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

Gibbs, N. K., Angus, C., Dixon, S., Parry, C. D.H., Meier, P. , Boachie, M. K. and Verguet, S. (2022) Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa. BMJ Global Health, 7(1), e007824. (doi: 10.1136/bmjgh-2021-007824) (PMID:34992078) (PMCID:PMC8739056)

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Abstract

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.

Item Type:Articles
Additional Information:This research was funded in part, by the Wellcome Trust (108903/B/15/Z). For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. It was also funded by the University of Sheffield and the South African Medical Research Council. PSM is also funded by UK Medical Research Council and Chief Scientist Office grants MC_UU_00022/5 and SPHSU 20. MKB is supported by SAMRC/Wits Centre for Health Economics and Decision Science—PRICELESS SA (grant number 23108). SV acknowledges funding support from the Trond Mohn Foundation and NORAD through BCEPS (#813596).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Meier, Professor Petra
Authors: Gibbs, N. K., Angus, C., Dixon, S., Parry, C. D.H., Meier, P., Boachie, M. K., and Verguet, S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:BMJ Global Health
Publisher:BMJ Publishing Group
ISSN:2059-7908
ISSN (Online):2059-7908
Published Online:06 January 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in BMJ Global Health 7(1):e007824
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048231Systems science research in public healthPetra MeierMedical Research Council (MRC)MC_UU_00022/5HW - MRC/CSO Social and Public Health Sciences Unit
3048231Systems science research in public healthPetra MeierChief Scientist Office (CSO)SPHSU20HW - MRC/CSO Social and Public Health Sciences Unit