The Norwegian government’s Health Directorate has examined the policy solution of alcohol warning labels since July 2021. Now the Directorate has concluded the investigation and delivered its letter of recommendation to the Ministry of Health and Care Services.
In the letter that comprises more than 30 pages, the Norwegian Directorate of Health emphasizes that warning labeling can be an important tool for increasing the population’s knowledge about possible health damage from alcohol use.
The health experts point out that the health risk particularly applies to the link between alcohol use and cancer and cardiovascular disease.
A large proportion of the population is unaware of the connection between even light alcohol use and cancer,” the directorate writes, as per NRK.
The Norwegian Directorate of Health
Linda Granlund, division director for public health and prevention at the Directorate, says that the evidence about the links between alcohol use and the cancer and cardiovascular disease risk has been growing in recent years.
It is now known that there is no safe limit, and that increased alcohol intake increases the risk of disease, and especially the risk of cancer,” says Linda Granlund, division director public health and prevention.
Linda Granlund, division director public health and prevention, Norwegian Directorate of Health
Movendi International contributed to the directorate’s investigation into the evidence base by supporting the advocacy work of the Norwegian Cancer Society with a dedicated briefing on the latest evidence and best practices worldwide, concerning alcohol warning labeling.
International research shows that alcohol industry self-regulation in the field of labeling is not effective. For this reason, the WHO recommends in its global strategy to include product information as well as health information and warnings on alcoholic beverage labels in order to reduce alcohol use.
Research shows that including health information and warnings on alcoholic beverage labels:
- leads to greater consumer awareness of the harmfulness of alcohol;
- increases the intention to reduce alcohol use; and
- reduces alcohol consumption.
Further follow-up
The new recommendation is a follow-up to the government’s new alcohol strategy.
It has now been sent to the Ministry of Health and Care Services, for further follow-up. State Secretary Ole Henrik Krat Bjørkholt writes in an e-mail that it is important to increase knowledge about disease and injury risk linked to alcohol use.
Warning labeling is a tool that can contribute to increased knowledge about alcohol harm,” writes Minister Bjørkholt, as per NRK.
Ole Henrik Krat Bjørkholt, State Secretary, Ministry of Health and Care Service
Mr Bjørkholt says that the reason why the directorate has been asked to study proposals for a system with alcohol warning labeling, with a view to introduce such labeling in Norway because recognition of alcohol’s cancer and cardiovascular disease risk is low but labeling can make a difference.
A recent study by Oslo Economics revealed that harm caused by the alcohol industry costs Norway between $9 to $11 billion annually.
Oslo Economics calculated the costs caused by the products and practices of the alcohol industry to Norwegian society. They report that the harm caused by the alcohol industry costs Norway between 80 to 100 billion Norwegian kroner ($9 to $11 billion) annually.
For context, the annual costs of alcohol harm in Norway amount to the cost of three Winter Olympics in Beijing 2022.
The Norwegian government aims to reduce population-level alcohol consumption by 10% by 2025. This would have wide-ranging benefits for people and communities in Norway, including better public health, fewer alcohol-related injuries, and a better quality of life.
Movendi International curates a resource page about the growing evidence base and concrete policy practices of alcohol labeling, including health and pregnancy warning labeling.
Front of bottle cancer warnings coming
The Directorate suggest to include health warning labeling for alcoholic beverages in the Norwegian Alcohol Act.
A more detailed and concrete proposal for design must be considered at a later date, the directorate writes, according to NRK.
We have not yet decided what the labeling should look like and how it should be implemented and managed,” said Ms Granlund.
First, there must be a political decision on whether we should do it or not.”
Linda Granlund, division director public health and prevention, Norwegian Directorate of Health
It is proposed that the warnings be in line with the World Health Organization (WHO) guidelines. The WHO has proposed that specific requirements be introduced for how information is to be presented on the packaging. The WHO recommendation proposes that guidelines for size and font be introduced, and that the warning be placed on the front of the product – with easy-to-understand information.
