ASSESSING ALCOHOL POLICY

IN AN INTERNATIONAL CONTEXT Marion DEVAUX, Health Policy Analyst, OECD RARHA Expert Meeting, Helsinki, 17 February 2016

• OECD report “Tackling Harmful Alcohol Use”, May 2015

• OECD health working papers No. 79 and 80

• «Social disparities in hazardous alcohol use: self-report bias may lead to incorrect estimates », Devaux M and Sassi F, Eur J Pub H, 2015

OECD recent work on Alcohol

Overall, Alcohol Consumption Has

Slightly Declined in Europe

5,0

7,5

10,0

12,5

15,0

17,5

20,0

1980 1985 1990 1995 2000 2005 2010

Lit

res

of

pu

re a

lco

ho

l p

er c

ap

ita

, 15

+

Finland France Sweden Germany Italy Ireland Belgium OECD-Europe

Source: OECD Health Statistics database, 2015

20%

30%

40%

50%

60%

70%

80%

2001-02 2005-06 2009-10

Sh

ar

e o

f p

eo

ple

ag

ed

15

or

le

ss

in

O

EC

D

Time (years)

People are Initiating Drinking and Get

Drunk at Younger Ages

Age of first drink ≤15

Age of first drunkenness ≤15

Boys

Girls

Girls

Boys

Source: OECD estimates based on HBSC data

Heavy episodic drinking has

increased in young women

0%

2%

4%

6%

8%

10%

12%

14%

16%

1995 2000 2005 2010

New Zealand

Germany Canada

Italy*

France

Finland*

Japan*

Australia US

10%

15%

20%

25%

30%

35%

40%

1995 2000 2005 2010

England

Ireland

HED at least once a month in Japan and once a year in Italy; crude weighted rates in Finland (age-standardised elsewhere)

Women aged 18-24

5

Source: OECD estimates on national survey data.

Highly educated women more likely to

drink hazardously, while inverted in men

Pro

ba

bil

ity

of

Ha

zard

ou

s D

rin

kin

g

0%

5%

10%

15%

20%

25%

Low education Medium education High education

0%

5%

10%

15%

20%

25%

Women

Selected European countries

Men

Source: Tackling Harmful Alcohol Use, OECD, 2015; OECD estimates based on national survey data

0%

25%

50%

75%

100%

Sh

ar

e o

f to

tal

alc

oh

ol

20% of Population Drinking the Most

Consumes the Largest Share of Alcohol

Source: Tackling Harmful Alcohol Use, OECD, 2015; OECD estimates based on national survey data

66%

Survey-based Estimates and Sales Data

Differ Widely

8

205 195 200

239 222

197

169 191

63

36

82

34 60

38

71 70

0

50

100

150

200

250Grams of pure alcohol per week, per capita

Recorded + unrecorded consumption Survey-based consumption

* Survey-based data refer to England only. Source: Devaux and Sassi, Eur J Pub H, 2015

Correcting for Self-Report Bias in Drinking

• Triangulation of self-reported survey data with aggregate WHO data (Rehm et al. 2009)

To shift the distribution of alcohol consumption to the aggregate data average .

• Assume the same degree of bias for all population groups, although differences may exist across SES groups or categories of drinkers.

9

Correcting for Self-Reporting Leads to

Higher Porportion of Hazardous Drinkers

10

21%

5%

16%

9% 12% 13%

37% 41%

30%

47%

42%

36%

0%

10%

20%

30%

40%

50%

England2002

France 2008-2010

Germany2009

Hungary2009

Ireland 2007 Spain 2006

% hazardous drinkers in total male population

Survey-based estimates Corrected estimates

Source: OECD estimates based on survey data.

What Policy-Makers Need to Know

• Does a policy improve health?

• Does it reduce health expenditure?

• Does it reduce health inequalities?

• Is it cost-effective?

• When will desired effects show up?

