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How does a nationwide alcohol ban affect injury-related mortality?

by Kai Barron, Debbie Bradshaw, Charles D.H. Parry, Rob Dorrington, Pam Groenewald, Ria Laubscher, and Richard Matzopoulos

(WZB, Berlin; University of Capetown; South African Medical Research Center)


“A five-week long complete ban on alcohol sales in South Africa shows that alcohol consumption causes a large proportion of all deaths due to unnatural causes.”


Excessive alcohol consumption is common in many developing and developed countries, particularly amongst the poor (WHO, 2019; Probst et al., 2020). It has been associated with numerous social harms, including motor vehicle collisions, violence and other crimes, risky sexual behavior, long-run adverse health effects, reduced productivity at work, mortality, and morbidity (see, e.g., Carpenter and Dobkin, 2011). These harms are often borne by other individuals in society, either directly (as in the case of interpersonal violence) or indirectly (as in the case of public health insurance). Consequently, questions regarding the morality, (religious) norms, and correct societal regulation of alcohol have been debated in societies around the world for over two centuries, with virtually all modern and historical societies placing legal and religious constraints on alcohol consumption (Phillips, 2014).

It is crucial, therefore, to accumulate robust empirical evidence that allows us to construct a clear picture of the true influence of alcohol on society. Despite this, our current understanding of the causal impact that alcohol has at a societal level is largely limited to the estimates of theoretical models (see, e.g., Rehm et al., 2003; Probst et al., 2018). There is a scarcity of direct causal evidence at a societal level. One reason for this is that it is rare to observe an abrupt abatement in alcohol consumption in the entire population of a country. Without an exogenous shift of this nature, it is difficult to parse the influence of alcohol consumption on a particular outcome from the influence of the personal characteristics of individuals who choose to drink heavily.

The sudden and unexpected ban on the sale of alcohol in South Africa on July 13, 2020, (implemented to reduce trauma admissions to hospitals, thereby making more space for COVID-19 patients) provides a rare opportunity to understand how alcohol consumption influences behavior and outcomes at a societal level. A recent paper by Kai Barron and his co-authors Debbie Bradshaw, Charles D.H. Parry, Rob Dorrington, Pam Groenewald, Ria Laubscher, and Richard Matzopoulos evaluate the impact of this five week alcohol prohibition on mortality due to unnatural causes (e.g. interpersonal violence, motor vehicle collisions).

The authors find that the policy reduced the number of unnatural deaths by 21 per day, or approximately 740 over the five-week period. This constitutes a 14% decrease in the total number of deaths due to unnatural causes in the country. This reduction was predominantly confined to men (who constitute approximately 80% of the 50 000 unnatural deaths in South Africa in a typical year). Furthermore, approximately half of the effect was amongst younger males, aged 15-34 years.

The authors argue that the estimated effect size of 14% represents a lower bound on the true impact of alcohol on short-run mortality, and underscores the severe influence that alcohol has on society—even in the short-run. This is valuable as it provides policy makers with robust evidence about whether reducing alcohol consumption is an effective way to save lives in the short-run. It therefore contributes evidence towards the larger discussion regarding the aggregate costs and benefits of alcohol consumption for society.

The full paper “Alcohol and Short-Run Mortality: Evidence from a Modern-Day Prohibition” is available as an SSRN Discussion paper.

This text is jointly published by BCCP News and BSE Insights.



References:

Carpenter, C. and C. Dobkin (2011). The minimum legal drinking age and public health. Journal of Economic Perspectives 25(2), 133–156.

Phillips, R. (2014). Alcohol: A history. UNC Press Books.

Probst, C., C. D. Parry, H.-U. Wittchen, and J. Rehm (2018). The socioeconomic profile of alcohol-attributable mortality in South Africa: a modelling study. BMC Medicine 16(1), 97.

Probst, C., C. Kilian, S. Sanchez, S. Lange, and J. Rehm (2020). The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review. Lancet Public Health 5(6), e324–e332.

Rehm, J., R. Room, K. Graham, M. Monteiro, G. Gmel, and C. T. Sempos (2003). The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction 98(9), 1209–1228.

WHO (2019). Global status report on alcohol and health 2018. World Health Organization.

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