Building Capacity Project
Third Meeting of Alcohol Policy Network
Stockholm, Sweden, 10-12 June 2009

Notes of the Meeting

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Welcome and scope of the meeting
Chair of the meeting Cees Goos welcomed everyone at the third meeting of the alcohol policy network, and thanked to the Swedish government, to the Secretary of State and to IOGT-NTO, for organizing the meeting for knowing the importance of the BCP, and to dual the meeting in the frame of the EU presidency with two other events, where alcohol and health are issued: event on alcohol marketing in July and an expert conference in September, in cooperation with EC and WHO.

The focus of the presidency is the protection of children and young plus prevention of alcohol abuse among adults for EU needs a long-term and comprehensive alcohol policy (AP) to reduce alcohol related harm. Our hope is that these activities will contribute to maintain efficient AP high on EU agenda (Secretary State: Roguwi Marchelind).

Chair also thanked to Drug department of SNIPH lead by Dr. Sven Andreasson, Sweden, for monitoring public heath development and for offering national expertise, as well as for making sure that this policy is legislative and implemented effectively (after the legislation a huge decrease was noticed in Sweden, and according to Swedish Institute of Public Health people in Sweden are concerned about drinking problem and support high taxation of alcohol drinks). It is to hope that Swedish experience will contribute to better AP at EU level (Dr. Sven Andreasson, Sweden).

As Pieter de Coninck of European Commission said the main objective of BC is to support EC to implement effective strategy, to raise awareness. It is very good and needed that there is cooperation between NGOs and health side and public health authorities. The role of NGO’s is to build knowledge and to lobby and to be brave and continue the good work.

As Sven-Olov Carlsson, of IOGT-NTO, stressed, Europe is a region that produces and consumes the most alcohol in the world, and there is a lot of work to be done here. Swedish presidency is a unique opportunity to contribute to changes, especially to increase knowledge and to prepare a policy to encounter the incorrect ones, and the APN meeting is a good opportunity to start this.

Mariann Skar of Eurocare stressed the need of Eurocare for help from all the APN Members to input on the questionnaire and other input.
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Bo Hogstedt welcomed everybody and introduced them with organizing matters.

As APN lost two valuable people, Andrej Marusic and Hasse Fahrenkrug, Cees Goos invited everyone to reflect a minute on this.

1. Development of local alcohol policy in Europe and the Netherlands (Wim van Dalen of Stichting Alcoholpreventie, Netherlands)
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2. Regional Alcohol policy (Karin Mernelius of AER, France)
We should be sceptical about ideal of prohibition and idea that education does not change behaviour, but enforcement does (Alfred Uhl, Ludwig Boltzmann Institute, Austria). Best policy probably lies somewhere in between (C. Goos), and a good enforcement policy, a realistic one, is needed. Education and enforcement are both relevant elements. It is that for many years that so much stress was on the education, but the enforcement is relevant as well (W. van Dalen). A question arose whether there is any research on this, how we should deal with this, once the project is over and the money disappears (Eleni Petridou of University of Athens, Greece). It is important to focus on one method and one topic so that the knowledge stays in the region (K. Mernelius). There was Education and enforcement elements should be all kept together (Jacek Moskalewicz of Institute of Psychiatry and Neurology, Poland), and we have to be aware that the decision makers at all levels are the ones who own the power (Maria Renström, Ministry of Health and Social Affairs, Sweden). When discussing binge drinking problem among young people, we have to be aware that police enforcement in terms of seizing the alcohol won’t stop the youngsters from creating a more inventive ways of acquiring alcohol (e.g. getting it from the family environment) for which reason the British government is trying to raise education among parents (representative of British government). Health authorities need to work on this, and the public support is another issue (W. van Dalen). Working with youngsters and educating them is good but not enough, more important is to have a good health system. (Gabriel Romanus, NORDAN). There is obviously a great importance of the authority, when the regional coordinator comes for help to the organization (Alcohol Concern) (Don Shenker, Alcohol Concern, Great Britain).pdf icon small Presentation

3. Future of the APN (presentation by Walter Farke of DHS, Germany)
APN as a network with new members is a very useful and powerful resource for 1) policy making in Europe; this APN is specific: for NGOs, GOs and science people to come together, at a level of country as well as on the regional level. It is the 3rd under the Building Capacity Project umbrella; and a resource for 2) a global strategy making (Cees Goos).

There are 47% of NGO members, 9% of GO, and 44% of other members. Members come from many Europe countries, as well as from Turkey and Lebanon. There are several alcohol networks in Europe, mutually connected: Inebria, Eucam, Amphora, APN, APYN, Eurocare and Emna.

