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 controlofficer destroysbrewing 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 indicate1. A 10% increase in price leads on average to a 5%

reduction in consumption2. Price increases lead to reductions in drinking by heavy

and problem drinkers3. 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

0

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Actual Model Predicted Linear Trend

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← 1983 Tax Increase 2002 Tax Increase →

Wagenaar et al, American Journal of Public Health, 2009

Effects of two tax increases on deaths from alcohol related diseases in

Alaska

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 IIStockwell, Zhao et al, American J Public Health, 2012

1 2 3 4 5 6 7 8 910111213 1 2 3 4 5 6 7 8 910111213 1 2 3 4 5 6 7 8 910111213 1 2 3 4 5 6 7 8 910111213

2008/09 2009/10 2010/11 2011/12

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Consumption of alcoholic beverages in Saskatchewan before and after a major Minimum

Price policy change

Total Ethanol

Beer

Spirits

Wine

Coolers

Cocktails

Liqueur

Fiscal period, April 2008 to March 2012Ag

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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 injuriesMotor vehicle accidentsPoisoningsAccidental poisoning & exposure to alcoholFallsFiresDrowningOther unintentional injuries

Intentional injuriesSelf-inflicted injuriesViolence-related injuriesIntentional self-poisoning by and exposure to alcoholOther intentional injuries

1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 4 1 2 3 42002 2003 2004 2005 2006 2007 2008 2009

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Rates of acute alcohol attributable hospital admissions and CPI-adjusted minimum alcohol prices in British Co-

lumbia, 2002-2009Hospital Admission Rate

Minimum price

Year and season

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Impacts on Harm IStockwell, Zhao et al, American Journal of Public Health,

2013

Model predicts a 10% minimum price increase is associated with a 9% drop in admissions (p<0.01)

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

SheffieldModel

[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

THANK YOU!

Thank you!