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Impact of Introducing a Minimum Alcohol Tax Share in Retail Prices on Alcohol-Attributable Mortality in the WHO European Region: A Modelling Study

33 Pages Posted: 11 Jan 2022

See all articles by Maria Neufeld

Maria Neufeld

World Health Organization (WHO) - WHO European Office for the Prevention and Control of Noncommunicable Diseases

Pol Rovira

Public Health Agency of Catalonia - Program on Substance Abuse & designated WHO Collaborating Centre

Carina Ferreira-Borges

World Health Organization (WHO) - WHO European Office for the Prevention and Control of Noncommunicable Diseases

Carolin Kilian

Dresden University of Technology - Institute of Clinical Psychology and Psychotherapy

Franco Sassi

Imperial College London - Centre for Health Economics and Policy Innovation

Aurelijus Veryga

Parliament of the Republic of Lithuania - Committee of Health

Jurgen Rehm

University of Toronto - Institute for Mental Health Policy Research

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Abstract

Background: Alcohol use and its burden constitute one of the largest public health challenges in the WHO European Region. Raising alcohol taxes is a cost-effective “best buy” measure to reduce alcohol consumption, but its implementation remains uneven. This paper provides an overview of existing tax structures in 50 countries and subregions of the Region, estimates their proportions of tax on retail prices of beer, wine, and spirits, and quantifies the number of deaths that could be averted annually if these tax shares were raised to a minimum level.

Methods: Review of databases and statistical reports on taxes and mean retail prices of alcohol beverages in the Region. Affordability was calculated based on alcohol prices, adjusted for differences in purchasing power. Consumption changes and averted mortality were modelled assuming two scenarios. In Scenario 1, a minimum excise tax share level of 25% of the beverage-specific retail price was assumed for all countries. In Scenario 2, in addition to a minimum excise tax share level of 15% it was assumed that per unit of ethanol minimal retail prices were the same irrespective of alcoholic beverages (equalisation). Sensitivity analyses were conducted for different price elasticities.

Findings: Alcohol is very affordable in the Region and alcohol taxes have clearly been under-utilized as a public health measure, constituting on average only 5·7%, 14·0% and 31·3% of the retail prices of wine, beer, and spirits, respectively. Tax shares were higher in the eastern part of the Region compared to the EU, where various countries did not have excise taxes on wine. Annually, the introduction of a minimum tax share of 25% (Scenario 1) could avert 40,033 (95% CI: 38,054-46,097) deaths in the WHO European Region (with 753,454,300 inhabitants older than 15 years of age). If a 15% tax share with equalisation were implemented (Scenario 2), 132,906 (95% CI: (124,691-151,674) deaths could be averted. All sensitivity analyses with different elasticities yielded outcomes close to those of the main analyses.

Interpretation: Similar to tobacco taxes, increasing alcohol taxes should be considered to be a health-based measure aimed at saving lives. Many countries have hesitated to apply higher taxes to alcohol, but the present results show a clear health benefit as a result of implementing a minimum tax share.

Funding Information: This work was supported by the National Institute on Alcohol Abuse and Alcoholism (1R01AA028224) and the Canadian Institutes of Health Research, Institute of Neurosciences, and Mental Health and Addiction (SMN-13950).

Declaration of Interests: The authors declare no conflict of interest.

Keywords: Alcohol, alcohol-attributable burden, Europe, health tax, taxation

Suggested Citation

Neufeld, Maria and Rovira, Pol and Ferreira-Borges, Carina and Kilian, Carolin and Sassi, Franco and Veryga, Aurelijus and Rehm, Jurgen, Impact of Introducing a Minimum Alcohol Tax Share in Retail Prices on Alcohol-Attributable Mortality in the WHO European Region: A Modelling Study. Available at SSRN: https://ssrn.com/abstract=4006130 or http://dx.doi.org/10.2139/ssrn.4006130

Maria Neufeld (Contact Author)

World Health Organization (WHO) - WHO European Office for the Prevention and Control of Noncommunicable Diseases ( email )

Moscow
Russia

Pol Rovira

Public Health Agency of Catalonia - Program on Substance Abuse & designated WHO Collaborating Centre ( email )

81-95 Roc Boronat St.
Barcelona, 08005
Spain

Carina Ferreira-Borges

World Health Organization (WHO) - WHO European Office for the Prevention and Control of Noncommunicable Diseases ( email )

Moscow
Russia

Carolin Kilian

Dresden University of Technology - Institute of Clinical Psychology and Psychotherapy ( email )

Chemnitzer Straße 46
Dresden, 01187
Germany

Franco Sassi

Imperial College London - Centre for Health Economics and Policy Innovation ( email )

London, SW7 2AZ
United Kingdom

Aurelijus Veryga

Parliament of the Republic of Lithuania - Committee of Health ( email )

Vilnius
Lithuania

Jurgen Rehm

University of Toronto - Institute for Mental Health Policy Research ( email )

Toronto
Canada

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