1. Minimum alcohol price policies The Canadian Experience
in action:
The Canadian Experience
Tim Stockwell, PhD
Director, Centre for Addictions Research of BC
Professor, Department of Psychology, University of Victoria
Calling Time on Europe's Alcohol Problem, European Parliament, Brussels, Belgium 24 April, 2013

2. Grateful thanks to
Jinhui Zhao, Chris Auld, Gina Martin, Kate Vallance & Scott Macdonald Centre for Addictions Research of BC, Victoria, Canada Gerald Thomas Canadian Centre on Substance Abuse, Ottawa, Canada Norman Giesbrecht & Ashley Wettlaufer Centre for Addiction and Mental Health, Ontario, Canada Bill Ponicki & Andrew Treno Prevention Research Center, Berkeley, USA Jane Buxton & Andrew Tu BC Centre for Disease Control, Vancouver, Canada Canadian Institutes for Health Research (Funding body)

3. Most of Canada's 11 provinces set minimum prices
for alcohol in liquor stores and/or bars

4. A private liquor store in Victoria, British Columbia

5. Minimum Pricing: Measures to set a floor price for alcohol In approximate order of effectiveness (low to high):
Bans on below-cost alcohol (UK)
Fixing a minimum profit margin (US)
Setting a minimum retail price per litre of beverage (Canada)
Setting a minimum price per unit of alcohol (Scotland)

6. for Alcohol Price Policies
Rationale
for Alcohol Price Policies
Despite popular beliefs to the contrary… Increased alcohol prices lead to reduced rates of illnesses and injuries associated with heavy drinking patterns

7. Effects of two tax increases
on deaths from alcohol related diseases in Alaska
Year
Wagenaar et al, American Journal of Public Health, 2009

8. Alcohol price and tax strategies have strong scientific evidence for effectiveness
Summary analyses of all high quality published studies indicate
A 10% increase in price leads on average to a 5% reduction in consumption
Price increases lead to reductions in hazardous drinking e.g. "binge drinking“
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

9. important for public health policy?
Why is cheap alcohol
important for public health policy?
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)
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

10. A Canadian illustration of Gruenewald et al’s Price-Quality Spectrum:
3 retail prices in $/standard drink (13.45g)
Cheapest Median Most expensive
58 cents $ $994

11. Distribution of sales of 4,275 alcohol products
in Ontario by price per standard drink, 2009

12. Canada is one of 6 countries to have minimum alcohol prices
Others are Russia, Moldovia, Ukraine, Uzbekistan, and the US (5 states have minimum mark-ups) Prior to 2012, no empirical evaluations of effectives but influential modeling of likely effectiveness by Meier, Brennan et al for the UK (The Sheffield Model) Canadian provinces are ideal for effectiveness research: many policy changes and excellent data

13. Do increases in the minimum alcohol prices lead to reduced consumption?

14. Case Study 1: British Columbia
Stockwell, Auld, Zhao and Martin (2012) Does minimum pricing reduce alcohol consumption? The experience of a Canadian province. Addiction, 107(5), 912 – 920.
The BC government monopoly has set minimum prices for several decades based on $ rates per litre of beverage NOT per litre of ethanol
Only spirit prices have been regularly updated in keeping with the cost of living.

15. Comparing 2010 minimum prices in dollars per standard drink in British Columbia, Ontario and Saskatchewan
Beverage
% Alcohol
Content
BC Official
Minimum
Ontario
Price*
Saskatchewan
Coolers/Cider 7%
$0.73
$1.00
$1.25
Beer 8%
$0.75
$1.49
Wine
12%
$1.02
$1.41
Fortified wine
22%
$0.56
$0.81
$1.04
Spirits (Tequila)
40%
$1.35
$1.43
$1.31
Spirits (Rum)
75.4%
$0.72
$0.76

16. Minimum price of different alcohol beverages in CPI-adjusted dollars per standard drink in British Columbia,

17. Statistical analysis of British Columbia price and sales data
Time series analysis of 80 annual quarters of data over 20 years controlling for the effects of:
Season
Overall trends in data
Trends in average alcohol prices
Trends in household income
Inflation-adjusted minimum prices used to predict volume of alcohol sales for each main beverage

18. Estimates of minimum price effects for different types of alcohol
Percentage decrease in consumption of ethanol for a 10% increase in minimum price:
ANY BEVERAGE TYPE VERSUS ALL OTHERS: -16.1%***
Beer = - 1.5%*
Spirits = - 6.8%**
Wine = - 8.9%*
AVERAGE MIN PRICE FOR ALL DRINKS = - 3.4%**
*P<0.05 **P<0.01.

19. Case Study 2: 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

20. Impacts on Consumption Stockwell, Zhao et al, American J Public Health, 2012

21. Statistical analysis of Saskatchewan price and sales data
ARIMA time series analysis of 52 “financial periods” between April 2008 and March 2012 controlling for the effects of:
Season
Overall trends in data
Trends in average alcohol prices
Trends in household income
Inflation-adjusted minimum prices used to predict volume of alcohol sales for each main beverage

22. Estimates of minimum price effects for different types of alcohol
Time series ARIMA models indicate:
A 10% increase in average minimum price associated with 8.4% reduction in consumption
Stronger effects for off premise then on premise sales
Stronger effects for higher alcohol strength varieties of beer, wine and cocktails

23. Do increases in the minimum alcohol prices lead to reduced alcohol-related harm?

24. Statistical analysis of British Columbia price and harm data
Mixed model regression analysis of 32 annual quarters of data between April 2002 and March 2010 for 89 health areas controlling for the effects of:
Season
Overall trends in data
Densities of liquor outlets
Trends in household income
Inflation-adjusted minimum prices used to predict rates of alcohol attributable hospital admissions

25. Impacts on Harm I Stockwell, 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)

26. Estimated impacts on alcohol attributable hospital admissions
% 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.
Stockwell, Zhao et al (2013) American Journal of Public Health, April 18

27. Impacts on Harm II Zhao et al, Addiction, 2013

28. Estimated impacts on alcohol attributable deaths
% Change in alcohol caused deaths associated with a 10% increase in average minimum price.
Type of admission
Immediate impact
Delayed impact after 2 years
100% Alcohol
-31.72%*
-9.26%
Chronic
-0.81%
-19.85% **
*P<0.05 **P<0.01.
Zhao, Stockwell, Martin, Macdonald, Vallance, Treno, Ponicki,
Tu and Buxton (2013) Addiction

29. Misleading and false industry criticisms
We only found effects for “hypothetical” alcohol related deaths using the attributable fraction method
Deaths in BC actually increased during study period
We only had 16 data points in BC harm studies
We ignored liver cirrhosis deaths

30. The Sheffield Model makes conservative estimates of health outcomes for British Columbia (pop. 4.4 million)
Comparative estimates of health outcomes of 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]
Health Outcome
Immediate
Delayed
Sheffield Model
CARBC Studies
Sheffield
Model
[10 years]
[2 years]
Change in Alcohol Attributable Deaths (N) 39
100 56
276
Change in Alcohol Attributable Hospital Admissions (N)
244
1432
610
1893

31. Some Conclusions
Gruenewald et al’s theory is likely correct and minimum pricing per standard drink may be the most targeted, feasible and acceptable variant of the most effective alcohol policy: increasing the real price of alcohol
Canadian studies suggest 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.

32. THANK YOU!
Thank you!