Research
report
INGEBORG ROSSOW
Challenges in an
affluent society
ABSTRACT
I. Rossow: Challenges in an affluent
society. Trends in alcohol consumption,
alcohol related harms and alcohol
Trends in alcohol consumption, harms
and policy: Norway 1990 – 2010
policy: Norway 1990 – 2010
Over the past two decades recorded
alcohol sales in Norway have increased
by almost 50%. Although control policy
measures are somewhat weakened
Introduction
over this period, the increase should
Compared to most European countries the lev-
also be viewed in light of the significant
el of alcohol consumption in Norway has been
increase in purchase power, implying
fairly low and use of control policy measures
that alcohol has become relatively
such as taxation and restrictions on availabil-
cheaper for the consumers. Most of
ity have been quite extensive. Over the past
the increase in alcohol sales is due to
15 years alcohol consumption in Norway has
the more than doubled sales of wine,
risen significantly, and it is therefore of signifi-
and the possible importance of wine
cant interest to assess to what extent this in-
journalism and bag-in-box wine is
crease in consumption has been accompanied
discussed in this respect. Despite the
by an increase in alcohol related harms as well
significant increase in consumption
as to assess what may be the most significant
indicators of alcohol related harms do
factors contributing to the observed increase
not show consistently increasing trends.
in consumption.
Several possible explanations for this
I will in the following first give a brief over-
are discussed. Finally the current
view of the trends in alcohol consumption, then
status of policy initiatives, the public
turn to a description of trends in various indica-
opinion and some future challenges are
tors of alcohol related harms, and finally discuss
outlined.
how the consumption trend may be explained
■ KEYWORDS
Alcohol, trends, consumption,
Acknowledgements
The Norwegian Institute for Alcohol and Drug
Research has funded the work with this paper.
I’m grateful for valuable comments by Sturla
Nordlund and two anonymous reviewers on a
previous version of the paper.
harms, policy, Norway
submitted 30.04.2010
initial review completed 14.09.2010
final version accepted 20.09.2010
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Challenges in an affluent society
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in terms of changes in alcohol policy meas-
alcohol, whereas the corresponding fig-
ures as well as other factors. The descrip-
ures for 1999 and 2009 were 5.5 liters and
tion of trends in consumption and alcohol
6.7 liters. Over the 16 year period from
related harms is mainly an extension of a
1993 (with the lowest recorded consump-
previous description of these trends in Nor-
tion figure in the past three decades) the
way (Rossow 2007). The framework of the
recorded rate per capita 15+ increased
paper and in particular the analyses of the
with 2.1 liters or 47%. The trends in sales
role of control policy measures are much
of alcohol by beverage type are illustrated
inspired by the two companion reports ‘Al-
in Figure 1. As can be seen, most of this
cohol, society and the state’ (Mäkelä et al.
increase in total recorded consumption
1981; Single et al. 1981).
could be attributed to the increase in wine
sales; from less than 1 liter of pure alcohol
Trends in alcohol
consumption
per capita 15+ in 1990 to 2.3 liters in 2009.
■ Recorded consumption
Sales figures constitute by and large offpremise sales in grocery stores (where all
alcoholic beverages up to 4.75% alcohol
can be purchased) and in the State retail
monopoly stores (where all alcoholic beverages can be purchased) and on-premise
sales in restaurants, bars, cafes, etc. In
1990 the recorded mean consumption per
capita 15+ was just over 5 liters of pure
than 10%; from 2.8 liters of pure alcohol
Beer consumption increased with less
per capita 15+ in 1990 to 3.0 liters in 2009.
Annual spirits consumption was at a fairly
stable level of around 1 liter till after the
turn of the millennium and then increased
over the past 6 years by around 30%. Thus,
beer – mostly medium strength beer (below 4.75%) – still accounts for almost half
(45%) of the recorded alcohol consumption in Norway, whereas wine and spirits
Total
8
Spirits
7
Wine
6
Beer
Alcopops
5
4
3
2
1
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
Figure 1. Recorded sales of alcohol in total and beverage specific by year. Figures in liters of
pure alcohol per inhabitant 15 year and above. Note: Sales data for 1998 are not available.
