Public health agencies derive recommended alcohol consumption limits from epidemiological mortality studies
the verdict
INSUFFICIENT LEANING
refutedsupported
the weight of evidence
3 sources for · 0 against
The retrieved literature indicates that regulatory health agencies rely on epidemiological data to establish health protections and risk functions, but does not fully detail the specific derivation of alcohol consumption limits.
Summary Background Contrary to most developed economies, Hong Kong has reduced and eliminated taxes on beer and wine over the last 15 years and observed increasing alcohol consumption. Methods We applied econometric epidemiological modelling to assess the impact of reverting ad valorem taxation to pre-2008 levels (20% on wine and 40% on beer) on consumption and health outcomes. We used 15 years of industry sales and pricing data (2004-2018) to derive 25 own-price and cross-price elasticity estimates. We applied risk functions from the World Health Organization 2018 Global Status Report to assess the impact on 25 alcohol-attributable conditions. Findings An estimated 616 deaths (91.3% in men) were attributable to alcohol in 2018. Raising taxes to pre-2008 levels is estimated to reduce consumption of pure alcohol consumption by 8.0%, 15.9%, and 31.1%; and reduce alcohol-attributable deaths by 11.6%, 21.8%, and 40.2% assuming 25%, 50% and 100% pass through rates of taxes to consumers. The largest projected decreases in alcohol-attributable mortality in absolute numbers are alcohol abuse, alcohol dependence, and alcoholic psychoses (wholly alcohol-attributable disorders). The largest absolute number of new alcohol-attributable cases in 2018 were hypertension, alcohol dependence and alcohol abuse; which are estimated to be reduced by 31.3%, 34.2%, and 34.3% respectively by raising taxes to pre-2008 levels. The alcohol-attributable health burden and absolute reductions in health harms are far greater in men. Interpretation Reversing the 2008 alcohol tax reductions is potentially effective in averting the alcohol-attributable health burden and thus mitigate against the avoidable harms of alcohol-related disease. Funding Health and Medical Research Fund, Food and Health Bureau of the Hong Kong SAR, China [03170067].
Summary Background Contrary to most developed economies, Hong Kong has reduced and eliminated taxes on beer and wine over the last 15 years and observed increasing alcohol consumption. Methods We applied econometric epidemiological modelling to assess the impact of reverting ad valorem taxation to pre-2008 levels (20% on wine and 40% on beer) on consumption and health outcomes. We used 15 years of industry sales and pricing data (2004-2018) to derive 25 own-price and cross-price elasticity estimates. We applied risk functions from the World Health Organization 2018 Global Status Report to assess the impact on 25 alcohol-attributable conditions.
Prior research has established higher alcohol taxes as an effective intervention for alcohol-attributable harms in Western populations with higher levels of alcohol consumption. The World Health Organization (WHO) recommends increasing alcohol taxes as an effective intervention tool for alcohol-related harms. Local studies and public health data have shown the 2008 alcohol tax elimination in Hong Kong led to increasing sales, binge drinking and alcohol-attributable mortality. The Hong Kong population has lower per capita alcohol consumption relative to other high-income economies, and thus lower burdens of alcohol-attributable disease.
Added value of this study Using econometric epidemiological modelling, we estimated that reintroducing the taxation policies revoked in Hong Kong would reduce alcohol consumption and, in turn, alcohol-attributable health burdens. We estimate introducing ad valorem taxes of 20% on beer and 40% on wine (pre-2008 levels) would reduce consumption of pure ethanol by one-third. We estimate significant reductions in deaths attributable to alcohol of 11.6%, 21.8%, and 40.2% assuming 25%, 50% and 100% of tax increases are passed through to consumer prices.
6 There is extensive evidence that taxes and higher prices reduces both alcohol consumption and related harms. 7 The World Health Organization (WHO) recommends increasing taxation as a ‘best buy’ to reduce the harmful use of alcohol. Taxation is among one of the most effective interventions to reduce alcohol use in high-income economies. 8 Previous studies have shown associations between the 2007-2008 tax reductions in Hong Kong and higher cardiovascular and all-cause mortality. 9 , 10 Despite the increasing consumption of alcohol in Hong Kong, the potential impact of reintroducing alcohol excise taxes on alcohol-related health burden has not been studied.
Policy impact on alcohol-attributable health harms Projected changes in alcohol-attributable mortality with the reintroduction of pre-2008 taxes are shown in Table 3 and Figure 2 . A total of 616 deaths in 2018 were attributable to alcohol (562 men and 54 women). Raising taxes to pre-2008 levels (20% on beer and 40% on wine) was estimated to reduce alcohol-attributable deaths by 11.6%, 21.8%, and 40.2% assuming 25%, 50% and 100% pass through rates of taxes to consumers. The WHO risk curves assume cardioprotective effects at low doses of alcohol consumption.
The public revenue raised, particularly if gained from alcohol industry profits, could be deployed to mitigate the adverse effects of alcohol and to improve population health elsewhere. Our analytical approach is highly conservative with regards to estimates of consumption and health harms. As we only estimated relative changes in alcohol consumption, this likely underestimates the true effects of the tax policies as some consumers may switch to abstinence in response to price rises.
