Alcohol policy modelling: moving beyond a healthcare perspective to include alcohol attributable crime and employment outcomes

Presenter: Alan Brennan, Sheffield University

Abstract

Public health interventions impact on society more broadly than just health outcomes and health services and therefore policy appraisals must consider a wide range of outcomes, incorporating evidence from a range of disciplines and sources. In this paper, inclusion of crime and workplace outcomes is considered for appraisal of alcohol price and promotion interventions for England.

For modeling crime impacts a series of methodological questions arise:

(i) to what level of detail should the categorization of crimes be defined, when it is known that crimes partially attributable to alcohol consumption include violent crime, criminal damage, thefts and robberies. (ii) should modelling to link risk of committing crime with levels of alcohol consumption should utilise either: mean weekly consumption of ethanol (expressed in UK units) or maximum daily intake within a week (which is used as a proxy for so-called binging behaviour)? (iii) The more general substance misuse literature on attribution deploys three models: intoxication, economic-compulsive (or gainful) and systemic. Should this approach be used for alcohol when it is intoxication related research that dominates the evidence base, and there is evidence only for small levels of gainful crime. (iv) Which method for attribution of the crime to the alcohol is most appropriate, those based on threshold blood alcohol levels, self-attribution that alcohol was the cause or simply the presence of alcohol? (v) How should quality of life metrics for valuing crime outcomes, especially valuation of QALY loss to victims of crime and costs to individuals and civil institutions be included?

Workplace outcomes include absenteeism from work attributable to alcohol and unemployment arising from heavy alcohol use. Lost productivity due to mortality could also be included, but this may lead to double-counting, depending on the method for the valuation of QALY losses in the health harms model. Key questions addressed by the paper include: (i) which consumption metrics are appropriate for absenteeism and unemployment?; (ii) how should causality issues for unemployment be addressed (does heavier drinking lead to unemployment or does unemployment lead to heavier drinking)?; and (iii) how should workplace outcomes be valued, given that increasing wages are generally shown to be positively correlated with increasing consumption levels.

The paper also discusses how uncertainty should be addressed in the policy appraisal for outcome areas where the evidence base is sparse, in particular considering the appropriateness of scenario analysis and probabilistic sensitivity analysis. We conclude with a discussion of wider perspective issues, including whether a single framework is appropriate for capturing costs and benefits.