Comments of the Distilled Spirits Council of the United States, Inc. on the Draft

Transcription

1 Comments of the Distilled Spirits Council of the United States, Inc. on the Draft Updated Appendix 3 of the WHO Global NCD Action Plan (WHO Discussion Paper dated July 25, 2016) The Distilled Spirits Council welcomes the opportunity to comment upon the draft updated Appendix 3 of the WHO Global Action Plan. The Council is a national trade association representing U.S. producers, marketers, importers, and exporters of distilled spirits products. The Distilled Spirits Council fully acknowledges that beverage alcohol products can be abused and result in harm. It is for these reasons that, throughout the decades, we have focused upon and pursued solutions that effectively address and combat the harmful use of alcohol. We support the WHO s objective and look forward to a dialogue about productive and effective measures to achieve our joint goal of reducing harmful use of alcohol. Thus, we welcome and support the WHO s effort to reassess the available interventions that can be used to address the harmful use of alcohol and reduce noncommunicable diseases (NCDs). Under the section pertaining to the harmful use of alcohol, the proposed update lists the following five Specific Interventions with WHO-CHOICE analysis: A1. Increase in excise taxes on alcoholic beverages A2. Enforcement of bans or comprehensive restrictions on alcohol advertising (across multiple types of media) A3. Enforcement of restrictions on the physical availability of retailed alcohol (via reduced density of retail outlets and reduced hours of sale) A4. Enforcement of drink-driving laws and blood alcohol concentration limits via sobriety checkpoints A5. Provision of brief psychosocial intervention for persons with hazardous and harmful alcohol use Of these interventions, A1, A2 and A3 listed as cost-effective should be supported by an evidence-based foundation demonstrating that these measures will in fact reduce the harmful use of alcohol. The body of scientific evidence and empirical data, however, do not support this presumption. As described below, higher alcohol taxes do not reduce abuse. Advertising bans and/or restrictions do not reduce abuse. Reduced outlet density and hours of sale do not reduce abuse.

2 Finally, the proposed specific measures ignore other interventions that are described in the Global Strategy to Reduce the Harmful Use of Alcohol (WHO, 2010), several of which are effective solutions in addressing the harmful use of alcohol. In contrast to the WHO s Global Strategy, Appendix 3 advocates a one size fits all approach that ignores the scientific literature demonstrating the ineffectiveness and variability of these measures in reducing harmful alcohol consumption. We respectfully urge that our views be taken into account in order to achieve the best possible outcomes offered in Appendix Higher Tax Rates and Higher Prices Do Not Reduce Alcohol Abuse Like other products, higher taxes/higher prices reduce overall purchases of beverage alcohol products. Higher prices, however, have little to no impact upon alcohol abuse. In fact, responsible consumers are most sensitive to prices and are the ones who cut back the most when prices rise. On the other hand, studies repeatedly have shown that the small percentage of chronic alcohol abusers are affected little by price. Moreover, in many countries, a significant proportion of all alcohol consumed is unrecorded and, as such, is not within the reach of regulation. When taxes are increased, the consumption of illicit alcohol increases, which can result in acute and chronic adverse health consequences. Raising taxes on legitimate products will only increase consumption of illicit alcohol and will do nothing to reduce alcohol abuse. Moderate alcohol consumption is associated with a lower risk of heart disease, the leading cause of death among women and men in the United States. Studies also show moderate alcohol consumption is associated with the lowest all-cause mortality among middle-aged and older adults. A 2011 report from the U.S. Centers for Disease Control and Prevention (CDC) cited moderate alcohol consumption as one of four key healthy lifestyle behaviors. (Ford E.S., 2011) In its 2013 Alcohol Awareness Month release, the National Institute for Alcohol Abuse and Alcoholism (NIAAA), the U.S. government s lead agency on alcohol issues, stated: Most adults who drink do so responsibly with no harm to their health. In fact, for some people, drinking moderately is associated with a variety of potential health benefits including a decreased risk of coronary artery disease, heart attacks, and certain types of strokes. (NIAAA, 2013) To the extent tax increases unduly affect moderate drinking patterns of responsible adults, these potential benefits would be jeopardized. Set forth below are examples of the literature that consistently have shown that the heaviest drinkers are not particularly responsive to higher prices. Raising taxes on beverage alcohol only serves to penalize responsible beverage alcohol consumers. A 2011 study (An R., 2011) reviewed 26 years of detailed data and concluded: Tax policies aimed to reduce alcohol-related health and social problems should consider whether they target the most harmful drinking behaviors.tax increases also appear to be less effective among the heaviest consumers who are associated with the highest risk

