Reduction of Alcoholic Strength: Does It Matter for Public Health?
Reducing population-level alcohol use is important to prevent and reduce alcohol harms.
One way to reduce intake of ethanol (pure alcohol) in the general population is to substitute higher-strength beverages with lower-strength ones. The authors of this research article list three potential pathways to achieve this goal:
- First, a beverage type with higher alcoholic strength (e.g., spirits with 40% alcoholic strength) can be replaced or partly replaced by lower alcoholic strength beverages (e.g., by beer or wine).
- This has been a successful strategy in Russia.
- The second pathway concerns the reformulation of products with lower alcoholic strength.
- To date, reformulation has mainly been done for beer (e.g., a beer with 4.8% alcoholic strength reduced to 4.5%).
- The third pathway concerns the introduction of products with low- or no-alcohol content, where the term low-alcohol beverage refers to a beverage with an alcoholic strength by volume (ABV) of between 0.05% and 1.2%, and the term no-alcohol beverage refers to beverages with an ABV below 0.05%
Specifically, the researchers examined the public health consequences of these pathways, operationalized via postponed deaths (averted deaths in a year).
They began with a scenario which assumed that the alcoholic strength of all beverages in six large Western and Central European countries (France, Germany, Italy, Poland, Spain, and the UK) were reduced by 10%.
Results of the modelling show that a 10% reduction in alcoholic strength for all alcohol beverages would lead to a reduction of alcohol-attributable deaths by between 5% and 10.25%.
In absolute numbers, this means that more than 4,500 deaths would have been adverted in Germany alone.
For all the six countries included in the study the number of averted deaths for one year would have been over 14,000.
As expected, the four biggest categories (cancer, cardiovascular disease, digestive disease [mainly liver cirrhosis], and injury) made up the vast majority of alcohol-attributable deaths averted.”Rehm J, Rovira P, Manthey J, Anderson P. Reduction of Alcoholic Strength: Does It Matter for Public Health? Nutrients. 2023 Feb 11;15(4):910. doi: 10.3390/nu15040910. PMID: 36839266; PMCID: PMC9959344.
The authors of the paper make the important point about that the methods to actually achieve a reduction in alcohol strength are unclear:
… the alcohol industry has shown no inclination toward reductions in the alcoholic strength of beer, wine, or spirits via a reformulation on a large scale.
The increase of excise taxation to achieve the public health gains of such a reduction would result in markedly increasing prices – a situation unlikely to be implemented in Europe.”Rehm J, Rovira P, Manthey J, Anderson P. Reduction of Alcoholic Strength: Does It Matter for Public Health? Nutrients. 2023 Feb 11;15(4):910. doi: 10.3390/nu15040910. PMID: 36839266; PMCID: PMC9959344.
One possible solution could be to use different taxation strategies. For example, a fixed duty per gram of alcohol, which would be multiplied by the alcoholic strength, but be steeper at lower strengths to incentivize low-strength products has been suggested.
Another potential solution, which was linked with reducing harm in the Northern Territory of Australia, was the implementation of a levy on all beers having an alcoholic strength greater than a threshold value of 3.0% alcohol.
When it comes to the introduction of low- or non-alcoholic products, available data is limited. The researchers used existing natural experiments from the UK and Spain and could see a small substitution effect, but not large enough to be relevant for public health consideration.
The alcohol industry often frames no- and low-alcohol products as beneficial for public health, but this is yet to be shown according to the authors of the paper:
…the uptake of such products by the general population has not been large enough to produce sizable public health effects. It would, therefore, be up to the industry to demonstrate that there could be conditions under which a public-health relevant substitution would take place.”Rehm J, Rovira P, Manthey J, Anderson P. Reduction of Alcoholic Strength: Does It Matter for Public Health? Nutrients. 2023 Feb 11;15(4):910. doi: 10.3390/nu15040910. PMID: 36839266; PMCID: PMC9959344.
In this work, reduction of alcoholic strength was discussed as a means to reduce consumption and alcohol-attributable harm.
Statistical modelling was conducted to
- estimate its potential for the largest six Western and Central European countries (France, Germany, Italy, Poland, Spain, UK);
- calculate the increase in taxation necessary to reach this potential, and
- estimate the mortality gains achieved with the introduction of no- or low-alcohol beverages in the UK and Spain.
The high public health potential of reducing alcoholic strength was demonstrated via modelling a scenario in which the strength of all beverages was reduced by 10%, which would avert thousands of deaths in these six European countries per year.
However, methods by which to achieve these gains were not clear, as the alcohol industry has shown no inclination toward reductions in the alcoholic strength of beer, wine, or spirits via a reformulation on a large scale.
The increase of excise taxation to achieve the public health gains of such a reduction would result in markedly increasing prices – a situation unlikely to be implemented in Europe.
Finally, the introduction of beer and wine with an alcoholic strength below 0.5% led to some substitutions of higher-strength beverages, but did not show a marked public health impact.
New taxation initiatives to achieve the potential of a reduction of alcoholic strength will need to be implemented.
Additional resources to complement this study
The researchers of the above study conclude that new alcohol taxation intiaitives are needed to achieve the potential of a reduction of alcohol strength.
The WHO European region has brought such an initiative underway.
WHO Europe Launches Alcohol Taxation Signature Initiative
Governments in Europe can save thousands of lives every year if they improve alcohol taxation. Research shows that increasing the price of alcohol products through raising taxes is the most cost-effective alcohol policy solution to prevent and reduce alcohol harm.
Despite the benefits of alcohol taxation, it remains one of the least implemented measures in the WHO European Region.
The NCD Advisory Council is planning to support member states to harness the power of health taxes. The brand new signature initiative on taxation focuses on five key areas that will increase the untapped potential of health taxes for alcohol in the Region in an unprecedented way.
The researchers also emphasize that the alcohol industry has not stepped up concerning the reduction of alcohol strength in their beer, wine, and liquor products.
The UK Responsibility Deal is a clear example of the alcohol industry failing to deliver on their own commitment to remove alcohol units from the market.
34 alcohol industry actors pledged to:
We will remove 1bn units of alcohol sold annually from the market by December 2015 principally through improving consumer choice of lower alcohol products”UK Responsibility Deal, Alcohol industry pledge A8(a)
Analysis showed that this was a complete failure.