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Updated: 24 August
THE GOVERNMENT PLANS to move forward with legislation that would impose minimum unit pricing on alcohol, this autumn.
In a debate on TV3′s Tonight With Vincent Browne on Monday, Junior Minister Marcella Corcoran Kennedy claimed that the policy has been “proven to work” in other jurisdictions, citing the example of British Columbia in Canada.
Is that true?
(Remember, if you hear a fact-fight over the airwaves, or read one in the news, email factcheck@thejournal.ie or tweet @TJ_FactCheck).
Claim: Minimum unit alcohol pricing has been proven to reduce health harms, elsewhere in the world
Verdict: Mostly FALSE
What was said:
You can watch a video of the relevant section from Monday’s debate, above and watch the full episode here. This is the most relevant part:
Minimum unit pricing has been proven to work, in British Columbia in Canada, for example. When they introduced it, they found, when they did the research that there were less deaths from…drinking, and there were less hospital admissions.
Minimum unit pricing (MUP) legally prevents anyone selling alcohol below a set price (under the government’s plan, €0.10 per gram of alcohol). It is not a tax.
The public health rationale behind the policy is that:
There is also an argument that the reduction in consumption purportedly brought about by MUP also leads to a decrease in alcohol-related crime (especially assaults) and sexually-transmitted diseases.
This FactCheck is sticking only to health issues, because that was the overwhelming focus of the Minister’s comments, and is the main rationale behind MUP.
We asked Marcella Corcoran Kennedy’s office and the Department of Health for evidence to support her claims.
In response, the department directed us to several different reports and academic studies on the issue.
One of those studies, published in 2013, related to the Canadian province of British Columbia and tracked minimum alcohol prices as well as alcohol-related deaths between 2002 and 2009.
A few important points:
The first thing to note is that the number of alcohol-related deaths and hospital admissions generally went up in British Columbia during the period of 2002 to 2009.
As you can see, there were only two occasions when the number of deaths was lower than the year before, and the number of hospital admissions rose every year.
This isn’t the key statistic, but it does show why it’s wrong to say, as Marcella Corcoran Kennedy did, that “there were less deaths from…drinking, and there were less hospital admissions”. There weren’t.
It is doubly wrong to say that this happened “when they introduced [MUP]“. As we’ve explained, this study relates to increases in already-existing minimum prices.
Let’s take into account changes in population, since (roughly speaking) more people means more drinkers, and more alcohol-related death and disease.
These are the death and hospitalisation rates (per 100,000 people):
The death rate was mixed during this period, rising and falling from year to year, while the rate of alcohol-related hospital admissions rose every single year.
By contrast, the study on alcohol-related deaths used complex statistical models to estimate the effects of price changes in geographical subdivisions of the province.
This also involved adjusting for factors like seasonality, aboriginal and minority population levels, population density, family income, and so on.
Here’s how the study describes how it measured deaths:
[Alcohol-attributable] deaths were estimated based on population attributable fractions (PAFs) for alcohol and the number of deaths for each of the disease or injury categories.
PAFs are the proportional reduction in population mortality that would occur if exposure to a risk factor such as alcohol use was eliminated or reduced.
They are calculated based on estimated population exposure to alcohol and established risk relations between consumption and different disease categories.
Only 14 out of the 64 correlations found by the researchers were statistically significant.
This chart shows what the estimated increase or decrease in alcohol-related deaths was, for every 1% increase or decrease in minimum prices, in several time periods following each price hike.
It is a measure of correlation, not a measure of actual price increases or decreases and actual deaths.
It is also important to note that while the nominal minimum price of alcohol increased successively during the period in question, inflation meant that the effective minimum price (“real value”) did, at times, fall as well as rise.
Acute alcohol-related deaths are sudden deaths, such as from alcohol poisoning or falls. Chronic alcohol-related deaths are those resulting from longer-term illnesses like liver disease.
Wholly alcohol-related deaths are deaths where alcohol was the only causal factor.
Remember that the study uses complex statistical models to estimate an association between a 1% increase or decrease in minimum prices, and a percent change in the number of deaths.
It’s not saying that prices actually went up or down by 1%, and these were the actual, observed ensuing increases and decreases in deaths.
If that’s a bit confusing, welcome to the world of statistical models.
The study does not actually list what the “real value” of the minimum prices (adjusting for inflation) were throughout the period, but our rough analysis of figures in the paper indicate the average increase was around 5.7%.