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account for 33% and 20%, respectively,
and the increase was observed for both
leaving alcopops, ciders etc. to account for
genders and in all age groups (Horverak &
a small proportion of the overall consump-
Bye 2007). Annual surveys among 15–20
tion (2%) (Edland-Gryt 2009).
year olds showed that self-reported consumption was doubled from 1995 to 2003,
■ Unrecorded consumption
In addition to the recorded sales data estimates of unrecorded consumption have
and thereafter a decrease was observed.
been assessed by use of survey data from
similar trend; among the Norwegian 15–16
the general adult population. These data
year old survey participants the propor-
have been collected with approximately 5
tions reporting alcohol use in the past 12
years intervals. In 1991 the estimated un-
months and in the past 30 days increased
recorded consumption was about 1.5 lit-
significantly from 1994 to 1999 and there-
ers pure alcohol per adult inhabitant and
after decreased significantly to 2003 and
increased to around 1.8 liters in 1994 and
furthermore to 2007 (Hibell et al. 2009).
Data from the European School Project
on Alcohol and Drugs (ESPAD) display a
thereafter decreased steadily to around 1.4
liters in 2004. Whereas home produced
spirits (‘moonshine’) and wine and smuggled spirits constituted around two thirds
of the unrecorded consumption in 1991,
private imports of alcohol in terms of taxfree purchases and border trade of alcohol
(mainly from Sweden) have become an
increasingly more important part of the
unrecorded consumption. In 2004 private
imports constituted about two thirds of
the unrecorded consumption and tax-free
purchases constituted approximately half
of the estimated unrecorded consumption. Thus, in 2004 around one third of
the unrecorded consumption comprised
(in order of relative importance) home
produced spirits (‘moonshine’), home produced wine and smuggled spirits (Horverak
& Bye 2007).
■ Consumption by demographic groups
The survey data from samples of the general adult population collected in 1991,
1994, 1999 and 2004 showed that self-reported alcohol consumption per year increased over the period from 1991 to 2004,
■ Drinking patterns
Sales figures have shown that beer accounts for almost half (45%) of the total
recorded consumption, yet most of the
increase in recorded consumption can
be attributed to the increase in wine consumption. Also among young people beer
accounts for a larger proportion of the
overall consumption than any other beverage, whereas wine constitutes a relatively
small proportion in this group. After the
introduction to the Norwegian market in
1996 alcopops and ciders have gained an
increasingly larger proportion of young
people’s alcohol consumption and in 2008
constituted about one fourth of 15–20 year
olds’ alcohol consumption (SIRUS 2010).
The number of drinking occasions that
led to intoxication also increased over
the period from 1991 and onwards in
the general population (Horverak & Bye
2007). Correspondingly, data from ESPAD
showed that the proportion of 15–16 year
olds reporting having had five or more
drinks on an occasion in the past 30 days
displayed a similar trend as the prevalence
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data on drinking, i.e. an increase from
and alcopops) can be sold in licensed gro-
1994 to 1999 and thereafter a decreasing
cery stores etc, whereas wine and spirits
trend (Hibell et al. 2009). Thus, a pattern
(with a higher alcohol content) are sold in
of drinking to intoxication seems to have
state retail monopoly outlets. In 2008 11
been continued parallel to the significant
grocery stores per 10,000 inhabitants 15+
increase in wine consumption.
were licensed to sell beer and alcopops.
Proximal contributors; alcohol
policy measures
■ Excise duties and price policy
Alcohol prices in Norway are fairly high,
mainly due to high excise duties. The
taxes are higher for high alcohol content
beverages; i.e. excise duties on beer and
wine are 4.0 NOK per cl pure alcohol and
spirits are 6.1 NOK per cl pure alcohol. In
1990 excise duties on alcohol comprised
both basic duties and value duties, but the
latter was gradually abandoned and transferred to basic duties, aiming at keeping
the excise duties at the same level. In the
1990’s excise duties on fortified wines
(15–22%) were twice those of table wines
(7–15%). In the year 2000 the taxes on
fortified wines were halved so as to harmonize the taxes on table wines. Fortified
wines constitute however, a small fraction
of total wine consumption (around 4%),
and although sales of fortified wines increased in the year 2000 in response to
the tax reduction, the sales have thereafter decreased year by year. In 2002 and
2003 excise duties on spirits were cut by
15% and 9%, respectively, whereas in the
following years the taxes have remained
fairly stable.
■ Outlet density
Most of the recorded alcohol sales in Norway are off-premise sales (i.e. around 85%).
