Swedish government inquiry: retail monopoly and alcohol tax remain central to public health policy

17.02.2026 - The Swedish government has received the final report of a major state inquiry into the follow up and evaluation of public health policy, including a specific assessment of alcohol policy instruments. The report, Strengthened follow up and evaluation of public health policy (SOU 2026:7), concludes that both the retail monopoly and alcohol taxation remain important tools for limiting alcohol consumption and reducing harm.

The inquiry was appointed in February 2024 under Committee Directive 2024:21. Its mandate included two parts. The first was to propose a health economic framework to strengthen the monitoring and evaluation of Sweden’s public health policy. The second was to evaluate the effects of key alcohol policy instruments, in particular the state retail monopoly and alcohol tax. The final report was submitted in January 2026.

A stronger framework for public health evaluation

In Part I of the report, the inquiry proposes that the Public Health Agency of Sweden should be given overall responsibility for developing and managing a new health economic framework. The aim is to improve how public health measures are evaluated, including better methods, stronger analytical models and improved use of register data.

The inquiry also proposes the establishment of a cross sectoral health economic secretariat to provide common methodological guidance for economic analyses in public health, as well as a national “method hub” to improve data quality and survey methodology. Furthermore, it highlights the need for more comprehensive, individual level data, particularly in areas such as primary care, school health services, social services and short term sickness absence.

According to the government, the purpose of the inquiry has been to strengthen the evidence base for decision making. Social Affairs Minister Jakob Forssmed stated that sound decisions require knowledge about which interventions make the greatest difference and where resources can be used most effectively.

Evaluation of alcohol policy instruments

Part II of the report focuses on the evaluation of alcohol policy instruments. Sweden has long pursued a restrictive alcohol policy aimed at reducing the medical and social harms caused by alcohol. Central components of this policy include limiting physical and economic availability through the state retail monopoly and alcohol taxation.

The inquiry notes that the retail monopoly means that sales of beverages above 3.5 percent alcohol by volume may only take place through the state owned company Systembolaget. The purpose is to limit physical availability by controlling store density, opening hours and age verification, and to counteract sales driven by profit motives. Alcohol taxation is designed both to influence consumption levels and to generate state revenue. In Sweden, tax rates are differentiated by beverage category and alcohol strength.

The report concludes that both the retail monopoly and alcohol taxation continue to play an important role in keeping consumption levels down and thereby reducing harm and societal costs. The instruments are described as part of a broader, integrated alcohol policy that also includes health care interventions, supervision, marketing regulation, information and local prevention efforts.

Trends in consumption and harm

According to data referenced in the report, total alcohol consumption in Sweden decreased by approximately 23 percent between 2004 and 2024. The share of unrecorded consumption has also declined significantly over that period. At the same time, alcohol related mortality and disease burden have decreased over the past two decades, according to data from the National Board of Health and Welfare and the Global Burden of Disease project.

However, the inquiry also highlights ongoing public health challenges, including socio economic inequalities in alcohol related harm and increased consumption among people aged 65 and older. The report emphasises that alcohol remains a major preventable risk factor for premature death, disease and injury.

Health Minister Elisabet Lann stated that while the health effects of alcohol are well known, there has been less systematic knowledge about how alcohol policy instruments such as Systembolaget and alcohol tax function in practice. The inquiry was therefore tasked with evaluating whether these instruments reduce alcohol related harm.

Next steps

The government will now consider the proposals. The inquiry underlines that continuous monitoring and evaluation are necessary to assess whether the alcohol policy instruments fulfil their purpose in relation to Parliament’s objective of reducing alcohol’s medical and social harms.

Taken together, the report presents both a proposal for a strengthened health economic framework in public health policy and a confirmation that Sweden’s core alcohol policy instruments remain central components of a broader public health approach.

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Source: Regeringskansliet