You might assume, then, as the authors do, that if a 1% change in prices was negatively associated with a 3.172% change in wholly alcohol-related deaths, then a 10% rise in prices is associated with (or would lead to) a 31.72% fall in wholly alcohol-related deaths.
This is a claim made in the report, but it is off the mark.
Correlations don’t work like that - they are not necessarily linear.
If they were, then you could take the 3.17% fall in wholly alcohol-related deaths associated with a 1% price increase, and extrapolate that a 100% fall in wholly alcohol-related deaths would result from a 31.5% increase in alcohol prices.
This would require you to believe that an increase the equivalent of a pint of lager going from €4.70 to €6.18, or a 750 ml bottle of whiskey going from €27 to €34 would completely eradicate that category of deaths.
It’s not plausible because correlations aren’t necessarily linear.
A second study, also alluded to by the Department of Health, was published in 2013 by the same authors, and used the same time period and similar, complex statistical models.
Remember that, as we saw above, alcohol-related hospital admissions actually rose every single year between 2002-2009, even when adjusted for population changes.
In any case, here are the study’s findings:
As you can see, the results were even more minimal for hospitalisations than for deaths, with only nine statistically significant correlations out of 64.
Nonetheless, there were some estimated negative correlations for acute, chronic and total alcohol-related hospitalisations. There were no statistically significant correlations for wholly alcohol-related admissions.
Almost every province in Canada has some form of minimum alcohol pricing, but FactCheck could find only two academic studies specifically measuring the effects of MUP on alcohol-related health harms – the two outlined above.
The others addressed the effect of price increases on consumption of alcohol, and found, in short, a correlation between higher minimum prices, and lower drinking rates.
Once again, though, these were largely based on statistical models, and in many cases consumption rates went up.
According to a 2014 WHO report, five other countries have some form of minimum pricing: Russia, Belarus, Kyrgysztan, Moldova and Ukraine.
A 2015 study of alcohol-related deaths in Russia and Belarus did not isolate minimum pricing as a causal factor, but did look at larger “anti-alcohol” crusades within those countries, which have historically had particularly high rates of consumption, mortality and morbidity.
It concluded that those policies (which included some minimum price measures) made a modest contribution to declining adult male death rates, but that “the continuous reduction in adult mortality which has been observed…cannot be explained by the anti-alcohol policies implemented…”
We could find no research on minimum pricing and health harms relating to Kyrgysztan, Moldova or Ukraine.
Predictions
There have been many more studies by academics and governments which essentially use statistical models to predict the likely effects of pricing policies on consumption and health harms.
Many of them employ a model called the Sheffield Alcohol Policy Model (SAPM), developed at the University of Sheffield, and most of them predict significant reductions in drinking rates, deaths, hospitalisations and alcohol-related crime.
A 2014 SAPM for Ireland predicted the effects of a range of MUP rates on alcohol consumption and health harms.
Among those scenarios was a €1 per standard drink MUP combined with a ban on promotions. A standard drink in Ireland is 10 grams of alcohol, so €1 per standard drink is 10 cents per gram – the MUP proposed by the government. The government is also proposing a ban on promotions.
The model predicted that, after 20 years, this MUP policy would cause:
However, this is a set of predictions based on a statistical model, one which has been pointedly criticised in some quarters as relying on overly-simplistic assumptions about consumer behaviour in response to MUP, particularly the extent to which MUP would change the habits of heavy or dependent drinkers.
It is not proof that MUP has worked in reducing alcohol-related health harms, where it has been tried, although it obviously should be carefully and seriously considered.
For all that has been written about MUP, and all the academic research and policy papers produced on it, we are left with just a few studies that retrospectively analyse the effect of minimum pricing on alcohol-related health harms.
In the case of Russia and Belarus, one study found that death rates would have declined pretty much in the way they did, anyway, even if governments there hadn’t regulated the supply and pricing of alcohol.
In the case of Canada, specifically British Columbia, the studies found some negative correlations between minimum price changes and changes in the number of alcohol-related deaths and hospital admissions.
However, the reality remains that, even after adjusting for population growth, alcohol-related deaths rose and fell during that time, and alcohol-related hospital admissions rose every year from 2002-2009, a period of successive nominal minimum price increases.
And the different method of alcohol distribution in British Columbia, the fact they already had MUP, and their system of MUP, make it difficult to transfer the experience there to what the government is proposing in Ireland.
