Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa

Datos Bibliográficos

ID21880110
AutoresNaomi Gibbs (0000-0002-4704-8082, University of Sheffield, autor de correspondencia), Charlie Angus (0000-0003-0529-4135, University of Sheffield), Simon Dixon (0000-0002-6098-481X, University of Sheffield), Simon J Dixon (0000-0003-3029-8007, University of the Witwatersrand), Charles Dh Parry (South African Medical Research Council), Petra S Meier (MRC/CSO Social and Public Health Sciences Unit), Micheal Kofi Boachie (0000-0003-1062-889X, University of the Witwatersrand), Stéphane Verguet (0000-0003-4128-0849, Harvard Global Health Institute)
Año2022
Volumen7
Número1
Páginase007824
Fecha de publicación2022-01-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007824
PMID34992078
OpenAlexW4205837814
IdiomaEN
Citas recibidas3
Referencias citadas32

INTRODUCTION: South Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa. METHODS: We draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence. RESULTS: We estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion. CONCLUSIONS: A MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology

Harm · Harm reduction · Population · Population health · Public health · Global Public Health Policies and Epidemiology · Homelessness and Social Issues · Substance Abuse Treatment and Outcomes · Health Policy