However, unlike taxation, increased revenue from minimum-unit pricing benefits industry rather than the public purse. Further research is needed on the application of health policy modelling including development and testing of alternative econometric methods and models, as well as validation against future data after actual policy implementation. There remains a lack of data on the risks of alcohol consumption among underage and youth drinkers; the WHO risk estimates of alcohol-attributable conditions are not applicable to people under 15 years.
Health Organization published a statement in The Lancet Public Health that concluded, "no safe amount of alcohol consumption for cancers and health can
Alcohol, sometimes referred to by the chemical name ethanol, is the active ingredient in alcoholic drinks such as beer, wine, and distilled spirits (hard liquor). Alcohol is a central nervous system (CNS) depressant, decreasing electrical activity of neurons in the brain, which causes the characteristic effects of alcohol intoxication ("drunkenness"). Among other effects, alcohol produces euphori
The alcohol consumption recommendations (or safe limits) varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The WHO published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health."
A standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example, and has been adopted by more countries than any other amount.
Alcohol, sometimes referred to by the chemical name ethanol, is the active ingredient in alcoholic drinks such as beer, wine, and distilled spirits (hard liquor). Alcohol is a central nervous system (CNS) depressant, decreasing electrical activity of neurons in the brain, which causes the characteristic effects of alcohol intoxication ("drunkenness"). Among other effects, alcohol produces euphoria, decreased anxiety, increased sociability, sedation, and impairment of cognitive, memory, motor, and sensory function.
Alcohol has a variety of adverse effects. Short-term adverse effects include generalized impairment of neurocognitive function, dizziness, nausea, vomiting, and symptoms of hangover. Alcohol is addictive and can result in alcohol use disorder, dependence, and withdrawal upon cessation. The long-term effects of alcohol are considered to be a major global public health issue and include liver disease, hepatitis, cardiovascular disease (e.g., cardiomyopathy), polyneuropathy, alcoholic hallucinosis, long-term impact on the brain (e.g., brain damage, dementia, and Marchiafava–Bignami disease), and cancers; alcohol and some of its metabolites (such as acetaldehyde) are IARC group 1 carcinogens. The adverse effects of alcohol on health are most significant when it is used in excessive quantities or with heavy frequency. However, in 2023, the World Health Organization published a statement in The Lancet Public Health that concluded, "no safe amount of alcohol consumption for cancers and health can be established". In high amounts, alcohol may cause loss of consciousness or, in severe cases, death. Many governmental agencies and organizations issue alcohol consumption recommendations.
Alcohol has been produced and consumed by humans for its psychoactive effects since at least 13,000 years ago, when the earliest known beer was brewed by the Natufian culture in the Middle East. Alcohol is the second most consumed psychoactive drug globally, behind caffeine, with global sales of alcoholic beverages exceeding US$1.5 trillion in 2017. Drinking alcohol is generally socially acceptable and is legal in most countries, unlike with many other recreational substances. However, there are often restrictions on alcohol sale and use, for instance a minimum age for drinking and laws against public drinking and drinking and driving. Alcohol has considerable societal and cultural significance and has important social roles in much of the world. Drinking establishments, such as bars and nightclubs, revolve primarily around the sale and consumption of alcoholic beverages, and parties, festivals, and social gatherings commonly involve alcohol consumption. Alcohol is related to various societal problems, including drunk driving, accidental injuries, sexual assaults, domestic abuse, and violent crime. Alcohol remains illegal for sale and consumption in a number of countries, mainly in the Middle East. While some religions, including Islam, prohibit alcohol consumption, other religions, such as Christianity and Shinto, utilize alcohol in sacrament and libation.
Alcohol has a variety of short-term and long-term adverse effects. Alcohol has both short-term, and long-term effects on the memory, and sleep. It also has reinforcement-related adverse effects, including alcoholism, dependence, and withdrawal. Alcohol use is directly related to considerable morbidity and mortality, for instance due to intoxication and alcohol-related health problems. The World Health Organization advises that there is no safe level of alcohol consumption. Many of the toxic and unpleasant actions of alcohol in the body are mediated by its carcinogenic byproduct acetaldehyde.
The long-term effects of alcohol have been extensively researched. The health effects of long-term alcohol consumption vary depending on the amount consumed. Even light
The alcohol consumption recommendations (or safe limits) varies from no intake, to daily, weekly, or daily/weekly guidelines provided by health agencies of governments. The WHO published a statement in The Lancet Public Health in April 2023 that "there is no safe amount that does not affect health."
A standard drink is a measure of alcohol consumption representing a fixed amount of pure ethanol, used in relation to recommendations about alcohol consumption and its relative risks to health. The size of a standard drink varies from 8g to 20g across countries, but 10g alcohol (12.7 millilitres) is used in the World Health Organization (WHO) Alcohol Use Disorders Identification Test (AUDIT)'s questionnaire form example, and has been adopted by more countries than any other amount.
Making decisions from numbers.
Regulatory agencies require numbers to provide health protection. The manner in which these numbers are derived from animal experiments and human epidemiology is considered together with the limitations and inadequacies of these numbers. Some recent examples of risk assessment in Canada are given including asbestos, drinking water, and indoor air quality. The value of these numbers in providing a measure of the hazard in a wider perspective is stressed, although they can never be the sole determinant of public policy.
Published in Regulatory toxicology and pharmacology : RTP (1987)
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