Dr. John Holmes:

I was asked what is happening in other places in Canada. Minimum pricing, or at least something close to what is being proposed in Ireland and in the United Kingdom, has not really been tried anywhere else in Canada. Russia and some of the other former Soviet states have had minimum prices, say on vodka or beer, but those countries are quite different because they have large illicit markets, high rates of alcohol consumption and significant problems of alcohol dependence of an order of magnitude greater than we see in western Europe. What has gone on in those countries, because the policies and context are different, cannot tell us much that is helpful.

The United Kingdom and Ireland are pioneers in terms of trying to implement this policy in a systematic way. That means we do not have a significant amount of evaluation evidence. We only have what has come from Canada. That is why our modelling has become so important.

What is important about our modelling is that it is not directly based on previous minimum price policies. It synthesises all the best evidence we have available on the relationship between prices and consumption and between consumption and harm. We bring that together, ask what we know and set out what we do not know. We also try and help policy-makers think about what those things we do not know might mean for the effects of a policy. The general conclusion has been that there are some uncertainties, there may be some unintended consequences but we remain pretty confident that harm reductions overall would ensue from a policy.

There were questions about what else works, and the point was raised about very high-risk drinkers or dependent drinkers. Minimum pricing is not a silver bullet. It is a public health policy. It is about the 20% to 30% of people who drink above recommended limits and thereby increase their risk of health problems. It is not about those very heavy dependent drinkers who have a much more narrowly defined problem. If one wants to tackle those people, there are alternative policies which can help. We are talking about treatment, in particular. A recommendation we would certainly make is adequate resourcing and alcohol treatment services. Treatment has been shown to be effective.

Many dependent drinkers buy large quantities of cheap alcohol, so they will be directly affected by minimum pricing. Therefore, we would expect to see some reduction in their consumption. It might not stop them being dependent drinkers, but it might reduce their drinking from 120 standards drinks per week, or far more in some cases, to 100 standard drinks per week. That might not sound like a lot, but in terms of their risk of suffering health problems, it really makes a difference, particularly when one aggregates that across a few hundred thousand people drinking at that level.

Dependent drinkers do not emerge out of nowhere. They become dependent drinkers for many reasons. One of the things that facilitates their addiction is the availability of large quantities of cheap alcohol. We do not model this aspect and there is not a huge amount of evidence for same, but it is reasonable to expect that the removal of very cheap alcohol from a market will prevent some of tomorrow's dependent drinkers reaching very high consumption levels.

There were questions on how I might change the culture of drinking and whether people would return to pubs and restaurants. That is not something we model directly. Our work is quite data-driven. There is a lot of evidence on how much people drink but there is not a lot of evidence on where they are drinking their alcohol. Therefore, we have to make some inferences and map across from evidence on retail revenue for different sectors. I will explain what we expect to see. We know from various research that one of the reasons people drink less in pubs is because supermarkets and shop prices are much lower. That is a factor which helps people to drink at home instead. As prices go up, we would expect to see some people return to pubs and restaurants. Cultural issues have also driven this change. In the heyday of the pub we did not have the wine market we have now and wine is a product that people primarily consume at home. Society has also changed. People work longer hours, they generally go out more, they live less in communities, particularly middle-class people, and they commute more and live more in the city and urban centres. There are other reasons for the decline in the pub market than just prices. None the less, we would expect some impact, or at least we would hypothesise there could be some impact from minimum pricing.

I was asked about the impact on young people. I can say that people are affected by this policy to the extent that they buy the alcohol that is affected, or at least that is what we can be more confident about. Young people tend not to buy huge amounts of this cheap alcohol because they tend to drink more of the on-trade. The price in the pub will not be affected by the policy as it is already well above the minimum price threshold. That said, young people buy cheap alcohol and are price responsive because they tend to have lower incomes. Therefore, we would expect the policy to have some impact on them. When we looked at this aspect in the UK, although we did not look at the impact on young people directly in our Irish report, we did do so in our UK and Scottish reports and we have seen some impacts. They are greater than the impacts on moderate drinkers and smaller than the impacts on heavy drinkers, but none the less they exist.