Besides those studies, there is little or no scientific evidence establishing an observed link between minimum unit pricing and declining health harms.
It might stand to reason that dearer drink leads to less drinking (and there is abundant evidence that minimum pricing does lower all-round consumption).
But the structure and pattern of that decrease (for example, how it effects the most at-risk drinkers) is less clear.
And the effects of minimum pricing on alcohol-related death and disease, although widely predicted and calculated to be significant, have not been conclusively proven.
These claimed effects may well be properly established in the future, as studies are replicated and improved and applied to more jurisdictions.
However, Minister of State Marcella Corcoran Kennedy claimed that MUP “has been proven to work”.
This is a very understandable conclusion to reach, but a close examination of what little evidence there is, does not support that assertion, as far as public health (the focus and context of her claim) is concerned.
The Minister also specified that MUP had been proven to work in British Columbia, because there were fewer alcohol-related deaths and hospitalisations (which is false) after it was introduced (which is a total misrepresentation of what happened, because British Columbia already had MUP).
We rate her claim Mostly FALSE.
Send your FactCheck requests to factcheck@thejournal.ie
Correction: This article previously inaccurately described parts of the two studies relating to British Columbia. In fact, the researchers estimated associations between changes in minimum prices (not increases, specifically, as we previously stated) and changes in alcohol-related deaths and hospitalisations.
While it is true that there were successive increases in the nominal minimum prices of alcohol in British Columbia during the period studied, adjustments for inflation meant that the effective price (“real value”) of alcohol did at times decrease, and this is what the researchers actually measured.
This does not change our verdict – the available evidence remains insufficient to support the Minister’s claim that MUP has been “proven to work” – but we are happy to correct the article so that it more accurately describes the details of the studies in question.
The article has also been amended to give fairer prominence to the negative correlations found in the studies between minimum price changes and changes in alcohol-related health harms, and (in the Conclusion) to more clearly explain the rationale behind the verdict.
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It’s by far the greatest act of public self-humiliation I’ve ever seen though
@Joe Phillips: Just read a new report our Aslyum seekers are piving in 3rd Wirld conditions . Yet we taje more in ?
@Paul Whelan: That is 3rd World spelling
@Paul Whelan: that’s great Paul
@Paul Whelan: Hahahahaha. That was priceless. Cheers Paul!
@Paul Whelan: thanks for clearing that misunderstanding up Paul
@Alan McDonald: you’ll often find people who speak like this are stupid and/or uneducated.
@Paul Whelan: dafuq
@Paul Whelan: “you know what aggrivateses me? Is those immigants. They want all the benefits of ireland. But won’t bother to learn themselves the language”
@seanfean: Yeah! Those are exactly my sentimonies!
Take back their territorial waters (they never lost them), their fishing stocks (most sold off by the U.K. government to foreign owners), save British steel (loss making industry for aeons) etc etc. This is all nationalistic hubris which wouldn’t enrich the U.K. one whit – the reverse in fact. The man is a pure snake oil salesman. What is shocking is that people fall for him. He is all about the glories of the last, current failures (the fault of foreigners, naturally) and has no real vision for the future. Fish and steel appears to be about it.
@John R: glories of the last ? What’s that then?
@John R: they lost the right to control who fishes in them… and in turn sell royalties to foreign vessels
It’s kind of funny that you accuse someone of being a snake oil salesman yet distort the facts/arguments yourself…
@John R: Yeah the Majority vited leave , also do you trust Leo ?
@Paul Whelan: On protecting Irish interests when it comes to Brexit, yes.
You can be damn sure Boris, Farage, Reese Mogg and Co have zero interest in protecting Irish interests.
The EU has done more for Ireland in the past 47 years than the British did in 800 years.
@Paul Whelan: did the majority vote for no deal? The overwhelming argument before the referendum was that a deal would be done. By rights they should put another vote to the people. Deal before leaving vs no deal
It’s funny how the pre-referendum narrative of: “we’ll get a great deal from the EU because we’re too important to them” has now changed to: “no deal is a good thing, and it’s what people wanted from the start.”
@Joe Bloggs: brilliant
Ah Nigel Farage, the man of the people, who also wants the UK to follow the American health system and make the NHS redundant in favour of insurance based healthcare.
