Finland. Country description. Case studies Finland. Finland in figures

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1 Finland Country description Finland in figures Finland is one of the Nordic countries and a member of the European Union since The population is 5.3 million people with 0.3 % as an annual population growth rate. Life expectancy is 76 years for men, and 83 years for women. Income group is high (World Bank) with GDP per capita (PPP) $35,400. Urbanization rate is 85 % of total population. Finland is a modern welfare state with a high standard of education, equality promotion and national social security system which is currently challenged by ageing population. Over the years, Finland has been one of the top ranking countries on the Global Gender Gap Index (2010). Alcohol consumption in figures In 2008, alcohol consumption in Finland was 10, 3 among population aged 15 years, which is somewhat lower than the EU average 10.8 (Figure 1; OECD, 2010). The use of alcohol in Finland is considerably higher than in other Nordic countries like Norway (6.8), Sweden (6.9) and Iceland (7.3). Between the years of , the alcohol consumption per capita increased as much as 30 % in Finland. (Alcohol consumption is defined as annual sales of pure alcohol in liters per person aged 15 years and over.) Figure 1 In Finland, the increase of alcohol consumption has happened in the context of rapid economic growth, increased prosperity and wider availability of alcohol. Since the 1970s, adult per capita alcohol consumption has been in decline in many Western countries (Figure 1). Finland is an exception, total alcohol consumption being on increase, even if the opinions of Finns on alcohol policy have become stricter over time. The proportion of those calling for stricter alcohol policies rose from 55 % to 88 % from 1994 to Alcohol related harms The documented unhealthy increase in the use of alcohol has been a reason for much debate and health concern in Finland. Age standardized death rates of liver cirrhosis and alcoholic liver diseases have significantly increased among men and women between the years of (WHO Mortality Database). In 2005, alcohol was claimed to be the leading cause of death for men, and a close second for women. Alcohol is also found to be a contributory factor in suicides, and alcohol intoxication is involved in nearly one quarter of deaths caused by accidents or other forms of violence. Alcohol is implicated in many social problems such as family conflict, arrests, drinking driving, job instability and frequent short periods of sick leave.

2 It is estimated that the direct costs of alcohol related are 800 1,000 million euro per year, with additional indirect costs of 3,300 6,300 million euros per year. Alcohol campaigns As a response, a variety of preventive campaigns and alcohol policies have been initiated in Finland order to bring alcohol consumption under control including health warnings and restrictions on TV advertising. A new Alcohol Program for was launched by the government as a continuation of the previous Alcohol program for The program is focused on co operation for reducing alcohol related harm. Methods of harm reduction include: renewed alcohol policy; substance abuse prevention; and care and services for substance abusers. The government supports the new alcohol program through a large scale health promotion policy. A new initiative is to lower the alcohol content of beer. There are positive results from Sweden showing that diluting the standard class beer reduces 'binge drinking' or heavy episodic drinking particularly among young people. In Sweden beer sold in grocery and other stores has a maximum alcohol content of 3.5 percent. In both countries alcoholic beverages containing more than 4.7 % of alcohol are sold from state run alcohol outlets (In Finland Alko). The preventive actions have been quite successful since the alcohol consumption shows a decreasing tendency for the third year in a row in Finland. In 2010 the per capita consumption was ten liters of 100 % alcohol, which is a decrease of 2 % on the previous year. The overall consumption of alcohol has decreased since The reported positive change in the alcohol consumption is also reflected in the drink categories: the consumption of mild alcoholic beverages has increased in Finland, while the consumption of strong alcohol spirits has decreased. The current trend has continued since Alcohol monopoly Alko Inc. One reason for the changes in the use of alcohol is that alcohol prices rose in Finland. The prices of alcohol beverages were, on average, 4 % higher in 2010 than during previous years. There is a national control (Alko monopoly) of sales of alcohol beverages in Finland. Alko is a government owned company administered and controlled by the Ministry of Social Affairs and Health. Alko has the sole right for the retail sale of drinks containing alcohol. The only exceptions for this are fermented beverages containing up to 4.7 % alcohol by volume and wines sold by Finnish farm wineries containing up to 13 % alcohol by volume. Alko s functions and operations are defined in the Alcohol Act and in a related decree. Alko is an essential element of the Finnish alcohol system, which aims to regulate alcohol consumption and curb its adverse effects. Alko has been very active in promoting preventive programs in multiple ways. One good program is In the Company of Children, which is targeted on young parents with children. The aim is to regulate parents use of alcohol in the company of children.