3 A 2013 study (Ayyagari P., 2013) that examined the impact of prices on alcohol consumption among older populations concluded: The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities.these results have policy implications. The NIAAA reported in its January 2001 issue of Alcohol Alert (NIAAA, 2001) that research suggests that the heaviest drinkers (5 percent of the population) do not reduce their consumption significantly in response to price increases, unlike drinkers who consume alcohol at lower levels. Consistent with NIAAA s findings was a 2009 meta-analysis (Wagenaar A.C., 2009), which found that heavy drinkers are far less responsive to price increases than the total population of drinkers. Another 2009 study (Ayyagari P., 2009), published by the National Bureau of Economic Research and conducted by researchers at the Yale School of Public Health, showed that heavy drinkers were not at all responsive to higher prices. This study concluded that higher alcohol taxes could not be justified based upon a public health or economic rationale. The authors stated: [O]ur results suggest that the heavier drinkers were least likely to respond to the higher taxes, thus neither the externality nor internality justification for higher alcohol taxes is supported by our results. A 2008 study (Zhang Y., 2008) showed that, for over 50 years ( ), the prevalence of alcohol use disorders in the population has been constant, despite the fact that, during the same period, the affordability of beverage alcohol and alcohol control policies in general have varied widely from the highly restrictive distribution policies and relatively high tax rates of the late 1940 s and 1950 s to the 1970 s and early 1980s when the legal drinking age was only 18 in many states. Despite these wide swings, the level of alcohol use disorders remained relatively constant. 2. Advertising Bans and/or Restrictions Do Not Reduce Abuse The overwhelming body of scientific literature shows that advertising does not cause an individual to begin drinking or to abuse alcohol. This body of scientific literature spans decades. Set forth below is a synopsis of that scientific evidence reaching back over the course of many years. There is no scientific evidence linking brand advertising to increased alcohol consumption or alcohol abuse. The 2004 National Academy of Sciences Report "Reducing Underage Drinking - A Collective Responsibility" (NAS, 2004) recognizes that a causal link between alcohol advertising and underage alcohol use has not been clearly established

4 The Department of Health and Human Services (HHS) Special Report to Congress (HHS, 2000) concluded that, when all of the studies are considered, the results of the research on the effects of alcohol advertising are not conclusive. HHS also states that [t]he bulk of this research supports the claim that alcohol advertising reallocates consumption among brands or beverage types. Ten years earlier, HHS reached the same conclusion in its 1990 Special Report to Congress: "Research has yet to document a strong relationship between alcohol advertising and alcohol consumption." (HHS, 1990) In 1985, the Federal Trade Commission concluded that its review of the literature regarding the quantitative effect of alcohol advertising on consumption and abuse found no reliable basis to conclude that alcohol advertising significantly affects consumption, let alone abuse and that [a]bsent such evidence, there is no basis for concluding that rules banning or otherwise limiting alcohol advertising would offer significant protection to the public. (FTC, 1985) There is empirical evidence from the U.S. and abroad that alcohol advertising restrictions do not reduce consumption. A 1991 study reported in the Journal of Studies on Alcohol compared alcohol beverage sales in the Canadian province of Saskatchewan before and after an almost total ad ban was ended in The study found no proof that alcohol advertising is a contributory force that influences the overall level of consumption of alcoholic beverages. (Makowsky C.R., 1991) Similar results have been found for British Columbia, Manitoba, Norway, and Finland. Recent studies further underscore the decades of research showing that alcohol advertising does not cause consumption. Rather, it drives brand choice among different alcohol products. For example, a 2015 study analyzed the relationship between annual alcohol advertising expenditures and per-capita sales of beer, wine and spirits in the U.S. from Over a 40-year span, the researchers found that per-capita alcohol consumption remained essentially constant, with changes occurring only between the three beverage alcohol categories beer, wine and distilled spirits. Conversely, during the same timeframe, alcohol advertising media expenditures increased almost 400 percent. (Wilcox G.B., 2015) The researchers concluded that advertising is a means to gain market share and [p]roposals to restrict or curtail truthful, commercial messages about a legal product work against rational public policy. The researchers also underscored that the outcomes of this study can be used to inform relevant public policy discussions regarding alcohol beverage advertising. (Wilcox G.B., 2015) - 4 -

