Change and continuity in Finnish drinking in the 21st century

Abstract

Aim:

Alcohol consumption and policy in Finland have undergone a variety of changes in the two last decades. In several cases, trends in both consumption and policy have shifted direction when moving from the first decade of the 21st century to the second one. The aim of the overview is to summarise the trends.

Data:

The overview draws on results primarily from the cross-sectional Finnish Drinking Habits Survey (FDHS) in 2000, 2008 and 2016, and also from the whole series including altogether seven separate data collections carried out every eight years from 1968 to 2016 and mainly covering Finns aged 15–69 years. Response rates show a falling trend (78% in 2000, 74% in 2008 and 60% in 2016). The overview also makes use of data collected within the European School Survey Project on Alcohol and other Drugs (ESPAD) and, for the elderly, the National FinSote study carried out by the Finnish Institute for Health and Welfare (THL).

Results:

After an all-time high of 12.7 litres of pure alcohol per capita 15 years and over in 2007, total consumption of alcohol had decreased by 21% by the year 2019. Underage drinking has decreased ever since the millennium shift. Older people’s drinking has continued increasing or levelled out. Along with reduced total consumption, heavy episodic drinking (HED) has also decreased, but the differences between manual and white-collar workers in HED have continued to grow. Drinking alcoholic beverages with meals has also declined since 2008. Liberal and restrictive alcohol policy measures have alternated.

Conclusions:

Finnish drinking culture seems to change at a slow pace; several typical drinking habits have remained unchanged.

The aim of this overview is to provide a comprehensive description of how Finnish drinking has developed, particularly in the 21st century. What makes the task interesting is that within just two decades, the Finnish alcohol scene has undergone a variety of changes, which are reflected in the drinking patterns. In several cases, the direction of the changes in both alcohol policy and consumption in the first decade of the century has been reversed in the second decade.

Finnish drinking trends may be of interest from a comparative perspective. In a recent European study (Sierosławski et al., 2017), Finland was classified as an eastern and northern intoxication-oriented drinking culture, where drinking mainly takes place outside of everyday situations. Another distinctive feature of Finnish drinking in the European context is the long-lasting increase in total alcohol consumption (15+), from 3.7 litres in 1960 to the all-time high of 12.7 litres in 2007. In a Nordic comparison, per capita alcohol consumption was highest in Denmark for decades. But in the early 2000s, Finland closed the gap between the two countries (Penttilä & Österberg, 2017).

The primary data of this overview come from the Finnish Drinking Habits Survey (FDHS), including altogether seven separate data collections carried out every eight years from 1968 to 2016. The study population consisted of Finns aged 15–69 years (15–79 years in 2016), excluding those living in the Åland Islands (0.5% of the population) and, since 1984, excluding the homeless and the institutionalised (1.5%). Response rates show a falling trend (78% in 2000, 74% in 2008 and 60% in 2016). In the 21st century, the sample has been drawn from population census records using simple random sampling. Sampling and interviews were conducted by Statistics Finland. Interviews were carried out face to face in the autumn of each year (Mäkelä et al., 2018). To some extent, we also make use of data collected within the European School Survey Project on Alcohol and other Drugs (ESPAD) study (see data description in Raitasalo, Tigerstedt, & Simonen, 2018) and, for the elderly, the National FinSote study carried out by the Finnish Institute for Health and Welfare (data description in Tigerstedt, Mäkelä, Vilkko, & Pentala-Nikulainen, 2018), as well as official statistics on annual consumption ( Yearbook of Alcohol and Drug Statistics 2019, 2020) and alcohol-related mortality (Statistics Finland, 2020).

This overview is based on the concluding chapter of the book Näin Suomi juo (This is how Finns drink, Mäkelä et al., 2018; Tigerstedt, Mäkelä, Karlsson, 2018) and draws on the results presented in the 21 chapters of the book covering a wide range of topics by a wide range of authors. A similar review was written on the basis of a previous book written after the 2008 FDHS (Mäkelä et al., 2012). A separate reflection piece in this issue (Warpenius & Mäkelä, 2020), also based on the 2018 book, looks at various results from the point of view of implications for policy makers and prevention workers.

The main part of this text is a review of empirical findings on various aspects of alcohol consumption and drinking patterns. However, in the 21st century, remarkable and greatly debated changes have occurred in the field of alcohol policy. Therefore, we will conclude the review by shedding light on the eventful Finnish alcohol policies in this period.

