Alcohol consumption poses a threat for many public health harms. Impaired driving is one of the largest contributors to motor vehicle crashes (Burris, Grunwald, Anderson, &ump; Filippoli, 2011). In the United States each year roughly 13,400 people die and an additional 255,500 are injured in motor vehicle crashes involving an alcohol-impaired driver according to Burris et al., 2011. In 2006, these crashes accounted for almost a third of all U.S. traffic-related deaths (Burris et al., 2011). Alcohol is the most commonly abused substance in the United States according to Pandrea, Happel, Amedee, Bagby, &ump; Nelson, 2010, and studies show that reducing alcohol consumption can lead to public health improvements such as decreased incidence of “liver cirrhosis, delirium tremens, male suicide, criminality, hospitalizations, alcohol-related disease mortality, workplace injuries, STDs, IPV, rape, robbery, and severe violence towards children” (Jernigan). Public heath deals with many other issues that cause burdens to individuals and society alike such as obesity and gun use.
Over the past several months, headlines in the news have been echoing “Chocolate Milk Removed from School Lunches,” and “Senate Considers Federal Tax on Soda.” While the removal of chocolate milk from school menus has actually happened in certain school districts across the country, federal tax on sodas has only been a proposal at this point. However, both echoes resounding through the news originated from escalating research that America’s twin epidemics of diabetes and obesity are due to diets high in sugar. The end result is that the actions taken to fight obesity have not been classified as either effective, uncertain, or harmful consistently through studies and research because there are too many variables like genetics, other sugar-loaded beverages and foods on the shelf, lack of exercise, abundance of video games, and the lifestyle one is accustomed that contribute to obesity as well. But even with the slightest inclination eliminating chocolate milk or federal tax on soda will eliminate sugar from obese population’s diet and thereby reduce weight, support groups and supporting research seem to load up the band wagons.
Alcohol abuse is certainly an epidemic, and the domino effect of negativity it can cause in one’s life and surroundings creates a dismal forecast into the future of American public health somewhat similar to the obesity epidemic. Obesity and alcohol consumption act as a comparison between two similar, yet contradictory issues, much like public health and public health law. High-risk drinking results in many consequences for public health and unlike obesity and soda tax, a multitude of systematic literature reviews conducted by highly-regarded scholars and published by credible organizations or peer-reviewed journals prove taxes that increase the price of alcohol effectively reduce overall alcohol consumption. Although ways to reduce alcohol consumption are not made glamorous in the news like many other trending public health epidemics, alcohol abuse is one of the few conflicts public health epidemiologists and economists have derived a bullet proof plan of action to effectively reduce its harmful effects.
This manuscript serves as an evidence brief summarizing the problem, the law, the evidence, and the bottom line pertaining to the effect of increasing tax levels on alcohol use, and to prove why understanding public health law and policy is essential in bridging the gap between proven studies performed by public health professionals and the legislators and lobbyists who can implement the findings. Using the current state of obesity as an example was merely to cast light on the standstill alcohol abuse is undergoing, which ultimately resides in the poor connection between public health research and public health law. However, it is worth noting that other strategies exist to control alcohol abuse besides trying to impose what some may call a “sin tax,” such as comprehensive prevention programs: 1) Offer and promote social, recreational, extracurricular, and public service alcohol-free options; 2) Create a social, academic, and residential environment that supports health-promoting norms; 3) Limit alcohol availability both on and off campus; 4) Restrict marketing and promotion of alcoholic beverages both on and off campus; and 5) Develop and enforce policies and laws at the campus, local, state and federal levels (The Demand for Alcohol: The Differential Response to Price, 2005).
