Day: September 20, 2012

Alcohol Retail Privatization and Health

I had a conversation recently about alcohol retail store privatization where I mentioned that there is quite a bit of research linking privatization of previously public sector alcohol retail outlets and increased incidence of adverse events, especially in alcohol dependent people. Since I’ve forgotten who it was I had this conversation with, here are three studies on this issue, dear conversation partner:

From British Columbia, where a 2002 decision by a new BC Liberal government to greatly expand private liquor stores was studied. Here’s a link to the full study ($$) and the press release is below:

http://communications.uvic.ca/releases/release.php?display=release&id=1193

Excerpting from the study abstract:

Findings  The total number of liquor stores per 1000 residents was associated significantly and positively with population rates of alcohol-related death (P < 0.01). A conservative estimate is that rates of alcohol-related death increased by 3.25% for each 20% increase in private store density. The percentage of liquor stores in private ownership was also associated independently with local rates of alcohol-related death after controlling for overall liquor store density (P < 0.05). Alternative models confirmed significant relationships between changes in private store density and mortality over time.

Conclusions  The rapidly rising densities of private liquor stores in British Columbia from 2003 to 2008 was associated with a significant local-area increase in rates of alcohol-related death.

From Alberta: A study linking greater alcohol privatization with increased alcohol related suicides.

We examine the impact of privatization of retail sale of alcohol in Alberta, Canada, between 1985 and 1995 on mortality rates from suicide. Privatization took place in three stages: The opening of privately owned wine stores in 1985, the opening of privately owned cold beer stores and the selling of spirits and wine in hotels in the rural area in 1989–90, and finally privatization of all liquor stores in 1994. Interrupted time series analysis with Auto Regressive Integrated Moving Average (ARIMA) modeling was applied to male and female suicide rates to assess the impact of the three stages of privatization. The analyses demonstrated that most of the privatization events resulted in either temporary or permanent increases in suicide mortality rates. Other alcohol-related factors, including consumption levels and Alcoholics Anonymous (AA) membership rates, also affected suicide mortality rates. These analyses suggest that privatization in Alberta has acted to increase suicide mortality rates in that province.

Here’s a fairly comprehensive review of 17 studies, which was conducted by the American Centres for Disease Control (CDC).

 

EVIDENCE SYNTHESIS:

A total of 17 studies assessed the impact of privatizing retail alcohol sales on the per capita alcohol consumption, a well-established proxy for excessive alcohol consumption; 9 of these studies also examined the effects of privatization on the per capita consumption of alcoholic beverages that were not privatized. One cohort study in Finland assessed the impact of privatizing the sales of medium-strength beer (MSB) on self-reported alcohol consumption. One study in Sweden assessed the impact of re-monopolizing the sale of MSB on alcohol-related harms. Across the 17 studies, there was a 44.4% median increase in the per capita sales of privatized beverages in locations that privatized retail alcohol sales (interquartile interval: 4.5% to 122.5%). During the same time period, sales of nonprivatized alcoholic beverages decreased by a median of 2.2% (interquartile interval: -6.6% to -0.1%). Privatizing the sale of MSB in Finland was associated with a mean increase in alcohol consumption of 1.7 liters of pure alcohol per person per year. Re-monopolization of the sale of MSB in Sweden was associated with a general reduction in alcohol-related harms.

CONCLUSIONS:

According to Community Guide rules of evidence, there is strong evidence that privatization of retail alcohol sales leads to increases in excessive alcohol consumption.

This Mothers against Drunken Driving (MADD) document has a comprehensive bibliography, so does the Canadian Centre for Addiction and Mental Health.

I would characterize myself as part of the majority of people who believe their alcohol consumption is well under control, and as a consequence, does not mind the proliferation of liquor stores open till late, on Sundays, and running promotions. But as a public health issue, the huge costs of alcohol consumption are well known and extensively studied. It is surprising that jurisdictions rush headlong into liquor privatization when this kind of literature showing clear correlation (and good causal relations) between increased retail privatization and adverse outcomes for vulnerable populations is out there.

References

  1. Stockwell, Tim, Jinhui Zhao, Scott Macdonald, Kate Vallance, Paul Gruenewald, William Ponicki, Harold Holder, and Andrew Treno. “Impact on Alcohol-related Mortality of a Rapid Rise in the Density of Private Liquor Outlets in British Columbia: a Local Area Multi-level Analysis.” Addiction 106, no. 4 (2011): 768–776.
  2. Zalcman, Rosely Flam, and Robert E. Mann. “Effects of Privatization of Alcohol Sales in Alberta on Suicide Mortality Rates, The.” Contemporary Drug Problems 34 (2007): 589.
  3. Hahn, Robert A., Jennifer Cook Middleton, Randy Elder, Robert Brewer, Jonathan Fielding, Timothy S. Naimi, Traci L. Toomey, Sajal Chattopadhyay, Briana Lawrence, and Carla Alexia Campbell. “Effects of Alcohol Retail Privatization on Excessive Alcohol Consumption and Related Harms: A Community Guide Systematic Review.” American Journal of Preventive Medicine 42, no. 4 (April 2012): 418–427.
  4. Provincial Liquor Boards: Meeting the Best Interests of Canadians. Mothers Against Drunken Driving (MADD), 2012.
  5. Alcohol Retail Monopolies and Privatization of Retail Sales. Centre for Addiction  and Mental Health, 2010.
Wine image from public domain used under a creative commons licence.