Alcohol taxation policy in Kyrgyzstan
Alcohol taxation policy in Kyrgyzstan Abstract Increasing the price of alcohol is one of the most effective policy measures to reduce overall consumption in a country, and hence to reduce the level of alcohol-related harm. Taxation is a common way to control the price of alcoholic beverages, and when adjusted according to inflation, it can be an effective measure to reduce harm while providing revenue for governments. This report outlines the alcohol taxation policy in Kyrgyzstan between 2006 and 2016, and its impact on revenue and alcohol-related harm. Implementation of strong policies in the period 2012–2014 reduced the affordability of alcohol and resulted in a decline in alcohol turnover and consumption and alcohol-related harm. While taxation policies in Kyrgyzstan appear to have had a positive impact, tax increases should be accompanied by government efforts to control the production, sale and consumption of illicit alcohol. Keywords Alcohol drinking – economics Alcohol drinking – legislation and jurisprudence Alcoholic beverages – economics Taxes Kyrgyzstan Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe United Nations City Marmorvej 51 DK–2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2017 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Contents Acknowledgements iv Abbreviations v Introduction 1 Methods 2 Information sources 2 Affordability calculations 2 Results 3 Sales and taxation of alcoholic beverages 3 Trends in alcohol-related harm 9 Alcohol taxation policy in Kyrgyzstan and the EAEU 11 Discussion 13 Conclusions 14 References 15 Annex 1 19 Trade codes for alcoholic beverages in Kyrgyzstan 19 iv Acknowledgements The author of this report is Dr Konstantin Krasovsky, Consultant, WHO Regional Office for Europe. The WHO Regional Office for Europe, in collaboration with the WHO Country Office in Bishkek, Kyrgyzstan, organized a workshop on alcohol taxation in Bishkek on 7 July 2017, where a draft version of this report was presented and discussed. Technical editing was done by Dr Lisa Schölin, Consultant, Ms Julie Brummer, Consultant, and Dr Lars Møller, Programme Manager for Alcohol, Division of Noncommunicable Diseases and Promoting Health through the Life-course, all of the WHO Regional Office for Europe; and by Dr Jarno Habicht, of the WHO Country Office, Kyrgyzstan. The report was reviewed by Dr Oskonbek Moldokulov, WHO Country Office, Kyrgyzstan; and Dr Konstantin Vyshinskiy, Epidemiology Department, Federal Medical Research Centre for Psychiatry and Narcology, Ministry of Health, Moscow, Russian Federation. This report was developed under the frame of the Biennial Collaborative Agreement between Kyrgyzstan and the WHO Regional Office for Europe. This report was produced with funding from the Ministry of Health of the Russian Federation within the context of the WHO European Office for the Prevention and Control of Noncommunicable Diseases. vAbbreviations ABV alcohol by volume APC alcohol per capita consumption AAI alcohol affordability index CPI consumer price index DALYs disability-adjusted life years GDP gross domestic product EAEU Eurasian Economic Union VAT value-added tax
1Introducti on Alcohol is the ninth leading risk factor for mortality and disease in the world; 3.5% of disability-adjusted life years (DALYs) and 4.1% of deaths are caused by the harmful use of alcohol (1). In the WHO European Region, alcohol is a signifi cant risk factor for noncommunicable diseases, and despite a reducti on in total alcohol per capita consumpti on (APC) in recent decades, the burden of premature mortality att ributable to alcohol is sti ll high, both in absolute terms and relati ve to other regions (2). In 2014, the total adult (15+ years) APC for Kyrgyzstan was 5 litres of pure alcohol (3 litres of recorded consumpti on, 2 litres unrecorded). Compared to the average APC for the WHO European Region, esti mated at 10.7 litres, the level of alcohol consumpti on in Kyrgyzstan can be described as relati vely moderate. However, alcohol consumpti on has increased since 2000, when the total APC was 3.6 litres (Fig. 1) (2). Fig. 1. Trends in recorded, unrecorded and total alcohol per capita consumpti on (APC) in Kyrgyzstan, 1990–2014 0 1 2 3 4 5 6 7 Total Unrecorded Recorded 201420102005200019951990 Li tr es o f p ur e al co ho l Source: Shield, Rylett & Rehm (2) Reducing the impact of the harmful use of alcohol requires a comprehensive approach to alcohol policy. Countries that take strong acti on to decrease alcohol consumpti on will reap considerable gains in terms of bett er populati on health and well- being, enhanced employment and producti vity, increased health and social welfare savings, greater health and economic equality, and greater social cohesion and inclusion (3). In the joint briefi ng for the 2011 United Nati ons high-level meeti ng on noncommunicable diseases, the World Economic Forum and WHO concluded that the three “best buys” to reduce alcohol-related harm are: (i) tax increases, (ii) restricted access to retailed alcohol, and (iii) bans on alcohol adverti sing (4). Currently, alcohol taxes in Kyrgyzstan are relati vely low, although they have increased in recent years. The aims of this report are: (i) to analyse the impact of alcohol taxati on policy on alcohol excise revenues and alcohol-related harm in Kyrgyzstan in the period 2006–2016; and (ii) to propose opti ons for alcohol taxati on policies in the coming years, in terms of their potenti al impact on alcohol consumpti on and revenues. 