1. Alcohol as a strong player in Estonia Andrus Lipand MD Andrus Lipand MD Estonian Ministry of Social Affairs Estonian Ministry of Social Affairs International Conference International Conference Reducing Alcohol Problems in the Baltic Sea Region Reducing Alcohol Problems in the Baltic Sea Region Riga, Latvia 12 – 13 March, 2007 Riga, Latvia 12 – 13 March, 2007

2. Two focuses of my presentation  Alcohol related situation in Estonia  Developments in reducing the health harms

3. Alcohol mortality rates among adults per 100 000 inhabitants Source: Estonian Statistical Office, 2006

4. Alcohol liver cirrhosis case rate per 100 000 inhabitants Source: Ministry of Social Affairs, 2006

5. Roots of alcohol related problems  Psychoactive effect → addiction → alcoholism  Conflict between business interests and health  Stress → alcohol as well accessible and false stress reducer  Super-liberal state alcohol policy  Weak surveillance and social control  Absence of political will to enforce effective measures and restrictions

6. Why alcohol is good, why bad? Why alcohol is good, why bad? Examples of 11 -12 year old schoolchildren´s Examples of 11 -12 year old schoolchildren´s expressions and attitudes (1) expressions and attitudes (1) ⌂ With beer you can win different things ⌂ When you drink you are happier ⌂ It is cool to talk to drunken people ⌂ Alcohol stimulates, helps the organism to work and you get half of vitamins ⌂ Cool advertisements ⌂ You get drunken and then you get a good feeling and new friends

7. Why alcohol is good, why bad? Examples of 11 – 12 year old schoolchildren´s expressions and attitudes (2) expressions and attitudes (2) ⌂ Good to drink with juice, pleasant, it calms and keeps away concern ⌂ Some blood needs red wine ⌂ To be stoned is pleasant ⌂ One glass of whisky keeps your heart beating ⌂ You feel relaxed and you can easily get into intercourse ⌂ It is sold everywhere and vodka is the most important thing at every party

8. What we can conclude?  All these children opinions and expressions reflect social norms and values of the adults society in which children are living their everyday life.  Low price of alcohol beverages;  Easy access to alcohol beverages;  Aggressive alcohol marketing policy;  Mentality  Values in psychosocial environment  Lack of national alcohol policy  Insufficient enforcement of existing laws  Is health education evidence based approach?

9. Drinking alcohol beverages 1990-2004 at least once a week (males) % Source: Estonia Union for Health Promotion, 2005

10. Drinking alcohol beverages 1990-2004 at least once a week (females) % Source: Estonian Union for Health Promotion, 2005

11. Knowledge that a friend was drunk and drove a car during last 12 months % Source. Estonian Union for Health Promotion, 2005

12. Opportunities and real tools to change the situation at the state level  Ministry of Finance – taxes and price  Ministry of Agriculture – product regulation  Ministry of Education – formation of the values  Ministry of Economy – handling of goods and responsibility in alcohol marketing  Ministry of Internal Affairs – surveillance  Ministry of Social Affairs – intersectoral coordination and capacity building in each level

13. Initiative of the Ministry of Social Affairs  In September 2006 was established special team to work out the basic principles of the state alcohol policy  Specialists from different ministries and competent professionals from other institutions were invited

14. MoSA proposals to reduce the health harms and economic loss of alcohol use (1)  To ban alcohol advertising in public places and in media  To make alcohol taxation policy more effective  To intensify the state supervision over existing laws  To limit the selling alcohol in fixed premises, areas and timeframe

15. MoSA proposals to reduce the health harms and economic loss of alcohol use (2)  To ban sponsorship and promotion of alcohol  To increase the age limit from 18 to 21 on handling, owning and buying alcohol  To change public attitudes and value assessments  To separate alcohol in selling space from other goods and soft drinks

16. Is consensus possible?  Hopefully, if we can continue the discussions after Parliament elections in March 4th and after formation the new government  Hopefully, if we can lobby that the state alcohol policy will be a part of the contract of new coalition  Hopefully, if the public pressure and majority of organizations help and support our position in achieving the clear alcohol policy which implementation will give positive results

17. Thank you!