Report from the Fourth Plenary Meeting of the Alcohol and Health Forum

The Fourth Plenary Meeting of the Alcohol and Health Forum took place in Brussels on Wednesday 11 March 2009.

The full report of the Plenary Meeting can be downloaded from the Eurocare website here.

Task Force Youth Related Aspects of Alcohol

Micheal Hubel, Chair of Task Force, presented the work of the Group to date. The final report of the Task Force includes the following set of recommendations to the Forum.

Youth involvement: Much of the discussions in the Task Force focused on the importance of involving young people in the design, implementation and evaluation of all activities which specifically target young people.

The Task Force strongly recommends that youth involvement at all stages of interventions should be promoted, and that more creative ways of bringing about this involvement, including in the commitments made by Forum members,should be considered. Beyond the framework of the Forum, formal consultation exercises of young people, such as the one carried out by the Irish Government, are considered as good practice, which other Member States may wish to examine for the further development of alcohol policy targeting young people summary report.

Protecting young people from the consequences of alcohol abuse by others: The Task Force underlines that harm suffered by children because of irresponsible alcohol use in their environment is an extremely important issue. Action to address this will need to be pursued particularly at Member State level.

The Chair also presented the final draft Concept Paper for the Clearing House. The Task Force clearly identified the need for an inventory of existing activities and projects aimed at reducing alcohol-related harm among young people, including basic information on key characteristics of the intervention, on monitoring and evaluation, and on the results achieved.

In response to this need, and as a means of fostering sustained actions, the Task Force suggests the creation of a “Clearing House” as an information point on activities and projects related to alcohol and health. The scheme, in which information regarding the effectiveness and evaluation of projects would be available in an easily accessible format, would be open to contributions from all interested organisations and agencies working on alcohol and young people. The information collected would be available on a public website, linked to the EU Health Portal.

A first implementation level of the Clearing House would be the establishment of a European on-line database in which information on projects and good practice is collected. The European Commission will ensure the financial support to launch the database and conduct a first evaluation.

The following issues were raised by Eurocare:

- Criteria for selection of projects and practices: these will need to be clearly defined by the Steering Group, which will be composed of Members of the Forum, and Science Group- the nomination of this Group should be done in a transparent way, the selected criteria must be approved by the Forum.

- Dissemination and Outreach: the Chair of the Task Force has stressed the need for active involvement of the Forum members (and TF members in particular) in order to make the database a success. A Communication Strategy should give some guidelines and practical advice for both outreach and dissemination.

- Translation of Projects : Language will evidently be a barrier to both collecting projects, as well as disseminating good practice; will the Commission services provide translation of summary projects in order to gain a broader geographical representation of projects?

- Name:It was felt that the anglo-saxon concept of the “Clearing House” was perhaps misguiding and unclear; suggestions included : Alcohol and Youth Projects Policy Hub.

- 2. Task Force on Commercial Communications

The Chair of the Task Force, Robert Madelin, presented the work of the task Force to date. As part of this Task Force, the Institute of Social Marketing were commissioned to write three background papers:

Mapping Report on Social Marketing

Mapping Report on Self Regulation

Mapping Report on Targeting / Not Targeting Youth

In addition, it should be noted that the first task given to the Science Group (to examine the impact of advertising on alcohol consumption among young people), was a direct outcome of debates taking place within this group.

Robert Madelin reiterated the “DG Sanco Working Hypothesis” that “alcohol related harm is multifactorial but the marketing of alcoholic beverages has an impact on alcohol consumption”.

The Task Force will continue; the next meeting is scheduled for November 2009.

3. Future Work of Task Forces

The Task Force on Youth will be replaced by a new working group but the Commercial Communications Task Force will continue.

HOTREC and Eurocommerce have opposed the idea of a Task Force around the topic of “Consumer Education”

Eurocare suggestions for Task Force are: Labelling; Point of Sale Education Measures (server training, unit information, etc)

4. Affordability of Alcohol Beverages in the European Union: Presentation by RAND and Discussion

The report “Understanding the Links between alcohol affordability, consumption and harms in the EU” was commissioned by DG Sanco to RAND Europe, and independent public policy think tank.

