CONFERENCE REPORT ORGANISED BY CO-SPONSORED BY WITH THE SUPPORT OF FOREWORD The European Alcohol Policy Alliance had the pleasure to host the 6th European Alcohol Policy Conference, 27th and 28th November 2014 in Brussels. The conference brought together over 300 participants from 36 countries, which ensured a broad representation of stakeholders concerned with alcohol related-harm, with participation from policy and decision makers, civil society, scientists and alcohol and health experts. The 6th European Alcohol Policy Conference intended to raise awareness among the key policy and decision makers about the current burden of alcohol in Europe, and the multiple health and social problems it creates. It is for this reason that we encourage you to support our Call for a Comprehensive Alcohol Policy Strategy in the European Union. In addition, the conference had the intention to strengthen networks, build capacity and stimulate action to prevent and reduce alcohol related problems at all levels. Topics covered at the conference were the need for a new EU Alcohol Strategy, price and taxation, health and inequalities, advertisement, information to consumers and the Joint Action on Reducing Alcohol Related Harm (RARHA). At the conference, Eurocare presented its report Eurocare Recommendations for a Future EU Alcohol Strategy, which gives clear policy recommendations on key priority areas for action from the EU on alcohol policies. Eurocare hopes the conference together with the recommendations presented will create a foundation for upcoming discussions in the EU on topics such regulation of marketing, consumer information, price and taxation and road safety. Tiziana Codenotti Mariann Skar Eurocare President Secretary General Page | 2 OPENING AND INTRODUCTION Tiziana Codenotti, Eurocare President, started by introducing the 6th European Alcohol Policy Conference, and welcoming delegates to the event. She noted that Eurocare are proud to host this conference of over 300 public health experts, civil society organisations and policymakers, and made special mention of the attendance of 45 ministers of health, WHO and European Commission who had collaborated on the event. She noted that the purpose of the conference was to stimulate action into alcohol policies at all levels and should inspire actions by all actors, in a continent that “is still the highest alcohol drinking region of the world”. It aimed to facilitate network and coalition building between and within European countries, to present co-financed projects by the European Commission and finally to call for an updated EU Alcohol Strategy. “It is the right moment to update the European Alcohol Strategy, building on recommendations from the WHO” She gave special thanks to the funders of the conference, who had made it possible, including the European Health Programme, Actis from Norway, The Norwegian Health Ministry, ANPAA from France, The Scottish Ministry of Health, EHYT from Finland, IOGT Sweden and Visit Mexico. Martin Seychell, is Deputy Director General for Health and Consumers at the European Commission, started by thanking Eurocare for creating this opportunity to meet and discuss alcohol and health policy in Europe. “I am confident that this conference hosted by Eurocare will bring the debate further.” Page | 3 He noted that alcohol is a societal problem, therefore it is essential that all parts of society at all levels, realise that they have a role and indeed a responsibility to contribute to reducing alcohol related harm. He also noted that we should not limit alcohol harm to just health effects because alcohol has social impacts, such as violence and on social behaviour. In the EU, he added that if we translate the harms of alcohol to economic term, it equates to 160 billion euros and that these harms fall disproportionally on certain groups in society. Not only those who are heavy drinkers but light and moderate drinkers also make up a significant proportion of the harm. He concluded “it is clear that a one size fits all approach is not a valid answer and all EU institutions, ministers, civil society organisations have a role to play.” The Commission cannot, however, substitute for action or inaction in member states and our work so far is based on supporting member states and to mobilise action on reducing alcohol related harm. Responsibility for public health remains with the member states and they are responsible for deciding on what actions they want to take and the European Commission will continue to support member states in their actions. Evelin Ilves, WHO spokesperson and the Estonian First Lady, noted the effort of Eurocare to reduce alcohol related harm in Europe. The European continent remains to consume twice as much as the world average and our overconsumption costs 186 billion euros in sickness and lost activity. “Alcohol overconsumption is often driven by the