I am glad that the health directorate leans on WHO’s recommendations, which are quite clear,” says Ragnhild Kaski, secretary general of Av-og-til, a civil society organization working for alcohol awareness, as per NRK.
Ragnhild Kaski, secretary general, Av-og-til
Sara Underland Mjelva is section leader for prevention at the Norwegian Cancer Society. She says a labeling scheme will make it easier for people to make healthier choices, according to NRK reporting.
A series of journal articles published on the Journal of Studies on Alcohol and Drugs in March 2022 supports that when alcohol bottles come with conspicuous labels providing information on the risks of alcohol consumption or alcohol use guidelines, people are better informed about alcohol’s harms and may cut down their alcohol use.
The World Heart Foundation (WHF) issued a policy brief in January 2022 that established the evidence base that no amount of alcohol is good for the heart.
The lastest scientific evidence shows that any amount of alcohol use, even low-doses, can harm cardiovascular health. The policy brief by WHF calls for urgent and decisive action to tackle the unprecedented rise in alcohol-related death and disability worldwide.
Ms Mjelva says it is “well documented” that alcohol increases the risk of 7 different types of cancers. In Norway, around 1,000 cancer cases each year can be attributed to alcohol use, with breast and bowel cancer being the most common.
Norway is far ahead in many alcohol policy areas,” says Sara Underland Mjelva, as per NRK.
Alcohol warning labeling should be the next action area. We know that knowledge about the link between alcohol consumption and cancer is very low, such a labeling scheme will be able to remedy this.”
Sara Underland Mjelva, section leader for prevention, Norwegian Cancer Society
Increases in individual-level knowledge of the alcohol-cancer link is associated with higher levels of support for pricing policies, specifically, setting a minimum unit price per standard drink of alcohol. Improving knowledge that alcohol can cause cancer using labels may increase support for alcohol policies, according to a study from January 2020.
European debate
More than 30 years ago the World Health Organization classified alcohol as a carcinogen – in the same group of cancer risk as asbestos and tobacco smoking. Nevertheless, few countries operate with a cancer warning on alcoholic beverages, similar to tobacco.
Ms Mjelva emphasizes there are good grounds for saying that an alcohol warning labeling scheme could improve knowledge, but that it is more uncertain whether it will affect consumption.
The reason for the uncertainty is that few countries have introduced a labeling scheme in line with WHO recommendations. In several places, the scheme has been stopped or reversed due to pressure from the alcohol industry.
In February 2021, the European Commission launched “Europe’s Beating Cancer Plan”.The ambitious plan aims to reduce the cancer burden in the European Union affecting patients, their families and health systems. Movendi International welcomed this plan which focuses on prevention, including alcohol policy solutions in particular for the effort to beat cancer in the EU. Europe’s Beating Cancer Plan contains the target of – at least – a 10% reduction in per capita alcohol use by 2025, in line with Agenda 2030.
One of the measures included in the plan is health warning labeling on alcohol.
Alcohol’s cancer link is irrefutable. Already in 1988, the World Health Organization (WHO) concluded that alcohol causes throat, liver, breast, and colon cancers. In the EU, in 2016 cancer was the most common cause of alcohol-related deaths at 29%.
The European Union (EU) is considering which health warning labels to put on alcohol products, following direction from the EU Beating Cancer Plan. But the alcohol industry has already launched an aggressive fight against labeling, using tactics of muddying the science and using their own corporate social responsibility (CSR) initiatives against this proven effective public health measure.
Alcohol’s cancer risk is well documented across the world. Nevertheless, the general public still remains largely unaware of this risk. Evidence shows that Big Alcohol is doing everything they can from muddying the science to propagating myths to keep people in the dark.
But alcohol health warning labeling is a growing priority in other EU countries, too. Research by the Trimbos Institute outlines the possibilities for a mandatory provision of product information and health warnings on the risks of alcohol on alcoholic beverage labels for Netherlands.
The research shows that labeling could raise awareness about alcohol harms and help reduce alcohol harm in the country. Furthermore, people have a right to know what is in an alcohol product and the risks entailed with it.
