European alcohol policy conference
Building capacity for action
Barcelona 3rd – 5th April 2008

At a consumption level of 11 litres of alcohol per adult per year, Europe is the heaviest drinking region in the world, over 2.5 times the rest of the world’s average. This brings a particular health and economic burden to Europe, leading to pain and suffering, harm to third parties,health inequalities, and a drain on Europe’s productivity.

The presence of high level policy makers reflected the growing strength of the public health lobby in European alcohol policy, a development probably not unconnected with the increasing tendency of alcohol scientists and policy advocates to draw direct parallels between alcohol and tobacco. Professor Robin Room, one of the world’s leading alcohol scientists, commented on how explicit comparisons were being made at the conference between alcohol and tobacco that would have been avoided only a few years earlier.

Consistent with this re-framing of the alcohol question, in his speech of welcome to the conference, WHO’s Marc Danzon, referring to the claim that moderate drinking has a protective effect in relation to cardiovascular disease, said that WHO could not accept the statement that alcohol even in ‘moderate’ quantities is ‘good for health’…….

In his address, Robert Madelin said that he hoped the World Health Assembly would pass the proposed resolution on alcohol as this would aid efforts in Europe to tackle alcohol related harm, and strong support was expressed at the conference for the development of a global alcohol strategy. Mr Madelin also outlined the Commission’s alcohol harm reduction strategy and described the functioning of the Alcohol and Health Forum established by the Commission as a stakeholder platform in which participants, including numerous alcohol industry companies and organizations, commit themselves to taking practical steps to tackle alcohol related problems.

Referring to the role of alcohol marketing, one of the key issues in alcohol politics, Mr Madelin said that the working hypothesis of DG SANCO, the Commission’s health and consumer protection directorate, was that the balance of evidence shows a cumulative effect of marketing on young people’s knowledge, attitudes and behaviour.

An outcome of the conference was the publication of a set of conclusions representing the consensus position in regard to public health policy on alcohol and the necessary actions to be taken to implement them.

Alcohol causes a high level of harm
Action: Community and municipal programmes need to be strengthened and implemented to raise awareness and support for alcohol policies; warning labels need to be added to alcohol containers Europewide to help establish a social understanding that alcohol is a special and hazardous commodity.

Young people are vulnerable to alcohol
Alcohol consumption in adolescence can trigger long term biological changes that may have detrimental effects on the developing adolescent brain, including neuro-cognitive impairment.The younger young people start to drink and the heavier they drink, the more they are at risk of alcohol dependence and alcohol-related harm during young adulthood, including suicide. Young people, and especially those that are heavier drinkers, are particularly susceptible to alcohol advertisements. There is growing evidence that alcohol advertising increases the likelihood that young people start to drink, and that the overall amount that they drink and the amount that they drink on one occasion is greater. There is a need to better protect young people.

Action: there needs to be much better regulation, enforcement and monitoring of alcohol marketing that not only deals with the content but which also substantially reduces the exposure of alcohol marketing to young people; the rules relating to the marketing of alcoholic products should be approximated across Europe, noting the need to specify the extent to which alcohol marketing in certain categories of media and publications is allowed.

Alcohol causes harm to people other than the drinker
The social costs due to harmful alcohol consumption to the EU as a whole is estimated to be €125bn a year, divided into health, crime and lost productivity costs. There needs to be tougher action in reducing third party harm.

Action: the economic and physical availability of alcohol should be regulated, and limited to reduce third party harm, including the implementation of alcohol-free zones; a maximum BAC limit of 0.5 g/L, eventually reduced to 0.2g/L, should be implemented Europe-wide with a lower limit of 0.0 g/L for novice drivers and drivers of public service and heavy goods vehicles (countries with existing lower limits should not increase them).

Government regulation needs to be strengthened
Alcohol is not an ordinary commodity like milk or potatoes. These are all powerful justifications for strengthened regulation, including managing the price and availability of alcohol. These are measures for which there is overwhelming evidence for effectiveness and cost-effectiveness in reducing alcohol-related harm. However, the implementation and impact of effective regulations can be compromised due to trans-national and cross border issues, particularly, for example, due to the high alcohol allowances for travellers between EU countries.

Action:minimum alcohol tax rates should be at least proportional to the alcoholic content of all beverages that contain alcohol, should cover the social costs due to alcohol, and should be increased in line with inflation; in the absence of agreed and harmonized tax levels, travellers’ allowances, which increase tax competition and lower taxes, should be reduced Europe-wide.

Help needs to be available for people with problems
Action: there needs to be a considerable health systems investment in appropriate strategies to ensure the widespread availability and uptake of early identification and brief advice programmes in primary care settings, in cost effective treatment for alcohol use disorders, and in support for sufferers of third party harm, including family members and children; evidence based standards for advice and treatment should be implemented and monitored Europe-wide.

Focusing on their product, economic operators have the potential to reduce harm
The responsibilities of economic operators in reducing the harm done by alcohol should be related to their product, the core of their businesses.

Action: it is imperative that economic operators should consider ways in which the price and strength of their product can be managed to reduce harm, for example a commitment to support regulation for a minimum pricing structure; producers and retailers should commit to share intelligence and knowledge of illegally traded and illicit alcohol, together with a commitment to support Europe-wide tax stamps.

Raising the voice of civil society
Although there appears to be citizen support for a range of alcohol policy options, it seems that social awareness of the extent of the harm done by alcohol and what can be done to reduce it is lacking in many societies. Further, there is a lack of adequate presence and strength of voice of non-governmental organizations active on alcohol issues and alcohol policies in many countries.

Action: greater investment needs to be given to European and country based non-governmental organizations to give greater voice to civil society to support a cultural change to reduce the harm done by alcohol; the actions of non-governmental organizations need more dominance, with enhanced visibility of their presence.

Capacity forAction
Greater capacity needs to be built in Europe, and country wide, for greater collective and synergistic action to support the 2006 Council Conclusions for sustained and monitored actions to reduce alcoholrelated harm; the negative alcohol-related health impacts of decision making across all policy sectors should be reduced, and the positive impacts identified and promoted.

Towards a Global Strategy
In its 2007 report on problems related to alcohol consumption, the WHO Expert Committee emphasized that in the coming years alcohol consumption is likely to increase substantially in south-east Asia and in the low to middle-income countries of the western Pacific (constituting nearly half of the world’s population), and that, in general throughout the world, poor people suffer a disproportionate burden of harm attributable to alcohol.

Action: greater support from Europe needs to be given to the development of a Global Strategy to reduce the harmful use of alcohol; recognizing the global trade and marketing of alcoholic products, and the need to respect the alcohol policies of other countries that are stronger, there is a need for a common legal framework to support collective action across borders.

Expanding the evidence base.
Action: greater investment needs to be given to research on the impact of drinking on others in work, home and social life settings, including the long-term impact of parental drinking on children and their development as adults; the measurement and monitoring of social harms from alcohol requires concentrated European attention.

The full conference report is available http://www.dss3a.com/btg/index.html