Neufeld Maria, Rovira Pol, Ferreira-Borges Carina, Kilian Carolin, Sassi Franco, Veryga Aurelijus, Rehm Jürgen
WHO European Office for the Prevention and Control of Noncommunicable Diseases, 9 Leontyevsky Pereulok, 125009 Moscow, Russian Federation.
Program on Substance Abuse & designated WHO Collaborating Centre, Public Health Agency of Catalonia, 81-95 Roc Boronat St., 08005, Barcelona, Spain.
Lancet Reg Health Eur. 2022 Feb 23;15:100325. doi: 10.1016/j.lanepe.2022.100325. eCollection 2022 Apr.
Alcohol use and its burden constitute one of the largest public health challenges in the WHO European Region. Raising alcohol taxes is a cost-effective "best buy" measure to reduce alcohol consumption, but its implementation remains uneven. This paper provides an overview of existing tax structures in 50 countries and subregions of the Region, estimates their proportions of tax on retail prices of beer, wine, and spirits, and quantifies the number of deaths that could be averted annually if these tax shares were raised to a minimum level.
Review of databases and statistical reports on taxes and mean retail prices of alcohol beverages in the Region. Affordability was calculated based on alcohol prices, adjusted for differences in purchasing power. Consumption changes and averted mortality were modelled assuming two scenarios. In Scenario 1, a minimum excise tax share level of 25% of the beverage-specific retail price was assumed for all countries. In Scenario 2, in addition to a minimum excise tax share level of 15% it was assumed that per unit of ethanol minimal retail prices were the same irrespective of alcoholic beverages (equalisation). Sensitivity analyses were conducted for different price elasticities.
Alcohol is very affordable in the Region and alcohol taxes have clearly been under-utilized as a public health measure, constituting on average only 5·7%, 14·0% and 31·3% of the retail prices of wine, beer, and spirits, respectively. Tax shares were higher in the eastern part of the Region compared to the EU, where various countries did not have excise taxes on wine. Annually, the introduction of a minimum tax share of 25% (Scenario 1) could avert 40,033 (95% CI: 38,054-46,097) deaths in the WHO European Region (with 753,454,300 inhabitants older than 15 years of age). If a 15% tax share with equalisation were implemented (Scenario 2), 132,906 (95% CI: (124,691-151,674) deaths could be averted. All sensitivity analyses with different elasticities yielded outcomes close to those of the main analyses.
Similar to tobacco taxes, increasing alcohol taxes should be considered to be a health-based measure aimed at saving lives. Many countries have hesitated to apply higher taxes to alcohol, but the present results show a clear health benefit as a result of implementing a minimum tax share.
This work was supported by the National Institute on Alcohol Abuse and Alcoholism (1R01AA028224) and the Canadian Institutes of Health Research, Institute of Neurosciences, and Mental Health and Addiction (SMN-13950).
饮酒及其负担是世界卫生组织欧洲区域面临的最大公共卫生挑战之一。提高酒精税是降低酒精消费的一项具有成本效益的“最佳选择”措施，但其实施情况仍不均衡。本文概述了该区域50个国家和次区域现有的税收结构，估计了啤酒、葡萄酒和烈酒零售价格中税收的比例，并量化了如果将这些税收份额提高到最低水平，每年可避免的死亡人数。
查阅该区域关于酒精饮料税收和平均零售价格的数据库及统计报告。根据酒精价格计算可承受性，并根据购买力差异进行调整。假设两种情景对消费变化和避免的死亡率进行建模。情景1中，假设所有国家特定饮料零售价格的最低消费税份额水平为25%。情景2中，除了最低消费税份额水平为15%外，还假设每单位乙醇的最低零售价格不论酒精饮料种类均相同（均等化）。针对不同的价格弹性进行敏感性分析。
在该区域，酒精价格非常低廉，酒精税显然未被充分用作一项公共卫生措施，分别仅占葡萄酒、啤酒和烈酒零售价格的5.7%、14.0%和31.3%。与欧盟相比，该区域东部的税收份额更高，欧盟的一些国家对葡萄酒没有消费税。每年，在世卫组织欧洲区域（有753454300名15岁以上居民）引入25%的最低税收份额（情景1）可避免40033例（95%置信区间：38054 - 46097）死亡。如果实施15%的税收份额并实现均等化（情景2），可避免132906例（95%置信区间：124691 - 151674）死亡。所有针对不同弹性进行的敏感性分析得出的结果与主要分析结果相近。
与烟草税类似，应将提高酒精税视为一项旨在挽救生命的基于健康的措施。许多国家在对酒精征收更高税收方面犹豫不决，但目前的结果表明，实施最低税收份额能带来明显的健康益处。
这项工作得到了美国国立酒精滥用与酒精中毒研究所（1R01AA028224）以及加拿大卫生研究院、神经科学研究所、心理健康与成瘾研究所（SMN - 13950）的支持。