Beverages with an alcohol content below
4.75% (i.e. medium strength beer, ciders
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Such licenses are given (and can be withdrawn) by the municipality. In 1990 the
number of licenses for off-premise sales of
beer and alcopops was higher; almost 14
per 10,000 inhabitants 15+ and thus has
decreased over these two decades. This
trend mainly reflects the trend in number
of grocery shops in Norway. The number
of municipalities without any such licenses has decreased significantly over
time, from around half of all municipalities in 1980 to 12% of all municipalities
in 1990 and since 2003, all municipalities
in Norway have had off-premise sales of
alcohol. The number of monopoly outlets
(for off-premise sales of wine and spirits)
doubled from 1990 to 2008; from 0.3 to 0.6
per 10,000 inhabitants 15+.
The number of licenses for on-premise
sales of alcohol was almost doubled from
1980 to 1990 and in the following period
the number has increased from 13 per
10,000 inhabitants 15+ in 1990 to 18 per
10 000 inhabitants 15+ in 2008.
■ Self-service sales
In grocery stores self-service sales has been
the rule for several decades, whereas within the monopoly outlets all sales were over
the counter until 1998. Self-service was
introduced in some outlets in 1999. In the
following years an increasing proportion of
outlets were converted from over-the-counter to self-service sales and in 2006 almost
all outlets had self-service sales (Horverak
2008). An evaluation of the early phase of
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introduction of self-service in monopoly
for beer and wine and 20 years for spirits).
outlets demonstrated that self-service im-
Another restriction relates to quotas for
plied a net increase in alcohol sales (in
private untaxed imports of alcohol. These
liters of pure alcohol) by 10% (Horverak
are very small compared to the EU ‘quotas’;
2008). The study was meant to inform fur-
when entering Norway a total of 2 liters of
ther policy decisions, but before the evalu-
beer and 3 liters of wine (or alternatively
ation study was finished it was decided to
1 liter of wine and 1 liter of spirits) can
continue the introduction of self-service to
be brought in untaxed. Moreover, alcohol
the monopoly outlets (Horverak 2008).
advertising was banned in Norway in 1975
and other promotion of alcoholic beverag-
■ Hours and days of sales
Off-premise sales of alcohol is not allowed
on Sundays and public holidays. Sales
hours on weekdays and Saturdays are restricted by national limits; i.e. from 8am
to 8pm (to 6pm on Saturdays). Sales hours
in monopoly outlets are somewhat more
restricted. Maximum sales hours for onpremise sales is to 3 am for beer and wine
and 1 am for spirits and on-premise sales
is also allowed on Sundays. The municipalities have the authority to extend sales
hours for on-premise and off-premise sales
from ‘normal hours’ to ‘maximum hours’
(i.e. the national limits) and they can restrict sales hours. Since the concepts of
‘normal hours’ and ‘maximum hours’ were
introduced by the revision of the Alcohol
Act in 1997 an increasing proportion of
Norwegian municipalities have allowed
off-premise and on-premise sales to extend beyond the ‘normal hours’, whereas
a small and slightly decreasing proportion
of the municipalities have restricted sales
hours (Skjælaaen 2009).
■ Other restrictions on alcohol
availability
Norwegian alcohol policy also comprises
a number of other restrictions on alcohol
availability. One of these is the minimum
legal age for purchase of alcohol (18 years
es by the industry is miniscule. The ban on
alcohol advertising was challenged when
brought to court by a wine magazine, but
court decisions upheld the ban.
In sum, Norwegian alcohol policy applies
a variety of control policy measures that are
shown to be effective in curbing consumption and alcohol related harms (Babor et al.
2010). These policy measures are in part administered at the national level (e.g. excise
duties, retail monopoly, age limits, maximum sales hours) and in part administered
at the municipality level (e.g. on-premise
and off-premise outlet density and sales
hours). The control measures systematically
favour low alcohol content beverages to high
alcohol content beverages by less taxation
and by better availability in terms of number
of outlets, sales hours, and age limits. Over
time the alcohol policy measures administered both at the national and at the municipality level have, however, been somewhat
weakened; in particular availability of alcohol has increased over the past two decades.