3 Drinking patterns in Finland gender differences Finland is typically a beer drinking country. Of the recorded adult (15+) alcohol consumption by type, the share of beer is 46 %, while the share of spirits (distilled beverages) is 28 %, wine is 23 %, and others (e.g., fermented beverages made from maize, rice or cider, fruit wine, etc) is only 3 %. There is a clear gender difference in drinking preferences; men drink beer while women prefer cider and milder wines. The alcohol consumption of Finns is unevenly distributed. A small part of the population does not drink at all, a large part drinks a little, most of them moderately, and a small part excessively. Men consumed virtually all of the alcohol in Finland until the late 1960s. Gradually, more women have started to drink alcohol. Today, 12 % of (adult) women say they never drink alcohol, while 30 % say they drink alcohol at least once a week. The corresponding figures for men are 10 % and 49 %. The share of women s alcohol consumption has increased, but is still remarkable small (25 %) of the total alcohol consumption. In the Finnish drinking culture it is rare to combine alcohol with midday or evening meals during the normal week. Alcohol is mostly consumed during weekend evenings and nights. There are some changes in drinking patterns, since drinking more often (but less quantity) during the week is today more common than it was a generation ago. This pattern is notable particularly among middle aged women and men. Drinking to get drunk, or binge drinking, is still common in the Finnish drinking culture. In Finland heavy episodic drinking is considered risky if a woman drinks five or more and a man seven or more drinks of absolute alcohol on at least one occasion weekly. According to a rough estimate, about one fifth of men and about 10 % of women, who say they drink alcohol, exceed the safe use guidelines in Finland. It is estimated that there are working alcoholics or heavy drinkers in Finland. 'Heavy drinker' is a term used to refer to a consumer of alcohol who drinks amounts of alcohol that exceed normal social or healthy drinking. The term alcoholic refers to a person who has a chronic neuron level disease. He/she might not drink often, but on those occasions is unable to properly stop drinking regardless of the extreme problems that drinking causes. The Finnish Medical Society defines alcoholism as a chronic and recurring brain disease. According to a recent European College of Neuropsychopharmacology publication (2011), alcohol related disorders were found to be among the three most important contributors to the burden of disease in the selected 30 European countries participating in the study. The study found clear gender differences in this regard: women were cited to be more affected by depression, while for men alcohol use disorders was the biggest relative contributor to the disease burden in Europe. Also regional differences were notable. (See more information about the study: Occupational safety and health (OSH) services in Finland In Finland all employers are responsible for organizing preventive occupational health care for their employees. The goal of occupational health care is to sustain and promote health and well being of employees. Occupational health services are planned as a cooperative effort at