Scope of the study: Review of precious research in this field Econometric analysis

• Link between alcohol affordability and consumption

• Link between alcohol consumption and harms Three country case studies in cross country alcohol consumption

Discussion: Affordability as a policy lever to reduce alcohol consumption and harms

Main findings:

Alcohol Taxation

Great variability in the excise duty rates in alcoholic beverages across the EU

But some decreases in the real value of excise duties in most MS

Minimum excise duty rates not changed since 1992, a 25% reduction in their real value

‘Over – shifting” in how tax changes passed on to consumers in the EU

Alcohol Retail

Evidence of growing off-trade alcohol sales

Off trade alcohol tends to be cheaper

Concerns that cheaper off trade alcohol are linked with higher and more harmful consumption

Alcohol affordability has gone up in most EU countries

Affordability is a function of relative price and disposable income

Affordability of alcohol has increased in all countries since 1996, apart from Italy – although to different extents

Across the EU, 84% in the change in affordability can be attributed to changes in disposable income; 16% to changes in prices.

Positive relationship between alcohol affordability and consumption

RAND find statistically significant association between affordability and consumption; 1% increase in affordability is associated with a 0.22% increase in consumption in the short term

The long run elasticity is even higher: 0.32%

This is consistent with existing research

Positive relationship between alcohol consumption and three measures of harm

RAND find statistically significant, positive relationships between consumption and fatal traffic accidents, traffic injuries and liver cirrhosis

A 1% increase in consumption is associated with:

• 0.86% in fatal traffic accidents

• 0.61 % 61 increase in traffic injuries

• 0.37% in chronic liver cirrhosis

This is consistent with existing research RAND do not find a statistically significant association between alcohol consumption and homicide at the aggregate level

Cross Border Alcohol consumption

RAND looked at selected borders with significant tax differentials Alcohol purchased abroad can be a significant proportion of all alcohol consumed

Current regulation on cross-border alcohol purchases infringe on fiscal basis and autonomy of i mporting country

• Tax decreases

• Revenue loss

Evidence of link between cross border alcohol consumption and harms more robust in Finland; less so for Sweden and very limited for the UK.

Only three case studies, but nearly 30 land borders across the EU!

Policy Implications

Pricing Policy can be effective in reducing alcohol harms

But not widely used to reduce harm in the EU

Still much scope for making pricing policy that contributes to alcohol- harm reduction

But alcohol consumption is a multi factorial issue

• So what is the optimal policy mix to reduce alcohol related harms?

7. Reporting from the Committee on Data Collection, Indicators and Definitions.

Pieter de Connick, DG Sanco , gave an overview of the work of the Committee so far; the first meeting took place on 4th December 2008 in Luxembourg. The meeting report can be found here.

Objectives

The Committee was set up as an independent structure to the Forum, in order:

To discuss reliable, comparable, and regularly updated data on alcohol consumption (volume and pattern of consumption and alcohol related health harm, and (if possible)

To identify one key indicator within each category: volume of alcohol consumption; pattern of alcohol consumption; alcohol related health harm.

Composition DG Sanco convenes the Committee composed of Commission Services, WHO, ESPAD, EMCDDA and other relevant partners.

First Meeting

Included Commission Services (including Eurostat and EMCDDA) and the following experts:

- Peter Anderson (Public Health Consultant)

- Alexandra Fleischmann (WHO)

- Bjorn Hibell (ESPAD) - Lars Moller (WHO)

- Jurgen Rehm ( Centre for Addiction and Mental Health, Canada)

- Maria Renstrom (Ministry of Health and Social Affairs, Sweden)

Discussion

Structures approach: for each category the experts looked at:

• suggested indicator and definition (eg: “binge drinking' problematic..)

• suggested source

• existing indicators / data

Conclusions

Volume of Alcohol Consumption

Indicator: total adult per capita consumption of alcohol

Definition: total (recorded and unrecorded) adult (15 years plus) per capital consumption of pure alcohol in litres. [Possible sub indicators for recorded consumption: beer, wine and spirits].

Source: production and sales , export/import data, based on official data, producer data and surveys.

Existing indicators/ data:

• WHO: Adult per capita consumption of pure alcohol per litre, available in Global Information System on Alcohol and Health.

