What happened to alcohol consumption and problems in the Nordic countries when alcohol taxes were decreased and borders opened?

Abstract

Aims: The study tests the effects of reductions in alcohol taxation and increases in travellers' allowances on alcohol consumption and related harm in Denmark, Finland, and southern Sweden. In late 2003 and early 2004, taxes on alcoholic beverages were reduced in Denmark and Finland, and the abolition of quantitative quotas on alcohol import for personal use from other European Union countries made cheaper alcohol more available in Denmark, Finland, and Sweden.Method: Analyses of routine statistical register data and summaries of results from longitudinal and repeated cross-sectional population surveys and other previous analyses, with northern Sweden as a control site for secular trends.Results: Contrary to expectations, alcohol consumption-as based on register data-increased only in Finland and not in Denmark and southern Sweden, and self-reported survey data did not show an increase in any site. In Finland, alcoholattributable harms in register data increased, especially in people with low socio-economic status. Few such effects were found in Denmark and southern Sweden. Neither did results for self-reported alcohol-attributable problems show any general increases in the three sites. These results remained after controlling for regression to the mean and modelling of drop-outs. Conclusions:Harms measured in register data did tend to increase in the short term with the policy change, particularly in Finland, where the tax changes were broader. But reducing price and increasing availability does not always increase alcohol consumption and harm. Effects are dampened in affluent societies, and other factors may intervene. The results for Finland also suggest some limits for general population surveys in testing for relatively small policy effects.

What happens to drinking when alcohol policy changes? A review of five natural experiments for alcohol taxes, prices, and availability

“…No studies were omitted for quality reasons, but in several cases there are data or method issues that require comment. Restricting results to English-language articles is not a major limitation as many articles in Nordic languages are preliminary results that are summarized or examined elsewhere in English (e.g., [11]). Both authors read the articles and together finalized the summaries.…”

“…Adding studies obtained from article-level references, a total of 149 primary articles were examined for relevant results with 59 articles selected for review for consumption or harms (a list of 90 excluded articles is available upon request). Several of 59 studies cover more than one country [11,28,23,39]. For alcohol consumption and drinking patterns, we recovered 29 studies containing a total of 35 results divided as follows: Denmark (6 results); Finland (9); Hong Kong (2); Sweden (13); and Switzerland (5).…”

“…Tabular summaries are grouped by type of data used in each primary study, which divides the studies according to target populations. Depending on the survey and time periods, sample sizes vary from modest numbers in the 1-5000 range (e.g., [11,13,41,40] to large samples with 40-100,000 respondents [25,42]. Subpopulations by age include legal-age individuals (ages 16 or 18 years and older); young adults (16-29 years); underage youth (\16 or 18 years); and older adults ([44 years).…”

“…An analysis of alcohol-related harms by Wagenaar et al [7] included only three studies for Finland. There also are a number of earlier reviews and commentaries that incorporate results from the Nordic Tax Study, including summaries by Ramstedt [8,9], Room et al [10,11], and Rossow et al [12], but these reviews also provide more limited results and comparisons. This study conducts a comprehensive review of research results stemming from natural experiments for alcohol policy interventions in five countries: Denmark, Finland, Hong Kong, Sweden, and Switzerland.…”

Do alcohol pricing and availability policies have differential effects on sub-populations? A commentary

“…In Finland in 2004-2005, after a reduction in alcohol prices, the rates for deaths from liver cirrhosis went up by almost half, while consumption increased only 10%, suggesting that the price decrease had the greatest impact on the heaviest drinkers (Mäkelä & Österberg, 2009). Room et al (2013) examined the impacts of a decrease in alcohol taxes in Denmark and Finland, using routine statistical register data and survey data for multiple years. While they found an increase in harm as measured by archival data, self-reported survey data did not show an increase in consumption or self-reported harms.…”