Implementing "best buy" alcohol control policies in Lithuania leads to decreases in mortality and improved public health

Lithuania

Photo: WHO Regional Office for Europe Ms Nijolė Goštautaitė Midttun, of the Lithuanian Tobacco and Alcohol Control Coalition, presents insights on Lithuania's alcohol control policy at a recent Copenhagen meeting -"Let’s Talk About Alcohol: WHO in Denmark Edition," 6 March 2024.

Lithuania reduces alcohol harm through policy

Over the last twenty years, Lithuania has grappled with a critical alcohol consumption crisis, marked by some of Europe's highest alcohol-attributable death rates.[1] To combat this, Lithuania started to implement strategies for alcohol control in 2007.[2] An extensive reform of its alcohol policies, adhering to the World Health Organization’s (WHO) guidance, has been conducted.[3] These measures significantly decreased overall mortality rates and deaths directly linked to alcohol use. Despite concerns, the increase in alcohol taxes did not result in a rise in the consumption of ‘unrecorded’ alcohol, which escapes official statistics due to its unregulated production, distribution, and sale. Additionally, these policy changes positively impacted the national budget.[4] Lithuania's strategy offers a valuable model for other nations striving to effectively reduce alcohol consumption and alcohol-attributable burden of disease. The Ministry of Health introduced WHO’s alcohol-related ‘best buy’ recommendations to reduce alcohol-attributable noncommunicable disease and mortality (i.e. increasing prices via taxation, reducing availability of alcoholic beverages, and banning marketing). This approach was also in line with WHO’s Global Alcohol Action Plan 2022-2030 which contributes to the advancement of several Sustainable Development Goals (SDGs): the eradication of poverty (SDG 1), the provision of quality education (SDG 4), the promotion of gender equality (SDG 5), the stimulation of economic growth (SDG 8), and the reduction of inequalities (SDG 10).[5][6][7]

These activities are also a clear example of putting “Delivering United Action for Better Health – a strategy for collaboration between the WHO Regional Office for Europe and Member States in the WHO European Region,” into practice, drawing on WHO’s normative guidance and using this to introduce evidence-informed policy measures to meet the country’s long-term strategic health goals.

WHO's Key Contributions

Provided Lithuania with internationally comparable data on alcohol consumption and alcohol-attributable burden of diseases as well as a set of "best buy" policies tailored to reduce this burden.
Played a pivotal role in the generation and use of evidence and facilitated feedback mechanisms, allowing Lithuania to periodically fine-tune policy.
Co-established a project designed to evaluate the success of the initiatives and disseminate best practice across the Region.
Continual advocacy to maintain the policies in place, including through interaction with the media and Parliamentary debates.
Supported the implementation, monitoring and protecting of “best buy” policies.

How did Lithuania, with the support WHO, achieve this?

Lithuania's comprehensive approach to reducing alcohol consumption and its associated harms began since 2008 with the introduction of a series of measures including daytime bans on alcohol advertising on television and radio (alcohol advertising allowed from 10 pm to 6 am), stricter restrictions for drink driving and increase in excise taxation.[3][8] Since 2009 prohibition of off-premise alcohol sales at night (sales allowed from 8 am to 10 pm) came into effect with an additional increase in excise taxation.3, Yet in 2010, Lithuania was reported to have the highest alcohol-attributable years of life lost in the EU, implementation of the WHO “best buy” policies led to a 20 percent reduction of this rate by 2016.[9][10]To bolster the gains made, additional measures were put in place such as increases of excise tax for all alcohol beverages in 2014-2016, complete advertising bans, and further limitations on retail sales including banned retail sales in petrol stations.[11] In 2017 the Government increased excise taxes, reducing alcohol’s affordability, which in turn led to an immediate decrease in male mortality rates.[3] Subsequent restrictions included raising the minimum legal drinking age from 18 to 20 in 2018, further limiting retail sale hours for off-premise alcohol (sales allowed from 10 am to 8 pm between Monday and Saturday and 10 am to 3 pm on Sundays), and a near total ban on TV, radio, and internet alcohol advertisements.[3] These regulatory efforts were supported by public health campaigns and the involvement of WHO, which played a crucial role in policy advocacy, and maintaining enacted policies.

