barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
barcelona . spain - European Association for the Study of the Liver
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BARCELONA . SPAIN<br />
160 POSTGRADUATE COURSE SYLLABUS ALCOHOLIC LIVER DISEASE 161<br />
APRIL 18 - 19/2012 THE INTERNATIONAL LIVER CONGRESS TM 2012<br />
in <strong>the</strong> price <strong>of</strong> alcoholic beverages are found not to vary by country. Policies that increase alcohol prices<br />
delay <strong>the</strong> time when young people start to drink, slow <strong>the</strong>ir progression towards drinking larger amounts, and<br />
reduce <strong>the</strong>ir heavy drinking and <strong>the</strong> volume <strong>of</strong> alcohol drunk on each occasion. Price increases reduce <strong>the</strong><br />
harm caused by alcohol, which is an indicator that heavier drinking has been reduced. Setting a minimum<br />
price per gram <strong>of</strong> alcohol can be as effective as an across-<strong>the</strong>-board tax increase, with both options<br />
increasing <strong>the</strong> cost to heavy consumers far in excess <strong>of</strong> <strong>the</strong> cost to light consumers. Natural experiments in<br />
Europe consequent to economic treaties have shown that as alcohol taxes and prices have been lowered,<br />
so sales and alcohol consumption have usually increased. Table 1 shows that tax increases (<strong>of</strong> 20% or<br />
even 50%) are highly cost-effective throughout Europe. Even accounting <strong>for</strong> longer life, and thus potentially<br />
increased social welfare costs, taxation remains a highly cost-effective alcohol policy option. As discussed<br />
above, <strong>the</strong> effect <strong>of</strong> alcohol tax increases could be mitigated by illegal production, tax evasion and illegal<br />
trading, which accounts <strong>for</strong> approximately 12% <strong>of</strong> all consumption in Eur-A countries and 40% in Eur-B and<br />
Eur-C countries. Reducing this unrecorded consumption (by 20–50%) via concerted tax en<strong>for</strong>cement ef<strong>for</strong>ts<br />
is estimated to cost 50–100% more than a tax increase but produces similar levels <strong>of</strong> effect. In settings with<br />
higher levels <strong>of</strong> unrecorded production and consumption, increasing <strong>the</strong> proportion <strong>of</strong> consumption that is<br />
taxed (and <strong>the</strong>re<strong>for</strong>e more costly to <strong>the</strong> price-sensitive consumer) may represent a more effective pricing<br />
policy than a simple increase in excise tax, which may only encourage fur<strong>the</strong>r illegal production, smuggling<br />
and cross-border purchases.<br />
Table 1 Costs, impact and cost-effectiveness <strong>of</strong> different policy options in Europe<br />
a) Implementation cost in 2005 international dollars (millions).<br />
b) Cost–effectiveness ratio, expressed in terms <strong>of</strong> international dollars per DALY saved.<br />
c) Not applicable because <strong>the</strong> effect size is not significantly different from zero (<strong>the</strong> cost–effectiveness ratio<br />
would <strong>the</strong>re<strong>for</strong>e approach infinity).<br />
MARKETING OF ALCOHOLIC BEVERAGES<br />
Despite <strong>the</strong>ir methodological difficulties, econometric studies <strong>of</strong> <strong>the</strong> link between alcohol advertising and<br />
consumption have found effects <strong>of</strong> alcohol advertising on behaviour, although not across all studies. The<br />
strongest evidence comes from longitudinal studies that have shown an impact <strong>of</strong> various <strong>for</strong>ms <strong>of</strong> alcohol<br />
marketing, including exposure to alcohol advertising in <strong>the</strong> traditional media as well as promotion in <strong>the</strong><br />
contents <strong>of</strong> films and via alcohol-branded merchandise, on when young people start to drink and on riskier<br />
patterns <strong>of</strong> drinking by young people. The effects <strong>of</strong> exposure seem to be cumulative; in markets where<br />
alcohol is more widely advertised young people are more likely to continue to increase <strong>the</strong>ir drinking as<br />
<strong>the</strong>y move into <strong>the</strong>ir mid-twenties, whereas drinking declines at an earlier age among those who are less<br />
exposed. These findings <strong>of</strong> <strong>the</strong> impact that advertising can have on young people’s behaviour are supported<br />
by experimental studies, and are in keeping with research on young people’s smoking and children’s food<br />
preferences. In some jurisdictions, alcohol marketing relies on self-regulation by economic operators,<br />
including in advertising, <strong>the</strong> media and by alcohol producers. Evidence from a number <strong>of</strong> studies shows<br />
that <strong>the</strong>se voluntary systems do not, however, prevent <strong>the</strong> kind <strong>of</strong> marketing that has an impact on younger<br />
people. It should be noted that a total marketing strategy is multilevel, including not only marketing and<br />
promotional activities but also product development, pricing, physical availability, and market segmentation<br />
and targeting. Fur<strong>the</strong>r, while alcohol is marketed through increasingly sophisticated advertising in <strong>the</strong>