In regards to the answers from DHS questionnaire (prepared within the WP4), question 27 “What does your organization have as to how the APN can be continued from June 2010 onwards?” 1) (structure) there should be a central coordination of the APN business; the APN should work as an umbrella organization and should be independent from formal structures (no board, no long decision making processes); costs for an office should be low and an APN office could be linked to an existing institution; 2) (funding) it should be funded by projects with (permanent) financial support form the EC, with financial support by the members from the national sources (Government, etc.), and fees and contributions from the members (to finance an office); 3) (strategy) directions and special issues can be defined depending on the needs; with focus on main topics and regular comeback of these topics; there should be yearly analysis of the influence of political developments on alcohol policy issues in Europe and the MS; there should be a close cooperation with EC and WHO (e.g. global strategy on alcohol); and there should be an extension of the cooperation with health professionals and Public Health researchers; 4) (tools and methods of internal cooperation) there should be online meeting, regular European conferences and meetings, and exchange of data and good practices (evidence based), with regularly carried out advocacy courses, and it could be a platform to find project partners with an opportunity to distribute relevant information (articles, reports, etc.); 5) (views on internal cooperation) more controversial and divergent perspective would be better from a scientific point of view; more lively networking are needed, cooperation should not only be focussed on meetings and conferences; there is an imbalance between advocacy and scientific rationality; participation of APN could be continued on voluntary basis; 6) (projects) the APN should carry out specific and relevant projects, there should be European projects on best practise, there should be a continuation in following the EC Calls for Proposals, and APN should not depend on any (running) projects. There is a project proposal already: Monitoring of alcohol policy in the new MS (research); 7) (other tasks) the support of alcohol advocacy institutions in Europe; support of NGOs with less resources; identification of new partners, organizations as well as networks; 8) (future challenges) there is a financial crisis, there are political changes on European and national level (e.g. EU election), and the development of the Alcohol and Health Forum should be noted, etc.

The APN should continue (a common consensus); Eurocare 1) could produce  space for APN at the website, 2) offers help to organize next AP meeting, and 3) proposes to pick up Advocacy course activities to train new advocates (Tiziana Codenotti of Eurocare Italy). Gencat continues to offer the secretariat (Peter Anderson on behalf of Joan Colom of Gencat, Spain).  Indeed, 1) capacity building is not possible if we can’t assure the continuity of APN, and 2) there should be a webpage to have all the data available (for essential GOs and NGOs and experts as well as others to have a website to turn to, where all the relevant information is gathered) and 3) what about the continuation in conferences? (V-K Petrič of Ministry of Health of the Republic of Slovenia) One option to keep APN continuation is engaging in projects, but eventually the future is to base APN somewhere, and the only organization that has the potential to keep all the three groups of members (GOs, NGOs and experts) is the WHO, but the EU part of WHO doesn’t seem to be putting so much attention to this (V-K Petrič). Maybe we can push them to host APN, which is difficult; resource may be from the Commission, but this needs further investigation (V-K Petrič). And, to continue APN under the umbrella of Eurocare is a problem for GOs to cooperate (V-K Petrič). There is a history in sense of Eurocare being the funding father of the first project (BtheG) and Eurocare portal to reach/access information should be considered here (Sven-Olov Carlsson of IOGT-NTO, Sweden). For now there are no more projects after this one, and it has to be noted that there is a an establishement of alcohol in schools, for which reason there is a great need to train people to advocate the right alcohol policy (S.-O. Carlsson). We should find a way to make APN independent of projects and individuals (Maria Renström, Ministry of Health and Social Affairs, Sweden). In Denmark there is still a gap - there is no common meeting place for all the three groups to meet (experts have theirs, NGOs theirs, and GOs theirs) (Johan Damgaard Jensen of Alkoholpolitiksk Landsråd, Denmark). Since WHO is a very rigid organization, it needs very defined requests and then they will adapt (H. Schneiderman of NORDAN). When working together which is also the case here, in many countries GO people can go to the countries to represent one’s country (H. Schneiderman).  We need time to think what it is all about to precise what the group will work on and what it will do with this (Jacek Moskalewicz of Institute of Psychiatry and Neurology, Poland). The very main thing is 1) to work on a strategy way to have a coherent way in changing AP in EU, which means having very clear main goals (at the moment there are no official papers on that), and 2) to think how we organize it (we are not focused enough – we have too mush different work), and we have to be practical doing that – the coordinator and the WP leaders should suggest how to go on (Wim van Dalen of STAP, Netherlands). It should be noted that this network is a network of different kinds of people (Maria Renström) and that we should first see if we have some common opinions (T. Codenotti)


