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

IntroductionSouth 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.MethodsWe 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.ResultsWe 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.ConclusionsA 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.

Effects of minimum unit pricing for alcohol in South Africa across different drinker groups and wealth quintiles: a modelling study

ObjectivesTo quantify the potential impact of minimum unit pricing (MUP) for alcohol on alcohol consumption, spending and health in South Africa. We provide these estimates disaggregated by different drinker groups and wealth quintiles.DesignWe developed an epidemiological policy appraisal model to estimate the effects of MUP across sex, drinker groups (moderate, occasional binge, heavy) and wealth quintiles. Stakeholder interviews and workshops informed model development and ensured policy relevance.SettingSouth African drinking population aged 15+.ParticipantsThe population (aged 15+) of South Africa in 2018 stratified by drinking group and wealth quintiles, with a model time horizon of 20 years.Main outcome measuresChange in standard drinks (SDs) (12 g of ethanol) consumed, weekly spend on alcohol, annual number of cases and deaths for five alcohol-related health conditions (HIV, intentional injury, road injury, liver cirrhosis and breast cancer), reported by drinker groups and wealth quintile.ResultsWe estimate an MUP of R10 per SD would lead to an immediate reduction in consumption of 4.40% (−0.93 SD/week) and an increase in spend of 18.09%. The absolute reduction is greatest for heavy drinkers (−1.48 SD/week), followed by occasional binge drinkers (−0.41 SD/week) and moderate drinkers (−0.40 SD/week). Over 20 years, we estimate 20 585 fewer deaths and 9 00 332 cases averted across the five health-modelled harms.Poorer drinkers would see greater impacts from the policy (consumption: −7.75% in the poorest quintile, −3.19% in richest quintile). Among the heavy drinkers, 85% of the cases averted and 86% of the lives saved accrue to the bottom three wealth quintiles.ConclusionsWe estimate that MUP would reduce alcohol consumption in South Africa, improving health outcomes while raising retail and tax revenue. Consumption and harm reductions would be greater in poorer groups.

Forecasting road traffic and its significance for transport policy

Traffic forecasting developed initially to decide how much road capacity to provide, but early methods tended to underestimate the growth. The methods were changed but then from the late 1980s systematically overestimated traffic growth, distorting the appraisal of benefits, and transforming the policy implications: it became evident that no feasible road capacity expansion would be enough to cope with the forecast traffic, and it would be necessary to manage demand instead. Since 2015 the official forecasts have sensibly avoided specifying a ‘most probable’ future, replacing it with a variety of different possibilities from almost no growth to exceedingly high. This creates a framework for a much more useful type of policy appraisal, though practical road proposals mostly still confidently assert high traffic growth at levels which have not been seen for over 25 years.

How well do national and local policies in England relevant to maternal and child health meet the international standard for non-communicable disease prevention? A policy analysis

Objectives(1) To identify national policies for England and local policies for Southampton City that are relevant to maternal and child health. (2) To quantify the extent to which these policies meet the international standards for nutrition and physical activity initiatives set out in the WHO Global Action Plan for the Prevention and Control of Non-Communicable Diseases (WHO Action Plan).DesignThe policy appraisal process involved three steps: (1) identifying policy documents relevant to maternal and infant health, (2) developing a policy appraisal framework from the WHO Action Plan, and (3) analysing the policies using the framework.SettingEngland and Southampton City.Participants57 national and 10 local policies.ResultsAcross both national and local policies, priority areas supporting public health processes, such as evidence-based practice, were adopted more frequently than the action-oriented areas targeting maternal and child dietary and physical activity behaviours. However, the policy option managing conflicts of interest was rarely considered in the national policies (12%), particularly in white papers or evidence-based guidelines. For the action-oriented priority areas, maternal health policy options were more frequently considered than those related to child health or strengthening health systems. Complementary feeding guidance (9%) and workforce training in empowerment skills (14%) were the least frequent action-oriented policy options adopted among the national policies. The maternal nutrition-focused and workforce development policy options were least frequent among local policies adopted in 10% or fewer. Macroenvironmental policy options tended to have a lower priority than organisational or individual options among national policies (p=0.1) but had higher priority among local policies (p=0.02).ConclusionsFurther action is needed to manage conflicts of interest and adopt policy options that promote a system-wide approach to address non-communicable diseases caused by poor diet and physical inactivity.

Plurality in understandings of innovation, sociotechnical progress and sustainable development: An analysis of OECD expert narratives

Deterministic theory and discourse on sociotechnical progress ignore the existence of multiple and equally viable pathways towards progress, obscure socioeconomic and environmental conflicting interests and values, and overshadow socially inclusive deliberative choices about policy strategies. Demystifying techno-determinism, by incorporating a plurality of understandings to policy appraisal, becomes a matter of not only democratic accountability but also of analytical rigour. This article analyses the normative and ontological understandings on scientific and technological pathways among a group of experts interviewed at one key Directorate of the Organisation for Economic Cooperation and Development, using Q-methodology. The three main framings detected do not correspond exclusively to any single innovation and development theoretical framework – namely Innovation Systems, Learning Systems, Catch-Up models or the science, technology and society approach. Each narrative organizes an array of policy understandings based upon different theories and practices. As these forms of discourse highly influence global policy recommendations, their plurality should be made explicit, negotiated and integrated into policymaking.