The European Union (EU) is the region of the world with the highest levels of alcohol consumption, more than double the world’s average. EU citizens aged 15 years or older drink on average 12.5 litres of pure alcohol per year, 27 grams a day. One in eight of this consumption is from unrecorded alcohol. Sixteen per cent of men consume 60g or more of alcohol a day, and nine per cent of women consume 40g or more of alcohol a day, definitions of heavy drinking. Eleven million people (5.4% of European men and 1.5% of women) are considered alcohol dependent. In 2004, almost 110,000 men and 28,000 women aged between 15 - 64 years living in the EU died prematurely due to alcohol. Two-fifths of these deaths due to liver cirrhosis, one third due to injuries, and one in five due to cancer. Three-fifth of these deaths occurred in people who are dependent on alcohol.
The problem is not new to Europeans, and does not seem to improve. Per capita alcohol consumption remained stable over the ten year period since 2000. During the last decade there have been a number of European initiatives on alcohol, including a series of WHO European Alcohol Action Plans and the European Commission’s ‘EU strategy to support Member States in reducing alcohol-related harms’ which was launched in 2006. These initiatives are now supported at the global level with the WHO strategy to reduce the harmful use of alcohol and the WHO 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases.
AMPHORA was launched with the aim of creating a European Alcohol Public Health Research Alliance that could influence the debate on alcohol policy at a European level by providing scientific support for alcohol policy development. This alliance provides a coordinated scientific framework that takes into account the economic, social and cultural diversity across Europe, and enhances the overall European research base on the effects of alcohol-related public health measures.
Ten core findings resulted.
- On average, European Union adults aged 15+ years drink 27g alcohol per day, more than twice the world’s average. One in eight of this consumption is from unrecorded alcohol, which, with the exception of ethanol, is not normally a health risk. One in eight citizens consume 60g or more of alcohol at a time at least several times a week.
- The best estimate is that about 138,000 people, aged 15-64 years, die prematurely from alcohol in any one year, with two-fifths of deaths due to liver cirrhosis, one third due to injuries, and one in five due to cancer.
- Ethanol is a carcinogen, a teratogen and toxic to many body organs. Using the European Food Standards Authority guidance on risky exposure for human consumption of toxic substances in food and drink products, European drinkers consume more than 600 times the exposure level for genotoxic carcinogens, for alcohol set at 50 milligrams per day; and more than 100 times the exposure level for non-carcinogenic toxins, set at 0.3 grams alcohol per day. [The average consumption of the 89% of EU citizens who drink alcohol is just over 30g/day].
- Countries with more strict and comprehensive alcohol policies generally have lower levels of alcohol consumption. Regulating the economic and physical availability of alcohol are particularly effective in reducing the harm done by alcohol, and such regulations have tended to become more restrictive throughout the European Union in recent years, particular so in the eastern part of the Union. Involvement of alcohol producers in alcohol policy making tends to be associated with weaker alcohol policies, whereas the involvement of academia tends to be associated with stronger policies.
- Socio-demographic changes impact on alcohol consumption. In general, increased urbanization results in increases in overall alcohol consumption, and a greater maternal age across all child births results in decreases in overall alcohol consumption. However, even when taking into account the impact of these socio-demographic changes, alcohol policy matters. Restricting the availability and advertising of alcohol, increasing the minimum purchase age, and lowering the legal blood alcohol concentration for driving can all reduce alcohol consumption.
- The greater the exposure 13-16 year olds have to online alcohol marketing and alcohol branded sports sponsorship, the greater the likelihood that young drinkers will consume alcohol 14-15 months later. Such 13-16 year olds would not feel deprived of information should the advertising of alcohol be banned.
- Brief interventions for risky drinking are effective in primary health care and emergency care settings, also in Europe, in reducing alcohol consumption by 18 grams and 11 grams per week respectively more than the control group at 12 month follow-up. The pharmacological treatments, acamprosate and naltrexone are effective in treating alcohol use disorders, also in Europe, with success rates of 18%-20% at 3-6 months follow-up.
