The Estimated Health Impact of Alcohol Interventions in New Zealand: A Modelling Study
Increasing taxes on alcohol, reducing its availability and banning alcohol marketing would bring significant health gains for New Zealanders, particularly for Māori, a modelling study from researchers at the University of Otago, Wellington shows.
The modelling looked at the impact of several measures: a 50 per cent increase in the tax on alcohol; reducing the number of outlets selling alcohol from 63 to five outlets per 100,000 people; cutting the number of hours outlets could open from 112 to 50 per week; and banning all forms of alcohol marketing.
As per NZ Doctor reporting, lead modeller on the study, Dr Anja Mizdrak, says the measures were selected based on consultation with stakeholders, including groups concerned over the impact of alcohol use in their communities.
The results of the study are published in the scientific journal Addiction.
The study found each of the changes would reduce per capita alcohol consumption by between 7.6% and 9% when applied individually and 30% as part of a comprehensive package. If all the measures were introduced, it would result in a population-wide increase in health-adjusted life years of 726,000, corresponding to an increase in median life expectancy of 87.6 days.
The study found significant health gains could be made if the New Zealand Government followed the recommendations of previous government-led inquiries on alcohol regulations.
What previous research found
Toll of Alcohol
- In 2016 in New Zealand, alcohol ranked fifth as a major contributor to health-related harm.
- 25 diseases and injuries are caused by alcohol.
- Alcohol’s harmful effects are not confined to the individuals who consume it. Instead, alcohol harm is affecting the entire community.
- It’s a web of consequences that extends to societal issues such as interpersonal violence and property damage.
- About 10% of cases involving fights and property damage are caused by alcohol.
- The economic cost of this alcohol is staggering. In 2005/06, the price paid for alcohol-related harm was ca, NZ$5 billion.
- That’s equivalent to 3% of New Zealand’s Gross Domestic Product (GDP). This cost exceeded the revenue generated from alcohol taxes.
- There are vast disparities in alcohol-related health issues between Māori and non-Māori populations.
- High-risk alcohol use is more prevalent among the Māori.
- Their share of the ill-effects of alcohol intake is large.
- Progress in implementing recommended alcohol policy changes has been stagnant.
- In 2010, the New Zealand Law Commission proposed a set of 153 reforms. The failure to enact these key recommendations has come under scrutiny.
- There are various effective alcohol policy solutions. These include measures like taxation, control over availability, and regulations on marketing.
- The World Health Organization (WHO) calls them “best buys” in reducing alcohol-related harms.
- In New Zealand, there is limited empirical evaluations of such interventions.
Added value of the present research – Enhancing Māori Health: alcohol policy analysis
The present research seeks to figure out which actions could have the biggest positive impact on the health of the Māori concerning alcohol harm. The research considered the potential benefits and how well these actions fit with the current policies in New Zealand.
To do this, the study examines four different ways to address alcohol harm in New Zealand:
- Tax: Increasing the tax on alcohol by 50% was estimated to reduce alcohol consumption by about 7.60%.
- Availability: Reducing the hours when alcohol can be sold was estimated to decrease alcohol use by around 8.64%.
- Outlet Density: If significantly lowered the number of places where alcohol is sold could reduce alcohol use by approximately 9.24%.
- Marketing: Banning all forms of alcohol advertising predicted to cut alcohol consumption by 8.98%.
When combined into an integrated approach to alcohol harm, all these alcohol policy improvements could reduce per capita alcohol consumption by a substantial 30.3%.
The study aimed to find out which of these actions could make the most positive difference in terms of people using alcohol less and having better health. It helps identify what would work best for the Māori and how these actions aligned with the current policies in New Zealand.
Highlights of the research findings
Combining all alcohol interventions could gain 726,000 HALYs (Health-Adjusted Life Years) in New Zealand.
On average, each person could live about a quarter of a year (87.6 days) longer. It could increase median life expectancy by 0.24 years per capita or 87.6 days.
Health gains are mostly seen about 20 years after implementing the interventions. The Māori would benefit more due to differences in alcohol consumption, age, and disease incidence.
Opportunities of taxation for revenue and health
If New Zealand increased alcohol taxes by 50%, it could result in 192,000 HALYs (Health-Adjusted Life Years).
This would be similar to gaining 200,000 years of good health for the population.
Other countries with higher alcohol taxes have seen even better health gains. In comparison, New Zealand’s alcohol taxes are relatively low. These taxes can help pay the costs linked to healthcare and social problems.
Despite recommendations, New Zealand hasn’t raised alcohol taxes enough to cover these costs.
Improving alcohol availability limits
If New Zealand limited the hours when alcohol can be sold, it could result in 233,000 HALYs (Health-Adjusted Life Years).
This is similar to gaining more than 200,000 years of good health.
Reducing the number of places that sell alcohol could yield 218,000 HALYs.
New Zealand currently has very long hours when alcohol can be sold. There are currently many places where alcohol can be sold, too.
Impact of banning alcohol advertising
If all alcohol advertising and promotion were completely banned, it could result in over 200,000 years of good health.
Available studies show a strong link between alcohol marketing and how much people use alcohol.
Several reviews have recommended making laws to regulate alcohol advertising. But progress in that direction is slow. Nevertheless, a partial ban can lead to significant improvements in public health by reducing alcohol consumption.
For each of the four alcohol policy solutions, the study specifies how much less alcohol people might use illustrating how effective they might be in protecting more people from alcohol harm and promoting health.
These measures have been consistently recommended by government-led reviews of alcohol policy options in New Zealand. As such, it underlines the urgency for government action to implement these evidence-based measures.
To estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non-Māori in New Zealand (NZ).
Multi-stage life-table intervention modelling study.
The researchers modelled two scenarios:
- business-as-usual (BAU); and
- an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100,000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing.
Setting and participants
The model’s population replicates the 2018 NZ population by ethnicity (Māori/non-Māori), age and sex.
Alcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption.
Disease incidence, prevalence and mortality were calculated using Ministry of Health data.
The study used dose–response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness.
Changes in consumption were based on the following effect sizes: total intervention package [−30.3%; outlet density (−8.64%); outlet hours (−9.24%); and marketing (−8.98%).
The researchers measured health gain using health-adjusted life years (HALYs) and life expectancy.
Compared with the BAU scenario, the total alcohol intervention package resulted in 726, 000 HALYs gained during the life-time of the modelled population.
Māori experienced greater HALY gains compared with non-Māori.
When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes.
Modelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non-Māori in New Zealand suggest substantial population-wide health gains and reduced health inequities between Māori and non-Māori.