Europe is the region that consumes the largest amount of alcohol in the world. In fact, consumption levels in some European countries are around twice the global average
. So it is no wonder that alcohol is the third biggest risk factor in Europe for non-communicable diseases (NCDs), ill health and premature death
. Apart from its action as a central nervous system depressant and its addictive properties, alcohol can directly or indirectly induce over 60 different types of illness, including mental and behavioural disorders, gastrointestinal conditions, cancers, cardiovascular disease, immunological disorders, lung diseases, skeletal and muscular diseases, liver disease, reproductive disorders and prenatal harm
Given how important a risk factor alcohol is, one would expect the European Union (EU) to take this issue seriously and have almost as robust actions as for tobacco. Unfortunately, this does not seem to be the case. In early June 2015, over 20 public health bodies — including Eurocare, a network of some 50 voluntary and non-governmental organisations working on the prevention and reduction of alcohol-related harm across Europe — have resigned from the European Alcohol and Health Forum (EAHF), a platform where bodies active at European level can debate, compare approaches and act to tackle alcohol-related harm. The decision followed the last meeting of the EAHF, where the EU Commissioner for Health and Food Safety Vytenis Andriukaitis announced that EU alcohol policy will be incorporated into a broad framework for the prevention of NCDs without any concrete action points.
How the EAHF failed
The EAHF was established as a tool to support the implementation of the EU Alcohol Strategy (designed to help national governments and other stakeholders coordinate their action to reduce alcohol-related harm in the EU), which expired in 2012. The EAHF brings together public health organisations and alcohol, advertising and hospitality industries. A requirement to be a member of the EAHF is to put forward commitments for actions in line with the EU Alcohol Strategy. Given the absence of plans to develop a new Alcohol Strategy, the public health community believed that its participation in the controversial EU Alcohol and Health Forum could no longer be justified.
The EU Commissioner’s announcement on 18 May 2015 seemed to be a final nail in the coffin of the EAHF and EU alcohol policy. In April 2015, the European Parliament demanded a comprehensive and focused EU Alcohol Strategy
. The EU commission ignored this and further requests from EU Member States via letters from 17 EU Health Ministers and the Committee of National Alcohol Policy Action
The incorporation of alcohol within broad NCDs framework will not sufficiently address the burden of alcohol harm in Europe. A general strategy is the best way to forget the specificity of alcohol problems and of alcohol policy. Crime, violence, domestic abuse, child sexual exploitation and road traffic accidents are just some of the many problems associated with alcohol harm that would be neglected through this approach. For instance, 80% of violent crimes committed by adolescents in Estonia are associated with alcohol use. Alcohol is an attributable factor in 40% of all homicides throughout the EU
. Around one accident out of four is linked with alcohol consumption, and at least 65,000 people are killed in alcohol-related road accidents in the EU each year. Drink-driving remains the second biggest killer on EU roads
Sadly, the European Commission’s approach to alcohol policy seems to be representative of the Juncker’s Commission (in office since 1 November 2014 and due to serve until 2019). Juncker announced that the European Commission will focus on the issues where it has exclusive competence in terms of legal powers, can show direct added value of European action and are of utter most importance. As he said: “I want to be serious about being big on big things and small on small things”
. Surely, given the burden of alcohol on the health budgets of the EU countries, it should be considered a big thing.
One of the first initiatives he scrapped in December 2014 was the revision of tax directives on alcohol. The recommended minimum excise duties in the EU have not changed since 1992 (not even a raise for inflation). The EU still recommends zero excise duty for wine.
In the same way as any issue at European level, alcohol has become politicised, strongly defended by some countries and mainly ambivalent for the rest of Europe. Alcohol, as any other product, is subject to EU law and any changes to it, whether at national or European level, are protected by the EU rules.
The most recent example is the fight in Scotland to introduce minimum unit pricing (MUP) for alcohol. On 24 May 2012, the Scottish Parliament passed legislation to introduce a minimum retail price for alcohol with the aim of increasing the cost of the cheapest, strongest alcohol products in order to reduce and deter harmful drinking.
Following this decision, the Scottish government has been taken to court by the same alcohol companies and organisations (including the Scotch Whisky Association, Spirits Europe and Comite Europeen des Entreprises Vins) that, for years, are in the EAHF telling stakeholders and the commission how much they care about preventing alcohol-related harm. The petitioners argue that MUP breaches Article 34 of the EU Treaties and cannot be justified on public health grounds.
One can understand the scepticism of public health organisations of the real value and purpose of platforms such as the EAHF, where the industry takes “actions” to reduce alcohol-related harm but then takes governments to court if they want to introduce any substantial regulatory actions.
EU’s failure to label alcohol
Another issue that has not been addressed because of the European Commission’s unwillingness and inability to act on alcohol is labelling.
The EU Regulation 1169/2011 on the provision of food information to consumers has made considerable changes to food labelling legislation. The vote was a culmination of some heated debates over a number of contentious issues. Unfortunately, this regulation exempted alcoholic beverages (containing more than 1.2% by volume) from the obligation to provide information to consumers. Alcoholic beverage manufacturers do not have to list their ingredients or provide nutritional information unlike, say, fizzy drinks or orange juice.
According to Article 16 of the EU Regulation 1169/2011, the European Commission was expected to adopt, by 13 December 2014, a report evaluating whether alcoholic beverages should in future be covered by the requirement to provide information on ingredients and nutritional content, and the reasons justifying possible exemptions.
To date, the European Commission is non-committal in terms of the publication date. For the foreseeable future, European consumers are left to wonder what their alcoholic drinks contain.
So what is in alcohol?
Because it is high in sugar, alcohol contains a considerable number of calories, with energy content of 7.1 kilocalories per gram (kcal/g). Only fat has higher energy value per gram (9kcal/g). Studies in the UK have shown that alcohol accounts for nearly 10% of calorie intake among adults who drink
. Therefore, daily energy intake may rise considerably when alcohol is consumed
Drinking alcohol also reduces the amount of fat the body burns for energy. While nutrients, protein, carbohydrates, and fat can be stored in the body, alcohol cannot. As a result, the body prioritises getting rid of the alcohol from its system, meaning that all other processes that should be taking place, including the absorption of nutrients and burning fat, are interrupted. Unsurprisingly, there are clear associations between alcohol and obesity, although these are also heavily influenced by lifestyle, genetic and social factors.
As public health professionals search for effective policies to address alcohol-related harm, labels stand out as a useful way to empower consumers to make healthy decisions about alcohol intake.
European Union institutions are perfectly positioned to coordinate common efforts to inform consumers of both the composition as well as harmful effects of alcohol. So far, the European legislation has failed to allow consumers to make an informed choice about the products they are purchasing.
The EU cannot regulate on the grounds of public health because this is an issue for member states. This has been used as an excuse for the lack of regulatory actions on alcohol for years.
However, if the European Commission had the will and courage, it could act through another legal base (as it did with tobacco) and introduce legal instruments that could help prevent alcohol-related harm. A prime example would be alcohol labelling, as well as restrictions on alcohol advertising and an increase on minimum excise duties.
Aleksandra Kaczmarek is senior policy officer at Eurocare, a network of some 50 voluntary and non-governmental organisations working on the prevention and reduction of alcohol-related harm across Europe.
 European Commission. Member States call on the European Commission for a new and comprehensive strategy to tackle harmful use of alcohol and alcohol related harm, Committee for national alcohol policy and action – scoping paper 2014.
 Dennis EA, Flack KD & Davy BM. Beverage consumption and adult weight management: a review. Eating Behaviors 2009;10:237.