Uncorking the problem
Comprehensive, effective and sustainable alcohol policies can only be achieved by ensuring the active and committed participation of all relevant groups with a stake in their implementation. While policy decisions have traditionally been the realm of government, recent years have witnessed the increasing involvement of the private sector (particularly the beverage alcohol industry), of non-governmental organisations, and of citizen and community groups.
The Amsterdam Group (TAG) and the International Centre for Alcohol Policies (ICAP), two groups funded by major international producers of beverage alcohol, representing the beer, wine and spirits sectors, have initiated a process intended to facilitate the bringing together of relevant stakeholders in the alcohol debate in several countries in central and eastern Europe, including Poland.
While Washington-based ICAP focuses on developing balanced national alcohol policies appropriate for the needs of individual countries, Brussels-based TAG translates these policies into practice through the implementation of tailored programmes for education and information.
The underlying premise behind effective policy and prevention initiatives in the alcohol field is based on the need to identify the local drinking culture and prevailing drinking patterns. Once this has been achieved, approaches can be created with these specific needs in mind. In cultures in which alcohol is a popular product, policy must be aimed at the reduction of problems, but in a way that will not infringe upon the rights of individuals to drink.
The alcohol culture here has traditionally been a spirits-based one. As in most countries in Europe, however, the traditional drinking patterns in the country are shifting. Vodka, formerly the beverage of choice, is being displaced by beer. With the opening up of markets, wine is increasing in popularity, and other beverage types, such as ready-to-drink products, are making their appearances.
The picture is further complicated by the fact that considerable amounts of counterfeit and smuggled beverage alcohol make their way across the country's borders. These beverages are generally cheaper than branded and commercial products, and therefore accessible to those with modest means. But they do not necessarily conform to standards of safety and quality, presenting a significant public health problem.
The drinking pattern here resembles that of the Nordic countries where alcohol is not well integrated into everyday life. Whereas drinking in the Mediterranean region, for example, is an activity to accompany meals and drunkenness is frowned upon, the Nordic pattern is typified by drinking bouts or binges, rapid heavy consumption to intoxication. While this drinking pattern carries with it considerable health risks, it is also associated with acute harms, such as road traffic accidents and violence. Indeed, the rate of traffic fatalities involving alcohol is higher in this country than in any other in the region.
According to recent research, some 20% of drinkers here are alcohol dependent, and another 20% are either problem drinkers or at risk. The remainder of the drinking population can be classified as moderate.
In view of the country's prevailing drinking patterns and the composition of the drinking population, approaches are needed both at the policy level and at the level of prevention that address specific problems and reduce the risk for harm. Alcohol-dependent individuals require particular attention and treatment, but they are only part of the picture. Those who are not dependent but who may experience other types of harm need to learn to drink responsibly and would benefit from the creation of a drinking environment in which the risk for harm is reduced.
Experience from other countries has shown that traditional population-wide approaches to reducing alcohol problems that rely simply on curtailing alcohol availability through measures such as prohibition, taxation, pricing or limiting outlets that serve and sell alcohol are inadequate in addressing the needs of populations at particular risk of harm. Indeed, such measures may drive demand further towards the black market, bringing on a new set of problems, such as those that are observable here today. Instead, an approach is needed that targets specific problematic drinking patterns and settings and educates the drinking public about alcohol and, more importantly, about responsible drinking.
At the same time, sustainable approaches to alcohol policy and prevention are also predicated upon two fundamentally important and increasingly accepted notions - social responsibility and partnership. Social responsibility around alcohol is a shared one. It must ensure that the risks and harms associated with alcohol misuse are minimised and that the health and psychosocial benefits associated with responsible consumption are maximised.
Individuals are responsible to themselves and others for their behaviour; family and community are responsible for facilitating the development of children and increasing the welfare of all of their members. Scientists and public health professionals are responsible for providing sound science, free of ideological or moral biases, that will inform the development of evidence-based strategies.
The alcohol beverage industry is responsible to its consumers and the public at large, recognising that beverage alcohol, if used responsibly, can enhance pleasure and the quality of life. However, if misused, it can bring about considerable harm to individuals and cost to society. As a result, the industry is responsible for behaving like a good corporate citizen and regulating its own sales, marketing and advertising efforts according to existing internal standards of responsible behaviour.
It is ultimately a government's responsibility to balance these various interests against the basic rights of individuals and the need to protect society. It is through government that many alcohol policies are developed. As a result, in arriving at its decisions, a government must do so in a manner that is responsive, transparent, and inclusive of all of its constituents.
While each of these constituencies has its own responsibilities, the common objective of preventing harm and safeguarding the well-being of society cannot be achieved in isolation. What is needed is a concerted and inclusive approach through partnership.
Partnerships among the industry, the public health and scientific communities, government, and consumer advocates are both possible and almost certainly necessary, in order to achieve the goals of developing and implementing an appropriate and effective alcohol policy. But an effective alcohol policy - like most other social policies - is likely to depend on co-operation and co-ordination among all those concerned, not simply on the unilateral imposition of rules and regulations.
The prevention of alcohol problems and the reduction of harm are a high priority the world over. Partnership approaches to address these issues have been developed in many countries. In several mature market economies, so-called social aspects organisations (SAOs), funded by the beverage alcohol industry, working in partnership with government, public health and research, have been established to address these issues and problems. The experience of such entities regarding successful approaches can easily be adapted to the specific needs of Polish society and the prevailing alcohol issues. While the prioritisation of problems around alcohol here may be different from that in other countries, the basic issues remain the same.
The groundwork has been laid for effective partnership development here. The objective of the next steps in this process is to identify and develop tangible and concrete initiatives that are relevant to the country and address its specific needs. TAG and ICAP remain committed to continuing this process here. However, it is also incumbent upon all other relevant parties, be they from the public or the private sector, to continue their commitment and ensure that viable and sustainable partnerships can be the way of the future.
Helmut B. Wagner is director general of The Amsterdam Group and Marjana Martinic is director of science policy at the International Centre for Alcohol Policies.
