Abstract
Background: Previous research in high income countries has found Minimum Unit Pricing (MUP) for alcohol to be an effective policy for reducing alcohol-related harm. However, these results may not translate well to South Africa, notable for high levels of abstinence, binge drinking, unrecorded alcohol and alcohol-related injury and infectious disease. Methods: We built an epidemiological policy appraisal model using secondary data to estimate the effects of MUP across sex, drinker groups and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance. Model outcomes include individual consumption, individual spend, tax revenue, retail revenue and group health harms (HIV, intentional injury, road injury, liver cirrhosis and breast cancer). Findings: We estimate that a MUP of R10 per standard drink (15ml of pure alcohol) would lead to an immediate reduction in consumption of 5.5%. The absolute reduction in standard drinks per drinker per year is greatest for heavy drinkers, followed by moderate drinkers and then binge drinkers (-97.76, -25.48, -17.16).A R10 MUP generates 23,149 lives saved and 1,009,477 cases averted across the five health harms over 20 years. Poorer drinkers would see greater impacts from the policy (consumption: -7.9% in poorest, -3.7% in richest quintile). The bottom three wealth quintiles accrue 76% of the deaths averted and 74% of the cases averted. Interpretation: Our model estimates minimum pricing would reduce alcohol consumption in South Africa, improving health outcomes whilst raising retail and tax revenue. Consumption and harm reductions would be greater in poorer compared to richer groups. Funding Statement: This work was supported by the Wellcome Trust Doctoral Training Centre in Public Health Economics and Decision Science [108903/Z/19/Z] and the University of Sheffield. Also the South African Medical Research Council. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval for engaging with stakeholders was granted by the South African Medical Research Council (Protocol ID: EC005-4/2019) and the School of Health and Related Research at the University of Sheffield, UK (Reference Number: 023357). All data for the model came from secondary sources and was managed according to an approved information governance plan.
Highlights
In South Africa (SA), there are high levels of reported abstinence coupled with high levels of binge drinking among those who do drink, resulting in significant levels of alcohol-related harm.1 This harm is not distributed evenly throughout society withOpen access been effective at reducing alcohol consumption, among the heaviest drinkers, as they commonly drink the very cheap alcohol targeted by this policy.5 6A limitation of transferring the current evidence for minimum unit pricing (MUP) is its focus on high-income countries
There was a gradient in average baseline weekly spend with the rich paying an average R257.36 per week compared with R148.03 in the lowest wealth group
For an MUP of R10, an immediate reduction in population alcohol consumption of 4.40% (−0.93 standard drinks (SDs)/week) and an increase in spend of 18.09%
Summary
In South Africa (SA), there are high levels of reported abstinence coupled with high levels of binge drinking among those who do drink, resulting in significant levels of alcohol-related harm. This harm is not distributed evenly throughout society withOpen access been effective at reducing alcohol consumption, among the heaviest drinkers, as they commonly drink the very cheap alcohol targeted by this policy.5 6A limitation of transferring the current evidence for MUP is its focus on high-income countries. In South Africa (SA), there are high levels of reported abstinence coupled with high levels of binge drinking among those who do drink, resulting in significant levels of alcohol-related harm.. In South Africa (SA), there are high levels of reported abstinence coupled with high levels of binge drinking among those who do drink, resulting in significant levels of alcohol-related harm.1 This harm is not distributed evenly throughout society with. A limitation of transferring the current evidence for MUP is its focus on high-income countries Transferring this evidence to SA would be problematic as it has very different drinking patterns, a very different harm profile with infectious disease and injury contributing significantly to the burden of alcohol, it has an informal sector, which is challenging to capture and it has very high levels of income inequality likely to result in differential baseline prices and price responsiveness. Beer is the most popular drink, the consumption of large quantities of cheap wine is prevalent and can be linked back to farm labourers being paid in cheap wine.
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