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OPINION AND ANALYSIS

Like having sex in church: Sweden’s uptight attitude to alcohol

Swedes have a deeply suspicious attitude towards alcohol, embodied in the state monopoly on its sale. Although ridden with guilt and hypocrisy, it is a healthy relationship, says David Crouch

Like having sex in church: Sweden’s uptight attitude to alcohol
A customer buys alcohol in Systenbolaget. Photo: Isabell Höjman / TT

Those boxes by the checkout sum up my problem with Systembolaget, Sweden’s chain of state-owned liquor stores. The boxes are called ångravagnar, from ångra, to regret. “Psst,” says the sign over each one. “Have you changed your mind? Here you can put back any drinks you don’t want to buy.”

The boxes are there to make you think again – do you really need all that booze? Won’t you hate yourself if you don’t put back a bottle or two? 

The regret boxes seem to serve little practical purpose, because they are almost always empty. Instead, they are there to send a message, whispering “Psst!” in your ear: “Don’t do it! Alcohol is wicked!”

Smiling assistants lurk around the stores, in theory so you can ask them what wine goes best with your food. Nonsense – they are the morality police, another “psst” in your ear. Talking to them feels like going to confession: forgive me, Father, for I am about to sin. Then there are all the TV ads for Systembolaget depicting toddlers being abused by drunken parents, or pious staff saying their aim is to sell less alcohol, not more

As a result, entering Systembolaget feels like having sex in church: a shameful pleasure. Here you cease to be an adult capable of taking decisions for yourself and instead become a wayward teenager who needs to be shepherded towards acceptable behaviour.  

Systembolaget – abbreviated to Systemet, or “the System” – is the embodiment of Swedes’ deeply suspicious attitude towards alcohol. It is institutionalised guilt on national scale. 

This guilt has historical roots. Sweden once had a serious alcohol problem. A century ago, average vodka consumption reached almost a litre a week for every man, woman and child. For decades, the country battled to find a way to bring down consumption, first with rationing and then the state monopoly from 1955.

The guilty view of alcohol lives on in all sorts of ways. Sweden, a nation renowned for embracing modernity and liberal freedoms, still has a significant temperance movement. The snappily named Independent Order of Good Templars has 24,000 members – more than most of Sweden’s political parties – and believes that Systembolaget should close at 5pm and be shut altogether on Fridays and Saturdays. 

In Britain, for example, politicians like to pose with a drink to show they are “of the people”. This could never happen here. I once went campaigning with a political leader in the run-up to elections, and we needed somewhere warm afterwards for an interview. But she declined to enter a convenient bar in case she might be photographed in a place selling alcohol. 

Quite apart from the System’s restrictive opening hours, there are very few stores – just 450, or one per 23,000 people. Until very recently, there were more golf courses in Sweden than places where you could buy a bottle of wine over the counter. (There are 449 golf courses, down from 454 in 2019.)

A recent opinion survey has compared attitudes to alcohol in the Nordics. Sweden emerges clearly as the Nordic nation that is the most uptight about alcohol. Fewer than half (45%) of Swedes say it’s okay occasionally to get drunk; one in five say it is even wrong to get drunk at a party. Finns and Danes come out as far more relaxed about booze. 

There is a whiff of hypocrisy here. In my experience, the best way to liven up a social gathering in Sweden is to uncork the gin and let it flow copiously. Not so long ago, a former government minister responsible for raising the tax on alcohol became so inebriated (berusad) at a party in the Stockholm archipelago that he exposed himself to the female guests. 

And yet, Sweden’s relationship with alcohol is a healthy one. Systembolaget is popular among Swedes, its reputation exceeding that of well-loved brands such as IKEA, Volvo or Spotify. More than three-quarters want the state monopoly on alcohol to remain in force, while only 18 percent say they want wine and spirits to be on sold in other stores

Despite its faults, Systembolaget represents society taking collective responsibility for a drug that has the potential to cause great harm. After decades of free-market liberalism across the globe, it is easy to forget that societies once behaved like societies, instead of leaving everything to individuals and the interplay of supply and demand. 

How refreshing that young people are not bombarded with advertising telling them they need booze to gave a good time. Living here, you would never have any idea that the country supplies the world with that supreme party drink, Absolut Vodka. Consumption is ticking downwards, and fewer than 3 percent of Swedes drink every day

When I see those regret boxes, part of me wants to scream: “Regrets?! No way! It’s been a hard week, let me get wasted in peace.” But the boxes are the price I have to pay for the comforting knowledge that, in this aspect at least, Swedish society takes responsibility for its citizens’ welfare. I don’t like it, but I accept that it is necessary. It is not ideal, but it works. 

David Crouch is the author of Almost Perfekt: How Sweden Works and What Can We Learn From It. He is a freelance journalist and a lecturer in journalism at Gothenburg University.

Member comments

  1. Now add drugs deaths per capita, average budget of a teenager and price per use (alcohol vs narcotics) into the mix.

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For members

HEALTH

Where are the ‘best’ hospitals in Sweden, Denmark, and Norway?

The Scandinavian countries have an international reputation for excellent healthcare, so it might not be surprising that several hospitals from the region have been ranked among the world's "best".

Where are the 'best' hospitals in Sweden, Denmark, and Norway?

The latest World’s Best Hospitals ranking by US-based Newsweek and global data firm Statista has revealed the top hospitals in Sweden, Denmark, and Norway.

Newsweek’s ranking, the only global comparison, draws from four key data sources. Firstly, recommendations from experts within the healthcare sector, including doctors and administrators, were sought. Over 85,000 experts worldwide were invited to participate, yielding responses from a significant portion of them.

Additionally, results obtained from patient surveys assessed aspects like treatment efficacy and communication. Quality metrics were also considered, including factors such as wait times, patient safety, and adherence to stringent hygiene protocols.