Distal contributors; economic,
demographic and social
changes
■ Economic growth
Leaning on huge state revenues from the
oil industry, Norway is a wealthy country, and the inhabitants have experienced
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a significant growth in economic wealth
over decades. Only from 1997 to 2008
average wages increased by over 70%,
whereas prices increased by 26%. It may
also be noted that relative to prices on other goods and services, the prices on spirits, fortified wines and beer have become
somewhat cheaper, whereas prices on table wine have increased much in line with
the consumer price index. Thus, relative
to income, alcoholic beverages have become significantly cheaper for Norwegian
consumers since 1990. Figure 2 displays
the trends in the index for the relationship
between alcohol prices and salaries. Correspondingly, we find that although the
consumers’ nominal expenditures on alcoholic beverages increased by 46% from
1990 to 2007, the percentage of household
consumption spent on alcoholic beverages
decreased significantly over the same period; from 4.6% in 1990 to 2.8% in 2007.
■ Wine journalism – wine promotion
In the early 1980s wine journalism was introduced in a few newspapers in Norway,
but has over the years since then become
a regular part of the editorial content of
almost every newspaper, and occurs also
on some of the TV channels. In the larger
newspapers wine journalism occurs mostly every weekend, but less frequently in
other media. Wine reviews are written by
journalists with no direct connection to
the wine trade and are probably perceived
as more objective than advertisements
(Horverak 2009). In addition to wine reviews one may find recommendations of
specific wines to go with specific dishes
or types of food, and one may occasionally also find reviews of beers and spirits.
In a recent analysis Horverak (Horverak
2009) found a significant association between wine reviews and wine sales; a 10%
increase in the reviewers’ score on a par-
spirits
140
fortifield wine
120
table wine
beer
100
80
60
40
20
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
0
Figure 2. Index for relationship between nominal price index for alcoholic beverages and
index for nominal salaries by year and beverage type.
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ticular brand was accompanied by an 18%
to keep track of the amount consumed.
increase in sales of that brand over the first
Consequently, it is possible that consump-
two months after the review and by a 14%
tion of bag-in-box wine may increase the
increase in sales over the next 22 months,
amount of alcohol consumed per occa-
taking into account a variety of other fac-
sion. Secondly, it is possible that the barri-
tors that may influence the wine sales.
ers to have one glass of wine from a bag-in-
In the absence of alcohol advertisements
box are lower than for opening a bottle of
wine journalism thus seems to have a sig-
wine, and if so, wine by bag-in-box allows
nificant impact on the demand for wine,
for more drinking occasions as well.
not only immediately after the review, but
also over a longer period of time.
■ ‘Old wine in new bags’
– the case of bag-in-box
In 1988 the bag-in-box container for table
wines was introduced in the Norwegian
monopoly outlets. The bag-in-box gained
quickly popularity among Norwegian
consumers; after the first two years on the
market bag-in-box wines constituted over
20% of all table wine sales. Over the past
20 years bag-in-box wines have increased
their share of the total wine sales and in
2009 bag-in-box wines accounted for 55%
of all table wine sales by volume. Whereas
wine sales by the bottle increased by 8.2
million liters from 1990 to 2009, the sales
of bag-in-box wines increased by 28.4 million liters over the same period (Nordahl,
personal communication). Thus, most of
the increase in wine consumption in Norway over the past two decades is attributable to the increase in sales of bag-in-box
wines. The bag-in-box containers usually
hold 3 liters of wine (equivalent to four
bottles).
Several possible impacts of the increasing importance of bag-in-box wine sales
can be assumed. Firstly, compared to wine
by the bottle the bag-in-box represents
a larger quantity of immediately available wine and it also implies less ability
■ Small demographic
and social changes
As alcohol consumption and drinking patterns vary systematically by demographic
and social characteristics such as age, background, income and employment status,
it is likely that significant changes in the
composition of the population along one
or several of these factors could imply that
the distribution or pattern of consumption
may have changed over time. Available
data from Statistics Norway (SSB 2010)
show that over the past two decades the
population size has increased by almost
15% and is now 4.9 million inhabitants.