5 According to a 2010 comprehensive review of advertising studies published in the International Journal of Environmental Research and Public Health, longitudinal studies claiming to show a causal link between alcohol ads and youth drinking are scientifically flawed. In this review of 20 longitudinal studies, which purport to show that advertising causes youth drinking, the author, Dr. Jon Nelson, Professor Emeritus of Economics at Penn State University, who has studied the effects of advertising for 25 years, found significant econometric and statistical problems, which preclude a causal interpretation. Dr. Nelson concluded that the emphasis on advertising bans and similar regulations in the public health literature is misplaced. (Nelson J.P., 2010) Among the studies flaws, the author reported problems with how researchers selected people to participate in their studies and how they drew conclusions from the data they collected, and concluded that the results [of this analysis] raise important issues regarding both internal and external validity threats to research conclusions, which are largely ignored by longitudinal researchers and public health reviewers. (Nelson J.P., 2010) Further, systematic reviews have shown that the impact of advertising bans on harmful drinking cannot be demonstrated. For example, a study entitled Alcohol Advertising and Advertising Bans: A Survey of Research Methods, Results and Policy Implications, concluded that advertising bans do not reduce alcohol consumption or abuse; advertising expenditures do not have a market-wide expansion effect; and survey research of youth behaviors are seriously incomplete as a basis for public policy. (Nelson J.P., 2001) (See also Siegfried N., 2014) This evidence has not been considered. It also should be noted that the vast majority of the beverage alcohol consumed worldwide is not advertised. This is especially true in developing countries and in economies in transition, where many beverages are home-brewed or produced illicitly. In the United States, commercial speech has First Amendment protection and the right to advertise is constitutionally protected. The First Amendment protection afforded to beverage alcohol advertising is equal in scope to the First Amendment protection afforded to the advertising of other legal products and services. Free speech has not impeded the declines in the harmful use of alcohol. In fact, federal government data show that underage drinking and binge drinking rates are at historic lows. On June 9 th, 2016, the 2015 National Youth Risk Behavior Survey (YRBS) issued by the CDC reported that underage and binge drinking rates among high school students are at their lowest levels since the survey s inception in (CDC, 2016) On December 16, 2015, the 2015 Monitoring the Future Survey reported that teen underage drinking and binge drinking rates are at their lowest levels since the study s inception in (Monitoring the Future, 2015) The Monitoring the Future Survey is a key federal measure of U.S. youth behavior. Among the Survey s highlights: - 5 -

