Examination of Witnesses (Question Numbers
280-300)
DR PETRA
MEIER AND
MS LILA
RABINOVICH
14 MAY 2009
Q280 Dr Naysmith: The measure is
you are pretty confident about your findings.
Ms Rabinovich: We are. We are
aware of the limitations and they have been highlighted in our
report. There are limitations on data.
Q281 Dr Naysmith: Can I move on to
something else, which is how much do you think the fact that the
Treasury raises a lot of money through alcohol duty influences
their attitude to minimum pricing?
Dr Meier: I really would not know,
sorry.
Q282 Dr Naysmith: Do you have any
idea from your studies?
Ms Rabinovich: No, we can only
guess.
Q283 Dr Naysmith: Would minimum pricing
lead to massive profits for producers and sellers of alcohol?
Would it have that perverse incentive?
Dr Meier: I do not know about
a definition for "massive", but there certainly would
be increases in retail revenue largely proportionate to the effects
on consumption and so on. We have given headline figures in our
report. One of the limitations of the report is that we have not
been able to model all the supply side responses that might be
possible to the introduction of a minimum price, for example whether
there would be different promotional tactics going on or whether
people might start including freebies with alcohol, all these
kinds of things that might also have an effect on how minimum
pricing works in practice. There is not any evidence out there.
Q284 Dr Naysmith: From what you said
earlier about the minimum price being a pound or so for on-sales
anyway, this would affect supermarkets much more than licensed
premises.
Dr Meier: It would affect supermarkets
much more, although where the prices in supermarkets increase
there is also a switching effect. If the prices become more similar
to the on-trade we see quite a bit of switching back from supermarket
alcohol to the on-trade sector. We also modelled some positive
effect on the on-trade.
Q285 Chairman: What do you think
of the Chief Medical Officer's view about the pricing of alcohol?
Dr Meier: We are glad that someone
seems to have read the report and understood some of the things.
I thought the introduction of the term "passive drinking"
was an interesting one. We have not included a lot of those harms,
so if you did you would end up with slightly different responses.
We do not have a view on the right level of minimum pricing. As
an academic institution we can only provide the evidence and say,
"Here it is. Use it, please".
Q286 Sandra Gidley: Last week we
heard that early intervention by GPs and other clinicians is effective
in treating one out of every eight patients. Is there any evidence
that minimum pricing would be a more effective policy than clinical
intervention?
Dr Meier: No. What we have not
done as yet is look at the comparative effectiveness in terms
of cost-effectiveness of different things. Work on that is underway,
as far as I know, but that has not been done. There is a general
list of what the cost-effective policies are and brief interventions,
for example, are certainly on that list, but how they have not
done that. It is probably not an either/or choice. If you wanted
to introduce some of both then you would need to be able to model
how different policies interact with each other and at the moment
we do not quite know how to do that. If you have got a change
in treatment budget and a new policy on brief interventions there
may be some changes in alcohol availability and a price increase
but it is very difficult to model how those policies would come
together.
Ms Rabinovich: There is a little
bit of evidence in the drink-driving area of alcohol policy where
there is some sense of how different drink-driving policies interact
with each other. Fines and random breath-testing, for example,
work better together than individually. Like Petra said, there
is very little on how the range of different alcohol policies
work together or compare in terms of cost-effectiveness.
Q287 Sandra Gidley: Are there any
other cost-effective non-clinical policies that have been shown
to be successful in reducing alcohol harm?
Dr Meier: Absolutely. There is
quite a lot of evidence on minimum purchase age and the enforcement
of minimum purchase age, so making it more difficult for underage
and also intoxicated persons to get access to alcohol. There is
good evidence on some of the availability issues such as licensing
hours and outlet density. There is not very much in terms of cost-effectiveness,
so far as I know, but certainly effectiveness research which demonstrates
that if you restrict trading hours then usually you see consumption
and harm going down.
Q288 Sandra Gidley: Are you saying
that reducing trading hours in supermarkets would be a good idea?
We have 24-hour supermarkets and 24-hour garages now which sell
alcohol.
