alcohol beverage regulation - emerging trends some lessons from public health science peter...
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Alcohol beverage regulation - Emerging trends
Some lessons from public health science
Peter Anderson, MD, MPH, PhD 12 March 2008
1.Alcohol matters 2.Regulation matters3.The alcohol beverage industry matters
1.Alcohol matters 2.Regulation matters3.The alcohol beverage industry matters
Consumption per occasion (grams of pure alcohol)
Riskper 1,000
Risk over lifetime that death in UK is due to alcohol-related injuryassuming 10,000 drinking occasions between 18-70 years (every other day)
Source: Taylor & Rehm, based on Taylor et al., AJE, 2008; Rehm et al. IJMPR, 2008
0
10
20
30
40
50
60
70
0 10 20 30 40 50 60 70
Men Women
Average daily consumption (grams pure alcohol)
Riskper 1,000
0
50
100
150
200
250
300
10 20 30 40 50 60 70 80 90 100
Men Women
Source: Taylor & Rehm, based on Taylor et al., AJE, 2008; Rehm et al. IJMPR, 2008
Risk over lifetime that death in UK is due to alcohol-related chronic illness
The risks are additive:
If a man drinks 60g alcohol on an occasion every other day the risk that his death is due to alcohol is about 10%
0
10
20
30
40
50
15-24 25-39 40-54 55+
22
30 27 27
Proportion of European people who have had 5+ drinks on one occasion at least weekly during past 12 months by age
Source: Eurobarometer 2007
Age (years)
%
0
10
20
30
40
50
Se
lf-e
mp
loye
d
Ma
na
ge
rs
Oth
er
wh
ite
colla
r
Ma
nu
al
wo
rke
rs
Ho
use
p
ers
on
s
No
t e
mp
loye
d
Re
tire
d
Stu
de
nts
38
26 27
32
22
32
2528
Proportion of European people of have had 5+ drinks on one occasion at least weekly during past 12 months by occupational group
Source: Eurobarometer 2007Occupational group
%
1.Alcohol matters 2.Regulation matters3.The alcohol beverage industry matters
1.Price2.Availability
1.Price2.Availability
100
110
120
130
140
150
160
170
1990 1992 1994 1996 1998 2000 2002 2004 2006
Aff
orda
bilit
y (1
00=
1980
val
ue)
8
8.5
9
9.5
10
10.5
11
11.5
12
Per
cap
ita a
dult
cons
umpt
ion
(L a
lcoh
ol)
Affordability
Consumption
England and Wales
Source: Anderson 2007
100
110
120
130
140
150
160
170
1990 1992 1994 1996 1998 2000 2002 2004 2006
Aff
orda
bilit
y (1
00=
1980
val
ue)
8
8.5
9
9.5
10
10.5
11
11.5
12
Per
cap
ita a
dult
cons
umpt
ion
(L a
lcoh
ol)
Affordability
Consumption
England and Wales
Source: Anderson 2007
England and Wales
18.2
9.1
6
8
10
12
14
16
18
20
1990 1992 1994 1996 1998 2000 2002 2004 2006
Mal
e de
aths
/100
,000
8
8.5
9
9.5
10
10.5
11
11.5
12
Per c
apita
alc
ohol
con
sum
ptio
n(L
alc
ohol
)
Alcohol-related deaths
Consumption
England and Wales
Source: Anderson 2007
Source: Office for National Statistics, UK 2008
UK alcohol-related deaths by age of death
Source: Goldacre et al 2004
Alcohol as a certified cause of death in a middle England population(Around Oxford)
Death certificate mentions alcohol
Death certificate states alcohol as underlying cause
0
10
20
30
40
50
60
I II III IV V
Alcohol deaths Total deaths
Distribution of deaths by social class
Source: Goldacre et al 2004
%
Higher Lower
Source: Moskalewicz et al 2000
Number of ½ L bottles of vodka an average monthly salary can buy
Alco
hol c
onsu
mpti
on, l
/cap
itaEconomic availability and alcohol consumption, Poland, 1960-1996
90,0080,0070,0060,0050,0040,0030,0020,00
15,00
12,00
9,00
6,00
3,00
0,00
Dea
ths/
100,
000
men
20022001
2000
1999
19961995
1994
1993
19921991
1990
1988
1986
19851984
1983
1982
1981
19801979
19771976
1974
1973
197219661964
Source: Moskalewicz et al 2005
Economic availability and liver cirrhosis deaths, men aged 20-44 yearsPoland 1968-2003
Number of ½ L bottles of vodka an average monthly salary can buy
Source: Moskalewicz et al 2005
Alcohol tax cuts and alcohol-positive sudden deaths, Finland
Source: Koski et al 2007
On 1/3/04, tax increased by 33% retail price increased by 22%
7.7 additional deaths/week
Num
ber o
f alc
ohol
-pos
itive
sud
den
deat
hs/w
eek
Alcohol-related deaths, Finland
Source: Puska 2007
Number of deaths
Total
Men
Women
At the end of November 2007, the Parliament decided to raise alcohol taxes by an average of 11.5%.