• ECHI: litres of pure alcohol consumed per person per year, based on trade and production data, published in ECHI shortlist (Sanco Website).

Patterns of Consumption

Indicator: binge drinking

Definition: intake of 60 grams or more on one occasion, monthly or more often, during the past 12 months

Source: European Health Interview Survey

Existing Indicators/ Data:

• WHO: heavy episodic drinking and patterns of drinking score (would need definition)

• ECHI: hazardous alcohol consumption

Alcohol related health harmsIndicator:

alcohol attributable years of life lost (YLLs)

Definition: sum of all years of life lost prematurely attributable to alcohol based on standard methodology of WHO/GBD).

Possible sub indicators:

• Alcohol attributable YLLs from chronic disease

• Alcohol attributable YYLs from injury

Existing indicators/data:

• WHO: eg: standardised death rates from selected causes of death (COD), data from WHO Mortality Databse or WHI Health for All Database

• ECHI; alcohol related deaths, e.g: collected from national COD registries, ICD-10 classification, EUROSTAT shortlist of 65 death causes

Conclusions

Next to agreement on key indicators:

Brief discussion on the development of key indicators in the five priority areas identified in the Alcohol Strategy; the Commission will circulate proposals Results of Meeting will be discussed with MS/ Meeting of the National Competent Authorities in February 2009.

8. Reporting from the Science Group and Presentation of the Scientific Opinion on “ Impact of Marketing Communication on volume (and patterns) of consumption of alcoholic beverages, especially by young people”.

The chair of the Science Group, Professor Ian Gilmore gave a short introduction: this report responds to a request from the Forum and highlights the need for clarity in this contentious and important area.

An internal Working Group (let by Peter Anderson) was set up within the Science Group to draft the report; the report was accepted unanimously by the Science Group, with no minority opinions. The findings of the review are clear, namely that Commercial Communications increase the likelihood that adolescents will start to use alcohol and to drink more if they are already using alcohol. Lastly, it should be remembered when reading this scientific opinion that only a small part of the marketing mix (namely, advertising) has been analysed and reported.

Dr Peter Anderson gave a presentation covering the methodologies of the studies examined in the report, and the principal findings. The full report can be found here

9. Exchange of Information regarding Commitments

Robert Madelin reiterated the importance of the Monitoring of Commitments in relation to the transparency of the Forum process.

In November, an assessment will be made as to whether enough has been done in the framework of the Forum. All Commitments made so far by members of the Forum can be searched in the online database.

All Eurocare and members' commitments can be found here

10. Preparation of the Open Forum, Thursday 30 April, 10 am to 5pm, Brussels

The Draft Programme of the Open Health Forum is as follows:

Welcome by Robert Madelin (Introduction to the program) (10.00-10.15)

The EU Alcohol Strategy and its implementation; the overall picture ( Commission) (10.15- 10.30)

The database of commitments by members of the European Alcohol and Health Forum ( Commission) (10.30-10.45)

Round table on consumer information and education (11.00-12.00)

Each Round table would start with a scene setter on the issue to be discussed and giving a general overview of actions and commitments – drawing from EAHF commitments, discussions in the Task Forces, and experience at national level (via the Committee on National Alcohol Policy and Action).

Participants in each round table: two/three holders of commitments, a Member State representative, a researcher (possibly member of the Science Group) to discuss/present lessons learnt from commitments in the area, what are good practice principles for interventions in this area etc., with an opportunity for input from the audience.

Round table on marketing communication (and responsible selling and serving, the role of the media) (12.00-13.00) (see above)

Round table on children and young people (14.15-15.15) (see above)

Round table on (inter)governmental policy developments (WHO, EU, MS, regions)

A round table for reflection of public policy makers on their contribution to the alcohol strategy debate – links to WHO strategy, MS work and regional/local partnerships (15.30- 16.30) Discussion on perspectives and next steps (16.30-16.45)

Concluding remarks (16.45-17.00)

Additional information: Outside the meeting room there will be exhibition spaces, and computer terminals to access the commitments database.

10. Membership Requests

Alcohol Concern, the national voluntary body working on reducing alcohol related harm in the UK has applied to join the Forum, pending acceptance of their membership of Eurocare.