Alcohol is a key public health and social concern across Europe. Europe has the highest proportion of drinkers in the world, the highest levels of alcohol consumption per capita and a high level of alcohol-related harm.
The European Union (EU) is the region with the highest alcohol consumption in the world: in 2009, average adult (aged 15+ years) alcohol consumption in the EU was 12.5 litres of pure alcohol, more than double the world average.
Alcohol related harm is a major public health concern in the EU accountable for over 15% of all ill health and early deaths among men and about 4% among women. The consequences of harmful and hazardous alcohol consumption also include a considerable number of fatalities on EU roads, a broad social impact such as violence, hooliganism, crime, family problems and social exclusion, as well as low productivity.
Before the EU Alcohol Strategy 2006-2012
In 2001, the European Council adopted the “Council recommendation: alcohol and young people, especially children and adolescents” as well as a set of Conclusions. In 2004, the Council recommendation was evaluated and the conclusion was that the time was ripe to come up with a comprehensive strategy. The Council invited the European Commission to put forward such a strategy.
The development of that strategy took several years, firstly because there was a lot of resistance to the mere thought of a community strategy by the drinks industry and secondly because the EC commissioned several preparing studies into the nature and extent of alcohol use and alcohol problems in Europe. This resulted in the lengthy report “Alcohol in Europe; a public health perspective” and two impact assessments: one on health aspects and one on economic aspects.
The EU Alcohol Strategy 2006-2012
Finally in October 2006 the European Commission agreed upon the “EU Alcohol Strategy”. The strategy - designed for the period 2006-2012 - contained soft law, which means that it does not propose the development of harmonised legislation. It just summed up five priority themes which are relevant in all member states and for which Community action in complement to national policies and coordination of national actions has an added value:
1. Protect young people, children and the unborn child;
2. Reduce injuries and death from alcohol-related road traffic accidents;
3. Prevent alcohol-related harm among adults and reduce the negative impact on the workplace;
4. Inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patters;
5. Develop, support and maintain a common evidence base.
In November 2006 the Strategy was endorsed by the Council. In its Conclusions the Council stated that they welcomed the Alcohol Strategy, but underlined that alcohol-related harm should be addressed in a coherent manner in relevant areas as research, consumer protection, transport, advertising, marketing, sponsoring, excise duties and other internal market issues.
Other European institutions, as the European Parliament, the European Economic and Social Committee and the Committee of the Regions also responded positive, although there were some critical notes.
The most concrete result of the EU Alcohol Strategy was the Alcohol and Health Forum, started in July 2007. This Forum is set up to give the drinks industry and relevant NGOs (among them STAP) the chance to come up with specific prevention and information projects. The Forum is now extended with a Science Group and two task forces. In addition, there is an annual Open Alcohol and Health Forum.
From STAP, Dutch Institute on Alcohol Policy, there has been criticism of the effectiveness of the prevention and awareness activities in the framework of the Alcohol & Health Forum, especially those from the economic operators in the Forum. To this end see, inter alia: alcoholreclame.nl.
Representatives of the Member States have their own platform: the Committee on National Alcohol Policy and Action (CNAPA).
After the EU Alcohol Strategy 2006-2012
In August 2013 the European Commission presented a report assessing the added value of the “EU Strategy to Support Member States in reducing alcohol related harm”. This did not result in a new strategy, partly awaiting the European elections. But to give meanwhile more structure to the activities in EU member states the European Commission prepared in spring 2014 a draft "Action Plan on Youth Drinking and on Heavy Episodic (Binge) Drinking" for the period 2014-2016. This Action Plan has been endorsed by the CNAPA in september 2014.
In the beginning of 2015 CNAPA called the new European Commission to formulate a second alcohol strategy. Therefore the CNAPA prepared a "scoping paper". The representatives of the member states argue that especially several cross-border issues (price and excise tax policy, alcohol advertising and marketing, labelling) need regulation at EU level.
Not only the CNAPA, but also the European Parliament asked the European Commission in a resolution (see below) to submit new proposal on labelling and start drafting a second European Alcohol Strategy.