- Across six European countries studied, there is great variation in the health systems and treatment provision for alcohol use disorders, with the proportion of people in need of treatment who actually access it ranging from 1 in 25 to 1 in 7.
- Across four countries studied, young people were already drunk by the time they went out to a drinking venue, fuelled by cheap alcohol purchased in shops and supermarkets; the drinking venues themselves exacerbated this problem by often being designed to promote further drunkenness and related problems.
- Monitoring alcohol policy and its impact in the European Union is rather poor. Although 18 of 32 countries (56%) had prepared a report on alcohol as of 2010, their coverage of relevant issues tended to be poor. Reporting of summary measures of alcohol-related harm tends to be outdated, sometimes by as much as eight years.
The core policy options that derive from these findings, which are consistent with the extensive published literature on alcohol policy, are:
- European countries should, in general, strengthen alcohol policy further as a matter of urgent public health policy to reduce alcohol consumption and the estimated 138,000 preventable deaths that occur annually. The most cost-effective way to do this is through implementing the three best busy for alcohol policy recommended by the World Economic Forum and the World Health Organization in their joint submission to the 2011 United Nations High Level Meeting on non-communicable disease, increase the price of alcohol, reduce the availability of alcohol and ban alcohol advertising.
- Pricing policy should include the implementation of a minimum price per gram of alcohol, an alcohol policy option that reduces consumption and harm, and one which targets in particular young people’s heavy drinking and drunkenness.
- Reducing the availability of alcohol should be matched with a licensing system for the sale of alcohol in all countries, with the receipt and maintenance of the license dependent on adherence to a minimum set of environmental standards in the licensed premise.
- Given their importance in promoting adolescent drinking, bans on alcohol advertising should include bans on digital alcohol advertising and alcohol branded sports sponsorship.
- The availability and standards of brief advice and treatment for risky drinking and alcohol use disorders should be dramatically improved and harmonized upwards across all European Union member states to improve the existing poor coverage.
- Standardized monitoring and reporting on alcohol consumption, alcohol-related harm and alcohol policy responses should be improved and harmonized upwards across all European Union member states to ensure a monitoring system that can evaluate up-to-date change in health status.
Dr Antoni Gual
Head of Alcohol Unit,
Department of Psychiatry,
Institute of Neurosciences,
Hospital Clínic de Barcelona,
Agenzia Regionale di Sanità della Toscana,
Peter Anderson (Project co-Lead)
Public Health Consultant,
Liverpool John Moores University,
Swiss Institut for the Prevention of Alcohol and Drug Problems,
University of York,
Eclectica Communicaton & Research,
European Institute of Studies on Prevention,
Azienda Sanitaria Locale di Milano,
University of Stockholm,
Government of Catalonia,
Avalon de Bruijn
National Foundation for Alcohol Prevention,
Institute of Psychiatry, King's College London,
European Centre for Social Welfare Policy and Research,
Corvinus University of Budapest, Hungary
Swiss Institute for the Prevention of Alcohol and Drug Problems,
Antoni Gual (Project co-Lead)
Hospital Clínic of Barcelona,
Liverpool John Moores University,
University of Maastricht,
Institute for Research and Development (Utrip),
Chemical and Veterinary Investigation Agency,
Central Institute of Mental Health,
Silvia Matrai (Project Manager)
Fundacio Privada Clinic Per A La Recerca Biomedica,
University of Bergen,
Norwegian Institute for Alcohol and Drug Research,
National Institute for Health and Welfare (THL),
State Agency for Prevention of Alcohol-Related Problems, Poland
University of the West of England,
Technische Universität Dresden,
Nordic Centre for Welfare and Social Issues,
Istituto Superiore di Sanità,
Centre for Applied Psychology,
Social and Environmental Research,
Institute of Psychiatry and Neurology,
Anton Proksch Institut,
Wim van Dalen
National Foundation for Alcohol Prevention,
Ninette van Hasselt