Per capita alcohol consumption and alcohol-related harm: an analysis of long-term evidence from Nordic and Mediterranean countries
Nowadays, the often so-called ‘population-based or public health approach’ (henceforth PBA) to tackle alcohol-related harm – mainly based on Ledermann’s (1964) log-normal distribution of alcohol consumption theory and on Skog’s (1985) theory of the collectivity of drinking cultures – is gaining popularity, spreading across countries and tend to suppress alternative approaches. Traditionally, countries with Protestant, Calvinist, and Puritan roots where a non-neglectable part of the population has reservations against any alcohol consumption, aim to control and protect their citizens from the potentially harmful substance ethanol. Alcohol policy measures that affect the entire drinking population, such as price policies, are claimed to be most effective and efficient to reduce alcohol-related harm (the evidence is usually derived from trendy models), since the level of per capita alcohol consumption is assumed to be closely related to problem drinking. But in how far is the PBA backed-up by empirical evidence today?
Method: I opted for a backward-looking, a–posteriori approach, using longer-term data and descriptive statistics as well as the explanation by contrast methodology, comparing Nordic to Mediterranean countries that differ culturally as well as regards the approach taken to tackle alcohol-related harm. Traditionally, in countries with Catholic roots, most citizens tolerate and view moderate alcohol consumption as compatible with a healthy lifestyle. Therefore, alcohol policy measures tend to focus not on the substance but attempt to support people with the intention to minimize risky drinking patterns without putting excessive burden on moderate drinkers (the so-called ‘health promotion approach’, henceforth HPA).
Results: Long-term data from Nordic as well as Mediterranean countries suggests that alcohol affordability has little impact (and explanatory power) on levels of and trends in per capita alcohol consumption. Moreover, positive trends in alcohol-related harm indicators, such as heavy episodic drinking, underage drinking indicators, drink-driving deaths, or life expectancy at birth, can be observed in both Mediterranean and Nordic countries irrespective of levels and trends in per capita alcohol consumption.
Conclusion: Long-term data in Nordic and Mediterranean countries does not confirm the population-based theory. The evidence does not suggest that the PBA performs better/worse than the HPA. Empirical evidence from the past is an important piece of information for further research that should transcend from empiricism to the underlying social conditions, which may better explain the declining trend in alcohol-related harm: perhaps it is worth drawing on the critical realist approach in economics.