The Green Paper on Alcohol Policy has been Estonia’s strategy document for addressing alcohol-related harms since 2013 [1]. The national alcohol policy objectives stated within the green paper were to:
- reduce total alcohol consumption;
- reduce harmful consumption;
- prevent alcohol consumption by minors;
- ensure a safe environment and reduce alcohol-related crime, social problems and health damage; and
- develop treatment and rehabilitation services for motivated people with alcohol dependence.
WHO conducted an evaluation to assess the public health impact of the green paper and associated policies [2]. The evaluation that was carried out presented an analytical overview of alcohol consumption and alcohol-attributable harms in Estonia between 2000 and 2023, examined the outcomes of predefined indicators, evaluated the overall public health impact of selected policy measures in Estonia.
The level of alcohol consumption among the Estonian population, measured as alcohol per capita consumption in persons aged 15 years or older (in litres of pure alcohol), was significantly lower between 2013 and 2019 compared with before 2013. Both key indicators for attributable harm – age-standardized all-cause mortality and life expectancy at birth – demonstrated steady decreases and increases, respectively, until the coronavirus disease (COVID-19) pandemic began. However, these indicators had already begun to change prior to the adoption of the green paper. The effects of a substantial taxation decrease and of the COVID-19 pandemic on both alcohol consumption and health indicators in Estonia have been clearly evident, leading to an abrupt halt in the increase in life expectancy, the polarization of drinking patterns and marked increases in 100% alcohol-attributable mortality. The evaluation concluded that while there was a notable reduction in alcohol consumption and intoxication among minors, the target of reducing the annual population alcohol consumption to under 8 L per capita was not achieved.
The evaluation provided evidence-based insights for future alcohol control efforts in Estonia and also gave following policy considerations:
- increasing alcohol excise taxation to reduce the affordability of alcoholic beverages and reduce consumption and attributable harms;
- increasing the capacity of the treatment and care system for alcohol-attributable problems and alcohol use disorders;
- implementing further availability restrictions, such as limitations on the density of sales outlets, further limiting purchasing hours (for example, limit sale hours on Sundays);
- prohibiting the sale of alcohol in gas stations;
- restricting hours for on-premises drinking;
- establishing a licensing system and banning internet sales of alcohol; and
- continuing to routinely closely monitor and evaluate all alcohol policy interventions.