HiAP and alcohol policies

The core of the Health in All Policies (HiAP) approach is to examine determinants of health that can be influenced to improve health but are mainly controlled by the policies of sectors other than the health sector. In this regard, alcohol policy serves as a good example of a policy area that should in fact be embraced by HiAP. In addition, HiAP concerns addressing policies in the context of policy-making at all levels of governance, including global, European, national, regional and local levels of policies and governance, making it even more relevant from the perspective of alcohol policy.

Examining the presence of alcohol policy in national level decision-making from a HiAP point of view, we can detect alcohol issues in several focal points for intersectoral actions. Policy briefings, committee work, health impact assessments as well as legislation on public health laws all take, or at least should take into consideration alcohol's impact on the health and welfare of citizens. One could therefore argue that from a national point of view the minimum requirements for HiAP are fulfilled with regard to alcohol, at least on paper.

In practice, however, HiAP both on a national level in Finland and on an international level has to compete with several other rivaling interests. In the field of alcohol, HiAP's main rivals are economic and trade interests, both on a domestic and international level. Therefore restrictive alcohol policy could first and foremost be described as a damage limitation strategy. There are a multitude of conflicts between different interests in the alcohol field and very seldom is consensus reached between the different views.

European Level Alcohol policies and HiAP

Although there is a strong legal basis for HiAP at European Union level, there is still a long way to go to see better integration of HiAP in the implementation of community policies and activities. Alcohol as a political issue in the EU has thus far appeared mainly to be a matter of agriculture, trade and taxation. One would be correct therefore in assuming that social and health concerns related to drinking has not occupied a high position on the political agenda in the EU. However, since the late 1980s and into the 1990s alcohol has increasingly appeared as a public health issue and social problem, even in the EU context.

In the Commission, DG SANCO deals with alcohol-related health issues, and based on Article 152 of the EC Treaty, the EU has competence and responsibility to address public health problems-such as harmful and hazardous alcohol use-by complementing national actions. One of the milestones in lifting alcohol up the EU's agenda is the 2001 Council Recommendation on the drinking of alcohol by young people. The Recommendation was followed by Council Conclusions that invited the Commission to put forward proposals for a comprehensive Community strategy aimed at reducing alcohol-related harm and set up to complement national policies. This invitation was repeated in the Council Conclusions on Alcohol and Young People in June 2004.

The most recent and significant achievement is the Commission's Communication on an EU Strategy to Support Member States in Reducing Alcohol-Related Harm (COM (2006) 625) - the first "alcohol strategy" of the EU - in whose preparation and approval the Nordic countries played a central role. The strategy sets out five themes with a view to reducing the harmful and hazardous effects of alcohol consumption in the European Union. These are:

• Protect young people, children and the unborn child;
• Reduce injuries and death from alcohol-related road accidents;
• Prevent alcohol-related harm among adults and reduce the negative impact on the workplace;
• Inform, educate and raise awareness on the impact of harmful and hazardous alcohol consumption, and on appropriate consumption patterns;
• Develop and maintain a common evidence base at EU level.

The priorities all aim at improving health, but they also go even further, meaning the EU strategy could therefore be considered good examples of HiAP. However, when trying to implement the recommendations of the alcohol strategy within the frame of HiAP, one must keep in mind that the EU still does not have a mandate to harmonise health policies in the Member States. When alcohol is approached at EU level as a social and health issue, the influencing methods are therefore often passed to the domain of "soft law".

Guaranteeing the preconditions of alcohol production and creating markets for alcoholic beverages as well as removing trade barriers is on the other hand considered "hard law" at EU level. The mandate on implementing HiAP in the alcohol field is not that strong in the EU. DG SANCO is also not among the most influential DGs in the Commission and has therefore difficulties convincing other, more powerful DGs, like for instance DG AGRI or DG TAXUDD, on implementing HiAP.