anu kasmel international union for health promotion and education enforcing nighttime alcohol sale...
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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
Alcohol related harm
Alcohol related harm
Behavioral riskfactors
Home Family Friends Neighbours
School Workplace Leisuretime Infrastructure
Economy Education Culture
Politics and policies
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
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
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
Nordic Alcohol Statistics, 2001-2006
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
Nordic Alcohol Statistics, 2001-2006
- 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