Can we define alcohol drinking guidelines in Europe?

Europe is diverse. As is our alcohol drinking culture. While everyone agrees that the harmful use of alcohol is detrimental and must be addressed, countries and governments take different approaches to do this. One approach is to provide drinking guidelines to citizens. These guidelines give information on alcohol consumption that is considered low risk. However, across Europe, these guidelines vary considerably – not only in what is considered low risk but also in the way of presenting the information.

The idea behind guidelines like these are based on principles of health promotion. Bernt Bull, Chair of RARHA’s Advisory Group, reported in the latest RARHA newsletter from the EC’s Committee on National Alcohol Policy and Action (CNAPA) meetings. The members of this policy group often ask questions related to guidelines for alcohol use: What advice should be given? Should everybody receive the same advice? How should such information be disseminated? RARHA and its work on guidelines aims to find answers to such queries.

‘Low risk’ alcohol consumption varies from one country to another

As part of the process to find these answers, the Italian Istituto Superiore di Sanità (ISS) carried out a survey to update information on national guidelines concerning ‘low risk’ drinking. The survey was disseminated amongst CNAPA members and covered EU Member States as well as RARHA partner countries. The purpose was to validate information previously gathered by the WHO and by the OECD Health Division. Obtaining the correct information is not always straightforward. In some countries, ‘low risk’ drinking guidelines are revised to take into account new scientific evidence. In other countries, no ‘low risk’ drinking guidelines are disseminated or the guidelines do not have an official status, that is, have not been issued by a medical or public health body.

The information also tends to be ambiguous because guidelines are given in different ways. When ‘low risk’ refers to health harm over a longer period of time, the guideline may specify average alcohol consumption per day or per week. When ‘low risk’ refers to immediate harm due to drunkenness, the guideline may specify a maximum amount of alcohol not to be exceeded on any single occasion. Guidelines for men and women are usually different, and there may be different guidelines for younger or older people.

As it turns out, the picture is even more complex than that. Although the properties of alcoholic beverages are the same and there are no differences across borders in how the human body reacts to alcohol, the level of alcohol consumption defined as ‘low risk’ varies between countries. In the 21 countries from which the ISS obtained information on the guideline for ‘low risk’ alcohol consumption per day, the average daily amount not to be exceeded ranged from 20 to 48 grams of pure alcohol for men and from 10 to 32 grams for women. (A ‘standard drink’ e.g. a small glass of wine or a half-pint of beer, contains approximately 10 grams of alcohol.) From a layperson’s perspective, this is puzzling to say the least.

Low-risk-guidelines-ISS-2014

What about guidelines for young people?

RARHA also looked at guidelines for young people and how these differ across European countries. This age group is more vulnerable to alcohol consumption. The discussion, held by RARHA, on guidelines for people under the legal drinking age centred on whether they should remain abstinent or whether a harm reduction approach with specific advice concerning risk and protective factors should be taken to address them. Typically, young people are difficult to reach with prevention messages, so any efforts to influence them must take into account their realities. Initial results of experts’ discussions indicate that different type of guidance are needed for different age groups.

Policy in an international context

The Finnish National Institute for Health and Welfare (THL) hosted a European expert meeting on drinking guidelines in the context of RARHA on 17th February this year. The aim was to present and discuss the outcomes of the work done on guidelines so far. The participants learned about alcohol policy in an international context with contributions from both the EC and the OECD as well as about guidelines’ developments in European countries (UK, Switzerland, France and Finland). A presentation on RARHA research on alcohol related health risks and how this can be used to inform policy making and the setting of low risk guidelines contributed greatly to the high level of discussions of the meeting. The presentations and videos can be accessed here.

On the 6th September 2016, EuroHealthNet organises a policy dialogue in Brussels to discuss the importance, relevance and implementation of the various RARHA outcomes with national and European policy makers. The dialogue will involve representatives from national ministries of health and the European institutions as well as experts from RARHA. The final conference of this Joint Action takes place on the 13th-14th October in Lisbon with participation of the EC’s Health Commissioner Vytenis Andriukaitis.

For more information, visit the website www.rarha.eu

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