The impact of road safety policies in a deregulated alcohol tax environment in Hong Kong: a 15-year time series analysis

BACKGROUND AND AIMS

Hong Kong reduced beer and wine tax in 2007, eliminated taxes on beer and wine and strengthened drink-driving legislation in 2008, and increased police traffic enforcement after the 2014 social unrest. This study aimed to measure the effects of implementing road safety policies on road traffic harm in the context of deregulated alcohol control policy in Hong Kong.

DESIGN

Population-based interrupted time series analysis using seasonal autoregressive integrated moving average (sARIMA) models. Multiple sensitivity analyses were conducted.

SETTING

Hong Kong, China and Singapore from January 2004 to December 2019.

CASES

A total of 313 728 road traffic injuries in Hong Kong and 163 773 road traffic injuries in Singapore as controls.

MEASUREMENTS

Monthly rates of road traffic injuries, non-fatal injuries and serious/fatal injuries from Hong Kong and Singapore Police Force.

FINDINGS

The elimination of alcohol taxes and the enactment of road safety legislation in 2008 were associated with immediate reductions in total road traffic injuries of 6.71% (95% CI, 1.99%-11.20%), serious/fatal injuries of 13.80% (95% CI, 1.85%-24.30%) and sustained declines in drink-driving and collisions involving drink-driving. The effects of the 2007 tax reduction were inconclusive. Progressively increasing traffic enforcement was associated with continuous reductions in road traffic injuries by 0.21% per month (95% CI, 0.13%-0.30%), and serious/fatal injuries by 1.10% per month (95% CI, 0.85%-1.35%). Effects at the corresponding timepoints in Singapore did not reach statistical significance; the results were inconclusive regarding confounding effects on both regions.

CONCLUSIONS

Despite weakened alcohol control and increased alcohol sales over the same period, road safety policies in Hong Kong are associated with net reductions in road traffic injuries, particularly serious/fatal injuries.

Alcohol control policy measures and all-cause mortality in Lithuania: an interrupted time-series analysis

BACKGROUND AND AIMS

Alcohol use has been identified as a major risk factor for burden of mortality and disease, particularly for countries in eastern Europe. During the past two decades, several countries in this region have implemented effective alcohol policy measures to combat this burden. The aim of the current study was to measure the association between Lithuania's alcohol control policies and adult all-cause mortality.

DESIGN

Interrupted time-series methodology by means of general additive models.

SETTING

Lithuania.

PARTICIPANTS

Adult population of Lithuania, aged 20 years and older.

MEASUREMENTS

Alcohol control policies were ascertained via a document review of relevant legislation materials. Policy effects were evaluated as follows: (1) slope changes in periods of legislative (non-)activity with regard to alcohol control policy (analysis 1); (2) level changes of three interventions following recommendations of the World Health Organization (analysis 2); and (3) level changes of seven interventions judged a priori by an international panel of experts (analysis 3). Mortality was measured by sex-stratified and total monthly age-standardized rates of all-cause mortality for the adult population.

FINDINGS

During the period 2001-18, effective alcohol control policy measures were implemented on several occasions, and in those years the all-cause mortality rate declined by approximately 3.2% more than in years without such policies. In particular, the implementation of increased taxation in 2017 was associated with reduced mortality over and above the general trend for men and in total for all analyses, which amounted to 1452 deaths avoided (95% confidence interval = -166 to -2739) in the year following the implementation of the policy.

CONCLUSIONS

Alcohol control policies in Lithuania appear to have reduced the overall adult all-cause mortality over and above secular trends.

Classifying Alcohol Control Policies with Respect to Expected Changes in Consumption and Alcohol-Attributable Harm: The Example of Lithuania, 2000-2019

Due to the high levels of alcohol use, alcohol-attributable mortality and burden of disease, and detrimental drinking patterns, Lithuania implemented a series of alcohol control policies within a relatively short period of time, between 2008 and 2019. Based on their expected impact on alcohol consumption and alcohol-attributable harm, as well as their target population, these policies have been classified using a set of objective criteria and expert opinion. The classification criteria included: positive vs. negative outcomes, mainly immediate vs. delayed outcomes, and general population vs. specific group outcomes. The judgement of the alcohol policy experts converged on the objective criteria, and, as a result, two tiers of intervention were identified: Tier 1—highly effective general population interventions with an anticipated immediate impact; Tier 2—other interventions aimed at the general population. In addition, interventions directed at specific populations were identified. This adaptable methodological approach to alcohol control policy classification is intended to provide guidance and support for the evaluation of alcohol policies elsewhere, to lay the foundation for the critical assessment of the policies to improve health and increase life expectancy, and to reduce crime and violence.

