ALCOHOL TAXES SAVE LIVES: RESPONSE TO HOLDER

Abstract

We are grateful to Harold Holder for his careful review of our paper and insightful summary of the implications of our findings (Holder 2005). We strongly agree that the main conclusion to be drawn from our somewhat complex analyses is that alcohol taxation is a potent means of reducing population level acute mortality caused by alcohol. We also agree that we cannot confidently attribute the reductions in deaths caused by the chronic effects of excessive drinking in the population as a whole to a delayed response to the Living With Alcohol (LWA) levy and/or programme itself. The results presented for Indigenous and non-Indigenous Australians both showed large reductions in chronic deaths after the Levy was removed, although this change was significant only with a simple t-test for the non-Indigenous population. We would note, however, that the results shown for Indigenous and non-Indigenous deaths lacked controls that were available for our other analyses, i.e. controls to reflect changes in alcohol-caused deaths in adjoining geographic areas and also in non-alcohol-caused deaths in the Northern Territory (NT) itself. This was due to the lack of reliable data on Indigenous status in the control regions and until quite recently in the NT (Chikritzhs et al. 2005). They are, however, indicative of some benefits from an alcohol tax increase to Indigenous Australians which is important, given concerns often expressed that price increases would only further disadvantage this sector of Australian society. We further acknowledge that we cannot be sure of the extent to which the new programmes funded by the alcohol tax contributed to the measured reduction of alcohol-caused deaths over and above the effects of the tax itself. In reviewing the nature of the programmes that were funded we formed the opinion earlier that many had been shown to be effective in other studies (Stockwell et al. 2001), such as the enforcement of liquor laws with supportive media campaigns (e.g. McKnight & Streff 1994) and drink-driving campaigns (McKnight & Voas 2001). We would like to add the information that while the tax administered for the first 5 years of the LWA programme on alcoholic drinks with 3.0% or more alcohol content by volume may seem minor—just 5 cents per standard drink (or per 10 g of ethyl alcohol)—at that time this amounted to a substantial increase in retail price of cheap high alcohol content drinks often linked with serious alcohol-related harm (e.g. Stockwell et al. 1998). The tax increase was indeed passed on to the customer (Chikritzhs et al. 1999) and was equivalent to approximately 15% of the retail price of popular packaged wine and some 8% of the price of full strength beer purchased from a liquor store (see e.g. Stockwell & Crosbie 2001). Another limitation was that our analyses were only of impacts on that most significant of all bottom lines in public health and safety—premature mortality. We were unable to access sufficiently complete and reliable data from all three jurisdictions for more fine-grained analyses of, for example, road crashes or hospital separations for specific causes other than those that were fatal. Our previous analysis of the first 4 years of the LWA (Chikritzhs et al. 1999; Stockwell et al. 2001) found evidence of widespread health and social benefits across these various domains. The unfortunate postscript to this story is that an Australian High Court ruling in August 1997 struck down the constitutional right of the states and territories to raise any taxes on alcohol (or tobacco or petrol). We believe our research adds to the international evidence that this very power to raise alcohol taxes is also the power to prolong the lives of tax payers. We hope our findings will be used to encourage other jurisdictions, including the Commonwealth Government of Australia, to use alcohol taxes as a means of preventing premature mortality caused by alcohol.