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4. Alcohol consumption among elderly European Union citizens: health effects, consumption and related issues (Mats Hallgren)
It is better and it is politically correct to say older people not elderly people, formally we define as older people who are aged 65 plus not 60 plus (E. Petridou of University of Athens, Greece). In Germany there will come forward some new publications (G. Bartsch of DHS, Germany). It might be, that the related death increase is because the people are getting older or it may be the combination (answer M. Hallgren to G. Bartsch’s question), there is no data on the generation effect (reply M. Hallgren to A. de Bruijn).
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5. Administrative and financial issues of the BC project (Sandra Rados Krnel of IVZ RS, Slovenia)

6. Swedish Presidency and the role of the public health community (Maria Renström of Ministry of Health and social Affairs, Sweden)
As to the question what to expect in terms of changes of policy (new agreements, big researches …) (W. van Dalen), Swedish goal is to inform ministers of EU countries, that the Swedish presidency itself will not change EU policy and that it is eventually up to the ministers to change the policy (M. Renström). As to the question about practical ways to assure sustainability (Peter Anderson), the main priority is to carry on the EU work and not to make a new agenda, whereas on alcohol and other areas Sweden will try to take a step forward and will need support (M. Renström).
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7. Supporting the coordinated implementation of the framework for alcohol policy and the Commission Communication on an EU Strategy to support Member States in reducing alcohol-related harm
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8. What are the outcomes of the WHO/EC project (Dag Rekve, WHO official)
The point of APN is to influence the global strategy of AP – strategies for the countries outside EU as well, and to understand the role of different players, who have different roles to play. WHO is not the one to be lobbied, but is working now on a working paper that is to be discussed with member states and the draft of it published in November. In winter, WHO will then really start to work on a global strategy (Dag rekve). Eurocare will support the global strategy (Mariann Skar, Eurocare). The process will be the same as well, and ministers need to be made aware of this (Maria Renström). It is very important to look the broader picture, beyond EU boundaries (H. Schneiderman of NORDAN). In the frame of the project it is essential to focus and work hard to protect from the alcohol industry by making good counterarguments (P. Anderson). NGOs on alcohol must scale up engagement, together with Public Health community (Ann Hope).
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9. Advocating for alcohol policy in the public health interest – the story of minimum pricing in Scotland (Evelyn Gillan of SHAAP, Scotland)
This example is one of the best to illustrate how things should be done; we need to build coalition to make sure to have this on country and national level, we need evidence and translate them to SMS that apply to different audiences, and we need to use politicians (V-K Petrič). It is not enough just to have a network doing the documentation on the subject, but to work immediately with ministers (M. Renström). As to the question what the APN can do for Scotland (P. Anderson), it would be very helpful to present good expertise and policy skills as well as to give political support, all together (E. Gillan).
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10. A sobering analysis of the link between alcohol affordability, consumption and harms in the EU (Lila Robinovich of RAND Europe)
As to the question how the increase is measured (G. Bartsch), it is all pro habitant (Han de Vries, of RAND), the effect of affordability on consumption won’t be the same in different countries, social groups. The research reports an average across countries, which is not ideal, and this is a reason to make more specific research (H. de Vries). As to the question whether the connection between affordability and consumption is linear (Janusz Sieroslawski of Institute of Psychiatry and Neurology, Polland), the connection is not exactly linear and something that still needs to be explored more (H. de Vries). It is good to have this report commissioned, since this study is very much in line with other findings that prove that the more you drink the more you are sensitive to the pricing (G. Romanus of Nordan). It is better, however, to relate price and consumption (rather than affordability and consumption) (J. Sieroslawski); there are systematic reviews that show relatedness of having higher prices and lower consumption (P. Anderson). This report should be used to raise a good debate at the national level (S-O Carlsson). As to the question where these data come from and how reliable they are (A. Uhl, Austia), it was best available data (Han de Vries), there is still a question of combining different drink categories (bear, wine, bottled, retailed, …) (Ben Baumberg).
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11. How to evaluate the effectiveness of alcohol advertising regulations? (Avalon de Bruijn of STAP, Netherlands)
In the future it would be useful to make a study about the impact of internet advertising, since the internet is more and more used by all age groups (Anne-Karin Kolstad).
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12. Can drinking environment be safer (Karen Hughes of Liverpool John Moores University, Centre for Public Health, UK)
Once you have the street full of bars it is impossible to cut down (H. Schneidermann). Drinking environment refers to public places to drink (K. Hughes answer to Maik Dünnbier’s question). Researches show that countries that close bars earlier have less violence (Anne-Karin Kolstad), and we should focus not just on making environments safer to drink but also working on advocating basic issues (E. de Bruijn, K. Hughes).
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13. Impact of workplace policies and programmes to reduce the harm done by alcohol to the economy (Peter Anderson)
Our job is to ask to promote testing blood level at emergency rooms (M. Skar of Eurocare). There is an assumption that no one today drinks at working place, whereas before there used to be 70% of people who drank on workplace. But, now they are drinking at home and this affects their work performance (H. Schneidermann of Nordan).
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14. Alcohol and accidents (Kaarina Tamminiemi, Finnish Centre for Health Promotion, Finnland)
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15. Alcohol labelling policies to protect young people (Ingrid Vanhaevre of CRIOC – OIVO)
In UK two studies about labelling have been done and there is a voluntary agreement between government and three big supermarkets labelling about negative effects of alcohol on alcohol products. The studies can be passed on to Vanhaevre (Don Shenker of Alcohol Concern, UK). There remains a question about best practices in other countries (not the member states) (P. de Coninck of European Commission).
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16. The NORDAN dimension (Gabriel Romanus, NORDAN)
Referring to the NGO’s there used to be Nordic alliance which was later abolished, then the Nordic researchers related with Eurocare which guarantied money but their voice was not heard, so the Nordan was established, as an umbrella organization for Nordic and Baltic countries). Now that the Eurocare is more democratic and transparent maybe there is an opportunity for the Nordan to organize a new scope for there is still a need that the Nordic voice is heard. Nordan has programmes to cooperate with Russia, and there are conferences organized, and website where all documentation is gathered (Gabriel Romanus, NORDAN).

