Anu Kasmel International Union for Health Promotion and Education

Anu KasmelInternational Union for

Health Promotion and Education

Enforcing nighttime alcohol sale ban in Estonia

Enforcing nighttime alcohol sale ban in Estonia

HEALTH PROMOTION

HEALTH CARE

REHABILITATSIOON

HEALTH PROTECTION

Health systemsHealth systems

65

70

75

80

85

1970 1980 1990 2000 2010 2020

EstoniaEU members before May 2004 EU members since 2004 or 2007

Life expectancy at birth, in years

WHO Health For All database, 2009

Life expextancy prognosis for Estonian women to be EU average in year 2030

70

75

80

85

1970 1980 1990 2000 2010 2020 2030

EstoniaEU(15-prior 1.05.2004) averageCSEC(15) averageCIS(12) averageNordic(5) average

060101 Life expectancy at birth, in years, female

Life expextancy prognosis for Estonian men to be EU average requires miracle or responsible alcohol policy

60

65

70

75

80

1970 1980 1990 2000 2010 2020 2030

EstoniaEU(15-prior 1.05.2004) averageCSEC(15) averageCIS(12) averageNordic(5) average

060101 Life expectancy at birth, in years, male

Alcohol related mortality

… is 3 times higher in Estonia than European average

2000 deaths in a year connected with alcohol (population 1,3 million)

50% of the car accidents, 50% of the drownings, 74% of the violence related crime and 80% of the violent crime commited by the

juveniles are connected with alcohol Average lifetime of Estonian men - 12 years

shorter than in EU countries

Alcohol related mortality in Estonia

and Nordic countries per 100 000 15 year and older

0

10

20

30

40

50

60

Estonia Sweden Norway Iceland

Nordic Alcohol Statistics, 2001-2006

Consumption of abs. alcohol in Europe litres per person

10

Changes: drunk before 13 years of age

Hibell B. The ESPAD Report 2003; 2004.

%%

%%

Alcohol related harm



Behavioral riskfactors

Home Family Friends Neighbours

School Workplace Leisuretime Infrastructure

Economy Education Culture

Politics and policies







INDIVID

COMMUNITY

MUNICIPALITY

GOVERNMENT

INDIVID

COMMUNITY

MUNICIPALITY

GOVERNMENT







INDIVID

COMMUNITY

MUNICIPALITY

GOVERNMENT

INDIVID

COMMUNITY

MUNICIPALITY

GOVERNMENT

SOCIAL ENVIRONMENT PHYSICAL ENVIRONMENTSOCIAL ENVIRONMENT PHYSICAL ENVIRONMENT

Evidence based cost effective policy

Estonian research supports the international findings (Lai, 2005).

Most cost-effective political strategies to prevent alcohol harm are:◦ Raising taxes◦ Restriction availability◦ Banning alcohol advertising

Alcohol policy – a Tower of Babel No existing National

Alcoholism Prevention Program - there was a National Alcoholism and Drug Prevention Program 1997-2007, which was closed in 2004.

In January 2010 MSA forwarded to the Government the principles of alcohol policy – these are not taken under the discussion.

No alcohol specialists in governmental structures

Alcohol not mentioned in Estonian Governments Coalition Agreement.

Current situation Alcohol excise duty was raised by 10% from

January 2010, and yet the price of alcoholic beverages has increased less than standard of living

Estonian Parliament accepted (12.12.2004) the law that makes the second time alcohol selling to the minor a criminal act. Punishment for that crime is up to one-year imprisonment

Alcohol advertising Beer ads from 20.00 Strong alcohol from 21.00

The case of restriction of the nighttime alcohol sale Suggestions to elaborate alcohol policy 1993,

(also availability of alcohol and restrictions connected with it has been important object for discussion;

Followed by the intense capacity building process in the communities and municipalities;

In 2004 first municipalities restricted nighttime alcohol sale; In 2006 MSA forwarded proposition to the Parliament - not accepted; more municipalities joined;

In 2007 Tallinn City Government accepted the ban to nighttime alcohol sale from 20.00-8.00;

In the Parliament in June 2008 accepted from 22.00-10.00; (barter: subsoil plots act for mining more oil-shale was an objective).

Prerequisites for policy changes – capacity building of decisionmakers

CoordinatingCentre

County

Municipality

STRUCTURE CAPACITY

to critically analyseto have a vision set priorities to keep the missionto mobilize stakeholdersto be able to reach consensusTo get social support

Government

Community

Alcohol related retail sites per 100000 inhabitants 1.01.2007

0

50

100

150

200

250

Estonia Iceand Finland Sweden Norway


State total benefit and costs from alcohol

0

50

100

150

200

250

300

350

400

Norway Finland Iceland Sweden Estonia

About 2 mio for health services 11% (Tikk, 2006)

Medicaments Mortality Disability Workplace costs Criminality Harm to families According to different

calculation 20-40 milliard per year


- About 2 milliard from excice taxes- About 2 milliard from excice taxes

Selection of approachesSelection of approaches

Easy access and availability

Easy access and availability

Selection of approaches

The main obstacle - lack of consensus Ministry of Justice, Economy and Internal

Affairs opposed the governmental law that prohibits alcohol sale during night hours.

Ministry of Justice proposed to accept alcohol consumption in public places.

Ministry of Justice supported the raising of BAC of drivers to 0,49%.

Prime Minister comments: “We do not need restriction of the nighttime alcohol sale”; “In alcohol policy we are in right track”.

Ultimative prerequisite for policy changes - Social responsibility

Documents

Anu Kasmel International Union for Health Promotion and Education