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COMMENTARY
Commentary on Ally et al. (2014): Increasing the price of cheap alcohol would contribute to decreasing health inequalities
Alcohol prices are a powerful instrument for alcohol policymakers for impacting alcohol consumption and related harms [1]. In the policymaker’s toolkit, the main tool for increasing alcohol prices has been taxation, with the implicit assumption that taxes are passed through to prices. The conditions and boundaries of this assumption have been studied surprisingly little, and the study by Ally et al. [2] is a welcome contribution. In the study, the passthrough rates are examined by product type and price category in the United Kingdom, and the results show that in connection with tax increases, the prices of cheaper—higher–selling—products are raised less than the prices of more expensive products. This has implications for how an increase in alcohol excise duties may be expected to affect consumption, and hence harms, in various consumer groups. This is particularly relevant from the viewpoint of addressing increasing socioeconomic disparities in alcohol-related harm. Socio-economic disparities in overall mortality and morbidity are large whether measured by educational, occupational or income differences [3,4], and in many countries in Europe and the United States these disparities have grown considerably over the past decades [5,6]. For example, in the United Kingdom, men in the highest occupational category were, at the beginning of the 2000s, expected to live 5.8 years and women 3.5 years longer than men and women in the lowest occupational category, which is a considerable increase from the difference of 4.9 years and 2.3 years observed 20 years earlier [7]. Closing these gaps has been identified as one key health challenge within the European Union [8]. Socio-economic disparities in alcohol-related mortality are also high, and often even higher than those for overall mortality [9,10]. This has not always been the case, however. In England and Wales the relative index of inequality in male liver cirrhosis mortality by social class rose from 0.88 [lower mortality in lower socio-economic status (SES) categories] in 1961 to 1.4 (higher mortality in lower SES categories) in 1981, and an even stronger shift was reported for men in Scotland (from 0.6 to 1.67) [11]. Since then, alcohol-related mortality in the United Kingdom has increased even further [12], and at the beginning of the 2000s, alcohol-related mortality was reported to be 3.5 greater in the routine occupational class compared to the higher and managerial occupations among men, and 5.7 times greater among women [10]. In this same period, with increasing alcohol-related mortality and mortality differentials, the price of alcohol has fallen relative to personal disposable income [13,14], © 2014 Society for the Study of Addiction
which has meant that consumption habits leading to liver cirrhosis and other alcohol-related diseases are increasingly within the reach of everyone. From Finland, there is more direct evidence that alcohol has played a central role in the increasing inequalities in overall mortality [9]. It is extremely important to prevent severe alcoholrelated harm in the lower socio-economic groups, where the burden is the greatest. The price of alcohol is particularly relevant in this group, making it a useful tool. Against this background, Ally et al.’s results are highly important. It is known that heavier drinkers and particularly heavy drinkers with lower incomes tend to purchase cheaper alcohol [15]. Ally et al. show that it is exactly in this cheapest price category where increased taxes are not passed through to prices. In other words, commercially operated companies are unwilling to increase the price of the alcoholic beverages for which this would be most important from a public health viewpoint, i.e. the cheapest alcohol which is bought and consumed in greatest quantities, by the heaviest drinkers, and hence lead to most harm. This renders tax increases less efficient from the public health viewpoint than they would be with an evenly distributed tax pass-through. Minimum unit pricing would in this case be an ideal supplement, a targeted measure, which would have little impact on moderate drinkers, even those with low incomes [15]. Minimum unit pricing would therefore be highly justified as an efficient method to combat harmful drinking and to reduce alcohol-related harm and its high socio-economic disparities. Declaration of interests None. Keywords Alcohol, minimum unit price, passthrough rate, policy, price, socioeconomic status. PIA MÄKELÄ
Department of Alcohol, Drugs and Addiction, THL, PO Box 30, Helsinki 00271, Finland. E-mail: [email protected] References 1. Babor T., Caetano R., Caswell S., Edwards G., Giesbrecht N., Graham K. et al. Alcohol: No Ordinary Commodity. Research and Public Policy. Oxford: Oxford University Press; 2010. 2. Ally A. K., Meng Y., Chakraborty R., Dobson P. W., Seaton J. S., Holmes J. et al. Alcohol tax pass-through across the Addiction, 109, 2003–2004
2004
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4.
5.
6.
7.
8.