Alcohol consumption

Our focus is on basic trends in total alcohol consumption and the present status in alcohol consumption in different (somewhat overlapping) social groups, i.e., underage (15–16 years), young adults (18–29 years), middle-aged people (30–49 years) and older people (50–69 years in the FDHS or 65+ in FinSote), respectively.

Total consumption

Regarding alcohol consumption, both the first and second decades of the 21st century were special, although in very different ways. In the first years of the century, Finnish total alcohol consumption increased by almost one-fifth and reached its all-time high in 2007 (i.e., 12.7 litres of pure alcohol per capita for those 15 years of age and older). In two generations, consumption had more than tripled. Since 2008, alcohol consumption started declining, and a slowly descending trend continued throughout the 2010s. From 2008 to 2019, consumption decreased by 21%, falling to pre-1995 levels. No similar reduction has occurred during the last 85 years when reliable data on Finns’ alcohol use have been available (Karlsson, 2018).

Underaged

There are two population groups – underage people and older people – whose alcohol use has at times differed from the consumption trend for the majority of the people. Since the turn of the century, both alcohol use in general and heavy episodic drinking have declined among the underaged. Even the reduction of alcohol taxes by an average of 33% in 2004 halted this trend only momentarily, if at all. This surprising phenomenon was acknowledged in wider public debate only in the 2010s, and the reasons for the declining use are still under close scrutiny. A Finnish study concludes that the falling trend is related at least to restrictions in the availability of alcohol in the underage population, parents’ tightened control of their children’s drinking and the weakened role of drinking and intoxication when spending time with peers (Raitasalo, Simonen, et al., 2018; Raitasalo, Tigerstedt, & Simonen, 2018).

Young adults

During the first decade of the 21st century, the diminishing trend of drinking in underage youth did not spill over when these young came of age and became young adults. However, during the 2010s, drinking in general and heavy episodic drinking showed a slight downward trend among young adults (Kinnunen et al., 2017). This may be related to the same factors that have decreased alcohol consumption in the general population, e.g., increases in alcohol taxes and unfavourable economic conditions in society. Moreover, there might be a cohort effect: the more abstinent underage people eventually bring their habits with them when coming of age. However, although alcohol consumption has decreased in young adults, heavy episodic drinking and related harms are still more prevalent among them than in other age group (Raitasalo, Tigerstedt, & Simonen, 2018).

Middle-aged

In the 2000s, the increase in alcohol consumption in Finland was concentrated particularly among middle-aged and older people. As consumption has decreased in the 2010s, use has diminished in all age groups, but least so and less consistently among those over 50 years of age (Mäkelä, 2018a).

The transformation from young adulthood to middle-age appears somewhat differently in men’s and women’s alcohol consumption. For example, men’s weekly alcohol use had already culminated by the age of 30, and the proportion of regularly drinking men hardly diminishes before they turn 70. In contrast, women’s weekly drinking continues to slowly become more common up to the age of 60. This gender difference stems partially from the fact that women’s alcohol use mushroomed from the late 1960s onwards. Weekly drinking has been more prevalent particularly in the female cohorts born between 1946 and 1969 compared to older or younger female cohorts (Mäkelä, 2018a).

Older people

Since the mid-1980s, alcohol use by older people (60+ years) has become more common, and their frequency of drinking has increased. However, this trend has attracted attention only in the 21st century. The spreading of alcohol use is related to the ageing of the wet generation (baby boomers), the increasing life expectancy, as well as (on average) an improvement in functional performance and increased purchasing power. Especially the proportion of alcohol-using older women has risen continuously, and is by now quite close to that of men. On the other hand, heavy episodic drinking is still much more prevalent among men over 65 years of age than among women of the same age (Tigerstedt, Mäkelä, Vilkko, & Pentala-Nikulainen, 2018; see also Tigerstedt et al., forthcoming, for an updated analysis).

It should be noted that regarding functional ability, older people form a very heterogeneous group. While drinking habits among 65–69-year-olds no longer differ much from those among 50–64-year-olds, alcohol consumption among 80–84-year-olds is much less prevalent, and the consumed volumes are significantly smaller. However, as older people’s alcohol use has increased all along the line, different kinds of problems reported by home care nurses or close relatives have proliferated (Koivula et al., 2016; Vilkko et al., 2013). Moreover, contrary to younger age groups in the 2010s, the number of fatal alcohol-related diseases has continued to increase among people over 60 years of age (Tigerstedt et al., forthcoming).

