Minimum unit pricing for alcohol: The most cost-effective cancer prevention strategy of all?

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Published: 23 Nov 2016
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Prof Tim Stockwell - University of Victoria, Victoria, Canada

Prof Stockwell speaks with ecancertv at NCRI 2016 about how alcohol-related cancer could be prevented through minimum unit pricing, similar to taxation of tobacco and sugary drinks.

A report has recently predicted 135,000 cancer cases related to alcohol in the UK over the next 20 years, and Prof Stockwell describes how minimum prices per unit of alcohol can help limit these risks in heavy drinkers, amidst other health benefits.

This is a session on general population approaches to prevent cancers and we were looking at different lifestyle risk-factors. I was talking about alcohol and research that my team has done both estimating the impact of alcohol consumption on cancer rates but also strategies which at the population level reduce peoples’ intake of alcohol and reduce risks of a whole range of alcohol-related diseases including cancer.

What strategy are you taking?

The one I was talking about in particular, and there’s a lot of interest here particularly in the UK, is of minimum pricing or Minimum Unit Pricing as it is known as here. People probably know that Scotland passed legislation some years ago to prevent cheap alcohol being available in Scotland as a means of improving health outcomes for the population. That was blocked by the multinational alcohol industry and has been held up for several years, been through the courts. My research has been used in that process as evidence because we have minimum pricing in Canada and I’ve done studies with teams of people from the States and the UK looking at the population health impacts whenever the minimum prices go up. There are ten provinces in Canada, they all do minimum prices differently so some of our studies have looked at in a quasi-experimental way what happens before and after a major change in minimum pricing. So we can estimate impacts on consumption and on rates of disease attributable to alcohol and rates of injuries. I was reporting some of those findings.

What are the findings in Canada thus far?

Well it’s been in place at least since prohibition ended. We had prohibition up until the ‘20s in several provinces including Ontario and British Columbia where I am. The government, as a sort of interim measure, took over the control and distribution of alcohol with a view to kind of keeping a lid on things but they rapidly realised that they could get massive revenues from it and minimum pricing was used as a device to keep the market stable to guarantee income for the government. Only recently are people waking up to the population health benefits of managing minimum prices for alcohol in a very considered way that looks at targeting the alcohol content so stronger drinks have higher minimum prices than weaker drinks for example.

Has this been seen to be beneficial?

Estimates are that if you imagine a 10% change either way, it could be increase or decrease, if it’s a 10% increase in the minimum price, consumption of alcohol goes down about 8%. We have found chronic diseases like cancers will be reduced by about 8 or 9% two or three years later. There’s an immediate impact on the acute injuries and poisonings and that’s a similar level, about 8 or 9% for a 10% increase in price. But if the price goes down, very often in some provinces the minimum prices are actually going down with inflation so it’s very important, you can’t just have Minimum Unit Pricing at 50p, it’s got to be updated with inflation every year.

Major effects and the great thing about minimum pricing also is it only affects a small proportion of the market, it doesn’t really punish moderate drinkers, it mainly targets the heavier drinkers who gravitate towards the cheapest alcohol. And there’s the other advantage is there are disproportionate benefits for low income people and low income areas. Both the modelling estimates and our observational research in Canada shows that people on lower incomes they have a disproportionate benefit, or heavy drinkers on lower incomes have a disproportionate benefit, some reduced risk of illness and premature death.

Would this end up as extra tax?

It depends on the system. It’s a very, very good question. In the UK I have to say that most of the benefits for simply setting a minimum price will flow to the industry because it’s like a price-fixing cut, it’s why the EU trade laws have been invoked because it’s anti-competitive. It’s stopping the market place being efficient. That means there’s more room for making profits from selling the stuff because you’ve got a guaranteed floor price and if that’s raised periodically it’s a bonanza in some ways. It’s kind of surprising that the multinational drinks industry is actually fighting it tooth and claw here in Europe, but that is only because, and I have talked to the people involved, the multinationals have interests not just in alcohol but in tobacco and fast food and a whole range of things and they do not want health to be used, to be recognised as being grounds for trade laws being worked around. They see it’s the thin edge of the wedge and trade in all manner of products could be restricted, God help us, on health grounds.

In theory, could we be taxing more and use the money for health?

In Canada it’s great because they have alcohol monopolies, this is I think the perfect system. If you’ve got a product, and I think nicotine falls into that category, we are legalising cannabis at the moment in Canada and alcohol we have, there’s major health consequences. Much better to put the sale and distribution of that in the hands of a body that reports to a health minister because in order to minimise the health consequences. So in Canada because the Government’s in the business of distributing and selling they make huge profits from the sale of alcohol. I wish they also in Canada reported to the health minister; they report to finance ministers. You have to beat them over the head with these statistics to say you do it this way not that way if you also want good health outcomes.

What is your take-home message?

My take-home message I guess was that something like minimum pricing is going to reduce health inequalities, and that’s a huge deal. It’s going to improve health outcomes specifically for this particular interest in cancer. It will reduce alcohol attributable cancers and there are many of those: in the UK 13 or 14000 a year, our research suggests those are underestimates. There’s certain problems in the research which lead to the rates of our contributable cancer being underestimated so this is something the whole of the UK and the whole of Europe should be looking at. It’s not just cost-effective, the government makes money while they are saving lives and reducing healthcare costs and preventing people getting seriously ill. This is something that should be looked at in all jurisdictions.