1. ANALYSIS OF ALCOHOL POLICY IN NORTHERN DEMENSION PARTNERSHIP COUNTRIES AND RECOMMENDATIONS FOR INCREASING ITS EFFICIENCY Koshkina Е.А., Pavlovskaya N.I., Vyshinsky K.V. National Research Center on Addictions Russian Federation Ministry of Health

2. Presentation is based on the Report ANALYSIS OF ALCOHOL POLICY IN NORTHERN DEMENSION PARTNERSHIP COUNTRIES AND RECOMMENDATIONS FOR INCREASING ITS EFFICIENCY Prepared by E.Koshkina and N.Pavlovskaya

3. Alcohol abuse is a major factor for demographic and social crisis, a principal threat to the individual, family, society, state. Alcohol is a causal factor for: Injury Violence Crime Traffic accidents Homicides and suicides Family breakdown Child neglecting Substance abuse in children and adolescents Decrease in fertility and other negative medical and social consequences

4. According to WHO: alcohol-related problems have severe consequences for individuals, families and society every year 2.5 million people die due to alcohol abuse alcohol abuse is the third leading risk factor for poor health in the world and one of four preventable risk factors for noncommunicable diseases.

5. Major contribution in tackling alcohol-related problems at the international level is made by the World Health Organization WHO is developing global and regional research and political initiatives, as well as alcohol control strategies WHO is making significant efforts to develop adequate methods for collecting information. On this basis it seeks to help all interested states in their efforts to reduce alcohol abuse and its health and social consequences.

6. Learning international best practices of effective alcohol policy is important for decision makers who shape the policy in reducing harm caused by alcohol abuse to individual health and to societies, and for assessing effectiveness of measures implemented

7. The Northern Dimension Partnership in the field of public health and social well-being (NDPHS) is intended to promote sustainable regional development by improving the health and well-being, addressing the social and economic differences, as well as improving quality of life. The Partnership has two priority areas of cooperation: reducing the spread of most harmful infectious diseases preventing non-communicable diseases related to individual lifestyles.

8. One of the strategic methods to implement effective guidelines and evidence-based strategies is developing and completion by countries of the “WHO questionnaires” on various alcohol- related aspects The important role of the Expert Group on Alcohol and Substance Abuse (EG ASA) of the Partnership is to serve as a focal point for implementation of national contributions by the partner countries and organizations to address problems related to the abuse of alcohol and other substances Analysis of the information should serve as a basis for developing effective recommendations to the governments of the Northern Dimension Partnership countries for implementing policies aimed to reduce alcohol abuse and its harmful effects.

9. For the present study 15 questions related most closely to issues of alcohol control policy out of 36 comprising the WHO Global Questionnaire "Alcohol and Health-2011" were selected. Answers were provided by following Northern Dimension Partnership countries: Estonia, Finland, Latvia, Lithuania, Norway, Poland, Russia, and Sweden Obtained information was analyzed and recommendations on reducing the harm associated with alcohol abuse were made. Methodology

10. 1EstoniaTriinu Taht 2FinlandKatariina Warpenius 3LatviaMarcis Trapencieris 4LithuaniaGelena Kriveliene 5NorwayBurnt Bull, Lilly Sofie Ottesen 6PolandJanusz Sieroslawski 7RussiaNatalia Pavlovskaya 8SwedenKarin Nilsson-Kelly Responses submitted by:

11. Question 2*: In which year was the written national policy on alcohol formally adopted for the first time? Development of the conceptual document on alcohol policy happened in two stages: 1995-2005 - the initial document adopted Russia – 1995; Poland – 1996; Estonia – 1997; Lithuania – 1998; Sweden - 2001; Finland - 2003; Latvia – 2005. 2005-2012: the political document was imroved and updated * Question numbering is preserved from the WHO questionnaire.

12. Question 3: If the control for production and sale of alcohol is at the national level, do you have a monopoly of any kind? State monopoly for all alcohol-containing products in Finland, Norway, Poland and Sweden No state monopoly in Estonia, Latvia, Lithuania and Russia* * In Russia there is no monopoly as such, still alcohol production, storing and sales require a license. The license is an instrument of monopoly and is issued by the Federal Service for Alcohol Market Regulation.

13. Question 4: In your country, at which levels of government are alcoholic beverages taxed? Alcohol is taxed at the national level in all the participating countries In Russia alcoholic beverages are subject to excise duty and taxation at national level, or at national, regional and local levels combined.

14. Question 6: Please assess the trend over the past five years for the price of alcoholic beverages compared to the percent change in the consumer price index (CPI) Recent alcohol pricing policies in the NDP countries appear very different from each other Increase in alcohol prices: Finland and Russia Prices remain stable: Norway (since 2010) Decrease in alcohol prices: Sweden and Poland Price changes process difficult to assess: Estonia and Latvia.

15. Question 8: In the last three years, did you have any nation- wide awareness-raising activities? All participating countries (except Lithuania) conducted to awareness-raising activities on various topics Finland and Sweden use of alcohol by young people, drink-driving, the impact of alcohol on health, alcohol-induced social harm, alcohol and pregnancy, alcohol in the workplace. Latvia and Estonia drink-driving, the impact of alcohol on health Norway alcohol and pregnancy Poland use of alcohol by young people drink-driving, the impact of alcohol on health. Russia youth drinking drink-driving, drinking among the indigenous people, the impact of alcohol on health alcohol-induced social harm, illegal/surrogate alcohol, alcohol and pregnancy alcohol in the workplace.

