|
Article Excerpt
Among alcohol policy interventions aimed at populations rather than individuals, taxation is one of the most controversial. Some U.S. citizens and politicians seem to see taxation as inherently undesirable and even distasteful. They are leery of arguments suggesting that taxes on alcohol can legitimately be used in order to reduce public health risks associated with drinking. Perspectives also differ on the role of government in managing health issues, on legitimate targets of intervention, on the relevance of environmental-level prevention strategies, and on the credibility or correct interpretation of available research. It has been shown that not all policies are equally effective in achieving beneficial impact on problem rates (Edwards et al., 1994; Babor et al., 2003; Giesbrecht & Greenfield, 2003). Nevertheless, considerable alcohol research has shown that policies that control price and/or increase taxation are more powerful than restrictions on advertising and a number of other policies in yielding benefits for public health (Edwards et al., 1994; Osterberg, 1995; Babor et al., 2003, pp. 101-115).
Given this background, this paper explores the following themes:
* Who are the key players at the federal level, and how do they view pricing and taxation as alcohol policy measures?
* How did the respondents in our study perceive the importance of the taxation issue?
* Does the opinion of respondents in our study parallel public opinion?
* What does research have to say about pricing and taxation?
* Is there any convergence between public opinion, research findings, and policy enactment on the issue of taxation and pricing?
Some caveats should be noted. Our focus is on the U.S. federal scene over a recent period of the 1980s and 1990s. The interpretations presented do not necessarily apply to state and local levels or to preceding and subsequent decades. Despite extensive searches of documentary and archival sources and our in-depth interviews with over 60 key informants, we acknowledge that more research needs to be done, including research that would utilize more fully the expertise of different categories of key players or potential key players, such as health economists.
Research synopsis: alcohol prices and taxation
Natural experiments have shown that increases or decreases in price are likely to be associated with sharp decreases or increases, respectively, in per capita alcohol consumption (e.g., Bruun et al., 1975; Cook, 1981; Cook & Moore, 1994, 2000; Chaloupka, 1993; Godfrey, 1997). For example, a study by Zhang and Casswell (1999), using time series analysis of consumption data from New Zealand, found beer consumption declined with an increase in real price during the early 1990s. They also found that an increase in wine consumption "in the 1990s was partly attributable to the decrease in real price of wine" (p. 378). An example from Switzerland examined a 1999 change in the spirits market, using data from a longitudinal study on changes among Swiss residents (Kuo et al., 2003). Because of tax reforms there was a 30%-50% decrease in the retail price of imported spirits--representing 58% of the spirits market, although the price of wine and beer did not change. The authors found an increase in spirits consumption, particularly among younger age groups, and noted that this population is "more likely to engage in alcohol-related problems such as motor vehicle accidents, property damage, physical injuries, unwanted sexual advances and encounters with police" (Kuo et al., 2003, p. 724). Studies on alcohol taxes and pricing also demonstrate an impact from these changes in access to alcohol on both consumption rates and certain drinking-related problems. These include problems among youth (Saffer & Grossman, 1987) and those involving heavy consumers (Cook & Tauchen, 1982), with specific problems studied including drinking-related vehicular crashes (Adrian et al., 2001), cirrhosis mortality, and various types of violence (see summary in Babor et al., 2003, pp. 111-112).
Research on this topic has been international in scope, as noted by, for example, Bruun et al. (1975), Edwards et al. (1994), Makela et al. (1981), Osterberg (1995) and Ponicki et al. (1997). An overview by Toomey and Wagenaar (1999) and chapters in Babor et al. (2003, pp. 101-116, 263-276) provided additional support for the long-standing finding that the relative price of alcohol is a powerful policy lever.
The inverse relationship between alcohol taxes and problem rates has also been demonstrated by studies from the U.S. (e.g., Chaloupka, 1993; Cook, 1981; Grossman et al., 1994; and see summary in Giesbrecht & Greenfield, 2003). Evidence on state-level changes in excise tax shows the potential of tax increases to effect a reduction in the level of harm associated with certain problem indicators, such as liver cirrhosis mortality and drinking-and-driving fatalities (Cook, 1981; Cook & Moore, 1994). U.S.-based research is thus in line with international studies showing that changes in taxation have the expected impact on consumption rates and certain problem rates--i.e., higher prices lead to lower rates of consumption and drinking-related damage. Furthermore, a study by Saffer and Grossman (1987) found that an increase in beer taxes seemed to have had a greater measurable positive effect on the problem of drunk-driving fatalities among young people than did an increase in the minimum legal drinking age.
Debate continues about whether alcohol tax increases are regressive. Do they create undue hardship for lower-income citizens and families? Are they an efficient means of improving the alcohol consumption behavior of high-risk consumers? Can they generate revenue for the government and at the same time advance the cause of public health (Cook & Moore, 2000; Kendel & Manning, 1996)? Kendel and Manning (1996) have noted that an organization's position on taxation tends to vary with the main item on its agenda, whether that is to reduce health risks, maintain jobs, promote products, or generate governmental revenue. Nevertheless, the reliable tendency of taxation and price increases to be associated with measurable declines in per capita consumption and reduced population-level problems suggests that alcohol pricing is always a policy option worthy of consideration (Babor et al., 2003, pp. 101-116). Although this point is only occasionally agued by those connected with the alcohol industry, the appropriateness of a population-level intervention is hotly debated. In general the alcohol industry adopts the position that heavy drinkers will be less affected or unaffected by tax and price measures, which will, in their view, unfairly apply equally to what they term moderate drinkers.
Studies using different methodologies, including both cross-sectional and longitudinal data from numerous countries over a number of decades, support the perspective that there are both short-term and long-term public health benefits to be derived from increased alcohol taxes. Moreover, these benefits apply not just to one but to several distinct problem measures, such as liver cirrhosis, drunk driving, and alcohol-related crime. According to a U.S. study (Cook & Tauchen, 1982), if the problem measure used is the death rate due to cirrhosis, the relative impact of increased price on this measure exceeds proportionately the impact on per capita consumption. This suggests that one generic unit of decreased per capita consumption may yield several comparable generic units of public health benefit. It is a reasonable assumption that higher taxes on alcoholic beverages would have equal if not greater potential than other specific interventions (e,g., Babor et al., 2003, pp. 263-276) to curtail per capita alcohol consumption, high-risk...
|