^{Gauden Galea, from the WHO Regional Office for Europe, discusses Lithuania's alcohol control policy as an example of successful collaboration between different stakeholders at a recent Copenhagen meeting - "Let’s Talk About Alcohol: WHO in Denmark Edition," 6 March 2024}Photo credit: WHO Regional Office for Europe

From 2016, national awareness efforts included participation by the WHO Lithuania representative in national TV shows and press conferences with international experts. This heightened public consciousness played a role in shifting societal norms, making alcohol consumption less socially acceptable, and led to the launch of a research project in April 2020, assessing the impact of alcohol control policies in the Baltic states on health and economies. The Project was coordinated by the WHO Collaborating Centre for the Prevention and Control of Noncommunicable Diseases at the Health Research Institute, Lithuanian University of Health Sciences, and aimed to equip national experts and decision-makers with the necessary knowledge and skills to gather data, identify and evaluate best practices, and assess the cost–effectiveness of alcohol control policies. WHO played a critical role by convening all the countries and experts to develop the grant proposal and by building capacity in alcohol research through a series of workshops.[12] Funded by the United States National Institute on Alcohol Abuse and Alcoholism (NIAAA), this project generated original research on the public health impact of alcohol taxation, along the evaluation of other policy interventions. The research has contributed significantly to the development of an alcohol taxation signature initiative by WHO/Europe launched in Vilnius in 2022. [13] The main idea of the Signature Initiative is to promote a minimum tax share in prices of alcoholic beverages – a measure that is already in place for the tobacco and has shown to be effective in lowering smoking prevalence and rates of death and disease.[14][15]

“By consolidating political commitment, engaging NGOs, academia and with unwavering WHO support, Lithuania has made a substantial breakthrough in alcohol control. The country has implemented comprehensive evidence-based alcohol control measures including WHO 'best buys' and has succeeded in reducing alcohol consumption and related morbidity and mortality.”

-Ms Ingrida Zurlyte, Head of the WHO Country Office in Lithuania

Throughout its policy reform journey, the Lithuanian government diligently monitored the impact of its strategies, utilizing the global WHO monitoring framework, capturing data on alcohol consumption, associated harms, and policy effectiveness. The WHO Regional Office for Europe played a key role in leveraging evidence from the Baltic Alcohol Policy Project, offering vital technical support. Lithuania's approach was characterized by dynamic collaboration with stakeholders, including WHO collaborating centres, academics, Member States representatives, technical experts, and NGOs, fostering a network that proven essential for feedback, capacity building and policy refinement. In May 2023, WHO hosted policy dialogues with the Baltic States to review the outcomes of their joint research and its policy implications, strengthening the collaborative effort and ensuring policy measures remained informed and effective.[16] The Project’s final conference is planned in 2025, which will review and summarize all the results and which will be co-hosted together with WHO/Europe and the WHO Collaborating Centre for the Prevention and Control of Noncommunicable Diseases in Lithuania.

The journey to refining policies faced challenges, notably in 2022 when Lithuania's Parliament (Seimas) Economic Committee debated repealing parts of the alcohol control policies, especially those limiting alcohol availability. Researchers, NGOs, and WHO countered with strong evidence of the policies' success and economic advantages. Their united advocacy led to the committee's decision to uphold all policies, highlighting the importance of evidence-informed policy making and protecting any progress made. Lithuania's experience showcases the effectiveness of evidence-based alcohol control on public health, serving as a valuable blueprint for other nations, particularly within the EU, seeking to implement similar public health strategies.