The elements of a comprehensive prevention program limit some of the damage caused by alcohol abuse but the epidemic flows forward. Numerous epidemiological studies have demonstrated that alcohol use disorders (AUDs) such as alcohol abuse and alcohol dependence are widespread in the general population of the United States, with approximately 8.5 percent of adults having had an AUD in 2007 (Falk, Yi, &ump; Hiller-Sturmhofel, 2008). Moreover, many people suffering from AUDs also suffer from one or more other psychiatric disorders, including other drug use disorders (DUDs), mood disorders like major depression, anxiety disorders, or personality disorders like antisocial personality disorder (Falk et al., 2008). Falk et al., 2008, also reported the prevalence of alcohol use and AUDs is much higher among people with drug use and DUDs, respectively, than vice versa. This reflects the fact that alcohol is much more widely used than other drugs may be a gateway to the use of illegal or more potent drugs (Falk et al., 2008). Falk et al., 2008, reported that their results showed a dose-response relationship between the two classes of substances, with rates of drug use, weekly drug use, and DUDs increasing “monotonically with increasing levels of alcohol consumption and the presence of AUDs.”
The descriptive study by Falk et al., 2008, not only portrays the grim effects of alcohol abuse but is also just one of the many credible reviews providing prevalence estimates providing health care policymakers and treatment planners with a “comprehensive assessment of the state of the use, co-use, and co-morbidity of alcohol and other drugs in the United States.” The flow of abuse and effects unfortunately does not have a dam, and floods further along into public health. Justice, Lynn, &ump; Fiellin, 2010, have shown that past and present alcohol consumption directly influences HIV progression and survival by altering timing of, adherence, and response to medication designed to minimize levels of HIV in the body like antiretroviral treatment (ART). Alcohol use also influences patient outcomes by increasing the risk for HIV and antiretroviral associated co morbidities, including liver disease, cardiovascular and cerebral vascular disease, pulmonary disease, bone disease, and cancer (Justice et al., 2010).
Those with HIV have a lower tolerance for alcohol, according to Justice et al., 2010, yet preserve intense levels of consumption as they age and the growing effects of past and current alcohol consumption is likely to increase because patients with HIV infection are expected to live 20 to 30 years with ART. Lamentably, alcohol is a terror that looms around society and affects the weak and strong alike. Strong populations mostly include college and university students, who likely do not have HIV or AUDs or DUDs while pursuing a higher education. However, 25 percent of students report academic problems caused by alcohol use according to The Demand for Alcohol: The Differential Response to Price, 2005.
Students who practice high-risk drinking are at risk for a host of problems, including: 1) A decline in academic performance due to poor grades, missed classes, and falling behind that may lead to academic probation or dropping out of school; 2) Engaging in unprotected sex; 3) Increased risk of perpetrating or being a victim of violence, including sexual assault, hazing, vandalism, and fights; 4) Health problems related to alcohol use; and 5) Injury, arrest or death due to drinking and driving, or other alcohol-related causes (The Demand for Alcohol: The Differential Response to Price, 2005).
Much like concrete cracking and eventually more and more cracks ensuing, are the secondary effects alcohol abuse has on campuses. Firstly, drinking undermines the goal institutions of higher education set forth, since heavy drinking leads to a decline in academic performance. Furthermore, heavy drinking can affect the campus as a whole through reducing retention rates, increasing expenses due to damage from vandalism, and branding the institution as a party school. The “party school” image may attract students who choose to be in high-risk settings, increasing the likelihood of alcohol-related incidents on campus (The Demand for Alcohol: The Differential Response to Price, 2005). Students who do not drink may also experience negative consequences of alcohol use by their peers according to The Demand for Alcohol: The Differential Response to Price, 2005. Effects may include study or sleep interruption, taking care of a drunken friend, having an unwanted sexual advance, having property damaged, and being a victim of violence including physical or sexual assault.
Over three-quarters of students living on campus have experienced at least one of the negative secondary effects of alcohol use at their school (The Demand for Alcohol: The Differential Response to Price, 2005). Perhaps a creative genius health professional strategizes a prevention program that eliminates alcohol consumption, only a short duration of time will pass and the marketing departments of major breweries will promote their brand in a way to pull the public right back into the flow of intake. Or maybe no successful prevention program forms, but raising the excise taxes on alcohol is being accelerated by legislature efforts in order to reduce alcohol consumption and abuse.