The CDP-Alcohol Model

Abstainer Drinker

Quantity

Pattern

Drinks per week (continuous)

Regular drinker Binge drinker Dependent drinker

Source: Tackling Harmful Alcohol Use, OECD, 2015

Entry

• Birth • Inward

migration

Population

• Gender • Age • Drinking

status

Diseases and injuries

• Incidence • Prevalence • Remission • Fatality • Risk

Exit

• Death • Outward

migration

Included Alcohol-related Conditions

Average volume

Pattern of drinking

Breast cancer

Mouth and pharynx ca

Liver cancer

Oesophagus cancer

Cirrhosis of the liver

Epilepsy

Stroke

IHD

Injuries

AUDs

Age

Gender

Socioeconomic status

Source: Tackling Harmful Alcohol Use, OECD, 2015

Alcohol Policy Options Assessed

Price policies

Regulation / enforcement

Education Health care

All consumption

Tax increase

Regulation advertising

Heavy use / dependence

Minimum pricing

School-based programmes

Brief Intervention

Drug / psychosocial

therapy

Workplace programmes

Injuries

Drink drive enforcement

Limit opening

hours

Source: Tackling Harmful Alcohol Use, OECD, 2015

No effect on drinking modelled for drink-driving enforcement and limit opening hours Source: OECD, 2015

Prevention Decreases Dependency and

Harmful and Binge Drinking, Germany

-12%

-10%

-8%

-6%

-4%

-2%

0%

main analysis further analysis

Dec

rea

se i

n

pre

va

len

ce

Hazardous/harmful drinkers Heavy episodic drinkers Dependent drinkers

Prevention Saves Lives and Keeps

in Good Health, Germany

**

**

**

**

**

**

**

**

**

**

**

**

**

**

**

**

**

ns

0 25 000 50 000 75 000 100 000 125 000 150 000

Brief interventions

Tax increase

Advertising regulation

Opening hours regulation

Drink-drive restrictions

Treatment of dependence

Minimum price

Worksite interventions

School-based programmes

DALYs Life Years

Source: Tackling Harmful Alcohol Use, OECD, 2015

Many Interventions Are Cost-

Saving, Germany

-600

-400

-200

0

200

400

600

800

main analysis further analysis

Ye

arl

y c

ost

(m

illi

on

US

D P

PP

s)

Intervention costs Health expenditureSource: Tackling Harmful Alcohol Use, OECD, 2015

Preventing Alcohol Consumption is an

Efficient Investment

Further analyses as dotted lines

0

10 000

20 000

30 000

40 000

50 000

60 000

70 000

80 000

5 10 15 20 25 30 35 40

CE

ra

tio

(U

SD

PP

P /

DA

LY

)

Time (years)

Brief interventions Drink-drive restrictions

Treatment of dependence Worksite interventions

Cost-saving interventions

Minimum price

School-based programmes

Opening hours regulation

Tax increase

Advertising regulation (7 years)

Source: Tackling Harmful Alcohol Use, OECD, 2015

Key Policy Implications

• Alcohol consumption is decreasing, overall, but with social & geographical disparities and a rise in binge drinking in some groups

• Brief interventions and price and regulation policies provide large health gains

• Alcohol policies produce significant reductions in health care expenditure. Many interventions are cost saving

• All policies become cost-effective soon after implementation

International Alcohol Policy Model

(RAND/OECD/WHO)

• New project funded by NIH for 2015-2019

• 3 types of policy: Price

Drink driving enforcement

Health care policy

• 8 countries: USA, Canada, Mexico, Chile, UK, Finland, Russia + France

• Modelling, Evaluation, Diffusion

Contact: Marion.Devaux@oecd.org

Read more about our work Follow us on Twitter: @OECD_Social

Website: http://www.oecd.org/health/health-systems/economics-of-prevention.htm

Newsletter: http://www.oecd.org/health/update

Thank you

This presentation was produced for a meeting organized within Joint Action

on Reducing Alcohol Related Harm (RARHA) which has received funding

from the European Union, in the framework of the Health Programme (2008-

2013).

The content of this presentation represents the views of the author/s and it

is their sole responsibility; it can in no way be taken to reflect the views of

the European Commission or of the Consumers, Health, Agriculture and

Food Executive Agency or any other body of the European Union. The

European Commission and the Executive Agency do not accept

responsibility for any use that may be made of the information it contains.