Saturday, 15 February 2014

Minimum alcohol pricing – how the poor pay and gain most

Australia is one of several countries where health officials are considering a minimum price policy for alcohol* with major argument of opponents being a lack of evidence of effectiveness and the potential effect on responsible drinkers plus concerns around the possibility of large effects on individuals with low incomes. This week a group of academics headed by Dr John Holmes of the UK’s Sheffield University published in The Lancet research aiming to assess the effect of a £0·45 (83 Australian cents) minimum unit price (1 unit is 8 g/10 mL ethanol) in England across the income and socioeconomic distributions.
Their interpretation of the findings was that, irrespective of income, moderate drinkers were little affected by a minimum unit price of £0·45 in their model, with the greatest effects noted for harmful drinkers. Because harmful drinkers on low incomes purchase more alcohol at less than the minimum unit price threshold compared with other groups, they would be affected most by this policy. Large reductions in consumption in this group would however coincide with substantial health gains in terms of morbidity and mortality related to reduced alcohol consumption.
Overall, a minimum unit price of £0·45 led to an immediate reduction in consumption of 1·6% (−11·7 units per drinker per year) in our model. Moderate drinkers were least affected in terms of consumption (−3·8 units per drinker per year for the lowest income quintile vs 0·8 units increase for the highest income quintile) and spending (increase in spending of £0·04 vs £1·86 per year). The greatest behavioural changes occurred in harmful drinkers (change in consumption of −3·7% or −138·2 units per drinker per year, with a decrease in spending of £4·01), especially in the lowest income quintile (−7·6% or −299·8 units per drinker per year, with a decrease in spending of £34·63) compared with the highest income quintile (−1·0% or −34·3 units, with an increase in spending of £16·35). Estimated health benefits from the policy were also unequally distributed. Individuals in the lowest socioeconomic group (living in routine or manual worker households and comprising 41·7% of the sample population) would accrue 81·8% of reductions in premature deaths and 87·1% of gains in terms of quality-adjusted life-years.

*See: Australian National Preventive Health Agency. Exploring the public interest case for a minimum (floor) price for alcohol: draft report.http://www.anpha.gov.au/internet/anpha/publishing.nsf/Content/minimum-price-alcohol-reports;
Department of Health. Steering group report on a national substance misuse strategy.http://www.drugs.ie/resourcesfiles/reports/Steering_Group_Report_NSMS.pdf,
Canadian Public Health Association. Too high a cost: a public health approach to alcohol policy in Canada. Ottawa: Canadian Public Health Association, 2013.
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