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Resent-date: Fri, 17 Sep 1999 09:13:27 -0005
Date: Fri, 17 Sep 1999 15:13:06 +0200
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From: Robin Room
Subject: "Swedish alcohol policy in an international perspective"
Sender: Kettil Bruun Society
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A 3-hour bilingual hearing with this title was held by a Swedish
parliamentary committee yesterday. (I cannot imagine a Canadian or U.S.
legislature holding a hearing with an equivalent title). Along with
various Swedish agencies and interests and a woman from the Canadian
embassy, Esa Österberg and I were asked to testify as researchers.
(Canada, and particularly Quebec's Educ'alcool, is being held up in
Sweden as a model of how to replace alcohol controls with education
without the rate of alcohol problems rising. Swedish TV last night
showed interviews with the head of Educ'alcool and of the Quebec monopoly
-- the latter apparently was frank about wanting a rise in per-capita
sales.)
My testimony at the hearing is below. Reactions welcomed. Robin
Testimony at a hearing of the Swedish Parliament on "Swedish alcohol
policy in an international perspective", 16 September 1999
I am pleased and honoured to be asked to talk to you. I speak from the
perspective of a sociologist who has worked in alcohol studies for 36
years, first in the United States, then in Canada, and in recent months
first in Norway and now in Sweden. I have been interested both in the
epidemiology of drinking and alcohol problems in an international
perspective, and in the effects of alcohol controls and of other alcohol
policies.
While drinking brings pleasure to many, it is also a substantial source
of harm, both to the drinker and to others. Considering only
health-related harms, the World Health Organization study of the Global
Burden of Disease concluded that in the established market economies --
the category which includes Sweden -- alcohol was responsible for about
10.3% of the disability-adjusted life-years (DALYs) lost. For comparison,
in the same group of countries all illicit drugs together were estimated
to account for 2.3% of life-years lost -- that is, less than one-quarter
of the level of alcohol’s harm to health.
Because of its adverse health and social impacts, alcohol is treated as a
special commodity in many societies. To cite a few examples, governments
takes an active role in controlling the alcohol market in such countries
as Turkey and India, there are warning labels on alcoholic beverage
advertisements in Mexico, there are government alcohol monopolies in
three Latin American countries, and alcohol sellers are specially
licensed in every English-speaking country. In the WHO study of alcohol
policy in developing societies, which I am presently coordinating, we
have come to see that on a global basis it is southern Europe which is
more of an exception than northern Europe, in terms of the special
cultural position of alcoholic beverages in the southern European wine
cultures.
In an international perspective, there are two things which are somewhat
unusual about Swedish alcohol policy. One is the fact that there is a
clear national tradition of aiming at an integrated alcohol policy. Since
alcohol issues reach across many government functions and areas of daily
life, it is still uncommon outside the Nordic countries to find the
extent of coherence in policy and coordination of effort that is taken
for granted in Sweden. The second distinguishing characteristic is the
extent to which Swedish policies have been informed by empirical research
on policy impacts. This reflects both a strong tradition of empirical
social research in the Nordic countries, and that the policy process is
relatively open to being informed by science.
At this point, there is in fact a solid base of knowledge for discussions
of alcohol policy. There are two main literatures which form this base.
One is the substantial accumulation of studies, both at the level of the
individual drinker and at the level of the population, on the role of
drinking in health and social problems. From a policy perspective, we may
draw two main conclusions from this literature. First, problems differ in
the form of their relation to drinking levels and patterns. For instance,
problems such as traffic injuries relate primarily to a particular
drinking occasion, while chronic health problems such as liver disease
relate to a history of heavy drinking. Understanding the details of these
relationships can be very important in designing strategies to prevent
the problems. Second, the level of consumption in a population is an
important determinant of the rate of problems. In a particular national
population, the level of problems tends to rise and fall with the overall
level of alcohol consumption. A national alcohol policy is thus well
advised to pay attention both to affecting patterns of drinking and to
constraining the overall level of consumption.
The second main literature underlying informed discussion of alcohol
policy is the tradition of alcohol policy impact studies. This tradition
was initiated and has been particularly strong in the Nordic societies
which have alcohol retail monopolies. One beneficial side-effect of the
monopolies, indeed, seems to have been a willingness to take an
experimental approach to alcohol policy, with well-designed social
experiments providing an empirical basis for social policy discussions
and decisions. Along with a variety of other studies in the last 25
years, these experimental studies have transformed our understanding of
the effects of particular alcohol policy initiatives. The literature is
still ragged and incomplete, but we are approaching the point where there
will be enough evidence, derived with diverse methods and in a range of
societies, to estimate the likely effects of particular policy
initiatives in particular social circumstances.
At a more general level, there are also some conclusions to be drawn from
these studies. Governments, as well as each of us in our own lives, can
undertake practical harm reduction strategies, separating the drinking
occasion from dangerous or harmful contexts. Within limits, market
controls -- measures which structure the conditions of sale of alcohol --
often do constrain or reduce rates of alcohol-related problems. On the
other hand, approaches in terms of persuading the individual drinker, for
instance through education, can show only limited success. The clear
policy success in the drinking-driving area, for instance, has depended
not on education and public information alone, but on a combination of
these with deterrence and enforcement.
The conclusions from these studies are not always what was expected, nor
are they always popular. Nor should their results necessarily be
decisive. Quite properly, research findings are only one of the
considerations in the policy process. But the growing maturity of these
research literatures provides an important resource for public debate
about policy, in Sweden as elsewhere. Sweden can continue to make a
special contribution here. It requires not only support for the research
effort, but also maintaining an experimental approach to alcohol policy.
The knowledge thus gained will be a contribution not only to the future
of Sweden, but of the world.
Robin Room
Centre for Social Research on Alcohol and Drugs
Sveaplan
Stockholm University
106 91 Stockholm
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