The increase is due to both net immigration and birth surplus. Life expectancy has
increased by about 4 years over the past
two decades, but the proportion of the
population above 70 years has been stable
(i.e. 11%). It should be noted also that the
proportion with immigrant background
has doubled over this period (from approximately 5 to 10%), mostly by people
originating from countries in East Europe,
Africa, Asia and Latin America. Estimates
of number of inhabitants with a Moslem
country background (e.g. Pakistan, Morocco, Turkey) suggest that this has increased
significantly since 1990; i.e. from less than
1% of the population to about 3.3%. Despite this relatively large increase, it seems
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unlikely that this has had any significant
Alcohol related harms
impact of importance on the distribution
Trends in alcohol related harms may in-
or pattern of alcohol consumption in Nor-
clude a variety of indicators, for instance
way.
alcohol related mortality, non-fatal alco-
Unemployment rates are low in Norway;
hol poisoning, arrests for public drunken-
in 1990 5.2% of the labour force was un-
ness, violent crimes and drunk driving.
employed and in 2008 this percentage was
Comparable data over time are available
even lower; 2.6%. Income distribution is
for various harm indicators. Comparable
not very skew in Norway; in 2008 the 10%
data on admissions in somatic hospitals
with the lowest income accounted for 4%
with underlying alcohol related diagnoses
of total income, whereas the 10% with the
are available only for the years from 1999
highest income accounted for almost 21%
and onwards. Correspondingly, data on
of total income. This distribution has been
admissions to in-patient or out-patient al-
fairly similar in the preceding two dec-
cohol treatment are available for the years
ades. Consequently, the significant growth
1998 to 2008. Comparable data on alcohol
in income over the past two decades has
related mortality comprise alcohol psy-
occurred in all income groups.
chosis and alcohol dependence (F 10) and
In sum, it seems likely that the relatively
small demographic and social changes in
chronic liver diseases (K70, K73–74) and
are available for the entire period.
Norway over the past two decades have
been of little, if any, importance for the
overall consumption or for the distribution of consumption or drinking patterns.
It should, however, be noted that there
has been an increasing tendency towards
urbanization of the population in Norway
over many decades, which has also continued through out the past few decades.
In 1990 73% of the population lived in
urban or densely populated areas, and
by 2009 this proportion had increased to
79%. Moreover, transportation by person
cars increased by 33% over this period,
and we may therefore assume that an increasing proportion of the population has
less travel costs related to alcohol purchases. Thus, this has probably contributed to a further increase in the availability of alcohol over time and may therefore add to the number of factors that may
help explain the increase in alcohol consumption.
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■ Discordant trends in register data
Alcohol related mortality (i.e. underlying
cause of death comprising alcohol psychosis, alcohol dependence and alcohol misuse, liver cirrhosis and other chronic liver
diseases) decreased from 12.7 to 9.2 deaths
per 100,000 inhabitants per year over the
period. The figures are average figures over
three years in the beginning and in the end
of the period, i.e. 1989–1991 and 2006–
2008, respectively. In contrast, the number
of hospital admissions with alcohol related diagnoses increased year by year over
the last decade; from 56.7 admissions per
100,000 inhabitants in 1999 to 81.9 admissions per 100,000 inhabitants in 2008, i.e.
an increase by 44%. The number of admissions to alcohol treatment (in alcohol and
drug treatment units, whether in-patient
or out-patient treatment modalities) also
increased gradually; from 140 admissions
per 100,000 population in 1998 to 185 ad-
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missions per 100,000 population in 2008;
crease may have been even stronger than
i.e. an increase by 32%.
the observed figures suggest.
The number of violent crimes contin-
the police, i.e. an increase by 32%. The
■ How do we interpret
the discordant trends?
As we have seen, the trends in various
indicators of alcohol related harms are inconsistent and discordant. A comparison
number of sanctions for driving under the
of trends in consumption and harm indi-
influence of alcohol and/or drugs has been
cators in the Nordic countries showed a
fairly stable over the period from 1998 to
fairly similar picture of discordant trends
2008, as has the number of tests from driv-
also in Iceland (Rossow et al. 2007) in
ers on the suspicion of drunk driving (SI-
consumption and harm indicators. Fol-
RUS 2009).
lowing the total consumption model (Skog
ued an increasing trend; in 1998 3.7 violent crimes per 1000 inhabitants were reported whereas in 2009 5.4 violent crimes
per 1000 inhabitants were reported to
1985) we would – a priori – assume that
■ Mixed trends in survey data
Survey data on self-reported alcohol related harms in the general population display
a mixed picture, i.e. for some harm indicators we find an increasing trend (e.g. been
in scuffle or fight due to own drinking), but
for most indicators, – whether reflecting
harm due to own drinking or harm from
others’ drinking – the prevalence figures
vary only somewhat and unsystematically
over time (Rossow 2007).
