcohol-related industries in Finland in the 1990s

From 1932 to 1995, the Finnish alcohol control system was based on the State Alcohol Monopoly. The purpose of the monopoly was to prevent profit-making from the production and sales of alcoholic beverages; however, exceptions were made from the very beginning regarding beer and wine production and on-premises retail licences of alcoholic beverages. Consequently, the private profit-seeking sector played a part in the formation of Finnish alcohol policy right after the prohibition era.

This article does not discuss the whole post-prohibition period; it focuses on more recent trends, concentrating on the interests and alcohol policy measures of alcohol industries in Finland in the 1990s. It examines alcohol-related industries, their alcohol policy interests and the persons supervising those interests at the outset of the 1990s, before Finland signed the treaty of the European Economic Area and joined the European Union. The article also presents an analysis of the efforts of people representing alcohol business interests in the parliamentary discussion of the 1994 Alcohol Act. Finally, the article deals with alcohol industries and their alcohol policy interests during the time the 1994 Alcohol Act has been in force.

We started with the hypothesis that the influence of alcohol-related business interests over alcohol policy has strengthened in Finland in the 1990s. The materials also lend support to this assumption. Private traders in the alcohol industry have not, however, increased their sway over alcohol policy in a straightforward way in the 1990s. The parliamentary proceedings on the 1994 Alcohol Act gave private economic interests an opportunity to influence the shape of the future area of operations, and in 1994 business interests succeeded in pushing through many proposals. Since then, their influence over alcohol policy seems to have weakened.

Consumption and Prices of Alcohol until 2004

If travellers' duty-free import allowance within the internal market is increased in the near future, the consumption of alcoholic beverages in Finland is set to increase – along with alcohol-related problems. This is true regardless of whether excise duties on alcoholic beverages are retained at their current level or whether they are lowered in response to the growth of duty-free imports. However, any decisions taken in Finland on excise duties will certainly influence the rate at which alcohol consumption and alcohol-related problems will increase; the extent to which people will buy their drink at home or import it; as well as state incomes from excise duties on alcoholic beverages and the business environment of alcohol-related industries. This article discusses the results of a project whose explicit aim was to weigh the health and social consequences of lowered excise duties on alcoholic beverages and lower prices, the impacts of such moves on the state and the public economy, and the impacts on alcohol-related industries.

The smuggling of alcholic beverages into finland in the 1990s

This article looks at the quantities of alcohol smuggled into Finland in the mid-1990s and at changes in the smuggling of alcoholic beverages, both in quality and quantity, since the 1980s.

Estimates of the extent of smuggling can be based on various sources. This article makes use of two types of information. On the one hand, it employs interview material where the interviewees have been asked about their possible purchase and use of smuggled alcoholic beverages, and about their attitudes towards smuggling. On the other hand, it draws on existing official statistics and registers, mainly data on alcohol seized by customs and on unlawful import or export.

According to drinking habit surveys conducted in 1968-1992, self-reported purchases of smuggled alcohol remained at less than 100,000 litres of pure alcohol per annum. Seizures by customs totalled less than 5,000 litres of 100 % alcohol. However, this article clearly illustrates that the smuggling of alcoholic beverages has reached significant proportions since Finland joined the European Union in 1995.

Based on two different interview studies conducted in 1996, and taking into account the possibility of hiding and cover-ups, our assumption is that the amount of smuggled alcohol (all kinds included) in 1996 totalled approximately one million litres, that is, nearly 2 % of the official alcohol consumption in the country.

In 1995 customs seized 183,600 litres of alcohol; the figure in 1996 was 85,000. In 1995, most smuggled alcohol came to Finland in containers or trucks from the EU internal market. After new regulations were issued in 1996, there was a marked shift in smuggling preferences to transports from Estonia and Russia. The alcohol was smuggled into the country either hidden in vehicle structures or among the cargo.