Paying the Tab

The Costs and Benefits of Alcohol Control
Philip J Cook

Professor Cook has written a masterly book on alcohol control policy. The book provides a critical analysis of approaches to alcohol policy in the USA from theTemperance Movement, to the enactment and repeal of prohibition, the ascendancy of the disease model advocated by AA and the alcoholism movement and to the fresh awakening of public health advocacy. Whilst the book provides a historical overview of the way in which these different alcohol strategies have been advocated and applied in the USA, it is nonetheless a useful primer for advocates of alcohol policy in other countries.

Effective advocacy must be evidence-based and Professor Cook’s book meets this essential criterion.

The Twenty First Amendment (Repeal of Prohibition) permits each State to establish its own alcohol control policy. Since this gives rise to interstate differences in policy and changes in key policy areas, it provides what social scientists have termed a ‘social science laboratory’ that can provide some of the strongest evidence on the effects of alcohol control policy. Cook effectively illustrates this with the changes that took place over the minimum legal drinking age during the 1970s and 80s – a period when States reduced the drinking age from 21 to 18 and then reversed the trend back to 21. This was due to the increase in youthful highway fatalities in States that had reduced the age limit compared with those that had not.

One of the main themes in the book is that alcohol is too cheap. Professor Cook deals with those that object to the use of tax by answering their objections that if price is high then drinkers would seek other substitutes, the creation of a black market and a decline in healthy drinking (protective effect). He also deals with the notion that excise is a regressive tax.

Between 1951 and 2005 Congress legislated for an increase in beer and wine excise only once and there were only two small increases in spirits excise.

Whilst public opinion surveys indicate support for raising alcohol taxes, the alcohol industry has pushed hard for Congress to reduce alcohol taxes. The beer industry and its lobby is particularly powerful and in 2005 a majority of Congress (240 members) agreed a Bill that would have halved the duty on beer.

Cook develops the theme whether alcohol is paying its way in the light of the external costs to society.

Price matters in alleviating the harm done by the use of alcohol. Cook demonstrates that increased consumption increases injury rates from accidents and violence and that both consumption and related damages fall in response to price increases – such evidence has accumulated over the past 25 years.

Cook estimates that a 10 cent per ounce increase on ethanol (a nickel per drink) would reduce per capita consumption by 12% and the following decreases in motor vehicle fatalities 7%; fatalities from falls 9%; suicide rate 6% and cirrhosis death rates by 32%.Cook makes a final plea for the need to recapture some of the ground that has been lost in the last few decades by a selective strengthening of alcohol control guided by the evidence and common sense.

The book should find a place on the library shelf of all alcohol policy advocates.