Continuity and long-term thinking in ANDT work

In February 2016 the Swedish Government adopted a new coherent strategy for alcohol, narcotics, doping and tobacco (ANDT) for the period 2016–2020. In the new strategy, the Government takes further steps to increase activity in this area to achieve the objective set by the Riksdag: A society free from narcotic drugs and doping, with reduced alcohol-related medical and social harm and reduced tobacco use.

Some young girls are sitting in a big crowd of people
The new strategy has a clearer child and youth perspective compared with the previous strategy. The social and gender equality perspective is also clearer. Photo:Folio

The ANDT strategy contributes to an equitable and gender-equal development of the population's health and to the Government's objective to close the avoidable health gaps within a generation.

A coherent strategy that rests on solidarity

ANDT is one of eleven objective domains in the national public health policy, which has the overarching objective to "create social conditions to ensure good health, on equal terms, for the entire population".

Swedish ANDT policy covers both legal (alcohol and tobacco) and illegal (narcotics and doping substances) drugs. This means that the conditions vary, but one common starting point in ANDT policy is the right of each and every person to have the best possible physical and mental health. This is also stated in the United Nations International Covenant on Economic, Social and Cultural Rights.

United Nations International Covenant on Economic, Social and Cultural Rights at United Nations website

ANDT policy is also part of Swedish welfare and rests on solidarity. This means that restrictions to personal freedom can be accepted in order to protect public health, which is expressed, for example, in strong support for the Swedish alcohol monopoly, age limits for the purchase of alcohol and tobacco, and the criminalisation of narcotics and doping.

For everyone to have the chance of maintaining good health, general measures need to be supplemented with targeted measures to people living in socially vulnerable situations as a result of substance abuse or addiction.

Social equality and gender equality to inform all work

The strategy builds on the previous strategy for the period 2011–2015 by making use of the experiences and knowledge that arose during that period. The new strategy has a clearer social and gender equality perspective compared with the previous strategy. The child and youth perspective is also clearer. All these perspectives must inform ANDT work at all levels of society if ANDT work is to have an impact.

There are six objectives that, combined, are to help achieve the overarching objective:

  1. Access to alcohol, narcotics, doping substances and tobacco must be reduced.
  2. The number of children and young people who start to use narcotics, doping substances and tobacco or who have an early alcohol debut must be progressively reduced.
  3. The number of women and men, as well as girls and boys, who become involved in the harmful use or abuse of or dependence on alcohol, narcotics, doping substances or tobacco must be progressively reduced.
  4. Women and men, as well as girls and boys, with abuse or addiction problems must be given greater access to good-quality care and support on the basis of their circumstances and needs.
  5. The number of women and men, as well as girls and boys, who die or are injured as a result of their own or others' use of alcohol, narcotics, doping substances or tobacco must be reduced.
  6. An EU and international approach to ANDT that is based on public health.

For each objective, there are fields of action that the Government considers to be most important for steering developments towards the objectives set.

Local and regional authorities responsible for practical implementation

Sweden has a decentralised system of governance. This means that there are three political levels that all work on issues related to ANDT.

The local level consists of 290 municipalities. Under the Swedish Social Services Act, the municipalities are to prevent and combat the abuse of alcohol and other addictive substances. This applies in particular to abuse among children and young people. Municipalities must also offer measures to people with abuse or addiction problems.

The regional level consists of 21 county councils or regions responsible for health and medical care. County councils must work preventively, and highlight and offer care and treatment for people with abuse or addiction problems.

Municipalities and county councils are obliged to enter into collaboration agreements for measures for people with abuse or addiction problems. The agreement is to state who does what.

Government agencies support local and regional authorities

At central government level there are a number of national agencies that help in various ways to implement ANDT policy. The Public Health Agency of Sweden and the National Board of Health and Welfare are central agencies that with their expertise support those working in the area at local and regional level. The Public Health Agency of Sweden is also responsible for following up public health policy and the ANDT strategy. In the new strategy, the Agency is given a stronger and clearer role in supporting the implementation of the ANDT strategy.

The State also has a regional organisation comprising 21 county administrative boards. They coordinate and support the implementation of the ANDT strategy in each county by weighing up national knowledge against local and regional conditions.

The Public Health Agency website

The National Board of Health and Welfare website

The county administrative boards website - Länsstyrelserna (in Swedish)

National council for dialogue with relevant agencies and organisations

Since 2008 there has been a national council for ANDT issues. The Government is planning to ensure that it continues during the strategy period 2016–2020. The council includes relevant agencies and the Swedish Association of Local Authorities and Regions, as well as researchers and representatives of civil society organisations. It is a forum for dialogue on development, commitments and needs for measures between the Government and relevant agencies and other organisations that are important for achieving the objectives of the ANDT strategy.

Systembolaget - the Swedish alcohol monopoly

The Swedish alcohol monopoly involves all trade in alcohol directly to consumers going via Systembolaget. Systembolaget – which has existed since 1955 – is a company that is owned and controlled by the State and run without profit-making interests.

The retail monopoly is a way of limiting sales while maintaining more efficient control over the number of outlets, opening hours, forms of sale, age and marketing. In Sweden, you have to be 20 years old to buy alcohol at Systembolaget, but 18 years old to buy alcohol at a restaurant.

There is a high level of support among the general public for Systembolaget. In 2015, this support was at its highest level since the beginning of the 2000s. Seventy-seven per cent of people supported Systembolaget and its exclusive right. Research reviews from a number of countries show that retail monopolies reduce both consumption and alcohol-related harm.