Among young people data from the
European School Project on Alcohol and
Drugs (ESPAD) show that among 15–16
year old students the prevalence of various alcohol related harms has increased
significantly from the first survey in 1995
(Hibell et al. 1997) to the most recent
survey in 2007 (Hibell et al. 2009). For
instance, the prevalence of accidents/
injuries increased from 4% to 15% and
the prevalence of having been in scuffle or fights increased from 10% to 17%.
It should also be noted that whereas in
1995 the figures were life time prevalence
rates, the figures for 2007 were last year
prevalence rates, implying that the in-
with an increasing total consumption we
would have an increase in the proportion
of heavy drinkers. Moreover, with a fairly
stable drinking pattern and a significant
increase in the number of heavy drinking episodes as well, we would therefore
expect an increase in the number of persons at significant risk of chronic1 as well
as acute alcohol related harms and also
an increase in occasions or events where
acute alcohol harms are likely to occur. In
consequence, we would thus expect the
level of harm indicators to increase. When
some of our observations fail to meet these
expectations there are several possible explanations to be considered.
First, – we may ask whether systematic
and opposite changes in measurement errors for various harm indicators contribute
to discordant trends. This could, at least to
some extent, possibly explain the discordant trends in alcohol related mortality and
morbidity. With regard to the mortality
data it has been suggested that the quality
of the Norwegian Cause of Death Registry
data have become poorer over time, in part
due to a decreasing autopsy rate. If this
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implies that deaths from alcohol attribut-
Second, – we may ask whether other,
able chronic diseases are less likely to be
counteracting or enhancing, forces have
coded as such, this could, at least in part,
been at play, and thereby contributed to
explain the observed decreasing trend in
drive the trends in one direction or an-
alcohol related mortality. As for alcohol
other. For instance, it has been suggested
related morbidity on the other hand, some
that mortality from chronic alcohol related
of the increasing trend in hospital admis-
diseases, such as liver cirrhosis, has de-
sions for alcohol related diseases most
creased in response to improved treatment
probably should be attributed to an overall
(Rossow 2007). If so, this would be in line
increasing trend in shorter hospital stays
with our observations that although hos-
and thereby a higher likelihood of re-ad-
pital admissions for chronic liver diseas-
missions for treatment of chronic diseases
es were more than doubled from 1999 to
(Rossow 2007). However, these changes
2008, the number of deaths from chronic
may possibly explain the discordant
liver diseases decreased by 20% over the
trends only to some extent. When it comes
same period.
to survey data several methodological
Third, we may also ask whether the al-
problems arise when interpreting preva-
leged underlying mechanism; i.e. a close
lence data over time. The generally falling
association between total consumption
response rates in surveys suggest that we
on the one hand and alcohol related
to an increasing extent do not obtain data
harms on the other, applies just as well
from heavy drinkers and drinkers at high
to a variety of alcohol related harms,
risk of experiencing harms. Moreover, it
whether they are acute or chronic, health
is also likely that the construct validity of
or social harms, or due to own or others’
alcohol related harms may change with an
drinking and in the same fashion over
increasingly wetter society. For instance,
time. Perhaps the association between to-
on a related matter Nordlund recently
tal consumption and various harm indi-
demonstrated that people’s conception
cators is moderated even over a relatively
of what is regarded as alcohol abuse has
short period of time such as a couple of
changed significantly over a four decade
decades. For instance, we could imagine
period; people consider frequent drinking
that much of the increase in wine con-
and intoxication as indicators of alcohol
sumption, which constitutes most of the
abuse to a far lesser extent nowadays – in
increase in total consumption, reflects
a relatively wet society – as compared to
an increase in drinking occasions where
four decades ago in a much drier societal
wine accompanies a meal and in a con-
context (Nordlund 2008). Correspond-
text where the risks of various acute and
ingly, it is possible that people’s concep-
social harms are minimal. In that case we
tion of harms attributable to drinking may
would expect that the strength of the as-
change along with changes in drinking
sociation between total consumption and
norms and drinking practices.
acute and social harms has decreased.
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Prevention and policy
initiatives
■ Adjusting to EU
The state alcohol monopolies constitute an
important pillar in the alcohol policy in all
Nordic countries except Denmark. As a result of Norway’s belonging to the European
Economic Area (EEA) the state monopoly
on whole sale of wine and spirits and production of spirits was abandoned in January
1996. Also in Finland and Sweden due to
EU membership in 1995 the state monopoly on alcohol was abandoned in all respects
except for the retail monopoly. Due to the
non-discrimination principle of the EU
and the EEA agreement, the product range
in the monopoly outlets increased significantly in Norway as well as in Finland and
Sweden (Örnberg & Olafsdottir 2008). With
competition between many private wholesalers one could also have expected that the
price at the wholesale and retail sale levels would have decreased, but this was not
the case, at least during the first year after
the privatization (Lund 1997). The privatization of the wholesale level also implied
more actors representing alcohol industry
interests.
