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Would minimum pricing for alcohol work?

Sun, 12th Jan 2014

Chris Smith

Listen Now    Download as mp3 from the show Are old habits hard to break?

A minimum per-unit price for alcohol, mooted by the UK government to combat problem drinking, was subsequently dropped in July 2013, despite evidence that such a strategy would effectively cut Beerconsumption amongst heavier users of alcohol. But what is the evidence that approaches like this work?

According to a recent report in the British Medical Journal (BMJ), the stance taken by the UK government not to introduce a minimum price tag per unit suggests that ministers were "under the influence" of industry insiders, who lobbied against the introduction of such a levy.

However, the case for a 50 pence-per-unit tariff (up from the present 39p), looks compelling, as this commentary, by Southhampton hepatologist Nick Sherin, and Kate Eisenstein, policy adviser at the Royal College of Physicians, outlines:

"The mean weekly alcohol consumption of patients with alcoholic cirrhosis is around 15 bottles of white wine or 5 bottles of vodka, 20 litres of super strong lager, or 20 litres of strong white cider brewed from fructose syrup. As a result, irrespective of income, these very heavy drinkers opt for the cheapest possible alcohol—currently around 30 pence (€0.36; $0.49) per unit. The average low risk drinker already pays around £1/unit of alcohol and so the impact of minimum unit pricing on low risk drinkers is negligible, and on pubs it is zero. A minimum price of 50p per unit of alcohol would mean that a 700 ml bottle of vodka with a typical alcohol content of 40% would cost at least £14, making it difficult for the heaviest drinkers to maintain their alcohol consumption without substantially increasing their expenditure.

All purchase taxes are regressive; they affect deprived communities more severely. But the effect of alcohol related harm on deprived communities is savage—a threefold excess mortality between the most deprived and least deprived socioeconomic groups. Taxpayers are already paying for the harm that alcohol causes. According to the Organisation for Economic Cooperation and Development alcohol misuse currently costs the UK 2-3% of gross domestic product; this equates to around £12 a week for each of the 60 million or so UK inhabitants, of which £3 comes back from the drinks industry in taxes. Moderate drinkers and non-drinkers in the UK are effectively subsidising heavy drinkers to the tune of around £9 a week.

The fiscal alternative to minimum pricing is a general increase in alcohol duty, and it is precisely because minimum unit pricing is so highly targeted that it is so effective. In Canada, where they have had minimum unit pricing for years, a 10% increase in the minimum price resulted in a 32% decrease in directly attributable alcohol related mortality. In the Canadian province of Saskatchewan a 10% increase in minimum unit prices reduced consumption of beer by 10.1%, spirits by 5.9%, and wine by 4.6%..." (from Commentary: Minimum unit price—how the evidence stacks up, BMJ 2014;348:g6)

As the commentators highlight, the impact on the pockets of such a measure would be minimal for more discerning, moderate drinkers and pub-goers, who already pay a higher price than the proposed minimum.

They do not, however, dwell on what steps retailers might take to compensate for any loss of revenue incurred through sales reductions. Loading these costs onto higher-priced or more premium beverages could see more reserved drinkers paying more in the longer term.

But since it appears I'm already paying £9 towards the nation's heavy-drinking habits, what's a few quid more?



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I will say that the impacts of high alcohol consumption go far beyond mortality.  The negative social impacts for both binge drinkers, and chronic high drinkers can be extreme. 

Both cigarette taxes and alcohol taxes are extremely regressive, and perhaps that is part of the point.  I was surprised by the high correlation between taxes and decreased drinking in the studies cited.  What will be the impact on binge drinking? 

Is there a way to truly correlate point of sale taxes and quality of life for those hit hardest by the taxes? CliffordK, Tue, 14th Jan 2014

Hold on a minute! Alcohol is mostly a chronic poison - cirrhosis etc don't kill in days or even weeks. So jacking up the price today might have an effect on price-sensitive drinkers in maybe 3 - 5 years' time. Meanwhile, what else has changed? Mostly, fashion, public attitudes to drink (including enforecement of drink-driving laws), and medical treatment for alcohol-related disease. You might reduce teenage consumption of alcopops by a price hike, but (a) they were a temporary fashion item rather than staple booze for hardened addicts and (b) they only produced acute fatalities due to accident or overdose, not longterm disease. In short, correlation is not proof of causation.

