5. Anderson Lessons from 20 years of European alcohol policy · Advertising (EU) : Finland in 2015...
Transcript of 5. Anderson Lessons from 20 years of European alcohol policy · Advertising (EU) : Finland in 2015...
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Lessons from 20 years of European alcohol policy
Peter AndersonProfessor, Alcohol and Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, NetherlandsProfessor, Substance Use, Policy and Practice, Institute of Health and Society, Newcastle University, England
Amsterdam 3 October 2014
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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Source: Lim et al 2012
Risk factors for disability adjusted life years, world, 2010
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41,4
12,6
27,7
74,1
Social costs due to alcohol EU 2010 (€155 billion)
CrimeTraffic accidentsHealthProductivity
Source: Rehm et al 2012
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Associations of a more than 3% rise in unemployment with death rates, EU, 1970-2007
0
5
10
15
20
25
30
Suicides Alcohol dependence
4%
28%
Source: Stuckler et al 2009
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Trends in adult per capita consumption, EU, Croatia, Norway and Switzerland, 1990-2010
12.4% decline
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12.4% decline12.5% decline
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Trends in adult per capita consumption, Netherlands, 1961-2020.
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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0%
2%
4%
6%
8%
10%
12%
14%
0 10 20 30 40 50 60 70 80 90 100
Risk
of d
eath
due
to a
lcoh
ol b
efor
e ag
e 70
Drinking level in g/day
Risk MRisk W
Risk of dying prematurely (up to age 70) due to alcohol consumption in European UnionSource: Rehm 2014
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International Agency for Research on Cancer:
Alcohol is a causal agent for cancers of:Ø Oral cavity, pharynx, and larynxØ OesophagusØ LiverØ ColonØ RectumØ Breast
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Relative risk of breast cancer by alcohol consumption
Source: Allen et al 2009
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4% of all male cancer deaths and 3% of all female cancer deaths in EU are due to alcohol
Source: Rehm 2014
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Ø The Margin of Exposure (MOE) compares a toxic threshold of a substance with the exposure of the substance.
Ø The European Food Safety Authority judges MOEsfor carcinogens above 1,000 as low priority for public health when based on human data.
Ø This means that provided that the dose consumed is 1,000 times less than the toxic threshold, this is acceptable for public health exposure (it does not mean that the consumption is completely safe).
Source: Lachenmeir et al 2011
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The toxic threshold of alcohol for human cancer is about 50g alcohol (5 drinks a day). [This is based on animal studies in which 10% develop cancer from the equivalent dose].
Source: Lachenmeir et al 2011
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Using European Food Safety Authority guidelines on exposure to carcinogens in food and drinks, exposure should be no more than one thousandth the toxic dose, which works out at 50mg ethanol a day, about 20g alcohol (2 drinks) a year.
Source: Lachenmeir et al 2011
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EU adults who drink alcohol on average consume about 30g (3 drinks) a day, 600 times more than the exposure level set by the European Food Safety Authority guidelines.
Source: Lachenmeir et al 2011
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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The impact of alcohol marketing in digital media on subsequent youth alcohol consumption was studied amongst 6,651 students with a mean age of 14 years from Germany, Italy, the Netherlands and Poland in a longitudinal setting.
Source: De Bruijn et al 2014
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Nearly one third of students reported using a social media site which contained alcohol advertisements, and two thirds reported noticing alcohol advertisements on an internet page.
Source: De Bruijn et al 2014
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In the Netherlands, exposure to high levels of alcohol marketing compared to low levels of exposure increases the relative chance of recent drinking by 58% 14 months later, and the relative chance of recent binge drinking by 52% 14 months later.
Source: De Bruijn et al 2014
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0,00
0,05
0,10
0,15
0,20
0,25
20% 40% 60% 80%
Impact of marketing on young people’s drinking in Netherlands
Drinking during previous month
Binging during previous month
Source: De Bruijn et al 2014
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As proportion of TV viewers aged 13-19 years goes up, intensity of alcohol advertising goes up
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0
0,2
0,4
0,6
0,8
1
1,2
1,4
All alcoholic beverages Beeer and cider
0,69 0,62
1,29 1,28
Incidence rate ratios for being exposed to alcohol adverts compared with adults by age group, NET
6-12 years13-19 years
Source: Winpenny et al 2012
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Advertising (EU) : Finland in 2015 Alcohol advertising with● digital games and gaming apps in consoles, tablets and mobile phones will be banned● product placement in video games will be banned● all kinds of competitions and prizes (both online and offline) will be banned (“Like us and win tickets to the next match/concert”)● allowing people sharing their stories, photos or videos in official company pages will be banned● producing and making available viral marketing (videos) intended to be shared online will be banned
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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Impact of 10% increase in minimum price of alcohol in Saskatchewan, Canada
Source: Stockwell et al 2012
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A study in British Columbia in Canada found that a 10% increase in the minimum price of alcohol led to a 3% decrease in acute alcohol caused deaths and a 8% decrease in chronic alcohol caused deaths.
Source: Zhao et al 2013
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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Ø Across the EU, commonly, less than 5% of those who could benefit are offered screening and advice in primary health care settings.
Source: Wolstenholme et al 2012
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Source: Angus et al 2014
[Netherlands]
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Source: Angus et al 2014
Saves nearly 1,000 alcohol-related deaths
Saves nearly 2,900 alcohol-related deaths
[Netherlands]
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4
6
8
10
12
14
16
18
20
Baseline Implementation
Impact of training and support and financial reimbursement on number of heavy drinking patients (per 1,000
consultations ) given brief advice in 5 EU countries
TS-TS+FR-FR+
Source: Anderson et al 2014
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1. Background2. Why no mandated warning labels?3. Why is advertising not banned?4. Why is a minimum price not introduced?5. Why do GPs not give advice?
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“Just how that U turn was achieved is not only a story of the power of lobbying, dubious connections, and the expert dissemination of misinformation. It is also a story of a political system both dependent upon and happy to fraternise with the drinks industry, both outside parliament and within.How else, for example, could it be seen as acceptable for a serving chancellor of the exchequer to accept the title Beer Drinker of the Year in celebration of his having cut duty on beer, and to pose for a photograph holding a beer named “Pennies from 11,” brewed in his honour?”
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“Despite these shocking statistics, the European Commission has offered no resistance to the alcohol industry. Worse, under the auspices of its 2007 alcohol strategy it has instead collaborated with industry’s preference for self regulation, building it a voluntary platform from which it can shout loudlyabout corporate responsibility and voluntary commitments, concepts that have proved largely ineffective in preventing the health harms caused by its products.”
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1. Background
Despite the known harms to health, productivity and society, not enough is done –alcohol consumption per person aged 15+ in the Netherlands has stayed more or less static for the last 40 years.
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2. Why no mandated warning labels?
Alcohol is a carcinogen - the least we could do is to inform consumers of this through mandated warning labels
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3. Why is advertising not banned?
Tobacco advertising is banned. A ban on alcohol advertising would save lives, save money and give a clear message that alcohol is not an ordinary commodity.
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4. Why is a minimum price not introduced?
Increasing the price of alcohol saves lives and saves money. Introducing a minimum price per gram of alcohol sold is one of the most effective and robust ways to increase the price of alcohol.
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5. Why do GPs not give advice?
There is no excuse - alcohol affects many diseases that GPs have to deal with. Simple programmes of screening and advising save lives, and in some cases, save money.