1. PhD Mindaugas Štelemėkas
The association of evidence based alcohol control policy and alcohol related harm in Lithuania
PhD Mindaugas Štelemėkas
Lithuanian University of Health Sciences,
Faculty of Public Health,
Health Research Institute

2. Outline Alcohol control policy: the role of excise tax
Sveikatos tyrimų institutas
Outline
Alcohol control policy: the role of excise tax
Lithuanian case of alcohol control policies
Alcohol related harm in Lithuania

3. Sveikatos tyrimų institutas
Total (recorded and unrecorded) alcohol per capita consumption, 2010 (liters of pure alcohol; 15+ years population)
Source: Global Status Report on Alcohol and Health 2014

4. WHO’s recommended 'best buys' in alcohol control
Sveikatos tyrimų institutas
WHO’s recommended 'best buys' in alcohol control
Raise taxes on alcohol
Restrict access to retailed alcohol
Enforce bans on alcohol advertising
“Reduction in the harmful use of alcohol is important in preventing and tackling cancers and cardiovascular disease. Harmful use of alcohol is also a preventable cause of other burdensome non-communicable and injury conditions, including liver cirrhosis, depression and road traffic injury. Enhanced taxation of alcoholic beverages and comprehensive bans on their advertising/marketing are recommended "best buys", based on their favourable cost-effectiveness, low cost and feasibility”
Sources: WHO Prevention and control of NCDs: priorities for investment:
AMPHORA Manifesto: for effective alcohol policy in Europe:

5. Price elasticities of demand for alcoholic beverages
Sveikatos tyrimų institutas
Price elasticities of demand for alcoholic beverages
Meta-analysis
Number of analyzed studies
Prices elasticity of demand
Other results
Strong beverages
Wine
Beer
Gallet (2007)
132 studies
-0,68
-0,7
-0,36
Price elasticity of demand for all alcoholic beverages = -0,497; short-run = -0,518;
long-run = -0,816
Wagenaar et al. (2009)
112 studies
-0,8
-0,69
-0,46
Price elasticity of demand for heavy drinking = -0,28
Nelson (2013)
182 studies
-0,55
-0,45
-0,3
Price elasticity of demand for all alcoholic beverages = -0,5

6. Short-run elasticity of 0.22 and long-run elasticity of 0.32
Sveikatos tyrimų institutas
A positive relationship between alcohol affordability and alcohol consumption in the EU
There is a statistically significant positive relationship between alcohol affordability (a composite measure looking at the effect of price and income) and consumption across the EU.
Short-run elasticity of 0.22 and long-run elasticity of 0.32
An increase in affordability by 10% is followed by an increase of consumption by 2-3%
Source: Rabinovich et al. (2009), p.17:

7. Affordability of alcohol in Lithuania, 1995-2012 (1995 = 100%)
Sveikatos tyrimų institutas
Affordability of alcohol in Lithuania, (1995 = 100%)

8. Affordability of alcohol in Lithuania, 1995-2012 (1995 = 100%)
Sveikatos tyrimų institutas
Affordability of alcohol in Lithuania, (1995 = 100%)

9. Sveikatos tyrimų institutas
Reflection of alcohol control policy measures on alcoholic psychosis incidence in Lithuania (1984–2012)

10. AAF for Lithuania: mortality group I
Sveikatos tyrimų institutas
AAF for Lithuania: mortality group I
100% alcohol attributable deaths:
Group I
ICD-10
Mental and behavioral disorders due to use of alcohol
F10
Degeneration of nervous system due to alcohol
G31.2
Alcoholic polyneuropathy
G62.1
Alcoholic cardiomiopathy
I42.6
Alcoholic gastritis
K29.2
Alcoholic liver disease
K70
Alcohol induced chronic pancreatitis
K86.0
Accidental poisoning by and exposure to alcohol
X45
Intentional self poisoning by and exposure to alcohol
X65
Poisoning by and exposure to alcohol, undetermined intent
Y15 …
...

11. AAF for Lithuania: mortality group II
Sveikatos tyrimų institutas
AAF for Lithuania: mortality group II
Group II
ICD-10
AAF
Men
Women
Malignant neoplasm of lip, oral cavity and pharynx
C00-C14
40 %
32 %
Malignant neoplasm of oesophagus
C15
24 %
18 %
Malignant neoplasm of colon
C18
4 %
3 %
Malignant neoplasm of rectum
C20
6,5 %
5 %
Malignant neoplasm of liver and intrahepatic bile ducts
C22
12 %
9 %
Malignant neoplasm of larynx
C32
25,5 %
19 %
Malignant neoplasm of breast
C50 -
7 %
Epilepsy and Status epilepticus
G40-G41
42 %
Hypertensive diseases
I10-I15
23 %
15,5 %
Cardiac arrhythmias+other arrhythmias
I47-I49
35 %
33 %
Haemorrhagic stroke
I60-I62, I69.0-I69.2
Oesophageal varices
I85
64 %
54 %
Gastro-oesophageal laceration-haemorrhage syndrome
K22.6
47 %
Liver cirrhosis
K73, K74
Acute and chronic pancreatitis
K85, K86.1
12,5 %
Psoriasis
L40 be L40.5
34 %
...

12. AAF for Lithuania: mortality group III
Sveikatos tyrimų institutas
AAF for Lithuania: mortality group III
Group III
ICD-10
AAF
Men
Women
Death from Pedestrian traffic accidents
V02-V04, V06, V09
12,5 %
Death from Road traffic accidents
V12-V14, V19-V87, V89
16 %
Water transport accidents
V90-V94
20 %
Fall injuries
W00-W19
42 %
Firearm injuries
W32-W34
46 %
Drowning
W65-W74
59 %
Inhalation of gastric contents/Inhalation and ingestion of food causing obstruction of the respiratory tract
W78-W79
58 %
Smoke, fire injuries
X00-X09
40 %
Accidental excessive cold
X31
73 %
Intentional self-harm/Event of undetermined intent
X60-X84, Y10-Y34 be X65, Y15
55 %
Assault
X85-Y09
64 %

13. Alcohol-attributable mortality in Lithuania in 2003–2011, age groups
Sveikatos tyrimų institutas
Alcohol-attributable mortality in Lithuania in 2003–2011, age groups
33,53
33,25
29,42
25,93
15,43
6,03
1,16

14. Alcohol-attributable mortality in Lithuania, 2003–2011
Sveikatos tyrimų institutas
Alcohol-attributable mortality in Lithuania, 2003–2011
10,21
9,41
9,69
9,65
9,14
9,03
8,35
8,20
7,86

15. Sveikatos tyrimų institutas
Alcohol attributable Potential Years of Life Lost (15-64) in Lithuania,

16. Economic costs of alcohol in Lithuania in 2010
Sveikatos tyrimų institutas
Economic costs of alcohol in Lithuania in 2010
Category
EUR
Health care
Outpatient care costs (group I and group II category costs only)
Inpatient care costs (group I and group II category costs only)
Premature mortality
Group I
Group II
Group III
Disability pensions
0-25%
30-40%
45-55%
Child homes
State child homes
Municipality child homes
Imprisonment
Prisoners’ incarceration costs due to crimes done due to drunkenness
Total

17. Sveikatos tyrimų institutas
Summary
Excise tax is one of the most cost-effective measures in alcohol control policies, but the measures that work best is the complex of various evidence based alcohol control measures
Alcohol harm is reflected in many social and economic areas, therefore effective alcohol control policy should target these areas as well
The Lithuanian example shows that evidence based measures do work, the consistency is what we need to ensure

18. Thank you!