The price of cocaine, heroin, marijuana or tobacco has almost no effect on consumption: increasing the price of good stuff merely reduces the quality of what people can afford, and people inject homebrew or stuff cut with rat poison. Jacking up the price of storebought alcohol, or even full Prohibition, just increases the production of homebrew which is a lot safer than do-it-yourself injectables.

Government should stick to the protection of third parties: DUA should always be treated as attempted murder  and being inebriated should never be considered a mitigating factor in any offence. 

Binge drinking was defined by the UK government as consuming more than half a bottle of wine at one sitting. As one irate Times letterwriter pointed out, that isn't a "problem", it's "lunch". I agree. That's why God invented taxis.  alancalverd, Tue, 14th Jan 2014

It seems morally questionable to raise taxes to discourage use but then put that money into a general fund. The government is making money from a destructive form of behavior. Some or all of the tax increase should go directly to helping people change their behavior if they want to, scientific research about methods that help people accomplish that,  as well as the medical system that has to deal with the associated morbidity. Otherwise it's  hypocrisy. Just my opinion. cheryl j, Tue, 14th Jan 2014

Excellent Point.
In many senses there is a huge conflict of interest.  Governments trying to maximize taxes while discouraging the activities that are being taxed.  I agree that it is appropriate to use some of the money for negative ads, counseling, addiction treatment, and anti-drug childhood education. 

In Oregon, a portion of the Cigarette taxes goes to funding health care for the poor through Medicaid, with the idea that it is a regressive tax and  more poor people smoke than wealthy people, and considering the ill effects of smoking.  CliffordK, Wed, 15th Jan 2014

Report was bad science logic, I'll post why on the article page. stewgreen, Sat, 18th Jan 2014

(I say Ban alcohol selling 1 day/week to break cycle)
- Very distressed by Chris's praising of the report. Because it clearly was not science, but logic fail; instead of A causes B hypothesis tested and failed to be disproved they started with a bit of science, but then extrapolated on from A-B way onto C, D, E without science. It was just supposition, and a failure in the chain of logic. (Although these days a lot of "non-science" is coming into science in the same way as people fail to see the limits/boundaries) .. no you can't just infer E from "A"
- An example is saying "higher fuel prices will cause more deaths", it sounds right to infer that, but do the the science and you find it's not true in the UK. Please look into that logic chain. ..
- Coincidentally Logician Jamie Whyte did a debunk of the report for IEA..
- A video also stewgreen, Sat, 18th Jan 2014

And then more non-science, when Chris comes over all conspiracy theory "the law was dropped, due to alcohol corp pressure"
.. you can't say stuff like that and then not give evidence.. it just sounded like an attempt to smear.. and was far removed from science. Too damm right alcohol business should PAY for harm they profit from, but you have to offer proper evidence.
stewgreen, Sat, 18th Jan 2014

Did you actually look at the report
rather than the commentary on it, before writing it off as bad science?
And do you really think that banning sales 1 day a week will help?
Do you not understand that people will simply buy in supplies for the "dry" day?
Bored chemist, Sat, 18th Jan 2014

I can say that if the alcohol industry did not apply considerable pressure, then they weren't doing their job!

It is an unfortunate fact that in our society, the mission of corporations is to maximise their own profits, not the government income, the well-being of their customers or the general well-being of the community.

If that corporation is selling a product which is causing damage to some segment of the community, then their mission is to do everything in their power to increase sales to that segment of the community. And if they don't do it, a competitor will.

The part of the podcast report that spoke to me most strongly about the "regressive tax" aspect was the part about the very regressive nature of the costs of excess alcohol consumption. This imposes a much higher death and disability rate on the poorest communities.

The example of price elasticity from Canada was interesting - a 10% increase in price led to a 5-10% decline in consumption. It is as if some segments of the community have a certain amount of money to spend on alcohol, and if the price goes up, consumption goes down.