Effectiveness and Feasibility of Taxing Salt and Foods High in Sodium: A Systematic Review of the Evidence

Diets high in salt are a leading risk for death and disability globally. Taxing unhealthy food is an effective means of influencing what people eat and improving population health. Although there is a growing body of evidence on taxing products high in sugar, and unhealthy foods more broadly, there is limited knowledge or experience of using fiscal measures to reduce salt consumption. We searched peer-reviewed databases [MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews] and gray literature for studies published between January 2000 and October 2019. Studies were included if they provided information on the impact on salt consumption of: taxes on salt; taxes on foods high in salt, and taxes on unhealthy foods defined to include foods high in salt. Studies were excluded if their definition of unhealthy foods did not specify high salt or sodium. We found 18 relevant studies, including 15 studies reporting the effects of salt taxes through modeling (8), real-world evaluation (4), experimental design (2), or review of cost-effectiveness (1); 6 studies providing information relevant to country implementation of salt taxes; and 2 studies reporting stakeholder perceptions toward salt taxation. Although there is some evidence on the potential effectiveness and cost-effectiveness of salt taxation, especially from modeling studies, uptake of salt taxation is limited in practice. Some modeling studies suggested that food taxes can have unintended outcomes such as reduced consumption of healthy foods, or increased consumption of unhealthy, untaxed substitutes. In contrast, modeling studies that combined taxes for unhealthy foods with subsidies found that the benefits were increased. Modeling suggests that taxing all foods based on their salt content is likely to have more impact than taxing specific products high in salt given that salt is pervasive in the food chain. However, the limited experience we found suggests that policy-makers favor taxing specific products.

Alcohol control policy and changes in alcohol-related traffic harm

AIMS

To study the impact of alcohol control policy measures (i.e. increases in taxation, restrictions on availability, including minimum purchasing age regulations, legislation on drink driving and advertisement bans) on alcohol-related traffic harm in Lithuania between January 2004 and February 2019.

DESIGN

Analyses of trend data on the proportion of alcohol-related collisions and crashes, injury and mortality, adjusting for secular trends, seasonality, periods of alcohol control measure implementation and economic development. Generalized additive mixed models were used. Multiple sensitivity analyses were conducted.

SETTING

Lithuania.

CASES

Monthly number of alcohol-related cases of traffic collisions and crashes, injuries and deaths.

INTERVENTIONS AND COMPARATORS

Periods of time during which new alcohol control measures were implemented and/or augmented compared to periods when they were not.

MEASUREMENTS

Monthly data for 2004 to 2019 from routine statistics of the Lithuanian Road Police Service.

FINDINGS

All indicators decreased consistently and significantly after the implementation of alcohol control measures, including increased taxation, reduction of availability and a ban on advertisement, starting in 2014. On average, each implemented policy measure permanently reduced the proportion of alcohol-attributable crashes by 0.55% [95% confidence interval (CI) = 0.21-0.90%; P = 0.002], the proportion of alcohol-attributable injuries by 0.60% (95% CI = 0.24-0.97%; P = 0.001) and the proportion of alcohol-attributable deaths by 0.13% (95% CI = 0.10-0.15%; P < 0.001).

CONCLUSIONS

Alcohol control policy measures, including measures to reduce overall level of alcohol consumption, were associated with a marked decrease in alcohol-related traffic harm.

Evaluation of research on interventions aligned to WHO 'Best Buys' for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015

Background

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, with low-income and middle-income countries experiencing a disproportionately high burden. Since 2010 WHO has promoted 24 highly cost-effective interventions for NCDs, dubbed ‘best buys’. It is unclear whether these interventions have been evaluated in low-income and lower-middle-income countries (LLMICs).

Aim

To systematically review research on interventions aligned to WHO ‘best buys’ for NCDs in LLMICs.

Methods

We searched 13 major databases and included papers conducted in the 83 World Bank-defined LLMICs, published between 1 January 1990 and 5 February 2015. Two reviewers independently screened papers and assessed risk of bias. We adopted a narrative approach to data synthesis. The primary outcomes were NCD-related mortality and morbidity, and risk factor prevalence.

Results

We identified 2672 records, of which 36 were included (608 940 participants). No studies on ‘best buys’ were found in 89% of LLMICs. Nineteen of the 36 studies reported on the effectiveness of tobacco-related ‘best buys’, presenting good evidence for group interventions in reducing tobacco use but weaker evidence for interventions targeting individuals. There were fewer studies on smoking bans, warning labels and mass media campaigns, and no studies on taxes or marketing restrictions. There was supportive evidence that cervical screening and hepatitis B immunisation prevent cancer in LLMICs. A single randomised controlled trial supported polypharmacy for cardiovascular disease. Fourteen of the ‘best buy’ interventions did not have any good evidence for effectiveness in LLMICs.

Conclusions

We found studies on only 11 of the 24 interventions aligned with the WHO ‘best buys’ from LLMIC settings. Most LLMICs have not conducted research on these interventions in their populations. LLMICs should take action to implement and evaluate ‘best buys’ in their national context, based on national priorities, and starting with interventions with the strongest evidence base.