supply and availability of alcohol“ We are sometimes made to believe that changing our attitude to alcohol in society is impossible. We must see through the PR and see how we can reconsider the role of alcohol in society and it is the governments of Europe and the European Commission who can control the availability and promotion. “Let us continue with the work that has brought us here today” Gauden Galea, from the WHO Regional Office in Europe, noted how over time the industry has someone managed to constrain us to a language but we should admit that alcohol is harmful and not just speak about harmful use of alcohol but more broadly about the harm caused by all types of alcohol use. He went on to demonstrate how alcohol use is one of the top causes of disease burden in Europe – “The question in Europe is far from being resolved” – and that in Europe we have high exposure and high mortality and disease. For men, between 15 and 64, 1 in 7 deaths caused by alcohol and 1 in 13 women, also noting the large variation between Turkey at one end of the scale and Belarus at the other. Mr Galea noted how we should not just count harm by the cases of liver cirrhosis. The point is that it is not just health that is the issue, it is the whole impact on society including absenteeism, accidents and unemployment. “We have agreed globally that something needs to be done” Page | 4 ALCOHOL IN ALL POLICIES: COST-EFFECTIVE INTERVENTIONS TO PREVENT AND REDUCE ALCOHOL-RELATED HARM Franco Sassi, Senior Health Economist at the Economics of Prevention Programme at the OECD, opened by emphasising his organisation’s productive relationship with Eurocare in the OECD work on prevention, and hoping that it will continue into the future. Mr Sassi displayed alcohol consumption trends in Europe, demonstrating an overall slow decline but a very mixed picture for individual countries. For example, in Italy has consistently decreased but Finland has risen to the OCED average, after starting from a lower level. This follows a general trend that in most southern countries consumption has decreased, while in most northern countries it has increased. However, even in countries which have seen dramatic declines in alcohol consumption, the picture is not comforting. We increasingly see that hazardous drinking in some groups, such as in young women. We also see an increase in binge drinking among young people, apart from in the UK and Ireland, which already had a high level in the past and remains high. Mr Sassi presented the J-Curve of the health effects of alcohol, based on mortality, but argued that this is not the only outcome to consider. Harms to others and quality of life are not included in the J- Curve, nor are other impacts on quality of life, so we should be careful about how we interpret it as a model. He then looked at the health outcomes of various alcohol policy measures such as tax increases and advertising regulation, according to a new study being undertaken by the OECD. Brief interventions and treatment of dependence also had significant health gains in DALYS, as well as measures such as opening hours regulation and drink drive interventions. Page | 5 MIND THE GAP: HEALTH AND INEQUALITIES Witold Zatonski, project leader for the EU funded “Closing the Gap” project, argued that we have “three-speed Europe” in terms of adult health if we divided it into Western Europe, Central Europe and former USSR states. He noted that women in Western Europe have had fantastic progress with life expectancy in particular. He noted that smoking and alcohol consumption were key factors in reduced life years and early mortality. He presented findings of liver cirrhosis mortality from 1950s until the present day. He then went on to look at all-cause mortality and how this was correlated with the price of alcohol in Poland and how through the decline of vodka prices, there was a decline in health gain in Poland from around the year 2002. He then looked at whether the health gap between the regions of Europe were increasing or decreasing, in which he showed data on the risks of dying from 1990 to 2010, rates remained high for Czech Republic, Slovakia, Slovenia, Estonia and Poland for men and high for women in Estonia, Czech Republic, Denmark, Hungary, Ireland, Slovakia and Poland. The speed of closing the gap is closing but he concluded that this gap is closing too slowly. He concluded that as alcohol is carcinogenic that we cannot treat it in any way like a normal commodity and that for this reason, it needs regulation, including price negotiation. Page | 6 WHY DOES THE EU NEED AN ALCOHOL STRATEGY? Maria Renström, seconded expert to the WHO in Geneva and previously working for the European Commission, opened the session by looking back on alcohol policy. Over the last 20 years, alcohol has grown as a topic in Europe, and we should be positive about the steps that we have managed to take.