Alcohol consumption

Alcohol consumption and closed borders – how COVID-19 restrictions have impacted alcohol sales and consumption in Europe | BMC Public Health

The COVID-19 pandemic has had a profound effect on individuals and communities across the world, including in Europe. As the pandemic has required a rapid reorganization of societies, it has given rise to unique research opportunities, especially in the area of ​​alcohol policy.

Already in May 2020, Rehm et al. predicted that two mechanisms would affect alcohol consumption during the Covid-19 pandemic [1]. The first mechanism, hereinafter referred to as the impact of the crisis, relates to the structural effects inherent in the pandemic itself. It is caused by heightened psychosocial distress triggered by the interplay of financial hardship, job loss, and uncertainty about the future. This was expected to lead to increased alcohol consumption and more harmful drinking patterns. The mechanism of impact of the crisis was apparent among citizens across Europe, but the degree of psychosocial stress appears to have varied between different European countries [2].

The second mechanism, hereafter referred to as the impact of the crisis response, concerns the effect on alcohol consumption of the measures adopted in response to the pandemic. While some of the crisis response measures led to effects similar to the first mechanism, such as psychosocial distress, the mechanism itself also had other effects. In Europe, most if not all countries have taken measures aimed at restricting physical and social contact and several of these measures have directly and indirectly targeted the consumption of alcohol. This included restrictions on alcohol sales in restaurants, pubs and bars as well as bans on social gatherings. Therefore, crisis response measures had to reduce alcohol consumption.

The impact of the crisis response also shows similarities across countries. As the Oxford COVID-19 Government Response Tracker (OxCGRT) shows, the overall stringency of these measures is quite similar across European countries, albeit with somewhat different actions taken and different dates for their implementation. [3].

This study, however, focuses on an asymmetric impact of the crisis response on alcohol consumption in countries, namely the effects of border closures and severe restrictions on cross-border travel on sales and consumption. of alcohol.

Alcohol consumption and closed borders

The possibility of traveling abroad has fallen sharply during the pandemic (see [3, 4]) and thus restricted the ability of residents of countries with relatively high alcohol prices to purchase alcohol in countries with lower prices to take home. As such, border restrictions have had an asymmetrical impact on alcohol availability by affecting residents of European countries with a large share of cross-border alcohol purchase inflows (country of arrival) differently from residents of countries with low net levels of cross-border alcohol movement (stable countries) or countries with a high share of cross-border alcohol purchasing outflows (leaving countries).

Consistent with previous alcohol policy research, restrictions on alcohol availability, whether affecting on-premises, off-premises or cross-border purchases, should reduce alcohol consumption even when taking into account some reallocation between or within buying channels (see for example [5]).

For inbound countries, much of the alcohol consumed by its residents is unrecorded in the country and for outbound countries, recorded sales include a large portion of alcohol purchased by visitors and consumed in the country. outside the country. In these countries, recorded alcohol consumption (domestic sales – hereafter also referred to as RAC) therefore deviates from actual consumption. Estimating the actual level of alcohol consumption per capita is therefore a challenge (for an overview of unrecorded alcohol in Europe, (see [6, 7]).

However, the closure of borders during the pandemic meant that the BCR in these entry and exit countries can be expected to closely reflect actual domestic alcohol consumption, providing a unique opportunity to study this phenomenon in a comparative context.

In Europe, there is a historical concentration of cross-border purchases towards two main border regions: Nordic-Baltic and Benelux-France + British Isles (see [8, 9]). Monitoring CAR trends in these countries should thus provide information on the impact of the pandemic on CAR in a cross-border context. Comparative analysis of the asymmetric effect of cross-border restrictions between countries should in turn improve our understanding of the extent and movement of alcohol between different countries in Europe.