6 Alcohol use continues its gradual downward trend among teens, with significant changes seen in the past five years in nearly all measures. Binge drinking (described as having five or more drinks in a row within the past two weeks) is 17.2 percent among seniors, down from 19.4 percent last year and down from peak rates in 1998 at 31.5 percent. Conducted by the University of Michigan and funded by the National Institute on Drug Abuse, the Monitoring the Future Survey has tracked substance abuse among American high school students since In 2015, the study surveyed over 40,000 students from 400 public and private schools throughout the United States. 3. Reduced Outlet Density and Hours of Sale Do Not Reduce Abuse Reducing alcohol outlet density is not a panacea to reducing alcohol abuse, is not supported by the evidence and oversimplifies the issue. It is misleading to suggest that arbitrarily reducing the number of retail outlets will decrease the harmful use of alcohol given that the determinants of alcohol-related harm are varied. There are many social, economic, demographic, cultural, and biological factors that must be considered. Many cities choose to concentrate their alcohol outlets to create thriving social entertainment areas that attract tourists and boost local hospitality businesses. Retailers and other members of the beverage alcohol industry have worked together to reduce abuse in their surroundings. Indiscriminately shutting down law-abiding businesses that are part of the local economy will not solve problems associated with abuse. The assumption that the presence of a retail outlet or its hours of sale automatically will increase the level of alcohol-related harms is belied by the data and studies that have examined this assumption. In analyzing two important measures of underage drinking prevalence, past month use and past month binge drinking, using data from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the number of retail outlets derived from the National Alcohol Beverage Control Association and state reports, there was no positive relationship found between the outlet density of a state and the prevalence of drinking among those under 21 years of age. Conversely, if a positive relationship existed, one would expect to see a pattern of states with lower outlet density to also have lower levels of underage drinking. This, however, is not the case. In fact, both trend lines show a downward sloping or negative relationship using the same data sets

7 The correlation between outlet density and alcohol-related violence to social factors has been attributed to factors endemic to the impacted neighborhoods. One study (Nielsen A.L., 2010) noted: Consistent with social disorganization theory, socioeconomic disadvantage and residential instability predict increased alcohol availability. Once such factors are taken into account, the impact of outlet density on alcohol-related violence was negated and the authors found no relationship between package liquor store density and domestic violence. (Livingston M., 2010) One study analyzed a natural experiment in which outlet density dramatically was reduced in certain sections of Los Angeles. The study shows that, while high alcohol outlet density was correlated with high levels of alcohol-related violence in Los Angeles, the level of alcohol-related violence did not decline after a reduction in outlet density following the 1992 riots. In short, even with lower outlet density, the level of alcoholrelated violence remained constant. (Yu Q., 2009) 4. Other Measures Demonstrated to Be Effective Are Not Highlighted By focusing upon the three measures listed above, the draft updated Appendix 3 does not consider the effectiveness of other interventions. The WHO s Global Strategy to reduce the harmful use of alcohol highlights 10 policy areas for multi-sectoral national action, which also are outlined in the Global NCD Action Plan. Among these policy areas, some have been shown to be effective in addressing harmful drinking in a more targeted approach. These interventions include education, school-based programs, family-based interventions, screening and brief interventions, social norms approaches, and multi-component interventions. (Hingson R., 2014) Recent studies show that interventions aimed at strengthening family relationships in the middle-school years can have a lasting effect on students drinking behavior. (NIAAA, 2014) Numerous studies consistently support the efficacy of brief individual motivational interventions to prevent underage drinking and reduce the quantity and frequency of heavy drinking and alcohol-related problems. (Cronce J.M., 2011) A recent study showed that a 4-hour on-the-job classroom training session improved help-seeking attitudes and behaviors and decreased alcohol risks. The reductions in drinking alcohol were directly correlated with on-the-job classroom training. (Reynolds G.S., 2015) August 31,