Shortly thereafter Vytenis Andriukaitis, the EU Commissioner for Health and Food, announced that the Commission will not come with a separate new alcohol strategy document. His idea was that alcohol policy would just be a section of a paper on the European policy on chronic lifestyle diseases.
The European health organizations saw the Commissions's unexpected decision not to come with a separate new alcohol strategy, despite the calls from CNAPA and the European Parliament, as a genuflection to the alcohol industry. Therefore, they collectively left the Alcohol and Health Forum.
In December 2015 the EU Health Council accepted Council Conclusions in which the European Commission is asked to formulate a new EU Alcohol Strategy before the end of 2016. This special EU-strategy document must focus - according to the Health ministers - on measures to reduce alcohol-related harm with a cross-border dimension. The new strategy should take into account the work carried out by CNAPA and the WHO.
It is striking that the Alcohol and Health Forum is not mentioned in the document of the EU Health Council.
After the adoption of the Council Conclusions early December 2015, the debate on European alcohol policy stopped completely. The hopes are now pinned on the Estonian EU Presidency in the second half of 2017, as the Estonian Minister of Health and Labour, Yevgeny Ossinovski, said: "We agreed that within the framework of the presidency, Estonia will put the focus on several Europe-wide topics of alcohol policy from online marketing to labeling of alcohol."
Within the WHO harmful use of alcohol is an important theme since the early 1990s.
The first two European Action Plans 1992-2005
At European level an “European Alcohol Action Plan” was adopted in 1992. That plan called for intensification of alcohol policy, which included more stringent national legislation and more international cooperation. One of the corollaries of this action plan was a European Ministerial Conference on Alcohol (1995), which unanimously adopted an “European Alcohol Charter”.
In 1999 the European Regional Committee of the World Health Organization approved the “European Alcohol Action Plan 2000-2005”. In this action plan the political strategies of the Charter are elaborated in concrete activities and objectives. In February 2001, this second action plan was endorsed unanimously during the Second European Ministerial Conference, together with a “Declaration on Alcohol and Young People”.
The Framework and the fourth European Action Plan 2005-2020
The “European Alcohol Action Plan 2000-2005” was followed up by a “Framework for Alcohol Policy in the WHO European Region”. That was adopted in Bucharest in 2005. Due to a lack of capacity at European Office of the WHO in Copenhagen this Framework was never elaborated.
In 2011 the thread was picked up at European level. In September 2011 the European Regional Committee endorsed the “European action plan to reduce the harmful use of alcohol 2012–2020”. Building on previous European alcohol action plans, the main objectives and action points of the new Action Plan are aligned with those of the WHO “Global Alcohol Strategy” (May 2010).
The action points, each presented with following strategies and options for action, are:
- leadership, awareness and commitment;
- health services’ response;
- community and workplace action;
- drink–driving policies and countermeasures;
- availability of alcohol;
- pricing policies;
- marketing of alcoholic beverages;
- reducing the negative consequences of drinking and alcohol intoxication;
- reducing the public health impact of illicit alcohol and informally produced;
- monitoring and surveillance.
Action plans of the World Health Organization have no legal force, but it is common that member states take these documents seriously and go to work with it after their adoption.
In march 2012 WHO Europe published a report on alcohol consumption, alcohol related harm and alcohol policy in the European Union, entitled "Alcohol in the European Union 2012".
STAP participated or participates in the following European projects (in alphabetic order):
ALICE-RAP: Addiction and Lifestyles in Contemporary Europe Reframing Addictions Project (www.alicerap.eu)
In this EC funded project (2012-2016) STAP, in collaboration with Maastricht University and the University of Amsterdam, investigated the impact of exposure to alcohol marketing on brain activity of heavy drinkers and of patients treated for alcoholism.
AMMIE: Alcohol Marketing Monitoring in Europe
The AMMIE project started in 2008 and stopped in 2012. The main aim of the project was the monitoring of alcohol marketing in 5 European countries (Denmark, Germany, Italy, Bulgaria and the Netherlands). This monitoring has been implemented by independent national NGOs based on the experience of the Dutch Institute for Alcohol Policy (STAP), who has been doing this since 2002 commissioned by the Dutch Ministry of Health, Welfare and Sport.