Retail prices are expected to raise by 5% on average.
1.Price2.Availability
8000
10000
12000
14000
16000
18000
20000
22000
24000
1992 1994 1996 1998 2000 2002 2004 2006
Hos
pita
l adm
issi
ons
(n)
72000
74000
76000
78000
80000
82000
84000
86000
Lice
nsed
pub
s (n
)
Acute toxic effects
Public Houses
England: licensed public houses and hospital admissions
21726
13572
8000
10000
12000
14000
16000
18000
20000
22000
24000
1992 1994 1996 1998 2000 2002 2004 2006
Hos
pita
l adm
issi
ons
(n)
72000
74000
76000
78000
80000
82000
84000
86000
Lice
nsed
pub
s (n
)
Acute toxic effects
Public Houses
England: licensed public houses and hospital admissions for acute toxic effects
Source: Department of Culture, Media and Sport 2007
Shift in pub opening times before and after November 2005, England and Wales
On average, pubs opened 27 minutes longer after the reform
Source: Hough et al 2008
Violence and crime-related offences, England and Wales
22% increase
No real change
Source: Hough et al 2008
Violence and crime-related offences, Birmingham City centre
Physical availability and first hospitalisations due to alcohol disordersPoland 1968-2003
50,0040,0030,0020,0010,00
80,0
60,0
40,0
20,0
2003 2002
2001
20001999
1996
1995
1993
1986
19831982
1981
1980
1975
1969
1968
Source: Moskalewicz et al 2005
Hos
pita
l adm
issi
ons/
100,
000
peop
le
Number of outlets/10,000 people
1.Alcohol matters 2.Regulation matters3.The alcohol beverage industry matters
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
28%:Home brew (legal and illegal)Cross borderOther untaxedSurrogate
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
What makes up the price of a bint of beer in the UK
Value of shop sales of alcohol
6.4
13
0
2
4
6
8
10
12
14
1996 2006
Shop
sal
es £
bnIncrease on off premise sales in UK, 1996-2006
UK supermarkets have pointed out that under existing competition laws they would face high penalties if they were to collude on prices. But, under new arrangements secured through proposed amendments to licensing laws, they could be allowed to consult with each other before raising the cost of retail sales
Increasing prices:Reduces consumptionReduces harmBut, due to the common inelastic relationship between price and consumption, consumption decreases less than the price increase, which can lead to increased profit
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
One supermarket chain in England will stop selling shot size ‘shooter’ alcopops
Areas for industry action (producers and retailers)
1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol3.Increase the price4.Moratorium on marketing beverages to young people 5.Better ensure that sellers do not sell alcohol to under age or intoxicated
One supermarket chain in England will stop selling alcohol between midnight and 6am
1.The volume of alcohol consumption matters, both on an occasion and overall, and matters for the younger and older middle age and the ‘middle class’
2.Making alcohol more affordable and more available increases harm; European countries are tackling this
3.Producers and retailers could manage the regulation of the product to reduce harm, and, in many cases, increase profit