Being a non-EU member Norway has, in
contrast to neighboring EU-member countries Finland and Sweden, kept its low
quotas on tax-free imports by travelers.
This has probably implied less pressure
on lowering taxes to reduce border trade
in Norway, as compared to Sweden and
Finland. In Sweden an increased border
trade following the gradual introduction
of EU travelers’ allowances was witnessed,
whereas in Finland taxes were cut significantly just prior to Estonia’s entrance into
EU, due to increased import of very cheap
alcohol in large amounts from Estonia.
■ The retail monopoly– keeping the
customers satisfied
As we have seen several changes implying
increased availability of alcohol (i.e. increased number of outlets and self-service
sales) have occurred within the state retail
monopoly system. These changes may be
viewed as the result of an increasingly
liberal policy, but also as a response to an
increasingly consumer oriented society. In
that respect Horverak noted that the Norwegian state monopoly started to change
its policy towards a more consumer friendly direction in the late 1980s in order to
increase its legitimacy and to be able to
survive (Horverak 2008). Along with increased number of outlets, introduction
of self-service and internet sales and significant increase in product range, public
opinion on the monopoly has changed.
General population surveys showed that
during the 1990s a decreasing proportion
of the population was in favour of sales
of wine and spirits in monopoly outlets,
whereas this tendency has been reversed
since 1999, showing an increasing support
(Storvoll et al. 2010). One may therefore
argue that the consumer oriented policy
with increased availability most probably
has led to a significant increase in the popularity of the monopoly, and accordingly
an increase in the support of the monopoly and its legitimacy. In the long run this
may be a way to secure continued existence of the monopoly system and thereby
the keeping of a significant instrument to
regulate availability of wine and spirits by
national authorities. Notably, similar and
fairly concurrent developments of consumer friendly policies were also taken
on by the state monopolies in Finland and
Sweden (Örnberg & Olafsdottir 2008).
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( Norway )
■ Public opinion and support for policy
measures – keeping the voters satisfied?
The public opinion on various alcohol
policy measures has been monitored in
Norway for almost half a century. Over
the entire period a majority of the survey
respondents have agreed on the statement
that national as well as local regulations
of alcohol sales are acceptable, whereas a
clear majority has agreed with the statement that alcohol prices are too high
(Østhus 2005). In 2004 the Norwegian Directorate of Health launched a campaign
to increase people’s knowledge about the
effectiveness of alcohol control policy
measures and thereby aiming at increasing public support for these measures. An
evaluation of the campaign showed that
people’s knowledge about the effectiveness of control policy measures increased
immediately after the campaign as did attitudes in favour of applying these measures
(Rise et al. 2005). Survey data covering the
subsequent period have shown a continued increase in support for these control
measures, yet it seems reasonable to attribute these changes in knowledge and
attitudes to other factors (Storvoll et al.
2010). Whereas the health directorate has
played an active role in addressing alcohol problems and alcohol policy measures
other actors in the public health area have
been less visible in this respect. This may
perhaps reflect that the basic training and
further education of medical doctors and
other health professionals in Norway have
covered alcohol (and drug) issues to a very
limited extent (Rossow 2005).
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NORDIC STUDIES ON ALCOHOL AND DRUGS
Concluding remarks and some
challenges for Norwegian
alcohol policy
Over the past two decades alcohol consumption in Norway has increased significantly and register data on indicators
of alcohol related harms suggest, although
not unambiguously, that this increase
in consumption has been accompanied
by an increase in alcohol related harms.
The Norwegian authorities both at the national and the local level apply – by the
standards of most European countries – a
set of fairly strict alcohol control policy
measures by high excise duties and significant limitations on alcohol availability. Although availability of alcohol has
increased somewhat over this period, the
significant increase in consumption most
likely also reflects that alcohol has become
relatively cheaper over this period. Moreover, increased availability and relatively
cheaper alcohol are also likely candidates
to explain the recent increasing support
for control policy measures.