Heavy episodic drinking

Although alcohol consumption increased at the beginning of the 2000s, heavy episodic drinking increased very little in the general population, particularly among men. On the other hand, heavy episodic drinking was more prevalent among manual workers than among white-collar workers, and the differences between these groups grew from 2000 to 2008. When consumption started falling in 2008, heavy episodic drinking also declined. Moreover, the proportion of heavy episodic drinking occasions to all drinking occasions has decreased. Considering harm prevention, this is good news. The bad news is that the decrease in heavy episodic drinking is not evenly distributed among different social layers. Quite the opposite, the differences between manual and white-collar workers in heavy episodic drinking have continued to grow. Some decades ago, the view used to be that heavy episodic drinking united different social layers. People with higher social status and better financial positions did have light drinking occasions – like going out for a pint with colleagues or enjoying a glass of wine for dinner – much more often than people with lower status, but different strata engaged in heavy episodic drinking to a similar extent. It seems that now heavy episodic drinking is no longer a shared behaviour pattern across social groups, at least not to the same extent (Mäkelä, 2018b).

One may therefore ask whether Finnish drinking culture is changing, not only quantitatively but also qualitatively. We suggest, however, that despite the decrease in heavy episodic drinking, it is not clear whether we are really dealing with a crucial cultural shift. A qualitative shift would imply that the total amount consumed by an individual alcohol user – let’s say, for example, 10 litres of pure alcohol in a year – would be composed to a greater extent as it is in southern Europe: by more drinking occasions than previously but by smaller quantities of alcohol per occasion. However, there are no signs of such a shift. In fact, a person who in 2016 consumed 10 litres got drunk exactly as often as a person who in 2008 consumed the same amount of alcohol. Those, in turn, who have drunk only 5 litres of pure alcohol in a year have always got drunk much more seldom compared to those consuming 10 litres. The point is that the decrease in heavy episodic drinking in the 2010s is a consequence of the fact that many people have switched to lower levels of average consumption and, simultaneously, to lower levels of heavy episodic drinking. If, then, the aggregate consumption of the population began rising again – and as a result, many people reverted to a higher level of average consumption – supposedly heavy episodic drinking would also increase. Time will tell whether such periods of growing consumption have passed and whether heavy episodic drinking would increase correspondingly (Mäkelä, 2018b).

With regard to possible cultural shifts, a fresh cross-sectional European study shows that, on average, alcohol is used more seldom but in larger quantities per occasion in Finland than in southern European countries. In this respect, Finland is not a unique case. Finland rather belongs to an eastern and northern drinking culture of which intoxication is an inherent part (Sierosławski et al., 2017). Several other observations point to persistent traits in our drinking culture: drinking beer and wine with meals has, in fact, declined since 2008; drinking is not typically woven into everyday situations (i.e., it occurs late in the evening and at night-time, on weekends and holidays), and this is particularly evident among women and people of working age.

Changes in the distribution of alcohol-related mortality

It is worth noting that, in Finland, chronic diseases now constitute a larger proportion of causes of alcohol-related deaths than before. Crudely speaking, assaults and accidents were previously the most prevalent alcohol-related causes of death. However, nowadays as many as 75% of the more than 2,000 annual alcohol-related deaths are caused by chronic diseases due to long-term drinking. This trend has strengthened during the 21st century. To be precise, we may distinguish between two phases in this period. In the early years of the 2000s, when alcohol consumption increased, deaths related to chronic alcohol diseases also increased significantly (Tigerstedt & Österberg, 2007). After 2008, when alcohol consumption has decreased, the number of deaths related to chronic alcohol diseases has declined, but the number of accidental and violent deaths under the influence of alcohol has decreased even more. That is, in both phases, the centre of gravity in the harm caused by alcohol, measured by alcohol-related deaths, has switched towards chronic diseases and health harms (Karlsson, 2018).

Drinking preferences

Finland is a former spirits country and a current beer country. The radical decline in strong beverages in the 1990s took an upward turn when, in 2004, the excise duties were lowered by 44%. Subsequently, as a result of several incremental smaller increases in alcohol taxes, the consumption of strong beverages has fallen even below the level of the 1990s. Simultaneously, the position of middle-strength beer (max. 4.7% alcohol by volume) has become settled as the most popular alcoholic beverage among Finns. On the other hand, the insignificant attractiveness of stronger beer, starting in the 1990s, has continued up to the present time. This state of affairs has started to change, however, as in recent years the assortment of beer products has changed rapidly, the new products often being stronger than middle-strength beer. This development was further strengthened in 2018 when new legislation allowed grocery stores to sell alcoholic beverages containing up to 5.5% alcohol by volume, compared to 4.7% before 2018 (see details below). This trend of increasing sales of stronger beer is especially driven by handcrafted beer produced by small breweries. In spite of the relative growth in the use of new beer types, ca. 95% of Finnish beer sales is made up of lager beer, while the rest is for ale, stout, wheat beer, etc. (Tigerstedt, Karlsson, & Härkönen, 2018).

