Alcohol in Europe Northern Dimension 30 September 2013 Dr Lars Møller Programme Manager WHO Regional Office for Europe 1

Status Report on Alcohol and Health 2013 Co-sponsored by the European Commission og Finnish Ministry of Health Use data collected in Member Status during 2012 Include EU countries + Croatia, Norway, Switzerland (CNAPA Members) and EU applicant countries (Iceland, FYR Macedonia, Montenegro, Serbia, Turkey)

Status Report on Alcohol and Health 2013 Three parts: Trends in alcohol consumption and alcohol-attributable mortality in the European Union in 2010 Alcohol policy update Country timelines Was launched 13 June 2013 at the 8th Global Conference on Health Promotion, Helsinki, Finland

Status Report on Alcohol and Health 2013 Trends in alcohol consumption and alcohol-attributable mortality in the European Union in 2010 Alcohol policy update Country timelines

Regional categorization

Recorded alcohol consumption in the EU including Croatia, Norway and Switzerland, 1990 – 2010 (in litres pure alcohol per capita 15+).

Central-Western and Western Country Group Central-Eastern and Eastern Country Group Nordic Countries Southern Europe On alcohol consumption the, there has been a marked decrease in recorded adult per capita consumption in the European region as a whole over the past 20 years. However, this trend does not hold for all countries or all areas in Europe. While the central-western and western country group showed an overall decline in consumption, the central-eastern and eastern country group has seen an upward trend in alcohol consumption in the past 10 years. The Nordic countries have the lowest consumption in Europe, which still above the global average, and there has been an increase in consumption in the past decade. The largest decline in consumption has been observed in southern Europe.

Country differences

High exposure, high burden of mortality and disease For men between ages of 15 and 64, 1 in 7 deaths were caused by alcohol (clearly premature deaths given the life expectancy in Europe) For women of the same age category, 1 in 13 deaths were caused by alcohol

In the EU among the 20% highest consumers we estimate that The Pareto principle 1/5 of consumers consume 4/5 of any product In the EU among the 20% highest consumers we estimate that 75.000 men and 17.000 women deaths are attributable to alcohol. We estimate that 5.4% of men and 1.5 % of all women are alcohol dependent The Pareto principle (also known as the 80–20 rule) states that, for many events, roughly 80% of the effects come from 20% of the causes. The original observation was in connection with population and wealth. Pareto noticed that 80% of Italy's land was owned by 20% of the population. In many countries researcher have found that 20% of the population are high alcohol consumers and they drink around 80% of the total alcohol consumed. Hazardous drinkers drink at least five standard drinks a day for men and three drinks a f^day for women. Most of the alcohol atributabel burden is seen in the heavy drinking group. In terms of DALYs 89% are found among these 20% and 77% of all alcohol attributable deaths. In the EU only this accounnts for 75.000 men and 17.000 women a year. In terms of alcohol dependence it is estimated that 5.4% of all men and 1.5% of all women in Europe are alcohol dependent. Three-quarters of the alcohol sold is drunk by hazardous/harmful drinkers

Alcohol attributable SDRs per 100.000 people - 2010

Differences in alcohol-attributable SDR, 2010

Alcohol attributable SDRs for cancer per 100.000 people - 2010

Alcohol attributable SDRs for liver cirrhosis per 100 Alcohol attributable SDRs for liver cirrhosis per 100.000 people - 2010

Alcohol attributable SDRs for injury per 100.000 people - 2010

Status Report on Alcohol and Health 2013 Trends in alcohol consumption and alcohol-attributable mortality in the European Union in 2010 Alcohol policy update Country timelines

Changes in alcohol policy areas over the five years 2006 - 2011 (N=30) Most respondents considered the elements of their respective national alcohol policies to have become stronger over the five years since 2006, set as the reference year because of the launch of the EU strategy to support member states in reducing alcohol-related harm. Respondents were asked to rate given policy areas on a scale from minus 3 (weaker) to plus 3 (stronger). For the purposes of this analysis, responses were grouped in three categories, stronger, weaker and unchanged. Apart from drink–driving policies, for which 23 countries reported stronger developments, the two main areas where the greatest movement towards stronger policies occurred were public awareness-raising (22 countries) and community actions (21 countries). The exceptions to the trend towards stronger policies were regulation of marketing, in which 17 countries reported no change and 3 weaker policies, and the affordability of alcohol, in which 13 countries reported no change and 3 weaker policies. Policies to address illegal alcohol were also an exception to the overall trend in the development of alcohol policies. Illegal alcohol may refer to illegally-produced or smuggled alcohol or the illegal sale of legally home-made (informally-produced) alcoholic beverages. Policies in this area, which may have varying importance in different countries, had mostly remained unchanged since 2006.