Dr Meier: In the UK it is slightly
more difficult because a lot of the research especially on the
trading hours is international research rather than UK research,
or the UK research I am aware of in terms of the recent Licensing
Act, and it is not as conclusive. There is some evidence that
we will see a displacement of crime and whatever, but there is
not a really clear relationship between the changes in trading
hours which is probably due to the fact that affects pubs and
not supermarkets. That is the international evidence. Drink-driving
laws say lowering blood alcohol content levels. We have got one
of the highest ones in the UK amongst European states and those
states that have lowered it to 0.5 rather than 0.8, or 0.2 even,
have seen drops in drink-driving related problems. Having a lower
BAC level for young drivers, novice drivers, is also usually seen
as cost-effective. What is less cost-effective or effective as
a policy is school-based education, the public service messages,
basically counter-advertising warning of the risks of alcohol
and also the warning labels on product labelling generally has
not been very well supported as an effective policy by recent
evidence.
Q289 Sandra Gidley: Have there been
countries where that has been universally adopted because here
it is voluntary and about 30% of products do not have any warnings
on them at all?
Dr Meier: There have been countries
where it has been adopted and has produced changes in awareness
or knowledge of the limits, but there was not any demonstrable
effect in terms of harm reduction.
Ms Rabinovich: I am not sure if
you mentioned taxation, but probably the largest body of evidence
on effective interventions is on taxation and the consensus is
that an increase in taxation where it leads to significant increases
in price can have a very important effect in terms of reducing
consumptions and harms.
Q290 Charlotte Atkins: I would like
to pick up on that taxation point. What effect would "stepped
taxation" have on consumption where, for instance, there
is a higher tax on beer with more than a 4% alcohol by volume
rating or, indeed, for wines which have a higher alcohol by volume
rating as well? Does stepped taxation impact on consumption in
any real way?
Dr Meier: Absolutely. Linking
taxation to the strength of alcohol in the product is a very good
idea in public health terms. Basically higher strength beverages
do get more expensive compared to lower strength, so having an
incentive to consume lower strength beers and wines, and that
would certainly counteract the current trend towards stronger
and stronger beers, and some countries have seen that. For example,
Australia, after introducing tax relief for lower strength alcohol
has seen the popularity of that increase by quite a lot. There
are things that you can do with taxation to provide incentives
to go for lower strength alcoholic beverages.
Q291 Charlotte Atkins: Which countries
have been most successful in adopting that approach?
Dr Meier: I am only aware at the
moment of research from Canada and Australia. There may be other
ones but, as I say, the literature on pricing and taxation is
absolutely huge.
Q292 Charlotte Atkins: Based on your
research, what system of taxation would you recommend? Would you
prefer a taxation approach to a minimum pricing approach? What
would your advice be?
Dr Meier: We have been specifically
asked not to look at taxation. We have modelled general price
increases, which is not the same as taxation. General price increases
are actual increases to the product price rather than taxation
where the pass-through to product price may not be a one-to-one
pass-through everywhere. There is some concern that supermarkets
may be able to absorb some of the tax rises, for example. We do
not have the data. We have not been asked to look at taxation,
so it would be difficult to say from our modelling what the right
taxation would be. From what we have seen on minimum pricing generally,
having something that works on the basis of alcoholic strength
seems to be a good idea. We would assume a similar effect if you
went for taxation by ABV, but that is based more on the international
evidence than our own work.
Ms Rabinovich: There is a little
bit of evidence coming from the US but it is focused mostly on
the on-trade where pass-through rates for increases in taxation
were higher than the actual increase in taxation, so the price
went up by more than the increase in taxation. That was in the
on-trade and it was only in the US. There is very little evidence
elsewhere of what the effect would be in terms of pass-through
rates, especially in the UK where off-trade consumption is so
important.
Q293 Stephen Hesford: Do liberal
licensing laws encourage people to drink more?
