Published on March 28, 2014
Tim Stockwell, PhD Director, Centre for Addictions Research of BC Professor, Department of Psychology, University of Victoria Minimum alcohol price policies in action: A report from Canada Presentation to Committee on Justice, Defence and Equality, Dublin, March 25, 2014
All of Canada's 10 provinces set minimum prices for alcohol in liquor stores and/or bars
British Columbia legally prohibited alcohol between 1913 and 1917 A liquor control officer destroys brewing equipment
Minimum Pricing: Measures to set a floor price for alcohol In approximate order of potential effectiveness (low to high): 1. Bans on below-cost alcohol (UK) 2. Fixing a minimum profit margin (US) 3. Setting a minimum retail price per litre of beverage (Canada) 4. Setting a minimum price per unit of alcohol (Scotland)
Despite popular beliefs to the contrary… Increased alcohol prices lead to reduced rates of illnesses and injuries associated with heavy drinking patterns Rationale for Alcohol Price Policies
Alcohol price and tax strategies have strong scientific evidence for effectiveness Summary analyses of all high quality published studies indicate 1. A 10% increase in price leads on average to a 5% reduction in consumption 2. Price increases lead to reductions in drinking by heavy and problem drinkers 3. Price increases also lead to reductions in serious alcohol-related injuries and illnesses Minimum pricing is just one variation - theory and evidence to date suggests it is particularly well targeted towards heavy drinkers and should be effective
1. Heavy drinkers prefer cheap alcohol: e.g. Top 10% of US drinkers by volume spend on average 79c per standard drink versus $4.75 for lowest 50% ie light drinkers Kerr and Greenfield (2007) 2. Greater responsiveness to price changes near lower end of “price-quality spectrum” favoured by higher volume drinkers Gruenewald et al (2006) In theory, minimum pricing might be a particularly well targeted and effective alcohol pricing strategy Why is cheap alcohol important for public health policy?
Do increases in minimum alcohol prices lead to reduced consumption?
Case Study: Saskatchewan • Evaluation of a public health inspired proposal to increase all minimum prices SIMULTANEOUSLY with higher prices for higher strength beverages [ie similar to MUP] • Four strength categories for beer (<6.5% to >8.5%) with minimum prices set between the equivalent of $1.58 and $2.48 per standard drink • Two strength categories for wine, 2 for coolers and 3 for spirits
Impacts on Consumption II Stockwell, Zhao et al, American J Public Health, 2012 80 85 90 95 100 105 110 115 120 1 2 3 4 5 6 7 8 9 10111213 1 2 3 4 5 6 7 8 9 10111213 1 2 3 4 5 6 7 8 9 10111213 1 2 3 4 5 6 7 8 9 10111213 2008/09 2009/10 2010/11 2011/12 Age15+percapitaalcoholconsumption Fiscal period, April 2008 to March 2012 Consumption of alcoholic beverages in Saskatchewan before and after a major Minimum Price policy change Total Ethanol Beer Spirits Wine Coolers Cocktails Liqueur
Findings • A 10% increase in minimum prices significantly reduced consumption of beer by 10.1%, spirits by 5.9%, wine by 4.6%, and all beverages combined by 8.4% • Significantly greater reductions for government liquor stores where minimum prices most affected retail prices and for beverages with most products affected • There was a significant shift away from high to low strength beers and wines • Increase in government revenue from liquor – approx. $40m per annum • Increase in profits to alcohol wholesalers
Informal reports of benefits “Higher prices for cheap booze cuts binge drinking, Sask. Finds” - Saskatoon Star Phoenix July 5, 2010 “Saskatchewan one of first jurisdictions in the world to implement across the board minimum pricing…linked to a formula accounting for the amount of pure alcohol in each product” "The concept is to discourage excess consumption through binge drinking,” - Saskatchewan Liquor and Gaming Authority Police calls per month related to intoxication or disturbances halved - local police inspector Late night violence and vandalism in public places dramatically reduced – Saskatoon Police Chief
Do increases in the minimum alcohol prices lead to reduced alcohol- related harm? Case Study of British Columbia
Acute Alcohol Attributable Hospital Admissions Unintentional injuries Motor vehicle accidents Poisonings Accidental poisoning & exposure to alcohol Falls Fires Drowning Other unintentional injuries Intentional injuries Self-inflicted injuries Violence-related injuries Intentional self-poisoning by and exposure to alcohol Other intentional injuries
Estimated impacts on alcohol attributable hospital admissions Stockwell, Zhao et al (2013) American Journal of Public Health (Open Access) % Change in alcohol attributed admissions with a 10% increase in average minimum price: Type of hospital admission Immediate impact Delayed impact after 2 years Acute -8.95% ** -1.67% Chronic -5.31% -9.22% * *P<0.05 **P<0.01.
Forthcoming Analysis of Crime Impact • 9 years of crime data for 89 local health areas in BC • Controls for season, cost of living, density of liquor outlets, household income, demographic profiles • 10% increase in average minimum price associated with decreases of 19.5% in alcohol-related traffic offences, 18.5% in property crimes and of 10.4% violent crimes • No significant effect on non-alcohol related traffic violations • Much larger effects than Sheffield Model predicts
Sheffield Model is supported but gives conservative estimates of health and crime outcomes for British Columbia Comparative estimates of health and crime outcomes from an increase in the average Minimum Price in BC from CA$1.15 to CA$1.50/Standard Drink [Equivalent to £0.43p to £0.55p per UK Unit] Immediate Delayed Category of Alcohol Attributable Harm Sheffield Model CARBC Studies Sheffield Model [10 years] CARBC Studies [2 years] Deaths (N) 39 100 56 276 Hospital Admissions (N) 244 1432 610 1893 Crimes (N) 1346 7600 n/a n/a
Some Conclusions • Most hypotheses regarding associations with alcohol consumption and related harm were confirmed • Gruenewald et al’s theory is likely correct and minimum pricing per standard drink is well targeted to heavy drinkers – and is a more feasible pricing policy • The Sheffield Model underestimates the health benefits of Minimum Unit Pricing for the UK • Replication studies in other jurisdictions are required See: Stockwell and Thomas (2013) Is alcohol too cheap in the UK? Institute for Alcohol Studies, London, UK, 24 April. Visit: www.carbc.ca and www.ias.uk.org for copies of papers
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