Canada is proof that state-controlled drinking is good for health

Under minimum pricing of alcohol, the state dictates the cost, or at least the "floor" price, that pubs, clubs and supermarkets must charge for beer, wine and other drinks. While many medical organisations want ministers to go down that road to reduce alcohol-related harm, it is fiercely opposed by the drinks industry. But new evidence from Canada, the first country in the world to introduce minimum pricing, shows that stipulating how much pints of beer, measures of spirits and glasses of wine have to be sold for brings significant health benefits.

The research, commissioned by the Institute of Alcohol Studies (IAS) think-tank, published onWednesday, comes just as the coalition decides whether to proceed with its original plan of bringing in minimum unit pricing (MUP) in England and Wales as a major new assault on the misery caused by heavy drinking – including death, disease, injury, crime and lost productivity. Organisations such as the IAS and Alcohol Health Alliance fear that David Cameron will confirm he is scrapping the pledge, as he recently hinted to MPs.

Yet the IAS report makes clear that minimum pricing leads to big falls in alcohol-related deaths and admissions to hospital. Crucially, as ministers decide what legislation is and is not included in next week's Queen's speech, it also suggests that Sheffield University researchers' calculations for the Department of Health (DH) of MUP's impact – which helped persuade DH and Cameron to back it – significantly underestimate the amount of harm that would be avoided.

The IAS research is set out in a report, Is alcohol too cheap in the UK? The case for setting a minimum unit price for alcohol, by Tim Stockwell and Gerald Thomas, academics at the Centre for Addictions Research at the University of Victoria in British Columbia. Canada's experience is relevant to the UK because parts of it have had some form of minimum pricing for as long as 40 years. Nine of its 10 provinces have some form of minimum costs for alcohol. In some, minimum pricing applies to just high-strength, large, single servings of beer (Manitoba), while in others it affects all beer (Quebec) or every alcoholic drink (Saskatchewan). Eight of them also have the same restrictions for on-trade premises such as pubs, hotels and restaurants. As a result, there is much more evidence from Canada on the impact of minimum pricing than from the five other countries which also have some form of it: Russia, Moldova, Ukraine and Uzbekistan, and a few states in the US.

After studying eight years of data from British Columbia, detailing price rises, alcohol intake and negative health outcomes from drinking, Stockwell and Thomas concluded that "a 10% increase in average minimum prices across all beverage types would result in a 3.4% decrease in total alcohol consumption." The same 10% increase was also "significantly associated with a 32% reduction in wholly alcohol-caused deaths", a 9% drop in alcohol-related hospital admissions and "significant delayed effects on deaths from alcohol-related diseases, such as liver cirrhosis and various cancers, after two years".

However, British Columbia implements minimum pricing in the way most Canadian provinces do. That is, unlike the proposal for the UK, it specifies a minimum price per litre of a particular drink rather than per unit of alcohol. The Scottish government had intended to introduce MUP this month, but a legal challenge from the Scotch Whisky Association and other drinks industry organisations prevented Scotland becoming the first country in the world to implement minimum prices based on the number of units of alcohol in every can, glass and bottle, with a starting price of 50p a unit.

The authors' findings about the experience in Saskatchewan, where minimum pricing is much closer to MUP, are perhaps more instructive for British purposes. In April 2010, it raised the price of drinks that already had a minimum price, including beer, wine and spirits, and put other drinks that did not have one under a minimum price, such as alcopops and cocktails. Crucially, though, the rates, which ended up being mostly the equivalent of 45p to 60p a unit, were adjusted to take into account for the first time the strength of the drink concerned – a policy Stockwell calls "halfway to MUP".

"The change was applied simultaneously and comprehensively to all beverages, unlike the more sporadic and piecemeal approach in British Columbia," he says. "We found that if you have higher-priced strong drinks, you encourage consumers to shift to lower-strength drinks, so there should be less health harm." The upside for the drinks industry, he adds, is that they should still make just as much profit as before because people still buy the same amount of alcohol, but more lower-strength products.

