By: Dr. Geoffrey Modest
An article was just published in the Washington Post arguing for an increase in the alcohol tax (see here).
They make the following points:
–There has been a remarkable cheapening of alcohol: a 10-drink/day drinker in 1950 had to spend 45% of their disposable income on the alcohol. today it is 3%.
–Taxes have fallen dramatically: in today’s dollars, the federal tax on a shot of 80-proof whiskey was 90 cents in 1951, now it’s 13 cents (7-fold decrease). Beer tax has decreased 5-fold.
–Cigarettes, in contrast, have less political support and have had record high taxes (and significantly decreasing consumption)
There is a voluminous literature finding that increased alcohol prices through state/national taxes decrease alcohol consumption, alcohol-related morbidity and mortality, and alcohol-related harmful social interactions (violent assaults, drunk-driving, sexually-transmitted infections). A few studies have been published looking at the effects of a small alcohol tax increase in Illinois in 2009, where the tax on beer was increased by 4.6 cents/gallon, wine by 66 cents/gallon, and distilled spirits by $4.05/gallon. In one study researchers looked at the relationship between this tax increase and sexually transmitted infection (STI) morbidity, finding that state-wide rates of gonorrhea decreased 21% (3506 fewer infections) and chlamydia decreased 11% (5844 fewer infections); these decreases were (not surprisingly) highest among 25-29 year olds (see Addiction 2014; 109: 904–912). In a study just published on-line in the Am J Public Health this group also looked at fatal car crashes, finding that the tax increase was associated with a 26% decrease in fatal alcohol-related car crashes (decreased 9.9/month), with a striking 37% decrease in those <30 yo. Similar reductions were found in those with alcohol levels <0.15 grams/dl (-22%) vs higher (-25%), and there was no significant gender or race differences. They controlled for weather, traffic law enforcement, safety policies, and compared their results to those of neighboring Wisconsin where there was no tax increase. Of note, alcohol-related car crashes account for 10K deaths and 500K injuries per year in the US.
So, there have been lots of studies in the public health journals showing that taxes lead to lower levels of harmful-substance use and fewer medical and social consequences. Even with the seemingly paltry tax increase in Illinois, there were pretty dramatic decreases in alcohol-related fatal car crashes and STIs. None of this is surprising. There have been very old observations (eg Prohibition in the US, German seizure of alcohol in France in World War II, Gorbachev’s anti-alcohol campaign in Russia) leading to major decreases in liver cirrhosis mortality, typically within 6-12 months. This all highlights the major health improvement attributable to decreasing alcohol consumption. Seems pretty clear that the current trend in effectively decreasing alcohol taxes/cost is wrong-headed, though unfortunately there are powerful political lobbies in the US which will make it difficult to change this…. (oh, wouldn’t it be great if public health concerns had a bit more of a role in determining policy??).