17. AMPHORA Project

Amphora – Alcohol Public Health Research Alliance (Peter Anderson)
There is a concern that too many data included in the research would miss out the essential core of the research (Aires Gameiro of Sociedade Antialcoolica Portuguesa, Portugal), but this research offers a bigger research data-base in EU, so we don't have to just draw from the USA researches (P. Anderson). Good research results are not enough, a good communication between research and policy has to be guaranteed (J. Moskalewisz, Polland), and maybe we should organize some kind of meetings between researchers and policy makers (P. Anderson). It would be good to have at least a few politicians to asses the needs of the researchers (V-K. Petrič, Slovenia), but for now it is not possible to add a new WP (P. Anderson’s reply to Kaarina Tamminiemi of Finnish Centre for Health).
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Economic and physical availability of alcohol (Esa Österberg of National Institute for Health and Welfare (THL), Finnland)
In Estonia there were made some serious changes in 2008 – from 10 p.m. till 10 a.m. there was a reduction of consumption (Lauri Beekman, Estonia), in Malta the minimum age to drink was raised to 16 and is planned to be raised to 18, the policy sample can be send to Amphora (Joan Camilleri of National Commission Drugs Alcohol, Malta).
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Unrecorded alcohol (Dirk W. Lachenmeier of CVUA Karlsruhe)
As to the question whether Amphora is using Amphora partners to collect the data about the unrecorded alcohol (T. Codennotti of Eurocare, Italy), others can send samples as well; it is collecting 10 samples per institute (not country) (D. Lachenmeier). The homeless people can be asked (Hana Sovinova, of Institute of Psychiatry and Neurology, Poland), and maybe the industry has some samples (D. Lachenmeier). Now, since it is illegal to buy unrecorded alcohol, we could try by the police force which collects these all the time (L. Beekman of Estonian Temperance Union, Estonia). It is also possible to send only the results without the samples (D. Lachenmeier’s answer to J. Colom question). The samples will not be representative (D. Lachenmeier) in regards to the price, distribution and contamination (Dag Rekve, WHO), since the research will include only 10 samples per institute (D. Lachenmeier). This is a pilot project, the first check out of this and if it turns out a problem, more research will be done (P. Anderson). A synergy in connecting with social exclusion agencies would be welcomed (A. Owen).
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Crime prevention in Sweden – The Kronobergs model (Scott Godwin, Swedish Police Service)
There is a big problem of smuggling since the boarder is so easily passable (S. Godwin), which is also the reason why there isn’t so much homemaking of alcohol anymore (D. Lachenmeier). Police works with youth organizations in terms of organizing parents meetings and working on the street all the time (Godwin’s answer to M. Dünnbier’s question). It is that children of middle class moderate their drinking, but there is a minority of children with less parental and social support that drink more (S. Godwin). This model is planned to be implemented in every Swedish county by this falls (S. Godwin).
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Wrap up and conclusions

Some conclusions:

We still have some work to do:

This is the last APN Meeting under umbrella of BC project. The APN has grown and wants to be independent of politics.

There is a big thank to the organizations that enabled this meeting: IOGT-NTO for all the practical work of organizing this beautiful program,  to IVZ for administering the project, the Secretary State of Sweden, and to all who had presentations and everyone that came to this meeting (C. Goos).  A special thank to C. Goos for chairing the meeting (G. Romanus). It was a great pleasure for IOGT-NTO to be hosting this meeting (S-O Carlsson).
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