A Call for action – improved focus on alcohol policy in the European region

We call on the WHO Member States for immediate, targeted and renewed joint action to tackle alcohol-related problems. As the European action plan to reduce the harmful use of alcohol 2012–2020 ends next year and the WHO’s Global strategy to reduce the harmful use of alcohol needs updating, and a renewed commitment, Nordic Alcohol and Drug Policy Network calls your attention to following developments and arguments to make proper next steps.

Is there a need for continued alcohol-specific policy in Europe and globally?

Since 13 years ago the first EU Alcohol Strategy was adopted in 2006 and since the years that preceded the adoption of Global Alcohol Strategy in 2010, the understanding of alcohol ́s effect to the drinker, people around them and society at large, has grown which means that we can now see a broader perspective on the harm that alcohol causes. The rationale for these international agreements is now even more convincing.

It can be argued that the previous goals have been met as at least in some cases, the overall consumption has come down a certain percentage. While that is true, it is crucial to look at alcohol problem more widely than just measuring the per capita consumption rates. The measurements that we used have changed, and our understanding of the harm has broadened and so has the need for an improved alcohol policy.

The link between alcohol and cancer is much stronger

Over there years, the scientific evidence that alcohol is a severe cancer-causing risk factor and that there is no safe level for this risk has made a substantial evolution. This is also reflected in the official IARC recommendations.

European Code against Cancer 3rd Edition´s (2003) recommendation on alcohol use was: “If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man or one drink per day if you are a woman.

12 years later, in 2015, when the 4th Edition of the European Code against Cancer was published the recommendation was much stronger and focused on the fact that there is no safe level. “If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.

The estimates for FASD prevalence in western societies have increased significantly

The level of birth defects caused by prenatal alcohol exposure is unknown in most European countries. At best, states have some estimates, based on global data and international studies. When in the middle of 2000 ́s the general understanding was that fetal alcohol syndrome occurs in 1-3 cases per 1000 live births, more recent studies using in-person assessment of school-aged children in several U.S. communities report higher estimates of FAS: 6 to 9 out of 1,000 children. USA´s Centers for Disease Control and Prevention report that based on the National Institutes of Health-funded community studies using physical examinations, experts estimate that the full range of FASDs in the United States and some Western European countries might number as high as 1 to 5 per 100 school children (or 1% to 5% of the population). According to a 2017 meta-analysis the WHO European Region had the highest prevalence of FASD (14.1-28.0 per 1000 population) with Croatia at 30.9-81.2 per 1000 population and Ireland at 28.0-73.6 per 1000 population.

Changing understanding on moderate alcohol consumption

The claim that moderate alcohol consumption can be good for your heart has been an essential argument in the discussion on how alcohol should be regulated. It frees the substance from being blamed and emphasizes the minority of consumers who don’t seem to know how to consume “right”.

Several studies and analyses have criticised that viewpoint for a time now as did a 2018 study, part of the annual Global Burden of Disease, which assessed alcohol-related health outcomes and patterns between 1990 and 2016 for 195 countries and territories and by age and sex. The study concluded, stronger than ever, that there is “no safe level of alcohol”.

The argument that alcohol could be healthy is a part of alcohol policy discussion is now only if people knowingly want to disregard existing facts and evidence.

Challenges that require new approaches

Most of our commercial communication regulations still do not have any effective ways to deal with the “new media”, even though it is not appropriate to call it “new” in 2019. Economic interests have always been several steps ahead of the regulators. As we might be discussing the permitted sizes of the outdoor posters, various industries and interest groups are investing into the blockchain technologies, which “have the potential of creating a completely disintermediated architecture that will allow ways of create, publish and monetise content without the need of a centralised management system”. Or “as Google claims, the new way of thinking will be “Machine-Learning first,” systems that adapt to people in real time based on smart, complex and self-learning algorithms. In relation to the media industry, the paradigm will become: “Whoever controls the algorithms, controls the way people understand and relate to the world”.

Cross-border trade cause Member States serious problems that are limiting the level that a specific country would like to regulate alcohol to safeguard its citizen’s health. Even if a particular government has the will to introduce evidence-based alcohol policies (for instance tax increases), lack of which is usually the problem, challenges that possible cross-border trade could create, limits that governments ability to act. It is a multinational problem that needs to be addressed internationally.

The abovementioned arguments are meant for policymakers and deciders to consider the urgency why we should continue with a stronger focus on alcohol as ever before. Each and every one of these areas of concern also lacks crucial public awareness. A study published this June in BMJ Open revealed that only one in five women attending breast clinics and screening appointments and only half of the staff questioned at one NHS UK centre knew that alcohol is a risk factor for breast cancer. A 2017 study on the global prevalence of alcohol use during pregnancy showed that in the WHO Europe region about a quarter of pregnant women in the general population consume alcohol during pregnancy.

Alcohol-related problems are avoidable problems, and as such, it is unethical to tolerate that harm. We all know what can help to solve these issues, and we know that people should be made aware of the risks that drinking alcohol causes. We call every government to work for these goals and to join in making alcohol policy a priority in the European and global sphere.