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Further support for minimum alcohol pricing

Research from the University of Sheffield, published in the medical journal The Lancet, provides further evidence that increasing alcohol prices could reduce illnesses, premature deaths and healthcare costs.

Dr Robin Purshouse and colleagues from Sheffield University’s School of Health and Related Research (ScHARR) and Department of Economics modeled the effects of alcohol pricing and promotion policy options for England, including:

  • across-the-board price increases
  • policies setting a minimum price per unit between 20p and 70p
  • policies restricting price based promotions in the off-licensed trade sector, ranging from prohibiting large discounts only, through to a complete ban

Population subgroups such as hazardous drinkers aged 18–24 years, harmful drinkers, and moderate drinkers were analysed and the researchers found that, if a minimum cost of 50p per unit were introduced, this could result in:

  • 2,900 less premature deaths per year within 10 years 41,000 fewer cases of chronic illness
  • 8,000 fewer injuries each year
  • 92,000 fewer hospital admissions per year
  • a saving to the healthcare system in England of £270 million each year

For a minimum unit cost of £0.40, the estimated effects are projected as:

  • 1,200 less premature deaths per year within 10 years
  • 17,000 less chronic and 3,000 less acute cases of illness
  • 38,000 fewer hospital admissions
  • a healthcare system saving in England of £110 million

The authors found that harmful drinkers are affected considerably more than moderate drinkers by minimum price policies. For a 50p minimum price, a harmful drinker will spend on average an extra £163 per year whilst the equivalent spending increase for a moderate drinker is £12. This targeted effect arises because harmful drinkers purchase more of the cheap alcohol that is affected by a minimum price policy.

A 50p minimum price would prevent 49,000 cases of illness within 10 years, about 30,000 of which would be in men. Most of the harm reductions arise in chronic disorders in people aged 45 years and older, including diseases of the circulatory system, alcoholic disorders and alcohol-related acute outcomes, including road traffic accidents and falls.

The research also identified patterns of purchasing. Purchasing preferences vary across the population, with women purchasing a higher proportion of their alcohol from off-trade outlets (supermarkets and off-licenses) than men, and people aged 18–24 years purchasing alcohol mainly in the on-trade sector (pubs, bars and clubs). Beverage preferences vary; beer and wine comprise about three-fifths of the alcohol consumed by men and women respectively, and adult consumption of ready-to drink beverages (alcopops) is low relative to other types of drink, peaking at 20% of total consumption for women aged 18–24 years.

Consumption patterns also vary. Moderate male drinkers (excluding abstainers) consume on average about 8 units per week and only a small proportion engage in heavy episodic drinking, whereas harmful male drinkers consume on average 80 units and 7 in 10 are heavy episodic drinkers. Male harmful drinkers incur the largest proportion of alcohol-attributable mortality, ill health, alcohol attributable admissions, and healthcare costs.

Of the other pricing policies considered, the authors say:

“Prohibition of large discounts (for example buy-one-get one- free offers) alone has little effect, but tight restrictions or total bans on off-trade discounting could have effects similar in scale to minimum price thresholds of 30p–40p. For young adults, and especially for those aged 18–24 years, who are hazardous drinkers, policies that raise the price of cheaper alcohol in the on-trade sector (pubs and clubs) are most effective for achievement of harm reductions.”

The authors concluded: “General price increases are effective for reduction of consumption, healthcare costs, and health-related quality of life losses in all population subgroups. Minimum pricing policies can maintain this level of effectiveness for harmful drinkers while reducing effects on consumer spending for moderate drinkers. Total bans of supermarket and off-license discounting are effective but banning only large discounts has little effect. Young adult drinkers aged 18–24 years are especially affected by policies that raise prices in pubs and bars. Minimum pricing policies and discounting restrictions might warrant further consideration because both strategies are estimated to reduce alcohol consumption, and related health harms and costs, with drinker spending increases targeting those who incur most harm.”

 

Failure to in introduce minimum alcohol price the government’s “biggest health failing”

The Government’s rejection of the idea of setting a minimum price for a unit of alcohol was described as the biggest disappointment of his term of office by Sir Liam Donaldson, who is soon to retire as the Government’s Chief Medical Officer.

Sir Liam made the comment in an interview reported in the Daily Telegraph ahead of the publication of his final annual report on the state of the public health. In his previous annual report he had said that supermarkets and shops should not be allowed to sell alcohol for less than 50 pence per unit.

However, Prime Minister Gordon Brown rejected the proposal immediately, saying the “sensible majority” of moderate drinkers should not be punished for the excesses of binge drinkers.

Sir Liam’s proposal has the backing of most of the public health field and alcohol misuse agencies. The House of Commons Health Select Committee also supported the Chief Medical Officer against the Government, and the Scottish Government has been trying to introduce minimum pricing north of the border.

Sir Liam said the rejection of his proposal had been his greatest disappointment during his 12 years in post. The majority of his most important recommendations – including a ban on smoking in workplaces, allowing embryonic stem cell research, and changes to the way doctors are regulated - have been introduced.

Asked about recommendations where action had not been taken, and which of those he was most concerned about, Sir Liam said that on the public health front it would have to be minimum alcohol pricing. He added that, while he still hoped it would come in at some point, he had little hope of either of the main political parties changing their views on the matter in the short-term, saying: “I think we have to wait until after the election – there’s a lot of momentum building in the public health community.”