References

World Health Organization. Global Status Report on Alcohol and Health 2014 [publication] (https://www.who.int/publications/i/item/global-status-report-on-alcohol-and-health-2014, accessed 26 February 2024).
World Health Organization. Reducing harm due to alcohol: success stories from 3 countries [news] (https://www.who.int/europe/news/item/15-04-2021-reducing-harm-due-to-alcohol-success-stories-from-3-countries, accessed 16 February 2024).
Rehm et al. Impact of the WHO "best buys" for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020. The Lancet Regional Health. Europe. Volume 33, 100704, October 2023 (https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00123-0/fulltext#%20, accessed 23 February 2024).
World Health Organization. Lessons from the Baltic Alcohol Control Policy Project: policies that contribute to decreasing burden of mortality and disease [report] (https://www.who.int/europe/publications/i/item/WHO-EURO-2023-7517-47284-69366#:~:text=The%20key%20findings%20of%20the,opposite%20effect%20on%20population%20health, accessed 28 February 2024).
United Nations. Department of Economic and Social Affairs. Sustainable Development. The 17 Goals [web portal] (https://sdgs.un.org/goals, accessed 26 February 2024).
World Health Organization. Tackling NCDs: 'best buys' and other recommended interventions for the prevention and control of noncommunicable diseases [publication] (https://www.who.int/publications/i/item/WHO-NMH-NVI-17.9, accessed 27 February 2024).
World Health Organization. Global alcohol action plan 2022-2030. Action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority [report] (https://cdn.who.int/media/docs/default-source/alcohol/final-text-of-aap-for-layout-and-design-april-2023.pdf?sfvrsn=6c5adb25_2, accessed 23 February 2024).
World Health Organization. Reducing harm due to alcohol: success stories from 3 countries [news] (https://www.who.int/europe/news/item/15-04-2021-reducing-harm-due-to-alcohol-success-stories-from-3-countries, accessed 16 February 2024).
World Health Organization. Europe. Reducing harm due to alcohol: Success stories from 3 countries [news] (https://www.who.int/europe/news/item/15-04-2021-reducing-harm-due-to-alcohol-success-stories-from-3-countries#:~:text=In%202010%2C%20Lithuania%20had%20the%20highest%20rate%20of,a%2020%25%20reduction%20of%20this%20rate%20by%202016., accessed 27 February 2024).
World Health Organization, Europe. Status report on alcohol consumption, harm and policy responses in 30 European countries 2019 [publication] (Status report on alcohol consumption, harm and policy responses in 30 European countries 2019 (who.int) accessed 27 February 2024).
Miščikienė et al. Review of the Lithuanian Alcohol Control Legislation in 1990-2020. Int J Environ Res Public Health. 2020 May 15;17(10):3454. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277450/, accessed 27 February 2024).
World Health Organization. Research project builds national capacities to evaluate alcohol control policies in Baltic states and beyond (https://www.who.int/europe/news/item/12-11-2020-research-project-builds-national-capacities-to-evaluate-alcohol-control-policies-in-baltic-states-and-beyond, accessed 27 February 2024).
World Health Organization. Lessons from the Baltic Alcohol Control Policy Project: policies that contribute to decreasing burden of mortality and disease [technical document]. (https://www.who.int/europe/publications/i/item/WHO-EURO-2023-7517-47284-69366#:~:text=The%20key%20findings%20of%20the,opposite%20effect%20on%20population%20health, accessed 16 February 2024).
World Health Organization. Alcohol taxes save lives: WHO/Europe symposium and launch of a new regional initiative [news] (https://www.who.int/europe/news-room/events/item/2022/02/23/default-calendar/alcohol-taxes-save-lives--who-europe-symposium-and-launch-of-a-new-regional-initiative#:~:text=Signature%20Initiative%20on%20alcohol%20tax&text=The%20main%20idea%20of%20the,rates%20of%20death%20and%20disease, accessed 27 February 2024).
World Health Organization. How many lives could be saved in the Baltic states with a minimum level of alcohol tax? Briefing note on the launch of the NCD Advisory Council Signature Initiative on alcohol tax (2022) [technical document] (https://www.who.int/andorra/publications/m/item/how-many-lives-could-be-saved-in-the-baltic-states-with-a-minimum-level-of-alcohol-tax--briefing-note-on-the-launch-of-the-ncd-advisory-council-signature-initiative-on-alcohol-tax-(2022), accessed 27 February 2024).
World Health Organization. A week of capacity-building, training and policy dialogues on alcohol control [news] (https://www.who.int/europe/news-room/events/item/2023/05/14/default-calendar/a-week-of-capacity-building-training-and-policy-dialogues-on-alcohol-control, accessed 27 February 2024).