16. Question 9: In your country, do you have a minimum legal drinking age? (Not to be mixed up with the legal age limits for on- and off-premise sales) In Norway, Sweden and Russia the law does not set age limits for the use of alcoholic beverages. In other countries age restriction are made at the national level: alcohol consumption is prohibited for persons under 18

17. Question 10: In your country, at the national level, what are the legal age limits for the following? (i.e., alcoholic beverages cannot be served/sold to a person under this age) In all the participating countries there is a national level prohibition to sell beer, wine and spirits in cafes, bars and restaurants to those under 18 years of age In Finland and Norway the law prohibits selling spirits in stores to persons under the age of 20 years In Sweden it is prohibited to sell not only spirits, but also wine to those who are under 20 years of age.

18. Question 11: Please provide information on the extent to which different public environments are alcohol-free in your country. Places of Restrictions FINLAND LATVIA LITHUANIA SWEEDEN RUSSIA POLAND ESTONIA NORWAY Health care establishments T B S RT BS RT BP R Educational buildings T B S RT B P R Government offices T B P RS RT B S RP R Public transport T BS RT BS RT BP RT B Parks, streets etc P RS RP R T B Sporting events P RS RP RS RT BP RS R Leisure events (concerts etc.) P RS RP RS RT BS R Workplaces T B S RT B P R Religious places of worship T BS RNoS RT BS RNoP R T B – Total ban P R - Partial statutory restriction S R - Voluntary agreement / self-regulation No - No restriction

19. Question 14: Are there any national rules in your country to prevent illegal production and sales of home- or informally produced alcoholic beverages? In most of the countries illegal alcohol production and distribution is prohibited by law. Production of wine and beer for personal use is allowed in Estonia. The Russian law currently does not have an explicit ban on moonshine manufacturing; production is allowed for personal use only.

20. Question 15: In your country, at the national level, what is the maximum legal blood alcohol concentration (BAC) when driving a vehicle (in mg%), for each of the following groups: general population, young/novice drivers, professional/commercial drivers? Places of Restrictions FINLAND LATVIA LITHUANIA SWEEDEN RUSSIA POLAND ESTONIA NORWAY Общее население 0,05 0,040,020,000,02 Молодые / начинающие водители 0,050,02 0,000,02 Профессиональные водители 0,05 0,02 0,000,02 Only Latvia and Lithuania are distinguishing BAC levels for different groups of drivers General population Young / novice drivers Professional / commercial drivers

22. Question 16: Is there a mandatory driver education/treatment program for repeated/habitual offenders? Programs for compulsory education or treatment for habitual offenders exist only in Finland and Lithuania In other countries such programs are not available.

23. Question 17: Are alcolocks (ignition interlocks that prevent an alcohol-impaired driver from starting the vehicle) being used in your country to prevent drink driving? Alkolocks are used: In Finland in conjunction with rehabilitation activities as an alternative to punishment for drink driving, and voluntarily In Norway in pilot projects and voluntary In Sweden in pilot projects and voluntarily; mandatory to public or commercial transportation companies Alkolocks are not used: In Latvia, Lithuania, Poland, Russia and Estonia

24. Question 23: In your country, are there regulations on alcoholic beverage industry sponsorship or sales promotion from producers, retailers (including supermarkets) and owners of pubs and bars? Norway: total advertising ban, including sponsorship. Estonia: ban on using alcoholic beverage brand, but not the company’s trade mark in sponsorship. All other countries:sponsorship and sales promotions by alcohol industry are not prohibited Russia: no regulations concerning alcohol industry sponsorship and sales promotion.

25. Question 34: Is there a comprehensive report on the alcohol situation drawn up and published regularly at national level in your country? Estonia, Finland, Latvia, Lithuania, Norway, Poland, and Sweden draw up and publish annual reports on alcohol situation. Russia annually publishes indicators of alcohol-related problems in the "Russian Statistical Yearbook", published by the Federal State Statistics Service (Rosstat)

26. Recommendations for improving effectiveness of alcohol policy based on results of the analysis 1. Introducing state monopoly on alcohol production and retail sales 2. Reducing the number of outlets trading in alcohol, including beer 3. Imposing alcohol price regulation, including those for low- alcohol beverages 4. Suppressing production of non-commercial and surrogate alcohol, tracing producers and sellers 5. Introducing criminal responsibility for illegal alcohol production and turnover 6. Introducing administrative responsibility for producing and selling home-made alcohol

27. Recommendations for improving effectiveness of alcohol policy based on results of the analysis 7. Introducing minimal age allowed for alcohol use 8. Establishing justified maximal BAC for drivers 9. Introducing educational programs for drivers, especially for repeated offenders 10. Developing legislative basis for the use of alcolocks 11. Sponsorship prohibition for companies that produce alcohol, including low-alcohol beverages 12. Immediate enshrining in law for all the effective measures of state alcohol policy

28. Additionnal Recommendations for improving effectiveness of alcohol policy 1. Considering ban on selling alcohol, including beer, during night hours, morning hours and on sundays 2. Reducing the number of alcohol trading outlets, including beer 3. Developing an effective system and procedure of levying fines for selling alcohol to minors 4. Increasing the minimal age of allowed sale of alcohol beverages and products up to 21 years 5. Promoting the “sober driver” type of services

29. Additionnal Recommendations for improving effectiveness of alcohol policy 6. Ban on alcohol-related advertising and sales stimulating 7. Control over established regulations of selling alcohol 8. Enforcing control over the ban on alcohol use in public places 9. Outlining territories for retail selling for alcohol production 10. Recommending to spare 3-5% of alcohol revenues for alcohol-preventive measures