Restrictions on alcohol consumption in public places (number of countries)

Number of countries carrying out national awareness-raising activities during 2009-2011

Minimum age limits for on-premise sale of beer, wine and spirits, by number of countries (n=30) 27 EU MS Croatia Norway Switzerland

Minimum age limits for off-premise sale of beer, wine and spirits, by number of countries (n=30) 27 EU MS Croatia Norway Switzerland

Alcohol use during the past 30 days, boys (2011)

Alcohol use during the past 30 days, girls (2011)

Being drunk during the past 30 days, boys (2011)

Being drunk during the past 30 days, girls (2011)

Maximum legal BAC level for category of driver, by number of countries (n=30)

Status Report on Alcohol and Health 2013 Trends in alcohol consumption and alcohol-attributable mortality in the European Union in 2010 Alcohol policy update Country timelines

Country timelines Summary of major steps or milestones in each country in the development of policy and action to reduce alcohol-related harm from 2006–2012 Followed by links to relevant documents, websites, publications, etc. Such a tool could help MS when they are revising, updating, and drafting new policies on alcohol and could facilitate networking between Member States in the area of alcohol policy.

Plans for the timeline data Country timelines Plan to develop an on-line database with a search function (English only) Include all 53 MS in the database Grouped by country, year, and policy areas Updated yearly

63rd World Health Assembly (17-21 May, 2010) Endorsed the Global strategy to reduce the harmful use of alcohol in the WHA resolution 63.13 Italy has been on the forefront in implementing effective alcohol laws by adopting national alcohol and health plan – recently also stricter laws on drink-driving BAC zero for under 21 years.

European action plan to reduce the harmful use of alcohol (EAAP) 2012–2020 – 10 action areas Leadership, awareness and commitment, as sustainable intersectoral action requires strong leadership and a solid base of awareness and political will Health services’ response, as these services are central to tackling health conditions in individuals caused by harmful alcohol use Community action, as governments and other stakeholders can support and empower communities in adopting effective approaches to prevent and reduce harmful alcohol use Policies and countermeasures on drink–driving, as it is extremely dangerous to drivers, passengers and other people using the roads Availability of alcohol, as public health policies to regulate commercial or public availability have proved to be very effective in reducing the general level of harmful use and drinking among minors

EAAP 2012–2020 – 10 action areas Marketing of alcoholic beverages, as systems are needed to protect people, particularly children and young people, from advanced advertising and promotion techniques Pricing policies, as most consumers, particularly heavy drinkers and young people, are sensitive to changes in the prices of alcohol products Reducing the negative consequences of drinking and alcohol intoxication, in order to minimize violence, intoxication and harm to intoxicated people Reducing the public health impact of illicit and informally produced alcohol, as its consumption could have additional negative health consequences due to its higher ethanol content and potential contamination with toxic substances Monitoring and surveillance, as relevant data create the basis for the appropriate delivery and success of responses

Best buys package population-based approaches Smoke-free environments Warning about the dangers of tobacco use Bans on tobacco advertising Raising taxes on tobacco Raising taxes on alcohol Restricting access to retail alcohol Bans on alcohol advertising Reducing salt intake and salt content of food Replacing trans-fat in food with polyunsaturated fat Promoting public awareness about diet and physical activity

European Union: http://who.int/gho/eusah Global: http://who.int/gho/gisah WHO European Region: http://who.int/gho/eisah European Union: http://who.int/gho/eusah

Thank you! LMO@euro.who.int http://www.euro.who.int/alcohol Contact details: LMO@euro.who.int Website: http://www.euro.who.int/alcohol European information system on alcohol and health: http://who.int/gho/eisah