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Commentary: Life after big alcohol policy changes in Lithuania

The good news is that Lithuania has lost the dubious first place as a country consuming most alcohol per capita to Moldova. This particular achievement had not received much attention, even though number one rank earlier has inspired accusations of deliberate tarnishing the country reputation with false statistics. Life in Lithuania continues, contrary to doomsday scenarios that were generously provided by the helpful alcohol industry. Per capita consumption is continuing to go down, so is the trend for lower mortality and hospitalization indicators, while excise tax income continues to increase. Industry still works relentlessly in its attempts to mitigate and maybe reverse some of the control policy measures. Their activities however have gotten quieter, less publicly visible.

Approximately 9 months ago Lithuania introduced new stricter alcohol control policy measures: a total ban on alcohol advertising, an increase of legal buying age up to 20 years and shorter retail hours. Before that, more than a year ago, substantial excise tax hikes were implemented. The society seemingly embraced those changes without much fuss, with some complaints in social media. In the beginning, there were more conflicts, mostly related to briefer alcohol retailing time, especially on weekends. The problem with alcohol advertisings in foreign magazines so acute in the beginning of 2018, seems to have gone with the wind. So far, things seem to function without additional changes in the Alcohol Control Law, as NTAKK and NordAN experts have advised. The soft dissipation of an issue which caused a small hurricane of memes in social and general media, and was even presented as a potential threat to national security, is in itself a very interesting phenomenon and might point towards industry involvement.

It is too early to assess statistical significance of the changes in health indicators, also difficult to obtain standardized data. However, the data collected by the State Sick Fund system SVEIDRA suggests that there is a substantial drop in illnesses caused by alcohol. When comparing the first quarters of the 2017 and 2018 there is a reduction in hospitalizations due to toxic effects of alcohol, mental illness caused by alcohol and alcohol psychosis. Many other indicators of social and health harms are also decreasing: there is a significant reduction in suicides, number of deadly traffic accidents, drowning cases, even fires and workplace accidents.

More research is necessary to assess the trends of alcohol consumption, confirming the positive trend for public health and effectiveness of the implemented measures. Nine months is not enough to provide a reliable overview and reflection upon all potential factors that could have contributed to the change. On the other hand, the Lithuanian Tobacco and Alcohol Control Coalition do not view the implemented measures as needing additional proof of effectiveness. These interventions were chosen from the evidence based WHO recommended “3 Best Buys”. We strongly believe that over time full potential for reducing per capita consumption and related harm will be revealed.

However the power of the implemented advertising ban, sale time and age restrictions is constantly undermined by alcohol producers and sellers.

One of the main methods of circumventing current restrictions is enormous increase in advertising of non-alcoholic beer and wine. This translates in record sale increases of these products and likely impacts the reduction of consumption. There is an increase of articles in the mainstream media discussing culture of food and drinking, ideology of freedom, while these narratives are frequently presented by internet influencers. Overall alcohol marketing seems to have shifted towards internet based activities and consumer generated content.

The persistent narrative in media that the control policy measures do not work and should be revoked is continuing. The messages are perpetuated by industry and industry funded NGOs, openly, but unregistered lobbyist organizations and also politicians.

Main industry supportive narratives are:
# Current restrictions have increased illegal alcohol sales and consumption. This narrative is facilitated by industry friendly NGOs, such as “Lietuva be šešėlio”. There is no peer reviewed independent research or alcohol related health indicators to support this.
# Current restrictions are not effective since people shop in Poland and Latvia, while state is losing tax income, while health harms are not reduced. This narrative is not supported by public health indicators and excise tax collection is increasing.
# Due to current restrictions businesses simply cheat and sell alcohol to young people, at illegal time, in illegal outlets, at restricted times on internet and illegally, so the harm is not reduced. This narrative is not supported by public health indicators and excise tax collection is increasing, however it is highlighted in media and police reports.

The civil society institutions do lack surveys and definitive research to be able to respond to these allegations with reliable evidence, therefore we have to acknowledge that the support for alcohol control measures and positive outcomes are not particularly visible in media. Another current trend is that media, when seeking comments, clearly favours politicians and state employees, rather than NGOs.

Difficult to know how much these latest control measures are supported by the general population, however anecdotal evidence and personal experience points that people are overall very accommodating to these stricter measures.

The Health care ministry and the minister are not very popular among public, despite improving public health indicators. Minister Aurelijus Veryga still seems to have full support of the ruling Peasants and Greens Union and respect within the government. Despite comical depictions in media and regular public clashes with opposition, the party still enjoys sizeable popular support in polls. The efforts to repair somewhat dwindling majority have resulted in minority opposition parties joining the coalition. The newer members of the coalition have been strong opponents of alcohol control measures in the past, and these moves might affect the stance of government towards alcohol control.

And recently we do see increasing coldness in the government towards new control proposals, such as restricting size and type of alcohol packaging, as well as banning sales of so called “champagne for children”. More ambitious plans for zero BAC have evaporated, and the Government seems to have lost appetite for consultations with civil society and NGOs regarding evidence based alcohol and tobacco control measures. Municipal and Presidential elections might be a real factor in these processes. As all elections are.

Nijole Gostautaite Midttun
Lithuanian Tobacco and Alcohol Control Coalition

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