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Alcohol-related harm perspectives


First Lady of Estonia Mrs Evelin Ilves at 6th European Alcohol Policy Conference in Brussels, 24 October 2014

Good morning, honored guests. I am glad to be here and have a chance to participate in this conference. Eurocare is doing much important work in creating a platform for us to come together to continue work on a common vision on how to reduce alcohol's harm in Europe - so thank you.

According to the World Health Organization, alcohol is the third leading risk factor for disease and mortality in Europe.

The European continent continues to drink twice the amount of alcohol compared to the world average - in 2010 Europe consumed 10.2 liters of pure alcohol per capita and our collective over-consumption cost Europe 156 billion euros in premature deaths, sickness and lost productivity – this is one expensive habit!

We are often made to believe that changing the role of alcohol in society is almost impossible, because for such a long time alcohol has played a part in the cultural, culinary and agricultural life of European societies. Alcohol has provided significant agricultural and industrial revenues and the industries that alcohol fuels have generated many jobs.

However, given the many complex demographic and economic challenges of the twenty first century, we must see through the PR, come together and take a new, thorough look at alcohol's role in European culture and traditions. We as the policy-makers, influencers of legislation, and researchers, must help to reconsider the role of alcohol also in culture and tradition, and hold ourselves accountable for different policy and regulation when it appears that the revenues from alcohol do not fully cover the costs from the damage over-consumption causes. In order for the role of alcohol in our economies and cultures to change, the legislative and policy environment must also change.'

What could help us convince the many interested stakeholders that over-consumption of alcohol may become incompatible in the long term with an innovative, educated and adaptive workforce that European strategy documents say we need?

An adaptive and smart work force requires well-functioning brains. Perhaps a closer look at what alcohol does to brain development might offer new, convincing perspectives. When I was a medical student in Estonia the early 1990s, the effects of alcohol on the development of the adolescent brain were not yet regularly taught.

Only in the last few decades has it become fully evident that the frontal part of the brain, known as the prefrontal cortex, is one of the last regions of the brain to undergo full myelination during adolescence, and is not fully matured until a person's mid-twenties. This means that during the teenage years, when adolescents in many European countries are drawn into experimentation and excessive drinking of alcohol, those parts of their brains crucial for navigating life in 21st century, are still undergoing development and maturation. Ethanol though, as we all know for a long time, is not good for developing organs, which is why pregnant women are advised to avoid alcohol.

The prefrontal cortex of the brain is responsible for some of the highest-order functions that humans perform: processed sensory information is integrated here to form perceptions, consciously command attention, control impulses and make decisions. The prefrontal cortex is the seat of willpower, self-regulation and one's ability to achieve goals. Responsible for maintaining various flows of information in working memory, the prefrontal cortex is involved in creativity and innovation.

The world is changing, and we face new challenges amid globalization, digitisation and rapid changes in how work and workplaces are organized. Future generations of working professionals will increasingly require the full capacity of the processes regulated by their prefrontal cortices.

However, at the current rate of consumption and unchanging cultural traditions interlinked with alcohol, our future workforce is in danger of lacking the necessary cognitive capacity to excel in our now globalized, digital and executive function-oriented world of work.

Unfortunately, alcohol's role in the connection between workforce health and general economic development remains a niche topic. It is not widely recognized that alcohol is a hindrance to human development on every level. It adversely affects the organ development of the fetus, the development of the teenage brain, it intervenes with adult adaptation to the 21st century work life. Alcohol is a hindrance to social development within families and overconsumption can be a hindrance to whole societies who lose in valuable productivity and innovation capacities of their workforces due to excess alcohol consumption.

Is there something we can do?

Alcohol-related problems and overconsumption have well known and evidence-based, population-level solutions that have been tried many times in many countries and with various rates of success. We know that alcohol-related overconsumption epidemics are driven often by the supply and availability of alcohol.

The supply of alcohol can be affected and has variously been affected by the rules and regulations, that governments regulate the sale of alcohol. Many of these regulations and solutions we shall discuss here during this conference - we shall hear about pricing strategies, regulation of alcohol promotion and availability. These measures are often simple, yet they are not easy to implement. Many decision makers and even whole institutions, are still simply not aware that alcohol's role in society is not an immutable force of history and tradition, and that policy can in fact help damaging alcohol-related effects to be decreased.

It is the governments of Europe and the European Commission that can significantly affect the ways alcohol markets and promotions are allowed to flourish in European societies. Yes, alcohol producers contribute tax and employment to society but these benefits are far outweighed by the harm that at current level of consumption alcohol causes to society and individuals.

We have a lot of work to do together.

1. First, we have to build stronger coalitions outside the health sector and educate policy circles outside the health sector. Engaging employers unions, trade unions and the private sector more widely could help us make the losses due to alcohol an economic development issue.

2. Second, having a commonly developed vision and strategy helps to bring people together over a shared goal and to educate and involve people outside the health sector who may not yet understand the logic of alcohol policy, but need to see the big picture to be inspired to engage.

a. In the country I know best, Estonia, I can attest to a significant increase in awareness among the politicians and parliament parties over the past three years since we went through a very public and inclusive process of compiling the first alcohol policy green paper.

I. Although the government so far has not rushed to implement major changes in alcohol policy, civil society organizations and local governments have started to take steps inspired by the comprehensive plan outlined in the alcohol policy green paper.

II. Thanks to increasing awareness in civil society, we have had several recent alcohol industry campaigns halted due to public disapproval of tying beer to patriotic events. Thanks to people like Lauri Beekmann - a Eurocare vice President, there is an increasing scrutiny on how much is spent on alcohol by the public sector.

III. Local governments also have taken the initiative. This past summer, for example, a public outcry was raised over legalizing alcohol consumption in public spaces nation-wide, whereas it had not been allowed before.

Many local governments took action and immediately established comprehensive zones in their territories, where drinking alcohol in public spaces was banned again. The central government finally had to follow suit and again ban alcohol drinking in public spaces nation-wide.

IV. Currently, as the parliamentary election is approaching, the City of Tallinn, Estonia's capital, has put forth a proposal to restrict alcohol retail sales on Sundays and to begin restricting the number of alcohol sales outlets. While these moves can be considered highly political before an election, there's no doubt the debate will further increase awareness.

3. Finally, we need a strategy, a common vision, on the European level in order for governments to recognize alcohol as a European issue and to tackle it together. Current fragmentation makes countries' individual strategies and hard-won policy victories vulnerable to cross-border trade, which often benefits large multinational companies who are capable of influencing governments on both sides of the borders in their own interest and undermine the health and well-being of European people. From the example of tobacco we know that it was, much easier to establish indoor smoking and advertising bans when they came with European directives.

Looking at alcohol in Europe together, we would be stronger and could include many necessary perspectives from the outset.

In a Europe that is still facing challenges from the economic crisis, reducing alcohol-related harm is important in contributing to a healthy work force and reducing costs for health care services, in line with the strategic aims of the Europe 2020 Strategy.

I wish us all many productive, inspiring and enriching conversations in the next two days; let us continue with the work that has brought us here today. Thank you!