Alcohol beverage regulation - Emerging trends Some lessons from public health science Peter Anderson, MD, MPH, PhD 12 March 2008

1.Alcohol matters 2.Regulation matters 3.The alcohol beverage industry matters

1.Alcohol matters 2.Regulation matters 3.The alcohol beverage industry matters

Consumption per occasion (grams of pure alcohol) Risk per 1,000 Risk over lifetime that death in UK is due to alcohol-related injury assuming 10,000 drinking occasions between years (every other day) Source: Taylor & Rehm, based on Taylor et al., AJE, 2008; Rehm et al. IJMPR, 2008

Average daily consumption (grams pure alcohol) Risk per 1,000 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%

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) %

Proportion of European people of have had 5+ drinks on one occasion at least weekly during past 12 months by occupational group Source: Eurobarometer 2007 Occupational group %

1.Alcohol matters 2.Regulation matters 3.The alcohol beverage industry matters

1.Price 2.Availability

1.Price 2.Availability

England and Wales Source: Anderson 2007

England and Wales Source: Anderson 2007

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

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 Alcohol consumption, l/capita Economic availability and alcohol consumption, Poland,

90,0080,0070,0060,0050,0040,0030,0020,00 15,00 12,00 9,00 6,00 3,00 0,00 Deaths/100,000 men Source: Moskalewicz et al 2005 Economic availability and liver cirrhosis deaths, men aged years Poland 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 Number of alcohol-positive sudden deaths/week

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.Price 2.Availability

England: licensed public houses and hospital admissions

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 disorders Poland ,0040,0030,0020,0010,00 80,0 60,0 40,0 20, Source: Moskalewicz et al 2005 Hospital admissions/100,000 people Number of outlets/10,000 people

1.Alcohol matters 2.Regulation matters 3.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) alcohol 3.Increase the price 4.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) alcohol 3.Increase the price 4.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) alcohol 3.Increase the price 4.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 border Other untaxed Surrogate

Areas for industry action (producers and retailers) 1.Address smuggling 2.Address illegal markets and productions of illegal and surrogate (perfumes etc) alcohol 3.Increase the price 4.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 Shop sales £bn Increase on off premise sales in UK,

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 consumption  Reduces harm  But, 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) alcohol 3.Increase the price 4.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) alcohol 3.Increase the price 4.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