Cross-border purchases of alcohol in Europe

In a recent overview of the cross-border trade in alcoholic beverages within the European Union (EU), three main concerns associated with cross-border purchases of alcohol were identified: its impact on public health, on fraudulent behavior (e.g. smuggling) and on economic distortion [9]. All three share the same underlying causal mechanisms driven by (a) alcoholic beverages being price sensitive (e.g. [10, 11]) (b) the existence of significant differences in excise duties (and therefore price differences) between EU countries (see for example [12]) c) the legal possibility in the EU to move from one EU country to another with almost unlimited quantities of alcohol for one’s own use without additional payment of excise duty in the country of consumption.Footnote 1

From a public health perspective, a large cross-border flow of alcohol can increase total alcohol consumption per capita,Footnote 2 and therefore, alcohol-related problems, through two main processes. First, by directly increasing accessibility to cheaper alcohol. Even if residents replace some domestic purchases with foreign purchases, the net effect of cross-border purchases is likely to be an increase in total alcohol consumption due to access to alcohol at a lower price. Second, by dampening the drive to use excise duties as a public health tool for fear of losing purchases to neighboring states. In open reaction to the large influx of alcohol, Denmark, Estonia, Finland and Sweden have taken decisions in recent decades to reduce excise rates, either actively through tax cuts (e.g. Sweden in 1997; Denmark in 2003 and 2019; Finland in 2004 and Estonia in 2019) and/or keeping rates at a stable nominal level.

Data and most, but not all, studies from these Northern European influx countries have provided evidence for both of these mechanisms (Denmark: [16]; Estonia: [17, 18]; Finland: [19, 20]; Sweden: [21, 22]). Studies carried out in other European countries are only available in a fragmentary manner. A recent survey of 6,250 respondents across 25 EU Member States in 2018/2019, however, confirms the pattern of large variations in cross-border alcohol purchases from country to country, with high price countries tending to display the highest volumes. [9].

Table 1 provides an overview by categorizing countries as inbound, outbound, or net stable based on knowledge of cross-border shopping flows before the pandemic. Where possible, information is drawn from national alcohol consumption surveys. When such surveys do not exist, a triangulation of differences in excise rates, the presence of specialized border stores and press articles is used (see Supplementary File 1: Table S1).

Table 1 Preliminary categorization of countries according to cross-border shopping flows

Four typical incoming countries are identified with a net balance of significantly higher inflow volumes than outflows (SE, NO, FI, DK). Two countries are identified as typical outgoing countries (LV and LU). A few countries are identified as having higher outflows than inflows or vice versa for some beverages, but low or stable net flows for others. The other countries are classified as net stable.

Hypothesis

The restrictions put in place during the Covid-19 pandemic to limit the spread of infection represent an unprecedented reduction in the physical and economic availability of alcohol for all residents of the affected territories. This applies to Europe in general, and to incoming countries in particular. Following the prediction of Rehm et al. [1] one would therefore expect a reduction in alcohol consumption from the start of the pandemic in all, if not a majority of European countries. Results of recent analyzes of survey data on the frequency of alcohol consumption also suggest that this has been the case. [23]. However, the lack of a clear link between the frequency and volume of self-reported data and alcohol consumption in surveys is generally greatly underestimated. [24] makes it difficult to draw firm conclusions regarding the effects on total alcohol consumption per capita. This article will test the hypothesis that total alcohol consumption decreased during the pandemic in the European countries included in the study.

The impact of the crisis response on cross-border alcohol purchases is of particular interest since RAC trends are affected by changes in cross-border purchase volumes. Operationalizing the hypothesis and taking into account the effect on the BCR of changes in cross-border shopping, this paper predicts that the pandemic will have the following effect on the BCR:

  • H1: The RAC will show a downward trend relative to the pandemic in countries where levels of cross-border alcohol purchases are low, or net.

  • H2: The RAC will show an upward trend of the pandemic in cross-border influx countries compared to H1 countries.

  • H3: The RAC will show a stronger pandemic downward trend in cross-border emigration countries compared to H1 countries.

Given the hypothetical effects on the ACR, one would expect the H1 results to indicate effects on total consumption.

Previous studies of relaxing cross-border buying rules have found a degree of additionality to cross-border alcohol purchases, meaning they not only displace domestic sales, but contribute to an increase in total consumption. of alcohol. Therefore, countries entering S2 are expected to experience a stronger downward trend in total consumption than other countries in the study, despite an expected increase in BCR, as cross-border accessibility to alcohol is reduced. Also, the change in total alcohol consumption in exiting countries is expected to be less than decreases in BCR, likely similar to H1 countries.

Furthermore, by looking at the development of RAC in different categories of countries and combining it with the results of individual national studies on cross-border shopping, it should also be possible to provide a rough estimate of any potential degree of additionality of shopping. resulting from access to cheaper alcohol. across a border. Although going beyond the test of the three main hypotheses, looking at potential additionality is interesting because previous studies have only ever been able to focus on situations of increased accessibility to cross-border alcohol.