Between 2008 and 2012, the same 10% increase in prices in Saskatchewan resulted in a 8.4% fall in total alcohol consumption – more than double that seen in British Columbia. "Interestingly, the new policy of having a higher minimum price for alcohol content varieties of a particular beverage, such as 8.5%-strength beer versus beer below 6.5% alcohol by volume (ABV), significantly shifted consumption towards lower-content varieties of both beer and wine," the report says. The authors based that on examining price and consumption data from before and after the 2010 introduction of ABV-based pricing.

Curiously, despite the health benefits Canada's version of minimum pricing has brought, Stockwell says the policy as pursued there is "flawed" because most provinces set rates according to the volume of the drink rather than alcohol content, as in Saskatchewan. In British Colombia, a 40% tequila is sold at CAD$1.35 per standard drink, whereas a rum that is 75% ABV is just 72 cents for a standard drink, giving consumers a real financial incentive to drink the hardest liquor. "A big loophole," he calls it.

One surprise about Canada's way of minimum pricing is that the provincial governments that do it do so mainly to bring in money rather than to protect public health, says Dr Perry Kendall, British Columbia's provincial health officer. Saskatchewan changed its policy in 2010 at least partly because it needed to generate revenue, for example. Similarly, health and medical organisations have had little influence on minimum pricing in British Columbia, Kendall adds – unlike here, where recent years have seen heavy lobbying of ministers at Westminster and Holyrood by doctors and health charities.

Despite its imperfections, Stockwell stresses that Canada's policy does cut consumption, and alcohol-related deaths and hospital admissions. Saskatchewan in particular, he says, should encourage the coalition to stick to its original plan to introduce MUP, which, as recently as last month, the DH lauded as a key way to tackle the huge consequences of drinking too much.

"The Canadian experience tells us that minimum pricing works and that introducing MUP could save more lives and avoid more hospital admissions than the Sheffield researchers originally envisaged, and thus reduce alcohol's burden on society," says Katherine Brown, the IAS's director of policy. Bodies as diverse as the NSPCC, St Mungo's and the Police Federation back MUP, not just the medical establishment. Any coalition U-turn will be because of unprecedented lobbying by big drinks firms that are hostile to MUP, and use partial and poor-quality evidence against it, she says. Brown points out that peer-reviewed evidence such as their new report should guide ministers' thinking, not the "junk science" the vested interests of the alcohol trade use to undermine MUP.

How Canada does it

Canada's 10 provincial governments have a degree of control over the alcohol trade that is unthinkable here in the UK, even if minimum unit pricing does finally get the go-ahead.

They buy, supply and distribute almost all alcohol sold in Canada, as well as owning and running off-licences – known as liquor stores – which are usually larger than, and may outnumber, private off-licences. Most provinces also set minimum prices for anything between a few and all alcoholic products sold in the area.

The key organisations involved are the provincial governments' liquor control boards, such as the Liquor Control Board of Ontario, which includes the cities of Toronto, Hamilton and London. The LCBO is typical of the boards in that it was set up in 1927, when outright prohibition of alcohol was in effect lifted in return for the provinces gaining control over the demon drink. LCBO describes itself as "an Ontario government enterprise and one of the world's largest buyers and retailers of beverage alcohol. Through more than 630 retail stores, catalogues and special order services, it offers nearly 19,000 products annually to consumers and licensed establishments."

Liquor boards are useful earners for provincial governments, and their finance ministeries usually set them revenue goals. In 2011-12, LCBO sold a total of CAD$4.7bn of booze, generating a CAD$1.63bn dividend for the Ontario government. "This revenue helps pay for healthcare, education and other important services," it says.

The businesses allowed to sell alcohol in the province are LCBO off-licences, The Beer Store – a chain jointly owned by several big brewers – and a few shops owned by wineries. In general, pubs, hotels, nightclubs and restaurants buy alcohol from provincial liquor boards.

All 10 provinces have a government monopoly on the wholesaling of alcohol. Alberta is the only province where all alcohol retailers are privately owned. A few have only government-owned off-licences , but most have a mixture of public and private outlets.

Nine of the 10 set minimum prices for at least one type of alcoholic drink bought at off-licences – again, Alberta is the exception; it has no minimum prices – while eight of the 10 have also established minimum prices for alcohol products bought at on-trade premises, such as bars and nightclubs.