Abstract
Researchers typically advise governments on the most effective methods for governing and regulating harmful substances and behaviours. This task is complex, requiring careful consideration of various knowledge, evidence, principles, values and traditions. Assessing the strengths and weaknesses of systems can be more straightforward for proponents of rational-choice institutionalism (RCI), who tend to overlook abstract, cultural and structural factors. RCI posits that all systems consist of rational, stable actors seeking to maximise their positions and interests. However, this perspective is challenged by scholars who recognise that even a seemingly straightforward regulatory model, such as a public health-based state monopoly system, can have different outcomes depending on the substance being regulated, how the system is implemented and the context in which regulation takes place.
The Nordic alcohol monopoly systems have a long history, and researchers have closely observed them over time in different countries. This extensive monitoring allows researchers to confidently discuss their strengths and view them, overall, as preferable to alternatives. However, not all public health-based state monopolies are identical. For instance, researchers have suggested that deregulating state influence could potentially lead to better public oversight, as examplified in the case of the Finnish gambling monopoly. In the late 2010s, Finnish social scientists began criticising the state gambling monopoly system due to its numerous internal contradictions and fundamental shortcomings. It was thought that the state-owned gambling monopoly company, Veikkaus, had failed to adequately address public health concerns and maintain the image expected of a system designed to safeguard public health. It became evident that tighter control or a fresh start was necessary. At least two circumstances made the consideration of a deregulation of retail state control less risky than in the question of selling alcohol:
First, gambling is today, to a great degree, produced and sold online and can no longer be regulated physically in the same way as alcoholic beverages. This means that any given new gambling regulation system would have to take on the exact same availability restriction and supervision challenges that the monopoly system was already facing. In this scenario, it looked like a realistic option was to start making the producers and sellers – whether they were former national monopoly operators or offshore companies – responsible for the online oversight flaws and also make them pay when they were breaking the law. In comparison, when it comes to physical substances such as alcoholic beverages, continuing a centralised collective oversight of a functioning retail monopoly is more likely to be saving public expenses compared with taking on the long challenging process of transforming the system into another type of control system. All new models come with different teething problems and need to be adjusted in continuous political processes and during this time problems may increase and lives are lost.
Second, the gambling issue and its regulatory system are in Finland a fairly young question of public health. Experts were likely to have reasoned that perhaps there was still a window of opportunity to shape the system into a model that is better than the current system at safeguarding public health and order? Sweden had just introduced a licensing system, so there was available documentation of how this solution could be outlined for Finland as well.
A comparison between alcohol and gambling regulation shows that it is not possible to choose a regulation system like dishes from a buffet table. Identical systems look different for different products and in different contexts. Statements like “There is never any reason to ever have a monopoly system” or “It always pays off to have a monopoly system” are assertions that have no place in serious societal analysis.
The RCI recipe for societal regulation is based on an assumption that everyone always pulls towards their own interests in the same way constantly in all matters and at all times. Designing a system is therefore always solely a question of taking into consideration all the risks one can think of in advance. Actors’ self-serving purposes that can become systemic weaknesses are acknowledged and minimised. As there are no forces outside the sum of rational agents, there is no social contract nor any cultural codes; everything is enforced by laws and rules or with the threat of punishment: “the preferences of the actors are exogenous to the ‘game,’ like a negotiation or an issue in an organization” (Olsson, 2020, p. 9).
Public health-based state monopoly systems are interesting regulatory systems because they juxtapose rights and principles in a way that removes what is above referred to as “the game”. The system communicates the message that our public health is not up for negotiation; rather, we have collectively decided that we do not want to take the risk of or waste resources on negotiating with and giving space to commercial forces.
As contemporary alcohol monopolies are planned we can have the cake and eat it too. If the justification for controlling consumers was moralistic at the point of the establishments of the Nordic alcohol monopolies, they have now developed into other types of societal institutions with other roles. As a consumer experience, they do not have much in common with the counters over which you could only order a given quota back in the day. They are based on rights to knowledgeable and efficient service combined with societal savings and public safety. In this way, they have been formed and dynamic over time. In in a recent analysis, PopNAD editor Mikaela Lindeman recounts the principles that Nordic alcohol policy has traditionally strived at incorporating (Lindeman, 2024). In the restrictive alcohol policy tradition found in Iceland, Norway, Finland and Sweden, the aim of the policy is to reduce overall alcohol consumption and related harm on the basis of three main pillars: limitation of private profit interest; restricted access to alcohol; and high prices and taxes on alcoholic beverages.
Inspecting these three pillars, it is hard to find any evidence-based public health motivated reason to reconsider them.
In most countries, alcohol causes different and more extensive harms than gambling, and the ways in which harmful consumption is acquired and internalised follow different patterns in the two issues. Whether we prioritise public health or liberalism, when we compare regulation systems, we simply cannot choose to selectively problematise certain aspects and simplify others to match what we believe in. Doing comparative research on regulations policies and systems always entails a balancing act.
In this issue
This all-qualitative issue contains research from Kousounadi Knountsen and colleagues (2024), who have studied young Danish peoples’ construction of sexual consent. Bjerge and colleagues (2024) discuss the dilemmas involved in caring for elderly substnace users. Heimdahl Vepsä et al. (2024) discern elements from Alcoholics Anonymous and relapse prevention in stories about recovery and relapse. In their Swedish language article, Lyrberg et al. (2024) account for children's perceptions of interventions in families where adults have problematic substance use. Rune Ellefsen (2024) has, on his part, taken a closer look at the establishment of heroine clinics in Norway. Blanzat and colleagues (2024) account for a qualitative evaluation of the peer-support experience of a “chill-out” harm reduction space and Johannessen and colleagues (2024) have investigated semantic aspects in women's accounts of life with a family member with problematic substance use. Two commentaries wrap up our issue: Rømer Thomsen and colleagues (2024) argue that the recent political agreement on a new tobacco, nicotine and alcohol prevention plan in Denmark is a missed opportunity; while Karlsson and Ekendahl (2024) take a closer look at the recently updated threshold for risky drinking by the National Board of Health and Welfare (NBHW) in Sweden.
