barcelona . spain - European Association for the Study of the Liver

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