The Nordic alcohol monopolies, shops that have the exclusive right to sell most alcoholic beverages in Finland, Iceland, Norway, Sweden, and the Faroe Islands, have contributed to relatively low alcohol consumption and reduced alcohol-related harm in the Nordic countries. This is a part of the WHO European Region historically known for harmful drinking patterns and high levels of associated harm.
Alcohol consumption levels in the European Union have remained largely unchanged for over a decade, making it the sub-region with the highest consumption levels globally. The EU is currently not on track to meet the global and regional reduction targets for alcohol consumption. In this situation, the public health community looks at good practices across EU countries, where alcohol consumption has been decreasing or has been kept at relatively low levels.
The WHO/Europe report “Nordic alcohol monopolies: Understanding their role in a comprehensive alcohol policy and public health significance today” highlights a comprehensive model used in the Nordic countries that other EU countries could learn some lessons from.
A model for reducing harms
Unlike for-profit alcohol sales models, the Nordic approach (excluding mainland Denmark and Greenland) restricts alcohol availability and minimizes commercial influence by preventing grocery stores and private retailers from selling stronger alcoholic beverages. State-owned monopolies – ÁTVR in Iceland (with Vínbúðin as the retail store for alcohol), Systembolaget in Sweden, Alko in Finland, Rúsdrekkasøla Landsins in the Faroe Islands, and Vinmonopolet in Norway, operate with a clear mission: to protect public health over profit. With limits on outlet numbers and sale hours and days, strict enforcement of age controls, and no marketing or discount pricing, these monopolies emphasize managing alcohol as a product with inherent risks, rather than treating it as an ordinary consumer product.
“This public health-first approach in the management of alcohol retail sales in Nordic countries is a great demonstration of alcohol policies that work,” says Dr Carina Ferreira-Borges, Regional Adviser for Alcohol, Illicit drugs and Prison health at WHO/Europe. “Countries with state-owned monopolies have lower per capita alcohol consumption compared to the EU average and generally have lower rates of alcohol-attributable harms , that span from liver disease, cancers and cardiovascular conditions to injuries and drownings.”
Challenging pressures and threats
Despite the monopolies’ strong public support and proven health benefits, recent legislative initiatives in several Nordic countries signal a potential shift toward privatization of retail alcohol sales, which could undo decades of public health gains. In Finland, for example, recent policy changes have allowed the sale of a large proportion of alcoholic beverages outside monopoly stores, and there is ongoing consultation on permitting home delivery of alcohol. Similarly, in Sweden, a new court case challenges the monopoly’s exclusive rights to online sales, while proposed laws would permit farm sales of alcoholic beverages.
“There is consistent evidence that the structure of the retail alcohol distribution system, in other words – how, when and where alcohol is sold, significantly affects alcohol sales,” said Dr Carina Ferreira-Borges. “Government monopolies on off-premises retail sales have been shown to reduce alcohol consumption, while privatizing alcohol sales tends to increase consumption.”
Facts on Alcohol in Europe (WHO, 2024):
– One in every 11 deaths in the WHO European Region is due to alcohol consumption. About 800 000 deaths a year result from alcohol use in the Region, almost a third of the global total of 2.6 million deaths. This means that death resulting from alcohol consumption is almost 3 times as common in the WHO Europe Region as it is globally.
– The European Union (EU), comprising around half of the WHO European Region by population, is the heaviest-drinking area in the world. Seven of the 10 countries with the highest per-capita alcohol consumption are in the EU.