@Devilsavocado: you dont half talk some rot – whether he does or not , most of his vote is solid working class – I’ve met em, tho then they voted UKIP.
Your average actual UKIP/b.party voter isnt as well off as your average labour professional middle class voter ,or your hedge fund owning , own house owning tory of the shire voter .
A ukip brexit voter is probably upper working class /skilled working class type , who may well have voted for Thatcher in essex sometime in the 80s – say what you will about thatcher , but she never attempted to abolish the NHS- she could see that would finish the tory party off….ditto farage .
@jackbello: can you not post comments like that please,unless youre vehemently pro Europe and anti brexit people round here cant handle the fact that its not the “unemployed layabouts” and idiots who vote for the like of Farage but ordinary working people
@Thomas Maher: more like poorly informed and easily led. The fact that the Sun is the most widely circulated daily paper in the UK tells you alot about the countries population.
@jackbello: After being involved in multiple online discussions with ardent Brexiteers they all have several things in common (A) They understand very little about the EU and how it works, (B) They don’t fully comprehend the damage Brexit will do to the UK economy in the Short to Medium term, (C) they have little or zero knowledge about the problems a hard border will cause, (D) they think the US is going to treat them as equals in trade.
And no matter what facts, evidence or reports even from their own Government they simply refuse to accept them.
So many of them are so wrapped up in the Flag that they are calling any UK citizen that disagrees with them Traitors.
@jackbello: really Jack,, ok so if you wouldn’t mind explaining this then, It’s kind of hard to deny it when you hear the words coming right out of his own mouth.
https://youtu.be/TUx0slUceNY
“We take back what is righrfully ours”, oh the irony..
Ah, the truth at last! It is not, nor was it ever about we nasty paddies with our backstop (how very selfish of us to want to honour tge agreement that ended 30 years of suffering). No, it is, and always was, about the British getting everything their own way and putting Johnny Foreigner in their rightful place
Never mind the party name, if they get into power they might as well rename the place U-kip
We tried to tell you before the referendum Nige, but you were too busy stroking your own ego and lieing to the gullible plebs who followed you off the cliff, ah well, you made your bed.
If one looks at many of the leading Brexiteers who have business’s, they don’t seem to have any faith in the UK economy after Brexit. Take Reese-Mogg for example, he is a partner in a company called “Somerset Holdings”. This company relocated lock stock and barrel to Dublin last year so it could remain in the EU after Brexit. Dyson has buggered off to Singapore who just happen to have a Trade Agreement with the EU, and the list goes on.
Now a question needs to be asked. Why are these guys pushing to hard for Brexit yet knowing it it will cripple many firms in the UK? Would it be that after the inevitable crash they can buy up distressed companies for a fraction of their pre Brexit worth while they themselves are insulated from the crash?
All mouth, no actions and no policies and a German passport waiting for him through his wife. He won’t be struggling when he runs off
Farage calls things a bad idea if he doesn’t personally profit. Idiots will still listen to him though, thinking he’s “just like them” when in reality he just knows how to use them for personal gain.
Sick of hearing about it. Let the pieces fall where they may. It’s not the end of the world
@Spud Murphy: for many, it might very well be. Businesses will fail and people will lose their jobs. Ex pats living modest lives on modest pensions in Spain are suffering from the losses in sterling. The bigger businesses transferring departments to Ireland and the EU who wont put those jobs back in the UK now even if Brexit was stopped tomorrow, the ferry routes and land bridge businesses that may never see a return to current volume when people are forced to find other options (see swansea). It might not be the end of the world for you…
Why are people falling for this no deal s**ite. They will have to do some kind of deal with EU at some stage. They export to Ireland twice as much as we do to them so it will effect them too. EU is 50%of their exports. Why do UK establishment think we would ever again want to align ourselves to their narrow-mindedness. We have more emigrants per capita than UK, have a more liberal society. We need UK as a corridor to drive THROUGH their countryside so the quicker they realize they are a hub not a destination the better for all
The Withdrawal Agreement is not Brexit, the Withdrawal Agreement is a betrayal of what 17.4 million people voted for, and if Mr Johnson you insist on the Withdrawal Agreement we will fight you in every single seat up and down the length and breadth of the United Kingdom!
Having watched Michael Collins the other night I can see another treaty Vs non treaty civil war coming
@Gert McNulty: Troll
I recommend Nigel Farage’s 5-day-a-week show on LBC radio to get his direct opinions:
have your say