Lastly, the utilisation of patient-reported outcome measures measured patients’ perception of treatment efficacy and their post-care quality of life.

Sweden’s Karolinska Universitetssjukhuset was the top-ranked Scandinavian hospital on the list, ending in 7th place out of the top 231.

Denmark’s Rigshospitalet – København in Copenhagen followed closely at 21st place, with Aarhus Universitetshospital in Aarhus, Denmark, and Oslo Universitetssykehus in Norway trailing at 23rd and 29th, respectively.

Other notable mentions on the list hail from Gothenburg and Uppsala in Sweden, as well as Odense and Aalborg in Denmark.

The Scandinavian hospitals that made the list included:

Karolinska Universitetssjukhuset (7), Stockholm, Sweden

Karolinska University Hospital is one of Europe’s largest university hospitals, boasting two campuses in Huddinge and Solna.

Over the years, it has been the birthplace of some of the world’s most significant medical discoveries.

Alongside the Karolinska Institutet, the hospital forms a medical hub renowned internationally for its excellence.

Karolinska University Hospital has 1086 beds and accommodates approximately 1,400,000 patient visits annually. Moreover, it has a dedicated staff of 15,300 employees.

READ MORE: Situation in Sweden’s hospitals ‘terrible and completely unacceptable’: watchdog

Rigshospitalet – København (21), Copenhagen, Denmark

Rigshospitalet – København, located in Copenhagen, Denmark, is a leading Danish hospital renowned for its highly specialised treatment options.

With 1135 beds spread across multiple sites, it offers comprehensive medical care, covering virtually all medical specialities.

Employing a workforce of 12,000, including 2,500 doctors, Rigshospitalet handles an impressive volume of medical cases annually. In 2022 alone, it conducted 64,000 operations, admitted 75,000 inpatients, and facilitated 1,150,000 outpatient visits, including 5,700 deliveries.

Aarhus Universitetshospital (23), Aarhus, Denmark

As it points out on its website, Aarhus University Hospital (AUH) is a comprehensive healthcare institution. In 2022, it recorded 81,126 admissions, with an average length of stay of 3.2 days. It has an average of 858 standard beds available daily.

Its workforce comprised 1,780.47 full-time medical positions and 3,471.55 full-time nursing positions, totalling 9,347 employees across various roles.

READ MORE: ‘Confusing and no communication’: How you rate Denmark’s health system

Oslo Universitetssykehus, (29) Oslo, Norway

Oslo University Hospital (OUH) serves as a local, emergency, and regional hospital, alongside undertaking numerous national responsibilities.

With a workforce exceeding 24,000 employees and a budget of approximately 27.5 billion kroner, it is Norway’s largest healthcare institution.

Functioning as a pivotal centre for medical research and the education of healthcare professionals in Norway, Oslo University Hospital delivers advanced patient care, conducts research, provides experimental treatments, and facilitates teaching endeavours.

It comprises 16 clinics and the Oslo hospital service unit, and is also one of Scandinavia’s largest hospitals. The OUH administers over 1.2 million patient treatments annually.

READERS REVEAL: What do foreigners think of the Norwegian healthcare system?

Sahlgrenska Universitetssjukhuset (74), Gothenburg, Sweden

Serving as the primary healthcare provider for residents of the Gothenburg region, the Sahlgrenska University Hospital draws patients from across the region seeking specialised treatments.

Its expertise spans approximately 25 special areas, encompassing cardiovascular care, reconstructive surgery, paediatrics, immunology, and catheter interventions. Notably, its Queen Silvia Children’s Hospital is nationally recognised for its excellence in child heart surgery, holding a prestigious healthcare permit from the National Board of Health and Welfare.

With a workforce of around 17,000 people, the hospital is one of the largest employers in the area.

Akademiska Sjukhuset (75), Uppsala, Sweden

Akademiska Sjukhuset, situated in Uppsala, boasts a rich history dating back to 1708.

Sweden’s inaugural nursing program was established here, and the hospital has served as a platform for Nobel Prize-winning research.

It’s recognised for conducting the first appendectomy in the Nordic region and pioneering the concept of an integrated children’s hospital.

As one of Sweden’s largest hospitals, it caters to over 700,000 people annually. With a workforce of 8,000 employees and 1,000 beds, it handles 55,000 admissions, 346,000 physician encounters, and 318,000 outpatient treatments each year.

Odense Universitetshospital (85), Odense, Denmark

Odense University Hospital (OUH) is one of Denmark’s university hospitals, forming an integral part of the country’s healthcare network alongside three others.

With an annual budget of 835 million euros, OUH employs a dedicated team of 11,281 people, including medical professionals, nurses, and support staff.

Its facilities have 1,038 beds, enabling over 40,000 operations and accommodating more than 100,000 discharged patients annually.

Aalborg Universitetshospital (92), Aalborg, Denmark

Aalborg University Hospital is the largest healthcare facility in the North Denmark Region, serving as a cornerstone of the region’s medical landscape.

Moreover, it is the primary employer in northern Jutland, with a workforce of around 6,000 people.

With a focus on highly specialised regional functions, Aalborg University Hospital caters to approximately 650,000 inhabitants, extending its services to parts of the Central Denmark Region.

Additionally, it provides regional functions to around 490,000 residents and serves as the primary healthcare provider for roughly 250,000 people.

About the ranking process

Newsweek ranked 2,400 hospitals across 30 countries in total through a combination of their national rank, the number of recommendations received through an online survey of more than 85,000 medical experts, public data from post-hospitalisation patient satisfaction surveys, quality metrics such as hygiene and patient-doctor ratio, as well as a Statista survey on whether hospitals use Patient Reported Outcome Measures (PROMs). The list did not include specialised hospitals.

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