Commentary
product and price range: do retailers treat cheap alcohol differently? Addiction 2014; 109: 1994–2002. Mackenbach J. P., Stirbu I., Roskam A. J., Schaap M. M., Menvielle G., Leinsalu M. et al. European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008; 358: 2468–81. Elo I. T. Social class differentials in health and mortality: patterns and explanations in comparative perspective. Annu Rev Sociol 2009; 35: 553–72. Mackenbach J. P., Bos V., Andersen O., Cardano M., Costa G., Harding S. et al. Widening socioeconomic inequalities in mortality in six western European countries. Int J Epidemiol 2003; 32: 830–7. Meara E. R., Richards S., Cutler D. M. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff 2008; 27: 350–60. doi: 10.1377/ hlthaff.27.2.350. Office for National Statistics (ONS). Trends in life expectancy by the National Statistics Socio-economic Classification, 1982– 2006. London: ONS; 2011. Available at: http://www .ons.gov.uk/ons/rel/health-ineq/health-inequalities/ trends-in-life-expectancy--1982---2006/trends-in-life -expectancy-by-the-national-statistics-socio-economic -classification-1982-2006.pdf (accessed 26 July 2014) (Archived at http://www.webcitation.org/6RLldzIgR). European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Solidarity in Health: reducing health inequalities in the EU.
© 2014 Society for the Study of Addiction
9.
10.
11.
12.
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14. 15.
COM(2009) 567 final. Brussels, 20 October 2009. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri =COM:2009:0567:FIN:EN:PDF (accessed 26 July 2014) (Archived by WebCite® at http://www.webcitation.org/ 6RLmbmiWz). Martikainen P., Mäkelä P., Peltonen R., Myrskylä M. Income differences in life expectancy. The changing contribution of harmful consumption of alcohol and smoking. Epidemiology 2014; 25: 182–90. Siegler V., Al-Hamad A., Johnson B., Wells C., Sheron N. Social inequalities in alcohol-related adult mortality by National Statistics Socio-economic Classification, England and Wales, 2001–03. Health Stat Q 2011; 50: 4–39. Marang-van der Mheen P. J., Smith G. D., Hart C. L., Gunning-Schepers L. J. Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes. J Epidemiol Community Health 1998; 52: 214–8. Leon D. A., McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 2006; 367: 52–6. Österberg E., Karlsson T. Alcohol Policies in EU Member States and Norway: A Collection of Country Reports. Helsinki: STAKES; 2003. The Information Centre. Statistics on Alcohol: England 2010. Leeds: The Information Centre; 2010. Holmes J., Meng Y., Meier P. S., Brennan A., Angus C., Campbell-Burton A. et al. Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. Lancet 2014; 383: 1655–64.
Addiction, 109, 2003–2004
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
COMMENTARY
Commentary on Ally et al. (2014): Increasing the price of cheap alcohol would contribute to decreasing health inequalities
Alcohol prices are a powerful instrument for alcohol policymakers for impacting alcohol consumption and related harms [1]. In the policymaker’s toolkit, the main tool for increasing alcohol prices has been taxation, with the implicit assumption that taxes are passed through to prices. The conditions and boundaries of this assumption have been studied surprisingly little, and the study by Ally et al. [2] is a welcome contribution. In the study, the passthrough rates are examined by product type and price category in the United Kingdom, and the results show that in connection with tax increases, the prices of cheaper—higher–selling—products are raised less than the prices of more expensive products. This has implications for how an increase in alcohol excise duties may be expected to affect consumption, and hence harms, in various consumer groups. This is particularly relevant from the viewpoint of addressing increasing socioeconomic disparities in alcohol-related harm. Socio-economic disparities in overall mortality and morbidity are large whether measured by educational, occupational or income differences [3,4], and in many countries in Europe and the United States these disparities have grown considerably over the past decades [5,6]. For example, in the United Kingdom, men in the highest occupational category were, at the beginning of the 2000s, expected to live 5.8 years and women 3.5 years longer than men and women in the lowest occupational category, which is a considerable increase from the difference of 4.9 years and 2.3 years observed 20 years earlier [7]. Closing these gaps has been identified as one key health challenge within the European Union [8]. Socio-economic disparities in alcohol-related mortality are also high, and often even higher than those for overall mortality [9,10]. This has not always been the case, however. In England and Wales the relative index of inequality in male liver cirrhosis mortality by social class rose from 0.88 [lower mortality in lower socio-economic status (SES) categories] in 1961 to 1.4 (higher mortality in lower SES categories) in 1981, and an even stronger shift was reported for men in Scotland (from 0.6 to 1.67) [11]. Since then, alcohol-related mortality in the United Kingdom has increased even further [12], and at the beginning of the 2000s, alcohol-related mortality was reported to be 3.5 greater in the routine occupational class compared to the higher and managerial occupations among men, and 5.7 times greater among women [10]. In this same period, with increasing alcohol-related mortality and mortality differentials, the price of alcohol has fallen relative to personal disposable income [13,14], © 2014 Society for the Study of Addiction
