>>>> Return-path: Resent-date: Fri, 17 Sep 1999 09:13:27 -0005 Date: Fri, 17 Sep 1999 15:13:06 +0200 Resent-from: [log in to unmask] From: Robin Room Subject: "Swedish alcohol policy in an international perspective" Sender: Kettil Bruun Society Approved-by: Robin Room Resent-to: [log in to unmask] To: [log in to unmask] Reply-to: Kettil Bruun Society Resent-message-id: X-MIMEOLE: Produced By Microsoft MimeOLE V4.72.3110.3 X-MSMail-priority: Normal Original-recipient: rfc822;[log in to unmask] 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 <<<<<<<<