8 References: 1. World Health Organization (WHO). (2010). The Global Strategy to Reduce the Harmful Use of Alcohol. Last accessed Ford E.S, Zhao G, Tsai J, Li C. (2011). Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study. Am J Public Health., (10): National Institute on Alcohol Abuse. (2013). NIAAA Recognizes Alcohol Awareness Month. NIAAA Press Release, April 1, An R, Sturm R.J. (2011). Does the response to alcohol taxes differ across racial/ethnic groups? Some evidence from Behavioral Risk Factor Surveillance System. Ment Health Policy Econ., 14(1): Ayyagari P, Deb P, Fletcher J, Gallo W, Sindelar J.L. (2013). Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals. Health Econ., 22(1): National Institute for Alcohol Abuse and Alcoholism. (2001) Economic Perspective in Alcoholism Research. Alcohol Alert, No Wagenaar A.C., Salois M.J., Komro K.A. (2009). Effects of Beverage Alcohol Price and Tax Levels on Drinking: A Meta-analysis of 1003 Estimates from 112 Studies. Addiction., 104(2): Ayyagari P, Deb P, Fletcher J, Gallo W.T, Sindelar J.L. (2009). Sin taxes: Do heterogeneous responses undercut their value? NATIONAL BUREAU OF ECONOMIC RESEARCH., Working Paper Zhang Y, Guo X, Saitz R, Levy D, Sartini E, Niu J, Ellison R.C. (2008). Secular trends in alcohol consumption over 50 years: the Framingham Study. Am J Med.,121(8): National Research Council Institute of Medicine of the National Academies. (2004) Reducing Underage Drinking A Collective Responsibility. The National Academies Press. 11. U.S. Department of Health and Human Services. (2000). Alcohol and Health. Tenth Special Report to the U.S. Congress. 12. U.S. Department of Health and Human Services. (1990). Alcohol and Health. Seventh Special Report to the U.S. Congress. 13. Federal Trade Commission. (1985). Federal Trade Commission Finds No Evidence Justifying Alcoholic Beverage Advertising Rulemaking. FTC Press Release, April 16, Makowsky C.R., Whitehead P.C. (1991). Advertising and alcohol sales: a legal impact study. J Stud Alcohol, 52(6): Wilcox G.B., Kang E.Y. and Chilek L.A. (2015). Beer, wine, or spirits? Advertising s impact on four decades of category sales. International Journal of Advertising,

9 16. Nelson J.P. (2010). What is Learned from Longitudinal Studies of Advertising and Youth Drinking and Smoking? A Critical Assessment. Int. J. Environ. Res. Public Health., 7, Nelson J.P. (2001). Alcohol Advertising and Advertising Bans: A Survey of Research Methods, Results, and Policy Implications. Advances in Applied Microeconomics, Volume 10: Advertising and Differentiated Products, edited by M.R. Baye and J.P. Nelson (Amsterdam: JAI Press & Elsevier Science, 2001), Chapter 11 (pp ). 18. Siegfried N, Pienaar D.C., Ataguba J.E., Volmink J, Kredo T, et al. (2014) Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents, Cochrane Database of Systematic Reviews, Issue 11. Art. No.: CD Center for Disease Control. (2016). Trends in the Prevalence of Alcohol Use National YRBS: Last accessed df. 20. Monitoring the Future. (2015). University of Michigan. Michigan News. December 16, Nielsen A.L., Hill T.D., French M.T., Hernandez M.N. (2010). Racial/Ethnic Composition, Social Disorganization, and Offsite Alcohol Availability in San Diego County, California. Soc Sci Res., 39(1): Livingston M. (2010). The ecology of domestic violence: the role of alcohol outlet density. Geospat Health., 5(1): Yu Q, Li B, Scribner R.A. (2009). Hierarchical additive modeling of nonlinear association with spatial correlations--an application to relate alcohol outlet density and neighborhood assault rates. Stat Med., 28(14): Hingson R, White A. (2014). New research findings since the 2007 Surgeon General's Call to Action to Prevent and Reduce Underage Drinking: a review. J Stud Alcohol Drugs., 75(1): NIAAA. (2014). Research-based strategies help reduce underage drinking Cronce J.M., Larimer M.E. (2011) Individual-focused approaches to the prevention of college student drinking. Alcohol Res Health.,34(2): Reynolds G.S., Bennett J.B. (2015). A cluster randomized trial of alcohol prevention in small businesses: a cascade model of help seeking and risk reduction. Am J Health Promot., 29(3):