The consumption of table wines (max. 14% alcohol by volume) increased above all in the early 2000s; but for the first time in 25 years, their use went down in the 2010s. Among the Nordic countries, Finland and Iceland consume the least wine per capita, both in relative and absolute terms (Tigerstedt, Karlsson, & Härkönen, 2018).

Hazardous drinkers’ and other drinkers’ choice of beverage type does not seem to differ much from each other (Lintonen & Mäkelä, 2018). This is especially true for men. Compared to other women, heavy-drinking women prefer spirits and strong beer. On binge-drinking occasions, both women and men prefer spirits and strong beer. In terms of health effects, the type of beverage plays a secondary role, provided that the amounts consumed do not change, let alone if the promotion of sales of mild beverages leads to an increase in alcohol consumption.

Alcohol policy and public opinion

The above shows that the first and second decades of the 21st century differ significantly with respect to the level of alcohol consumed, binge drinking and alcohol-related harms. In addition, a variety of both liberal and restrictive legislative measures have been adopted in this period. Possibly as a response to these policy changes and the debate around them, public opinion on alcohol policy has fluctuated considerably over the two past decades.

Undoubtedly, the changes in alcohol consumption and related harm have been affected by general social circumstances, such as the favourable economic prospects in the first decade and the unfavourable prospects in the second. However, specific measures concerning the physical and economic availability of alcoholic beverages have also played a key role. In fact, Finnish alcohol policy in the 21st century is an interesting story with unexpected, contradictory and even major twists and turns.

During the 21st century, Finnish alcohol policy adapted to regulations from the European Union (EU), on the one hand, and to the increasingly active domestic alcohol industry on the other. Moreover, the internationalisation of the domestic alcohol industry has influenced political power relations. As a result, claims for liberalised alcohol sales and market promotion have gained strength in day-to-day politics.

The first decade of the century was dominated by the decision by the EU to abolish all private import quotas on alcoholic beverages in the EU by the end of the year 2003. While Estonia happened to join the EU some months later on 1 May 2004, cheap alcohol was to be available only a couple of hours away from the metropolitan area of Helsinki. In that situation, Finnish decision-makers felt forced to reduce excise duties on alcohol in order to protect the domestic alcohol business and prevent the emergence of a black market in alcohol. The decision was made in one stroke, and alcohol excise taxes were reduced by 33% on average. Consequently, the price of the cheapest strong beverages was reduced by more than 30% and for beer by over 10%. The combined effect of alcohol tax cuts and increased imports by travellers from Estonia was an increase of 10.6% in alcohol consumption in litres per capita 15 years or older, and a considerable increase in various harms including alcohol-related mortality (Mäkelä & Österberg, 2009).

In the 2010s, Finnish alcohol policy has revolved around the preparations and enforcement of the new alcohol legislation. All in all, this work took six years. The initial phase was directed by the Ministry of Social Affairs and Health, whose aim was to update the alcohol law to meet the technical requirements relating to the amended constitution of Finland. However, the political atmosphere changed, probably because alcohol consumption and its related harm started to decline, but also due to the active, rapid and even aggressive lobbying of organisations representing alcohol industries and interests. Since 2015, the pressure to liberalise the alcohol markets gained important flank support from the idea of abolishing “unnecessary bureaucracy” and “overregulation” inscribed in the Strategic Programme of the Government. In public discussion in general and on social media in particular, alcohol policy restrictions were characterised as a model example of a “nanny state”, and removing them was perceived as “reducing regulation” and “cutting red tape”. At the same time, expanding consumers’ rights, improving employment and getting rid of a number of different regulations gained the upper hand in popular opinion. Compared to such issues, social and health policy opinions based on research were often labelled as partial or biased, secondary or invalid (Karlsson et al., 2020).