Although the collaborating Member States differ in terms of drinking pattern as well as alcohol marketing regulation systems, AMMIE developed a systematic monitoring tool that can be used in all selected countries.
Report Key findings of independent monitoring of alcohol marketing in five European countries can be downloaded here.
AMPHORA aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. This knowledge will be disseminated to those engaged in policy-making for development and implementation of more effective public health measures. AMPHORA is a four-year project co-financed by the Seventh Framework Programme (FP7) of research of the European Commission and is overall coordinated by the 'Hospital Clínic de Barcelona' (HCPB) in Spain. STAP coordinates a longitudinal study into the impact of alcohol marketing on drinking behaviour of young people in Germany, Italië, Polen and the Netherlands.
APN: Alcohol Policy Network (www.alcoholpolicynetwork.eu)
APN is a European platform for sharing knowledge, experiences and opinions on public health oriented alcohol policy issues. It emerged in the context of the Bridging the Gap project and was initiated at the meeting of this project in Warsaw in 2004. Over the years the APN has grown, both in number of participants as well as in importance, functioning as a real network: a community of individuals who exchange news, share information and in some cases, cooperate on joint activities; an inspiring, knowledge-increasing, and capacity- strengthening forum for its participants.
Bridging the Gap:
Bridging the Gap (BtG) was co-funded by the European Commission for the years 2004-2006. The main aim of the project was to create a vibrant alcohol policy network to support and encourage European countries to implement the "Council Recommendation on the drinking of alcohol by young people". The project included partners in 30 European countries as well as the World Health Organization (European Office), the European Youth Forum, and the European Public Health Alliance.
Building Capacity: (www.ias.org.uk) .
The Building Capacity project (2007-2009), with 31 country partners and 10 European organizations, was build on the work of the project "Bridging the Gap". The aim was to unite and develop existing knowledge to the European Commission to support their communication in the field of alcohol. STAP coordinated the work package on local alcohol policies. This resulted in a manual based on the theories of Harold Holder and Bob Reynolds.
DRAIN: Dutch Romanian Alcohol policy Implementation Network (www.drain-project.eu)
DRAIN (2007-2010) was funded by the Dutch Ministry of Foreign Affairs, Department of Matra. Romania had no tradition of alcohol policy, while drinking (illegal) alcohol is embedded in the culture. In addition to the enforcement of laws and regulations, it was therefore a need for politicians, policy makers and citizens to be aware of the dangers of drinking alcohol. In the Romanian city of Piteşti a model for effective local alcohol policy was developed. The results are recorded in a manual, that has been distributed under Romanian municipalities.
ELSA : Enforcement of national Laws and Self-regulation on advertising and marketing of Alcohol (www.stap.nl) .
The ELSA-project, which was co-financed by the European Commission, was a two year project (2005-2007) that assessed the enforcement of national laws and self-regulation on the advertising and marketing of alcoholic beverages in all 24 Member States and applicant countries and Norway. The project was coordinated by STAP. The main objective of the project was to assess and report on the enforcement of national laws and self-regulation on the advertising and marketing of alcoholic beverages in EU-Member States, applicant countries and Norway. To that end a network of experts from the different participating countries was established. The partners of ELSA together have succeeded to deliver 6 reports (www.stap.nl/elsa).
EUCAM: European Centre for Monitoring Alcohol Marketing (www.eucam.info).
EUCAM has been set up to collect, exchange and to promote knowledge and experience about alcohol marketing throughout Europe. The knowledge partly results from ELSA-project and from FASE.
EUCAM was established in 2007 by STAP and operates under the support of the NGOs: AV.OG.TIL (Norway), IOGT-NTO (Sweden), Alcohol and Society (Denmark), Eurocare Italia. EUCAM organizes publishes summaries of recent scientific studies on alcohol marketing regulations in Europe on a website and a monthly magazine.
EUROCARE: The European Alcohol Policy Alliance (www.eurocare.org)
EUROCARE is a network of public health organizations. It advocates the prevention and reduction of alcohol related harm in Europe through effective and evidence based alcohol policy. STAP is member since 2002.