which has meant that consumption habits leading to liver cirrhosis and other alcohol-related diseases are increasingly within the reach of everyone. From Finland, there is more direct evidence that alcohol has played a central role in the increasing inequalities in overall mortality [9]. It is extremely important to prevent severe alcoholrelated harm in the lower socio-economic groups, where the burden is the greatest. The price of alcohol is particularly relevant in this group, making it a useful tool. Against this background, Ally et al.’s results are highly important. It is known that heavier drinkers and particularly heavy drinkers with lower incomes tend to purchase cheaper alcohol [15]. Ally et al. show that it is exactly in this cheapest price category where increased taxes are not passed through to prices. In other words, commercially operated companies are unwilling to increase the price of the alcoholic beverages for which this would be most important from a public health viewpoint, i.e. the cheapest alcohol which is bought and consumed in greatest quantities, by the heaviest drinkers, and hence lead to most harm. This renders tax increases less efficient from the public health viewpoint than they would be with an evenly distributed tax pass-through. Minimum unit pricing would in this case be an ideal supplement, a targeted measure, which would have little impact on moderate drinkers, even those with low incomes [15]. Minimum unit pricing would therefore be highly justified as an efficient method to combat harmful drinking and to reduce alcohol-related harm and its high socio-economic disparities. Declaration of interests None. Keywords Alcohol, minimum unit price, passthrough rate, policy, price, socioeconomic status. PIA MÄKELÄ
Department of Alcohol, Drugs and Addiction, THL, PO Box 30, Helsinki 00271, Finland. E-mail: [email protected] References 1. Babor T., Caetano R., Caswell S., Edwards G., Giesbrecht N., Graham K. et al. Alcohol: No Ordinary Commodity. Research and Public Policy. Oxford: Oxford University Press; 2010. 2. Ally A. K., Meng Y., Chakraborty R., Dobson P. W., Seaton J. S., Holmes J. et al. Alcohol tax pass-through across the Addiction, 109, 2003–2004
2004
3.
4.
5.
6.
7.
8.
Commentary
product and price range: do retailers treat cheap alcohol differently? Addiction 2014; 109: 1994–2002. Mackenbach J. P., Stirbu I., Roskam A. J., Schaap M. M., Menvielle G., Leinsalu M. et al. European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med 2008; 358: 2468–81. Elo I. T. Social class differentials in health and mortality: patterns and explanations in comparative perspective. Annu Rev Sociol 2009; 35: 553–72. Mackenbach J. P., Bos V., Andersen O., Cardano M., Costa G., Harding S. et al. Widening socioeconomic inequalities in mortality in six western European countries. Int J Epidemiol 2003; 32: 830–7. Meara E. R., Richards S., Cutler D. M. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff 2008; 27: 350–60. doi: 10.1377/ hlthaff.27.2.350. Office for National Statistics (ONS). Trends in life expectancy by the National Statistics Socio-economic Classification, 1982– 2006. London: ONS; 2011. Available at: http://www .ons.gov.uk/ons/rel/health-ineq/health-inequalities/ trends-in-life-expectancy--1982---2006/trends-in-life -expectancy-by-the-national-statistics-socio-economic -classification-1982-2006.pdf (accessed 26 July 2014) (Archived at http://www.webcitation.org/6RLldzIgR). European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Solidarity in Health: reducing health inequalities in the EU.
© 2014 Society for the Study of Addiction
9.
10.
11.
12.
13.
14. 15.
COM(2009) 567 final. Brussels, 20 October 2009. Available at: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri =COM:2009:0567:FIN:EN:PDF (accessed 26 July 2014) (Archived by WebCite® at http://www.webcitation.org/ 6RLmbmiWz). Martikainen P., Mäkelä P., Peltonen R., Myrskylä M. Income differences in life expectancy. The changing contribution of harmful consumption of alcohol and smoking. Epidemiology 2014; 25: 182–90. Siegler V., Al-Hamad A., Johnson B., Wells C., Sheron N. Social inequalities in alcohol-related adult mortality by National Statistics Socio-economic Classification, England and Wales, 2001–03. Health Stat Q 2011; 50: 4–39. Marang-van der Mheen P. J., Smith G. D., Hart C. L., Gunning-Schepers L. J. Socioeconomic differentials in mortality among men within Great Britain: time trends and contributory causes. J Epidemiol Community Health 1998; 52: 214–8. Leon D. A., McCambridge J. Liver cirrhosis mortality rates in Britain from 1950 to 2002: an analysis of routine data. Lancet 2006; 367: 52–6. Österberg E., Karlsson T. Alcohol Policies in EU Member States and Norway: A Collection of Country Reports. Helsinki: STAKES; 2003. The Information Centre. Statistics on Alcohol: England 2010. Leeds: The Information Centre; 2010. Holmes J., Meng Y., Meier P. S., Brennan A., Angus C., Campbell-Burton A. et al. Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: a modelling study. Lancet 2014; 383: 1655–64.
Addiction, 109, 2003–2004
This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.