4 the workplace by the occupational health professionals, the workplace HR department and the person responsible for occupational safety and health questions (OSH committee or delegate). Employers can arrange occupational health services either by themselves, together with other employers or purchase the services from a private or a municipal service provider. The Social Insurance Institution pays the employers 60 % of the costs in compensation. Correspondingly, entrepreneurs and other self employed persons are paid compensation for the occupational health services. Provisions on occupational health care are laid in the Occupational Health Care Act, Occupational Safety and Health Act, the Primary Health care Act, and the Health Insurance Act. In 2006, an Agreement of the Treatment and Care of Alcohol and Intoxicants in the Workplaces was signed by all principal Social Partners in Finland. The Agreement gives recommendations and explicates the general procedures of the stepwise alcohol and intoxicants treatment and care process. It includes rules and sanctions if the procedure is not followed, e.g., under which conditions a dismissal process can be started. Alcohol prevention as part of OSH services brief interventions According to recent Finnish studies, % of alcoholic dependencies can be successfully treated. The first step is to identify the problem by using AUDIT test and then start step tostep treatment process, or brief intervention. A four year project was launched in 2004 to introduce brief interventions for heavy alcohol consumers in occupational health care. The idea was to make brief intervention a routine procedure among health care professionals to ask about patients alcohol use. Interactive training in small groups was provided and tailored to local needs Brief interventions are practices in health care which aim to identify real or potential alcoholrelated risks and motivate patients to do something about hazardous drinking. Brief interventions cover a range from one five minute interaction to several 45 minute sessions. In Finland the recommendation is minutes with one to four follow ups. In the course of the project attitudes became more favorable about brief interventions, and at many workplaces the management strongly supported the preventive activities. The project provided new tools, networks and methods for integrating the brief intervention model into health care services throughout Finland. (Source: From theory to practice. Integration of a brief intervention into health care work and occupational health care. Edited by Kaija Liisa Seppä. Report of the Ministry of Social Affairs and Health, Helsinki, 2008) A recent dissertation study (2010) proved that introduction of brief intervention as a new model in health care has been slow and fraught with obstacles. The study evaluated the views of professionals (physicians and nurses) towards implementing brief interventions. The major problem was lack of time and adequate reimbursement. Altogether 59 % of the surveyed health care professionals (n=473) in primary, occupational and specialized health care were positive in the matter of asking patients alcohol consumption and 68 % could bring up alcohol problems for discussion. However, only 19 % believed that they could influence patients drinking very well or quite well. Respondents own alcohol consumption did not correlate with these attitudes. Even if alcohol screening and brief interventions were found to be slower than hoped in becoming part of health care

5 professionals everyday work, the attitudes had become more favorable. (Source: Janne Kääriäinen: Stepwise, Tailored Implementation of Brief Alcohol Intervention for Risky Drinkers in Health Care. Tampere University Press, Tampere 2010). A new study was published in 2010 by a research team at FIOH exploring alcohol related harms and their prevention policies (Kivistö, Jurvansuu, and Hirvonen 2010). The study examined the need for prevention and analyzed the actions being undertaken to prevent harmful effects of excessive alcohol use in eight Finnish workplaces and their OHS (Occupational Health Services). The need for preventive actions was considerable at both workplaces and their OHS, but actions were mainly focused on acute problems. In many workplaces alcohol policy documents were missing. Problem drinking was brought up in OHS, but advisory material was poorly shared. Practices for preventing alcohol related harm were not in place, and co operation between the workplace and OHS proved to be far from effective. (Source: Marketta Kivistö, Hanna Jurvansuu & Leena Hirvonen: Alcohol and the workplace need for actions to prevent alcoholrelated harm in the workplace. Finnish Institute of Occupational Health, Research report: 38 in Finnish with English abstract.) Important links: National Institute for Health and Welfare Finnish Institute of Occupational Health National Insurance Institute Ministry of Health and Social Affairs Alco Inc. is an independent limited company wholly owned by the Finnish Government and administered and supervised by the Ministry of Social Affairs and Health clinc.fi The A clinic foundation operates to reduce alcohol, drug and other addiction problems AddictionLink has been the most popular site in Finland to deal with substance abuse and addiction

6 Finnish Center for Health Promotion Association for Healthy Lifestyles Figure Alcohol consumption among population aged 15 years and over 2008 (or nearest year available) Change per capita, Turkey Malta Norway Sweden Iceland Italy Greece Cyprus Netherlands Slovak Republic Romania Germany Latvia Switzerland Finland Belgium EU Poland United Kingdom Bulgaria Denmark Slovenia Portugal Spain Czech Republic Ireland Austria Lithuania France Hungary Estonia Luxembourg Source: OECD Health Data 2010; Eurostat Statistics Database; WHO (2010).