■ Alcohol policy research
Along with neighboring countries Finland
and Sweden, Norway has a long tradition
for alcohol policy research. Changes in
alcohol policy measures have often been
evaluated with respect to impact on consumption and harms. Indeed, some alcohol policy studies have been initiated by
national authorities in order to inform alcohol policy strategies and in some cases
implementation of a policy change has
even been designed and organized as experimental trials. An example of the latter
was the change from over-the-counter to
self-service sales in alcohol monopoly outlets. Building on a similar policy change
V O L . 2 7. 2 0 1 0 . 5
Challenges in an affluent society
( Norway )
and research study design in Sweden
(Room 2003). The experience of alcohol
(Skog 2000) self-service sales in the Nor-
control policy in the Nordic countries has
wegian alcohol monopoly were first intro-
for a long time, however, been that effec-
duced in some outlets. These were select-
tive control policies indeed are – or can
ed based on a case-control design so as to
be – politically possible (Room 2002).
allow for assessment of the impact of this
Yet, it seems probable that keeping effec-
policy change (Horverak 2008). Interest-
tive control policies may to an increasing
ingly, despite predictions of a 10 percent
extent be politically more difficult in sev-
sales increase due to self-service sales the
eral respects. First, it is possible that the
Norwegian authorities decided to allow
amount of unrecorded alcohol consump-
for self-service sales in all monopoly out-
tion, in particular that from border trade
lets. This example may thus also illustrate
in Sweden, may become an increasingly
the limitations of alcohol policy research
stronger argument to reduce (or at least
to influence the making of alcohol policy.
not increase) the excise duties on alcohol.
Second, although the state monopoly has
■ Alcohol policy measures at two levels
Norwegian authorities administer alcohol
policy measures at two levels; the national
and the municipal level, which reflects
a basic principle of distribution of political power in Norway. It is argued that
there may be stronger public support for
decisions that are made at the local level
(Østhus 2005), yet over the past two decades a tendency by national authorities to
limit the content of the policy measures
tool case at the local level can be observed.
In 1997 the municipal authorities’ power
on deciding sales hours was restricted by
national restrictions on maximum sales
hours and at present national health authorities have suggested further restrictions on maximum sales hours for onpremise sales.
gained more popularity and public support
over the past decade and thereby gained
a stronger position to survive, the future
of the monopoly may nevertheless seem
somewhat uncertain. In line with a majority of the population (Storvoll et al. 2010),
several political parties, which in sum
may gain sufficient political power, are in
favour of removing the retail monopoly on
wine sales, yet keeping the monopoly for
spirits sales. If wine sales in grocery stores
become a reality, it has been argued that
the volume of spirits sales is not sufficient
to run an economically efficient monopoly
system, and therefore imply that the retail
monopoly will be abandoned.
Third, within the larger alcohol and
drug area it seems that the public debate
and public concern evolve more around
the use and problems related to illicit
■ The challenge of evidence based
alcohol policy in the Norwegian context
Robin Room has elegantly summarized
the challenge of evidence based alcohol
policy by the following statement: “Popular approaches are ineffective, effective
approaches are politically impossible”
drugs than around alcohol issues. Again,
much in line with a popular perception,
several political parties view the problems
related to illicit drug use as more severe
and extensive than those related to alcohol
use. For instance, more than half of survey
respondents agree with the statement that
NORDIC STUDIES ON ALCOHOL AND DRUGS
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461
Challenges in an affluent society
( Norway )
within the alcohol and drug area the au-
the effectiveness of various alcohol policy
thorities should concentrate [their efforts]
measures but also industry interests and
on illicit drugs (Storvoll et al. 2010). More-
the public opinion, it may be politically
over, less than half or a third of survey re-
more difficult to uphold the control policy
spondents agree with statements that high
measures in the future.
prices on alcohol, a state monopoly on
Ingeborg Rossow, researcher
Norwegian Institute for Alcohol and
Drug Research
PB 565 Sentrum, N–0105 Oslo, Norway
E-mail: [email protected]
wine and spirits, and restrictions on sales
hours are effective policy measures to
curb alcohol related harms (Storvoll et al.
2010). Thus, when considering not only
NOTES
1 Although chronic diseases due to long term
heavy drinking may take decades to evolve,
it is well demonstrated that at the population level rates in morbidity and mortality
from for instance liver cirrhosis may follow
changes in total consumption with a short
time lag (Ramstedt 2001).
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