The 2021 edition of the Annual Alcohol Report by Systembolaget, the Swedish government’s alcohol retail monopoly, has a special focus on alcohol’s impact on healthcare.
The report illustrates that alcohol harm does not only result in human tragedies but also in enormous costs to society. Figures from the analytics company Ramboll show that care and treatment for diseases and injuries caused by alcohol products, costs Swedish society several billion Swedish crowns every year.
Alcohol remains a major risk factor for diseases that cause a large public burden, mostly non-communicable diseases (NCDs), such as cancer and heart disease. Moreover, alcohol harm is affecting children severely.
Despite the heavy alcohol burden and enormous costs to society, the Swedish public has low awareness about alcohol harms. The new report provides latest data and insights into how the products and practices of the alcohol industry affect both the individual and society at large.
Alcohol costs to the Swedish healthcare system
Analysis by Ramboll shows that the total cost of alcohol-related health and medical care in Sweden amounts to almost SEK 4.2 billion (approx. US$ 488 million) annually. These costs do not include primary care or substance use disorder care in the social services.
Men are at the highest risk, accounting for 70% of alcohol-related health and medical care, specifically those in the age group above 35 years.
Specific healthcare costs due to alcohol are:
- Injuries and poisoning caused by alcohol is the category with the highest healthcare costs at SEK 1.71 billion.
- Care and treatment for mental health and behavioral disorders caused by alcohol costs Sweden just over SEK 1 billion.
- Healthcare costs of cancer caused by alcohol amount to SEK 381 million.
- For cardiovascular disease healthcare costs are SEK 469 million.
Furthermore, the report shows that while inpatient care accounted for only 8% of the health service provided for alcohol-caused conditions, it makes up a major portion of 43% of the healthcare costs spent on all alcohol-caused conditions. This illustrates the high cost of inpatient care.
These findings demonstrate the importance of prevention interventions and population-level alcohol policy solutions to protect and improve public health, and avoid high costs for treatment of conditions that are preventable.
Alcohol major risk factor for public diseases in Sweden
‘Public diseases’ are common diseases that affect population health greatly. Since the second half of the 20th century, Swedish public diseases were exclusively non-communicable diseases (NCDs) until the COVID-19 pandemic hit.
Both physical and mental public diseases have a large impact on Swedish people and society as they disrupt life and work and lead to higher healthcare needs. Alcohol is a major risk factor for some of the Swedish public diseases with the highest impact, such as diseases of the heart and blood vessels, diabetes and mental illness.
It is estimated that 5% of the disease burden in Sweden is caused by alcohol. For teenagers between 15 to 19 years alcohol causes the biggest disease burden.
The report examines five specific public diseases related to alcohol:
- Heart disease
- Alcohol use leads to atrial fibrillation (AF; irregular heart beat) and alcohol is high in calories and raises blood pressure which can lead to stroke over time. Stroke is the most common neurological impairment among adults and the third most common cause of death, after heart attack and cancer.
- A study with 140 AF patients found reduced alcohol use led to less AF episodes and thus reduced risk of stroke.
- Half a million Swedes are estimated to have diabetes.
- Heavy alcohol use disrupts blood sugar control, leads to fatty liver, leading to insulin resistance, destroys the effects of the drugs and risks exacerbating the symptoms of diabetes.
- Mental illness
- Alcohol impairs the serotonin system increasing the risk for depression and anxiety.
- Mental illness is common among those suffering an alcohol or other substance use disorder.
- A Swedish study showed that almost 50% of all suicides were related to alcohol.
- Overweight and obesity
- This is one of the main causes of premature death in Sweden.
- Alcohol is high in calories, and releases cortisol, which promotes storing belly fat and the body lacks capacity to store alcohol which inhibits fat burning. Therefore, it is likely that alcohol use leads to weight gain.
- A British report from 2015 highlights that heavy alcohol consumption is likely to increase the risk of obesity. The report also calls for more research in this area.
- Heavy alcohol use has a negative impact on both men’s sperm production and on fertility in women.
- A study has shown that just five units of alcohol a week is enough to negatively affect sperm quality.
Worryingly low awareness about alcohol harms among Swedish public
The Swedish public has worryingly low knowledge about alcohol harms. A survey conducted by Kantar Sifo on behalf of Systembolaget including 1,524 participants, 1,000 from the general public and 524 who work in healthcare found the following key results:
- 72% of the public believe that they have enough knowledge about alcohol but misconceptions exist and major knowledge gaps persist among the public.
- Only one in four among the general public knows that all alcoholic beverages are equally harmful.
- 56% inaccurately believed that spirits were more harmful than other types of alcohol.
- Only 14% of the public know that even low-dose alcohol use can cause cancer.
- Only 17% of the public know that heavy alcohol use can cause skin problems.
- 43% of the public and 56% of healthcare staff believe that the public need more knowledge about harms caused by the products and practices of the alcohol industry.
- Healthcare staff were more aware about alcohol harms than the general public.
- 30% of healthcare staff reported they find it difficult to talk to their patients about alcohol use.
- This explains why 45% of the Swedish public claim their doctors have never asked about alcohol use.
- In the general public, those who used alcohol in lower doses were more aware of alcohol harms than those who used alcohol heavily.
Children in harms way due to adults’ alcohol use
What’s worse is alcohol harm is increasingly affecting Swedish children. The pandemic made the situation worse for children as found through the BRIS (Children’s Rights Society) report for 2020.
Adults/household alcohol use had increased during the pandemic making children more scared, depressed and anxious in their homes. Closure of schools due to the pandemic meant the usually safe spaces and support available for children were not there anymore.
- Children reached out to BRIS significantly more during 2020. For example, Christmas time in 2020 saw a 40% increase in calls compared to the same time in 2019. The calls were often regarding alcohol intoxication and abuse by adults.
- BRIS had more calls than ever in 2020. Compared to the previous year children increased calls to BRIS about anxiety (+61%), depression (+55%), family conflicts (+43%) and mental and physical violence (+32 and +28 percent, respectively).
Changes in children’s schooling and increased isolation meant great challenges,” said Magnus Jägerskog, Secretary General of BRIS, as per Systembolaget Annual Alcohol Report 2021.
This was particularly noticeable for children who were already in a vulnerable situation before the pandemic.”
Magnus Jägerskog, Secretary General of Bris