Ending cheap alcohol gets promising results

The evidence from real world implementation is compelling

There is no shortage of evidence‐based recommendations regarding measures for reducing the considerable health and social harms associated with alcohol misuse in Australia and elsewhere1 — nor of opposition from the powerful alcohol industry and its allies to anything that might be effective. Their counter‐arguments, here as elsewhere, are all too familiar: voluntary approaches are best; anything that might reduce alcohol harms is draconian, penalises ordinary consumers, and interferes with individual liberties; no one measure will solve the problem overnight; more research is needed — and above all, as in other areas, nothing should ever be done for the first time.2

In 2016, we wrote in this Journal about the evidence and the need for alcohol price and tax reforms as part of a comprehensive approach, noting the “overwhelming consensus … that alcohol taxation is one of the most effective policy interventions to reduce problems related to alcohol”.3 Now as then, “even small increases in the price of alcohol can have a significant impact on consumption and harm at the population level”, and “a minimum floor price set at an appropriate level” would bring a range of benefits, “and has been strongly supported by groups concerned about alcohol‐related problems in Aboriginal communities”.

Arguments for a floor price in the Northern Territory were, of course, strongly opposed by vested interests with all the familiar arguments,4 but, following sustained advocacy, legislation mandating a floor price of $1.30 per standard drink was implemented in October 2018.5

In this issue of the MJA, Secombe and colleagues report that, in the six months after the introduction of the floor price, “the proportion of presentations associated with acute alcohol misuse was 54% lower” than during the preceding six months.6 To see such a substantial, immediate reduction in critical care admissions is encouraging and noteworthy. While the reduction in presentations associated with chronic alcohol misuse was not statistically significant, the authors note that this may well change with time and should be further monitored.

Recently published research into the immediate impact of introducing minimum unit pricing in Scotland in May 2018 found not only that it “appears to have been successful in reducing the amount of alcohol purchased by households in Scotland”, but also that it was well targeted, “in that reductions of purchased alcohol only occurred in the households that bought the most alcohol”.7 This report has been followed by a commitment from the Welsh Government to introduce minimum unit pricing from March 2020,8 with a similar intent expressed by the Irish government as part of a comprehensive approach to reducing alcohol‐related harms, including curbs on alcohol promotion.9

Continuing evaluation will be needed, but the evidence from real world implementation is already compelling: controlling price is a measure that can prevent substantial harms, especially among the most vulnerable, and it will not lead to the end of civilisation as we know it. And there is, of course, a pressing need for further, complementary actions to reduce alcohol harms in Australia. But in a world in which the power of alcohol lobbyists and their allies has been successful in preventing effective action at the national level in areas such as protecting children and young people from alcohol promotion, research‐based warning labels, and tax reform to end incentives for producing and promoting cheap wine, we should welcome the straightforward evidence from Australia and overseas of the benefits that state and territory governments can bring to their communities by restricting the availability of cheap alcohol. As an added benefit, this simple measure alone is likely to substantially reduce the massive health, law enforcement, community service, and other costs caused by excessive alcohol use. In this context, it will be important that researchers also review the impacts and costs of policy changes predicted to increase alcohol‐related harms over time, such as recent changes to late night alcohol availability in New South Wales.10

There has been interest in other Australian jurisdictions in setting an alcohol floor price.11 The initial evidence reported by Secombe and his colleagues should both encourage them and provide health and community organisations with further impetus for advocacy at the jurisdictional level. We have learned from tobacco control that action at the state level can be a helpful precursor to national action, illustrating both the art of the possible and the absence of doomsday consequences predicted by opposing vested interests.

Where there is cheap alcohol, there will be preventable problems. To their great credit, the Northern Territory and Scottish Governments have explored the art of the possible. The challenge for other governments is to follow with similar and complementary actions. This will bring immense benefits to their communities, and great comfort to the health and other professionals who must deal with the immediate impacts of alcohol misuse on a daily basis.