Eyes on Ages
The Eyes on Ages study was an EC tender, focussed on the age limits for selling and consuming alcohol, law enforcement practices and compliance research. STAP coordinated the study that was executed in the beginning of 2013 in all EU member states. The results of the study were reported at an event that took place on 30 May 2013 in Amsterdam. In October 2013 STAP published the final report.
FASE: Focus on Alcohol Safe Environment (www.faseproject.eu).
The FASE project (2007-2009) was partly a continuation of the ELSA project. In the framework of FASE STAP examined - on the basis of a detailed literature analysis - the criteria alcohol advertising regulations must meet in order to prevent alcohol drinking among youth. The investigation has shown that the existing regulations in Norway (total advertising ban) and in France (far-reaching restrictions on alcohol advertising and sponsorship) are by far the most protective.
FASE project also aimed to collect best practices in work-place strategies to reduce the impact of harmful and hazardous alcohol consumption on the economy as well as best practices on well-resourced community mobilization and intervention projects to create safer drinking environments. Funded by the EU Commission.
Let it hAPYN! (www.eurocare.org/eu_projects/let_it_hapyn).
The main aim of the project 'Let it hAPYN!' is to reach a better overview of good/ bad practices of alcohol intervention programmes that are happening in youth organisations or that are applicable to youth organisations in Europe. This will result in a better understanding of the youth sector and allow possible evidence- based best practices of alcohol interventions to be implemented in other youth organisations. By including youth organisations in the process, the project is giving a permanent added value to the whole youth sector.The project has received funding from the European Union, in the framework of the Health Programme.
Let it hAPYN! project will be running from April 2013 till April 2016.
RAHRA: Reducing Alcohol Related Harm (www.rahra.eu)
RAHRA, co-funded by the Health Programme of the European Union, was a 3 years (2014-2016) Joint Action aiming at supporting Member States to take forward work on common priorities in line with the EU Alcohol Strategy and strengthen Member States' capacity to address and reduce the harm associated with alcohol. RAHRA was initiated by the Member States. STAP participated in this project, as well as two other Dutch institutes (Trimbos-institute and RIVM).
One of the concrete results of RARHA is an European 'tool kit' for evidence-based alcohol interventions. STAP made a significant contribution to the composition of this tool kit.
ESPAD: European School survey project on Alcohol and Drugs (www.espad.org)
The ESPAD project was started due to the lack of comparable data on substance use among European teenagers. In order to collect such data, a common methodological protocol was established in the early 1990s, including a master questionnaire. For pragmatic reasons the survey is conducted among 15-16 year old students in class rooms. Data collections are organised every four years in more than forty European countries. The first ESPAD survey was carried out in 1995, while the subsequent waves took place in 1999, 2003, 2007, 2011 and 2015.
Both the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and the Pompidou Group of the Council of Europe supports the project, as well as national ministries involved.
Eurobarometer Special Surveys (ec.europa.eu) .
The last decade the European Commission carried out two Special Eurobarometer surveys on alcohol. One in 2006 (number 272b, published in March 2007) and one in October 2009 (number 331, published in April 2010).
These studies give trends in drinking patterns and attitudes towards alcohol policies. Awareness of alcohol-related risks was only measured in 2009.
HBSC (Health Behaviour in School-aged Children) (www.hbsc.org) .
The HBSC-study is a cross-national research study conducted in collaboration with the WHO Regional Office for Europe. The study aims to gain new insight into, and increase our understanding of young people's health and well-being, health behaviours and their social context.
HBSC was initiated in 1982 by researchers from three countries and shortly afterwards the project was adopted by the World Health Organization as a WHO collaborative study. There are now 43 participating countries and regions. The first cross-national survey was conducted in 1983/84, the second in 1985/86 and since then data collection has been carried out every four years using a common research protocol. The most recent survey, the eighth in the series, was conducted in 2013/2014.
Since its inception, the study has been developed by a multi-disciplinary network of researchers from a growing number of countries in North America and Europe (f.i. the Netherlands)