The challenge for the government is to collect scientific evidence, potentially to do a trial (let's call Canada a trial), and implement corrective policy if evidence shows that our economic system is doing itself harm. The scientific evidence is in - now the government should reconsider the implementation. evan_au, Sat, 18th Jan 2014

Government advertising isn't always entirely effective.  However, if the government states that they will impose a certain tax because of the problems associated with the product, perhaps it gets the people to start thinking about the product.  And some make better choices based on the publicity, rather than sheer economics. 

Of course that isn't necessarily bad. 

If the greatest problem is the cheap beer, is there any way to force people to just buy the expensive imported stuff?  Except that the German beer may have a slightly higher alcohol content  CliffordK, Sat, 18th Jan 2014

Someone complained in the UK parliament that supermarkets were selling beer cheaper than bottled water. Cries of "hear, hear" and general mutterings of shock horror something must be done. Now since beer is made from very pure water plus a whole load of other stuff and a lot of time and energy, the scientific conclusion must be that the water industry is ripping off the customers. But did anyone leap to the barricades on behalf of the gullible teetotaller? Not a bit.

Frankly, if some people are stupid enough to pay over the odds for water and others are stupid enough to complain that beer is too cheap, there is little hope for the human race.

And for as long as the Houses of Parliament have subsidised bar prices, government has no business telling anyone else how much they should pay. alancalverd, Sun, 19th Jan 2014

- NS show is a science show, so give us the science.
Chris's intro made it clear BMJ article is an OPINION piece
- It quickly seemed to me BMJ writers were using the trick of starting off with a base in science, to articulate for a particular MAGIC policy. No let's have the proper science.. brick by brick to decide the RIGHT policies.
- Alcohol addiction/misuse is a serious problem that is really neglected and we should spend resources to tackle it (on the basis that producers pay for the negatives of their products).
- However what we should NOT do is start off with a "magic solution" (PRICE) then post justify it.
- I very much suspect that Canada is not an alcoholic free utopia.

- One thing I suggest breaking cycles of addiction
... My experience is that most addicts don't have the ability to hoard, but rather consume all they have on a daily basis.
BTW the world service prog on alcohol was very informative.

Qns arise
- Do countries where alcohol is already above our prices have alcohol problems ?
- Do countries where it is significantly cheaper have worse problems thatn the UK ?
stewgreen, Sun, 19th Jan 2014

Fair enough if the product is defective or turns out to have unexpected side effects, but you can't expect the manufacturer to pay fo the consequence of misuse, nor can you consider alcohol to be a novel product with unknown effects, and why should the manufacturers and responsible consumers of Brand A have to pay for my addiction to Brand B (especially if Brand B is homebrew)?


1. Yes (Norway)
2. No (Belgium)
alancalverd, Sun, 19th Jan 2014

Fair enough if the product is defective or turns out to have unexpected side effects, but you can't expect the manufacturer to pay fo the consequence of misuse, nor can you consider alcohol to be a novel product with unknown effects, and why should the manufacturers and responsible consumers of Brand A have to pay for my addiction to Brand B (especially if Brand B is homebrew)?

I think the beer companies should pay for repairing my flat bicycle tires  ... but that is just my opinion.

Cigarette companies have been forced to pay "damages", but by now just about everyone in the USA who smokes has heard about the ill effects of smoking.  Yet, there are still people who START smoking, and companies still produce the cigarettes.

Many people don't consider alcohol to be harmful in moderation, and it may even be "protective".  Yet, for some, it can have a huge negative social impact, and certainly is related to cirrhosis of the liver, and perhaps throat cancer.  I'm not sure the same liability criteria as smoking can be applied to alcohol producers, as cigarette companies, but I believe bars have been found responsible for not cutting off clearly inebriated individuals, and allowing them to drink and drive after visiting their establishment.

One might point out.  Tylenol (acetaminophen or paracetamol), one of the most common pain meds is also considered safe in moderation, but also damages the liver when taken in excess.  It has been used for suicide, although it is not a good way to go.  Should we also add punitive taxes to Tylenol? CliffordK, Sun, 19th Jan 2014

I think the scientific/medical evidence is relatively clear: excess alcohol intake over the long term leads to cirrhosis of the liver, dietary and neurological problems; excess intake over the short term leads to increased road accidents and violent incidents.

Where it starts getting more tricky is when you try to calculate the Economics; turning that costing into a justifiable Policy is downright devilish.

