If we may, we’d like to start this interview with a challenge. Explain to me, in as few words as possible, the rational—the raision d’être—behind public health policy.
AV: To be very short, public health policy should make people's lives, in terms of health problems, as boring as possible so they can live out their normal lives, so they can spend time with their family, so they can work. I would say this is the most general definition of public health.
You supported a ban on alcohol advertising in Lithuania in 2011. Why?
AV: This is actually a story that started before 2011. In the beginning, the idea was just to restrict advertising on TV and on the radio, not to implement a total ban. Actually, nobody was even dreaming of a total ban! Interestingly enough, the proposal for a total ban did not come from our coalition but from the alcohol industry itself. A complete ban was never introduced because the same industry became very active a few months before entry into force and worked very hard to remove it. The total ban was supported by NGOs and the health sector because it would save the state money. When the state has regulations like restrictions on content, time and place of advertisements, it requires a lot of public administrative resources to monitor and eventually sanction violations. When the ban is total, there is no such need.
We have the experience with tobacco advertisements. There is nearly a total ban in Lithuania, and it works very well. It does not require very high levels of public resources to enforce, and the impact has been very high—we observed a drop in smoking prevalence immediately after implementation. That‟s why we supported a ban for alcohol, too.
Just to clarify, you say the alcohol industry played an interesting role there. At first they supported the ban, and then afterwards they said ―we have the restrictions so we don’t need it.
AV: Almost, but there were a few other important players, too. At first, it was the alcohol industry that was most involved. When it was removed, the media industry had also jumped in because we were talking about a lot of money that was going to newspapers and television from alcohol. But the alcohol industry wasn‟t being entirely genuine at first. They were so sure the ban would be removed that they were eager to propose it.
Let’s talk about other market-based measures. At the Population Europe event in Riga, we had a short discussion on penalising certain health behaviour, if you remember. How effective are those market-based measures, such as so-called "sin taxes" or minimum pricing?
AV: When we talk about penalising, we usually refer to the taxation of the behaviours we want to avoid. That is, the taxation of alcohol, tobacco, or even unhealthy foods like in Finland or Denmark. This is a very classical tactic that in the beginning was not even used for public health but to raise tax revenue. Finance ministers knew that people reacted very slowly to the increase of those taxes because people who are addicted will not quit immediately. The price increase generated more income, but it was also found to lead to a decrease in consumption.
Taxes also have the added value of acting like an advance payment from the user for future health problems caused by alcohol or tobacco use.
Let’s look at the underlying factors of these risky behaviours. Alcohol production and consumption hold a prominent cultural place in many European societies. Are such cultural links compatible with public health objectives?
AV: The term tradition has become more and more relative. Traditions are constantly changing. Look at production. The industry itself is more and more global. We know that, for example, the global production of beer is held in very few hands. It is not like it was in Belgium or Germany, the small breweries making beer in local communities. Now we have big brands, big companies actually owning most of the market in the world. The same is happening with wine and hard liquor.
As for consumption, not only do we see younger generations consuming more, but what they consume is very different than what was consumed by their parents. In Lithuania, the older generations drink liquors like brandy or vodka. They believe they are healthier. The younger generations drink beer, wine and cider, and then say “We are not alcoholics!”
It‟s mainly a matter of marketing, though, which today is more targeted and borderless thanks to the internet and social media like Facebook.
For our Brussels readers, what is the value of action at the EU-level for alcohol and tobacco controls? What should be done in the future, especially since the expiration (and non-renewal) of the EU Alcohol Strategy?
AV: Tobacco and alcohol have to completely different stories at the EU level. If we take tobacco, there is the EU Tobacco Products Directive and its revision, which is legally binding. With alcohol, it is a completely different story.
Alcohol is still treated as a food product at the EU level, but at the same time it is not even regulated like other food products. There is no labelling, no calorie count. Alcohol control is in the Stone Age in the EU. Europe needs EU-wide measures to support their member states, especially small member states who are too weak to resist the pressure from big multinational companies. That was clearly understood with tobacco, but it is not with alcohol.
In a 2014 webinar, you presented 7 popular myths about risky behaviour (which can be found here). Which of these myths do you find the most damaging to public health, and why?
AV: One of the most damaging is the idea that tobacco and alcohol controls are different. With tobacco, from the public health and political perspective we understand there is no safe consumption. There is no safe limit and there are no health benefits. The message is clear—there is no discussion. When we talk about alcohol, we see a completely different picture. We see manipulation. One of the most damaging myths at the moment is that alcohol can even be good for your health.
Another myth is that people can learn to drink responsibly. When we start to drink, whether we become dependent is up to our genes and to our metabolism. It is basically a lottery!
From my perspective, what I see as a public health advocate and a doctor, at this level we have to make people believe that not drinking is at least as normal as drinking. Nowadays in many places people believe that not drinking is not normal. People not drinking are not socially accepted. We have to change this to help those who are already motivated to change their behaviour, to help them feel that they are socially accepted, and that they are normal people.
Thank you!
Aurelijus Veryga is medical doctor and public health lecturer, but his most visible work is dedicated to the Lithuanian National Tobacco and Alcohol Control Coalition, of which he is president. We asked Prof. Veryga about a number of different policy interventions, whether traditions are at odds with public health objectives, and to debunk some of the most ubiquitous myths in public health.