Economic efficiency of alcohol policy

The production, sale and use of alcohol has proliferated since the first recordings of alcohol use in the middle ages. Today, alcohol is consumed by over 2 billion people, with global sales of alcoholic beverages in excess of $US967 billion (year 2005 value). Alcohol has many positive features, including individual pleasure to the drinker; a lubricant in the context of socializing and celebration; aesthetic appreciation; a source of income, employment and export; a promoter of other economic activities; and a generator of tax revenue. Conversely, alcohol consumption and, in particular, excessive or harmful use of alcohol can bring about many negative consequences, including adverse health effects, reduced productivity and/or increased workforce absenteeism, crime and violence, road traffic accidents and premature death. Recent advances have been made in understanding the health implications of alcohol misuse, with the weight of the evidence suggesting that the misuse of alcohol represents a leading cause of illness, injury and prematuremortality. Epidemiologists have ascertained causal relationships between average volume of alcohol consumed andmore than 60 types of disease and injury. An estimated 3.8% of deaths and 4.6% of disability-adjusted life-years are attributable to alcohol use globally. However, the burden across countries is not equally distributed. Disease burden is closely related to average volume of alcohol consumption, and, for every unit of exposure, is strongest in people who are poor and marginalized in society. Economic costs associated with alcohol misuse indicate that more than 1% of GDP purchasing power parity in highand middle-income countries is attributable to alcohol consumption. The evidence base underpinning the negative consequences of alcohol misuse for drinkers, their families and society, while sometimes lacking in rigorous scientific quality, supports the claim that using alcohol inappropriately is harmful to one’s health and a considerable drain of society’s scarce resources. Given that this evidence base is derived predominantly from developed countries, the call for alcohol action is more heeded in developed countries than developing countries. However, in a review of alcohol action in 12 developed countries, Crombie et al. found that countries varied markedly in their commitment to intervene, with very little consensus on which strategies to adopt or what levels of drinking should be targeted. To date, the development of alcohol policy has largely been ad hoc and reactive, with subsequent policy relying on strategies that are ineffective but popular. For example, school-based education is an ineffective measure to reduce alcoholrelated harm but is nonetheless a very popular optionwith governments and their constituencies. Conversely, volumetric taxation is a very costeffective strategy to curb alcoholmisuse but is rarely adopted. While countries such as Australia and theUKhave at least attempted to curb alcoholrelated harm through a range of measures, too many countries are still lagging behind the development of effective and appropriate alcohol policy. A range of factors impede such a process, including political instability or a vested interest in governments in alcohol manufacturing, a lack of appreciation of the evidence base, challenges EDITORIAL Appl Health Econ Health Policy 2010; 8 (5): 351-354 1175-5652/10/0005-0351/$49.95/0