Ms Rabinovich: There seems to
be some evidence that it does insofar as where it increases opening
hours and outlet density international evidence seems to suggest
that this encourages people to drink more so consumption and harms
go up. I cannot say very much about what happened in the UK, for
example, where those things did happen. Petra mentioned before
about existing research being inconclusive and not terribly clear
within the UK context in particular.
Dr Meier: It is probably important
to see that availability works in two ways. One is in terms of
making it easy for people to get hold of alcohol around the clock
or in terms of walking distance, outlet density. There is also
possibly a cultural signal that at the moment we do not understand
very well, there is very little research. If you change the availability
of alcohol towards making it more available, is that a signal
for especially young people about the acceptability of drinking.
That is something that is in urgent need of some proper scientific
research.
Q294 Stephen Hesford: In terms of
comparative studies, how do our licensing laws compare with the
continent, for example?
Ms Rabinovich: We did not do a
comparative analysis and did not really look at licensing laws
that much either. Because there is very little evidence from across
the EU on what licensing laws are in all 20 countries that we
looked at, I cannot say where the UK ranks compared with the other
countries. We know there are countries that have less stringent
licensing laws. For example, in some places in Spain and Austria
up to the early 2000s there was no licensing for on-trade or off-trade
whereas in countries like Sweden and Finland licensing laws are
much stricter. They are still stricter even though they have been
relaxed over the last couple of decades.
Q295 Stephen Hesford: Just in terms
of that narrow inquiry, what can you learn from that? What goes
on in those different regimes in terms of harms, availability
and those sorts of issues?
Ms Rabinovich: It is really hard
to say. For example, in Scandinavia, about which a lot of research
and information is available, what happened with alcohol policy
was it all became more liberalised over the years, so it was not
just changes in licensing. We do not know exactly the attributable
proportions.
Q296 Stephen Hesford: You cannot
break it down or you have not broken it down?
Ms Rabinovich: No, we have not.
Q297 Stephen Hesford: In your view,
from what you have studied should supermarkets and pubs be banned
from using price promotions on alcohols, like happy hours and
stuff like that?
Dr Meier: We modelled the effect,
not to say should they or should they not, of having restrictions
on price promotions or a total ban. What I have to say about that
is that assumes no change to general trading practice, so assumes
that supermarkets would not then just opt for everyday low prices.
Assuming they were not able to shift to everyday low prices and
you had a ban that worked as intended, that would be about comparable
with the 40p minimum price in terms of the overall effectiveness
in terms of health and crime harms. That is just to give you a
bit of a comparison on what total ban on off-trade promotions
would look like.
Q298 Stephen Hesford: Are you saying
that in terms of Dr Stoate's questions before about a 50p minimum
price that the two would have to go hand-in-hand with banning
price promotions?
Dr Meier: We have got a concern
that if you just banned price promotions it would be very easy
to circumvent by making the normal price drop. If you wanted to
play devil's advocate you might end up with lower prices if you
just banned promotions and did not do anything else. It could
be an effective policy if it was in combination with something
else.
Q299 Stephen Hesford: Would that
be true for all markets, supermarkets, pubs, or would one be more
differentially affected than others
Dr Meier: To be honest, I do not
know. I assume because pub promotions are more on the basis of
happy hours and not time-based promotions which run over a very
long time it would be less likely that pubs would respond by lowering
their everyday prices but, to be honest, I do not know. That comes
under what I said before, that modelling the supply side responses
to any of these policies is incredibly difficult.
Ms Rabinovich: There is a very
small number of countries that we know of in the EU that have
banned sales below costs in the off-trade and some on-trade promotions
but there is no evidence about what the effect was. This is still
an area that requires further research.
Chairman: Thank you very much. We will
see if we can find the CEBR study. We do know what it stands for
as well. We may want to share that with you, Petra, so we can
have your views on it if we do find it.
Q300 Stephen Hesford: Did you say
that ASDA had done something?
Dr Meier: Yes, saying that the
evidence on the link between pricing and consumption was very
weak, which surprised us.
Chairman: We may pursue that as well.
Could I thank both of you very much for coming along and helping
us with this inquiry this morning. Thank you.
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