Background

Alcohol use as well as the associated harms in the World Health Organization (WHO) European Region is among the highest in the world. A combination of population-level measures are recommended by WHO to address alcohol use and related harms. Key to the recommendations are measures that focus on limiting alcohol advertising, availability, and affordability, the latter including minimum pricing. The use of minimum pricing and minimum unit pricing (MUP), along with its strengths and limitations and evidence of its impact, are examined in a 2022 WHO report.1

Objections commonly raised in response to minimum pricing and MUP are also addressed in the report and evidence-based counterarguments are provided. The report also examines legal issues relating to minimum pricing policies and provides an overview of different minimum pricing models as well as offering considerations for implementation, enforcement, monitoring, evaluation, and revision of minimum pricing policies.

Key findings

Policy mapping – which countries and regions have a minimum price for alcohol?

The report highlights that many countries do not use alcohol pricing policies and alcohol taxation approaches in their alcohol policies, despite being recommended by WHO, as well as being an economical approach with proven effectiveness in reducing alcohol use in heavier drinkers (and consequently alcohol-related harms). Alcohol taxation is common throughout the WHO European Region but is implemented in such a way that it has limited effectiveness in reducing harms. Eleven of the 14 countries globally with minimum pricing policies in place are located in the WHO European Region. Ireland is one of just four countries with a MUP on all alcoholic drinks. The report compares the minimum price for alcohol products internationally and notes that the MUP in Ireland (€1 per 10 g) is among the highest.

Evidence for minimum pricing

The report outlines the evidence available to support the effectiveness of minimum pricing. This includes the indirect evidence that increasing the price of alcohol reduces the amount of alcohol consumed and in turn reduces alcohol-related health and social harms. Simulation modelling studies also conclude that greater benefits are seen with the highest minimum price and conclude that minimum pricing can reduce healthcare costs, crime, and workplace absences caused by alcohol. Direct evaluation studies demonstrating the impact of minimum pricing are also outlined in the report. They include how in Australia’s Northern Territory, alcohol use declined by 8% in the year following the introduction of MUP and that rates of alcohol-related ambulance callouts, emergency department presentations, assaults, arrests for being dangerously intoxicated, road-traffic collisions, and child protection cases all declined.2

Common objections to minimum pricing policies

Those who challenge minimum pricing argue that it costs moderate drinkers financially, despite being specifically targeted at the heaviest drinkers. However, this has been rebutted by the evidence outlined in the report.3 It has also been claimed that minimum pricing penalises those on lower incomes and indeed the report does acknowledge that more deprived heavier drinkers are more affected by minimum pricing. However, they are also the drinkers suffering the most harm and thus the cohort specifically targeted to reduce harm and health inequalities. A common objection are the costs to businesses and the economy, and it is acknowledged in the report that minimum pricing policies do reduce the total volume of alcohol sold. However, it is countered by an increase in the average prices paid, meaning little or no negative impact on the alcohol sector. In addition, less alcohol-related harm and associated gains in economic productivity will accrue to all sectors of the economy.

Also proposed as an argument against minimum pricing is that it costs the government money as it reduces government revenue from alcohol taxes. Although true, the costs borne are undoubtedly exceeded by reductions in costs associated with alcohol harm. Illicit consumption or production and/or cross-border trade may increase with the introduction of minimum pricing. However, the evidence suggests this is not common and the authors recommend complementary policies to address unrecorded alcohol use.

It is also argued that dependent drinkers will not change their drinking. However, the authors make an important observation: the majority of very heavy drinkers are not dependent and there is strong evidence that they will reduce their consumption when prices rise. However, there is evidence of some unintended negative impacts on dependent drinkers, and additional supports should be considered for this group. Finally, it is claimed by those who oppose minimum pricing policies that it will increase alcohol industry revenue. The authors agree, but also propose that complementary use of taxation or other policies could be used to recoup some of this revenue.

Legal issues relating to minimum pricing policies

The report includes a chapter analysing the compatibility of minimum pricing policies with relevant free movement of goods provisions in legislation pertaining to the European Union (EU), World Trade Organization, and Eurasian Economic Union.

Considerations after minimum pricing has been implemented

Once legislation commencing minimum pricing has been passed, of equal importance is how the policy will be practically implemented and enforced, monitored and evaluated, and reviewed and revised over time. The report outlines examples of how this is done in countries with minimum pricing in place along with recommendations.

Choosing the most appropriate pricing policies

Throughout the report, minimum pricing and MUP have been shown to be an effective approach to reducing alcohol use and associated harms, and the evidence indicates that such policies are most effective when used in combination with other measures to reduce alcohol affordability and improve public health. This chapter of the report outlines important considerations for policymakers to assist in informing decision-making by examining different minimum pricing models.

Conclusion

This report outlines the growing evidence that the potential minimum pricing (including MUP) has in reducing alcohol-related harms across the WHO European Region when implemented as part of a suite of measures. By targeting the cheapest, highest-strength alcohol, the heaviest drinkers who experience the highest rates of harm will be the most impacted. Policymakers considering introducing minimum pricing measures should consider the drinking patterns and harm profiles unique to their jurisdictions as well as their needs and technical capacity.

1  World Health Organization (WHO) Regional Office for Europe (2022) No place for cheap alcohol: the potential value of minimum pricing for protecting lives. Copenhagen: WHO Regional Office for Europe. https://www.drugsandalcohol.ie/36494/

2  Coomber K, Miller P, Taylor N, et al. (2020) Investigating the introduction of the alcohol minimum unit price in the Northern Territory: final report. Geelong, Australia: Deakin University. https://www.drugsandalcohol.ie/31922/

3  O’Donnell A, Anderson P, Jané-Llopis E, et al. (2019) Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015–18. BMJ, 366: l5274. https://www.drugsandalcohol.ie/31142/