The most notable change in the Alcohol Act, finally adopted in 2018, is that more than 5,000 new outlets were allowed to sell all kinds of alcoholic beverages with an alcohol content of max. 5.5% by volume (up from the previous 4.7% for fermented products) (Karlsson et al., 2020). The law has had a range of effects, many of which are still unknown. However, we know that the monopoly’s share of the alcohol market has been further reduced. In 2000, the shares were about even: the grocery stores’ share of the total consumption of alcohol in Finland was 31%, whereas the state alcohol monopoly’s share was 32%. Since 2009, the share of grocery stores has exceeded that of the monopoly: in 2016, the proportions were 38% and 33%, respectively, and two years later 41% and 32%, respectively. One outcome of the reform was a strong increase in the sales of pre-mixed alcoholic beverages and strong beer, but the net impact on total alcohol consumption seems to have remained small (Mäkelä & Norström, 2019).

It is hardly surprising that public opinion on alcohol policy has fluctuated considerably under such circumstances. In the first years of the 2000s, there was strong support for relaxing alcohol policy regulations. When alcohol consumption and related harms increased due to major tax decreases in 2004, opinions tightened markedly. Only some 10% of the population supported liberalisation, while tightened rules were advocated by one-fourth (or at most even one-third) of all Finns. However, the decline in alcohol consumption is also reflected in public opinion. Between 2015 and 2017, one-third (or even 40%) of the population has supported liberalisation of the alcohol policy. Correspondingly, only some 10% have preferred more restrictions, while 40–50% have supported the status quo (Härkönen & Karlsson, 2018). Since the new Alcohol Act came into force in 2018, people’s opinions have become more favourable towards alcohol policy regulations. In 2020, 57% of the population was content with the current alcohol policy, and 28% wanted further liberalisation.

Discussion

In this overview article, we have made a key-word-like summary of the mobile status of the Finnish alcohol scene, without forgetting that, amidst the changes, we can also observe more lasting characteristics of the Finnish drinking culture. One important lesson is that while the century is still young, Finnish alcohol consumption, drinking habits and opinions on alcohol policy have been subject to considerable changes. Interestingly, some of these changes pertain to specific population groups, and in several cases the direction of the changes in the first decade of the century has even been reversed in the second decade. Bearing this in mind, it might be wise not to predict what the 2020s will look like. However, drawing on the research, we can offer some general points of departure for the discussion on the years to come.

There have been two principal explanations for the all-time high level of alcohol consumption and related harms that was reached in the first decade of the century. First, in 2004, prices of alcoholic beverages dropped drastically, while at the same time alcohol consumption was already increasing. Second, the drop in prices coincided with favourable economic development, which in itself was apt to increase consumption. Correspondingly, the downward trend in alcohol consumption and related harm in the 2010s is, to a large extent, explained by several gradual increases in alcohol taxes on the one hand and unfavourable economic conditions on the other. That is, economic availability has been a key explanation in both decades. This leads us to expect that economic availability will also be a central factor in the future, so that both the development of the national economic situation and the prices of alcoholic products will continue to have a strong impact on the amounts of alcohol that Finns consume.

Some sales trends point to cultural changes where the use of alcoholic beverages is associated with taste rather than alcohol content, including increasing sales of non-alcoholic beverages and types of beer other than lager. This development may well continue. However, even if the percentage increases for non-alcoholic beer are large, so far its sales are relatively marginal when compared to the sales of alcoholic beer. Also, in order for the sales of non-alcoholic beverages to matter for public health, they need to replace sales of alcoholic beer rather than be added as new contexts where some beer is consumed. Monitoring this is important.

According to an old wise saying, national alcohol policy measures are able to regulate first and foremost the level of alcohol consumption. In contrast, governmental measures are much less effective in changing drinking habits and drinking culture. For example, in the world of youth, global influences may well be stronger than national policies. What then will happen with the downward trend in underage drinking? Will older people’s alcohol consumption and related harm continue increasing? Will a considerable share of the Finnish “lager beer people” start consuming other types of beer; and if so, will it decrease the volumes consumed? Is the decline in heavy episodic drinking in the 2010s a weak signal of a more persistent change? Will the annual, weekly and daily rhythm of alcohol use remain the same in the 2020s as it has been for decades? And will alcohol-related harms continue to pertain to socio-economic groups differently?

Obviously, there are no answers to these questions. However, based on the above-reviewed results, it is possible to conduct sensible and structured discussions on a whole range of forthcoming alcohol-related issues – for example, how research results may be applied in policy and preventive work (see Warpenius & Mäkelä, 2020).