Traditionally, external costs (ie costs paid by someone else, like the customers, their families, the goverment or the environment) are ignored by the individual company doing the costing. However, the government must take a broader view, and includes some of these external costs in their Economic evaluations (while quite possibly ignoring different external costs like deforestation in the Amazon or economic destruction in the Middle East).

I am aware of one large corporation which discovered that one of its products was bio-accumulating in the Arctic environment. Before any evidence existed that this was harmful, they took the courageous decision to shut down that product. This is taking external costs seriously, probably beyond what most governments would consider. And it is not entirely illogical - do they take a loss in stopping a profitable product now, or do they expand production until it possibly becomes a disaster, and destroys both their name and the environment? It just depends on which costs you consider, and over what timescale.

And then there is the issue of a Feasible Policy - in a democratic country, is it more acceptable to introduce a minimum price at 50p/unit, or introduce it at 45p/unit, and after the benefits are clearer, possibly raise the minimum price by 10%? There is little science in this - although you could do some experiments to test various price points (providing there is no-one making a profit by buying from the low-cost test site and selling into the high-cost test site!).

And Policy always needs some adjustments to avoid glaring inequities - for example, if Do-It-Yourself kits are shown to be causing problems, you could apply the same effective price per unit to brewing kits. But I think if brewing kits were a problem, they would be a self-limiting problem. A truly tragic alcoholic, when he ran out of full-strength beer, would drink his slightly aged half-strength brew, and then his barely-fermented new brew... evan_au, Mon, 20th Jan 2014

But what constitutes a brewing kit? Will there be a tax on bakers' yeast?

Far more sensible to tell people that alcohol is dangerous and addictive, prosecute anyone who harms a third party whilst inebriated, and let adults run their own lives. Is there a tax on aspirin, knives, rope, or bullets?  alancalverd, Mon, 20th Jan 2014

Aha, I think I have put my finger on what bothers me.
.. I heard Chris say “Wow this is amazing, this BMJ report says on this (super complex) issue the science is clearcut : alcohol pricing is the way to go and the government were  100% wrong We know A→B, C→D, D→E and E→F” (paraphrased)
- dinga-ling that “amazing” and then the RUSH through A→F triggers my “too good/bad to be true” alarm.
- I heard an extraordinary claim, but not extraordinary evidence. A→B seemed like science, but in connecting that to the rest seems like going BEYOND science.
-  The idea that the government went against evidence that is 100% clearcut is possible, but it is amazing, so it does need some extraordinary evidence to back it up.
- Now in reports you can go beyond science entirely by accident, but there is also the phenomenom of “policy based science”, where you come up with a policy and then search out the evidence to back it up.
- On complex issues this is attractive to people rather than do the hard work of analysing the complex science jigsaw and working out the policy that way. But such shortcuts can lead to bad practicalities, so in the long run proper science is the way to go
stewgreen, Mon, 20th Jan 2014

I noticed in the video that there was a nominal price put on "fun".

Since alcohol is a stimulant at low doses, and a depressant at higher doses, we should assume by this logic that we should discourage heavy consumption strongly, without blocking light consumption.

It seems that a price per unit does this... evan_au, Tue, 21st Jan 2014

I just watched the rest of the Jamie Whyte "Quack Policy" video... A few comments (paraphrased from notes):

The advertising industry already spends millions of Pounds/Dollars to ensure that people are fully aware of the benefits of alcohol - especially the fun factor. However, advertising ignores the costs unless forced to acknowledge them by government legislation. So the government must pay for alcohol education because people are already bombarded by information which is totally biased to be pro-alcohol.

The alcohol industry certainly won't pay for this message!

Inebriation suppresses the ability to assess risks accurately, so that even though people may be intellectually aware of the risks before they drink, this ceases to have much influence on a person's behaviour once they are drunk.

Co-workers must pick up the slack for a person who calls in sick after a big night - or who turns up to work anyway and is unable to function effectively. At least in my country, sick leave and wages are paid by the employer, not the employee. And the customers end up with worse/more stressed service.

I would suggest that Fetal Alcohol Syndrome and domestic violence are external health costs which are not directly paid by the drinker. evan_au, Wed, 22nd Jan 2014

The challenge for government when proposing a tax on an industry is that this industry will campaign against the tax - trying to get voters and politicians to vote it down.  And such campaigning is entirely justifiable as a tax deduction, since the industry is protecting future profits.