In this case, consistent industry political donations and lobbying aimed at keeping alcohol excise taxes from increasing are in place for these companies profiting from their unhealthy product. The primary problem this brief sought out to analyze is alcohol abuse and the extensive list of problems discussed in detail above it causes. The problem paves the way to the law. And given the circumstances that stricter law enforcement and prevention strategies have only resolved a minute fraction of the problem, the law is the answer as it offers a glass ceiling. No federal tax increases have been implemented since 1991 and many states, although legislative efforts have been accelerating across the country, have failed to increase the tax.
However, tax law in the epidemic of alcohol abuse, is the solution with most opportunity for proving effective. Burris et al., 2011, define tax law as a mechanism for reducing consumption of unhealthy products. The same news that reported the removal of chocolate milk from selected school districts has reported increased taxes on cigarettes, so it is simple to understand that both the federal government and the states have used taxes as a means of increasing the cost of products associated with health risks in the past. Taxes can be levied upon the production and or sale of alcohol and are often described as excise taxes Burris et al., 2011, have reported. According to the Federation of Tax Administrators, almost every state taxes the sale or production of beer, liquor and wine (Burris et al., 2011). Nevertheless, increasing alcohol tax is not as straightforward and effortless as simply applying the definiton of tax law to the problem and stepping away. State readiness to act on alcohol tax research findings marks the beginning of constructing the bridge that will essentially connect public health to public health law.
Many key factors are subject to broad consensus among members of the Coordinating panel and other participating experts (Tremper &ump; Mosher, 2005). Components that are most important are the budget deficit or other substantial need for the state to raise taxes, the strength of the advocates/coalition that would introduce research findings, and the availability of funds that can be used for legislative advocacy. Items of decreasing importance are existence and efficacy of a lobbyist for the issue, well-positioned champion in both houses of the legislature, and the political strength of the alcohol industry and its allies. Other factors include support of the governor, permissibility of earmarking, high proportion of nondrinkers, high proportion of evangelicals and/or fundamentalists, and support of major media (Tremper &ump; Mosher, 2005). Discussion of the former findings serve as a starting point for analyzing the conclusions of specific literature reviews that increasing alcohol taxes improves public health and that various factors affect the likelihood that research findings will influence alcohol tax policy.
After the preliminary analysis, possibly the most important finding to extract is the consent among alcohol tax advocates, legislative process experts, advocates who have successfully used research findings to influence tobacco tax policy, and other interested parties in regard to state tax policy, and whether a state needs to raise taxes for financial reasons. Tremper &ump; Mosher, 2005, have stated that in practical terms reflecting political realities, if a state is not facing a budget deficit, raising alcohol taxes to achieve public health benefits is highly unlikely. Continuing strain on state budgets has a high likelihood of continuing; therefore, raising taxes is going to be on most states’ legislative agenda for the projected future. Another important finding that bodes well for alcohol tax to appear on legislative agendas is that alcohol taxes are low by several measures and in some states have not been raised for decades, which means that inflation has reduced them to a fraction of their previous level (Tremper &ump; Mosher, 2005).
For example, had the beer tax merely kept up with inflation, it would be more than three times today’s rate of $18 per barrel; the liquor tax would be more than five times its current rate of $13.50 per proof gallon (Alcohol Taxes on the Federal Front, 2005). As prices rise, the relative importance of the taxes falls, unless Congress raises them according to the website Alcohol Taxes on the Federal Front. The website further foes on to state statistics indicating beer and wine taxes have been raised only once in the past 55 years, liquor taxes only twice and as a result, tax revenues that accounted for 12 percent of the sales of alcohol in 1980 now amount to only 7 percent of total sales. The result is a de facto subsidy on drinking and extra profits for alcohol manufacturers at the expense of taxpayers (Alcohol Taxes on the Federal Front, 2005).
The beer industry has long opposed raising taxes on its products, even maintaining that they should be lowered. However, lower beer taxes would only add to the deficit, cater to a prosperous industry, reward and encourage heavy drinking, and attract more young drinkers, fueling increased alcohol problems and increasing public costs. The best interests of consumers, young people, the U.S. Treasury, and the public health and safety of America would be better served by raising, not lowering beer taxes. (Alcohol Taxes on the Federal Front, 2005)