However, the public only tolerate a certain amount of advertising stating "Drinking is good for you - vote down the tax! Signed: The alcohol industry".

To reach more sectors of the community, this campaigning will include advertising, funding scientific-sounding research, and paying people to call radio stations and post on social media to promote their message (including this forum). This sounds like genuine public opinon, and is not so obviously blatant self-interest, and so is a bit more convincing.

As in many areas, you find this out by following the money. But (as seen with the tobacco debacle), the source of funding is often hidden by the industry and the opinion leaders. Indeed, some charitable organisations effectively "launder" money by accepting grants, and then issuing them to recipients specified by the donor, thus hindering the ability of the public to assess the credibility of the opinions expressed.

As with medical research, perhaps we need a declaration of any "conflict of interests" in such debates over finances.

PS: These are my own opinions, and nobody is paying me to express them...
We should expect similar statements from the likes of Jamie Whyte & Stewgreen, and other participants in the debate (perhaps even MrVat7?). evan_au, Sun, 26th Jan 2014

Utter confusion reigns. There's a huge difference between making and selling a pleasant beverage, and being inebriated. Society should penalise anyone who harms or inconveniences a third party, and to do so when under the influence of any intoxicant must be classed as "intentional".

IMHO all drugs should be on open sale, with proper quality controls and a reasonable tax take to cover statutory quality monitoring. If anyone wants to get high or get pissed in his own home, it's nobody else's business, but his behaviour in public must not be compromised, and no help should be given to anyone who intoxicates himself. Yes, a few drunks will die in the snow and there will be plenty of deaths from heroin, but as a result, far fewer pedestrians will be mown down by drunk drivers, fewer pensioners will be mugged to pay for illegal drugs, and pretty soon the world will realise that (a) you are responsible for your own life and the safety of those around you and (b) nobody really cares what harm you do to yourself.  alancalverd, Mon, 27th Jan 2014

I agree in principle, but sometimes when I see public service announcements about "drinking responsibly", it does seem to be a bit of an oxymoron - relying on an impaired brain to make judgements about its impairedness, which studies have shown are wildly wrong. People almost always overestimate their perception and reflexes, and underestimate their BAC.

Laws that permit a certain moderate level of alcohol while driving (say, up to .08 or 1) just invite people to make those very same misjudgements, but I suppose it would be socially unrealistic to lower the limit to .02 People don't realize that after a late night out and a lot of alcohol, they probably aren't even near zero BAC until afternoon the next day. And it's much harder to judge ones intoxication coming down, than going up.

In that respect the public services ads promoting designated drivers and making a plan to get home before you start consuming are much more realistic. Don't rely on your alcohol addled brain to figure it out later.  cheryl j, Mon, 27th Jan 2014

The first results have been collated on Sydney's measures to curb problem drinking: a 30% reduction in ambulance callouts due to alcohol-fueled violence.

So it seems that government legislation can have a beneficial effect on public health (if we let it). evan_au, Sun, 30th Mar 2014

I believe personal breathalyzers are extremely cheap.  Less than the cost of about a fifth of bourbon. 

Blow into the machine.
Wait 15 minutes (without drinking), blow again. 

If the results aren't rapidly going up, and are significantly below 0.08...  then it should be fine.

The idea of a cutoff is a determination above which most drivers exhibit some impairment, and is something that can legally be used in court rather than stating that the individual wobbled while walking on the fog line (I know a person that would likely fail the fog line test while sober). CliffordK, Sun, 30th Mar 2014

I believe personal breathalyzers are extremely cheap.  Less than the cost of about a fifth of bourbon. 

Blow into the machine.
Wait 15 minutes (without drinking), blow again. 

If the results aren't rapidly going up, and are significantly below 0.08...  then it should be fine.

The idea of a cutoff is a determination above which most drivers exhibit some impairment, and is something that can legally be used in court rather than stating that the individual wobbled while walking on the fog line (I know a person that would likely fail the fog line test while sober),  not that I'd like to be in a car that he was driving. CliffordK, Sun, 30th Mar 2014

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