2Methods Information sources Changes in alcohol taxation legislation were reviewed using the Central Databank of Law Information of the Ministry of Justice (5). Data on alcohol excise revenues were taken from reports produced by the Central Treasury of the Ministry of Finance (6) and by the State Tax Service (7). Data on prices, income, population, mortality, morbidity and other indices were taken from the National Statistics Committee website (8). Data on imports and exports were taken from the Customs Service site (9) and the Eurasian Economic Commission site (10). Trade codes for all alcoholic beverages are shown in Annex 1. It was assumed that average alcohol by volume (ABV) was 40% for vodka, liquors and cognac, 5% for beer, and 14% for wine. Low-alcohol beverages are beverages with commodity code 22089069 and alcohol content 7% or lower. To estimate annual alcohol sales in the country, two methods were used: (i) calculation of the turnover (production plus import minus export) for specific alcoholic beverages; and (ii) estimation of taxable sales, which are calculated as annual amount of revenues for specific alcoholic beverages divided by the excise rates for those beverages effective in that year. Affordability calculations For calculations of the affordability of alcohol, the index developed by the National Health Service Information Centre in England was used (11). This index gives a measure of relative affordability of alcohol by comparing the relative changes in the price of alcohol with changes in disposable household income over the same period. When calculating the affordability of alcohol, it is important to note the following: (i) income per capita provides the most accurate results as an income measure, especially in populations with rapidly changing size or structure; however, household data can be used if per capita data are unavailable (12); and (ii) the income measure and the alcohol price measure should both be either in nominal terms or adjusted for inflation. In the current analysis, the alcohol affordability index (AAI) is used to estimate the changes in alcohol affordability. The AAI is calculated as the percentage of annual change in disposable income per capita divided by the alcohol price increase (consumer price index (CPI)), as follows: AAI = (income increase/CPI for alcohol – 1) x 100 Data collection to calculate the individual household income has some limitations (13), so an additional income indicator was used – World Bank data on annual percentage growth rate of gross domestic product (GDP) per capita based on constant local currency (14). As the GDP change is expressed in constant local currency (adjusted for the effects of price inflation), the AAI was calculated as follows: AAI = (GDP annual change/CPI for alcohol x CPI for all items) – 100 3Results Sales and taxation of alcoholic beverages Alcohol excise rates Table 1 shows the alcohol excise rates in Kyrgyzstan set by the Kyrgyz parliament. However, these are only so-called basic rates, which are not usually used to calculate excise duties. For trade codes, see Annex 1. Table 1. Basic excise rates for alcoholic beverages set by the Kyrgyz parliament (in soma per litre) Beverage type Law reference No. 67 No. 101 No. 230 No. 33 No. 47 8 July 1999 22 Sept 1999 17 Oct 2008 30 May 2011 3 Mar 2015 Ethyl alcohol, undenatured and >80%, or denatured 80 70 – 350 350 Vodka 44 40 – 200 300 Liquors 44 40 – 200 300 Fortified beverages 44 40 – 200 300 Cognac 28 25 27 135 200 Low-alcohol beverages – – – 60 200 Wine 10 – – 100 100 Sparkling wines 20 – – 110 130 Wine materials 2 – – 10 35 Beer 3 – 5 25 30 Source: Central Databank of Law Information of the Ministry of Justice (5) a Average exchange rates (€1): 2006 – 50.39 Kyrgyz som; 2007 – 51.04 som; 2008 – 53.73 som; 2009 – 60.00 som; 2010 – 61.01 som; 2011 – 64.28 som; 2012 – 60.44 som; 2013 – 64.35 som; 2014 – 71.27 som; 2015 – 71.59 som; 2016 – 77.37 som (Source: National Bank of the Kyrgyz Republic (http://www.nbkr.kg/index1.jsp?item=1562&lang=ENG, accessed 2 August 2017)). The Kyrgyz government sets actual excise rates (Table 2), which should not exceed the basic tax rates. Where no actual rates are set, the basic rates apply. Between 2000 and 2015, alcohol excise rates in Kyrgyzstan increased; however, the rate increase was inconsistent and different for the various beverage types. In accordance with the Tax Code of the Kyrgyz Republic of 17 October 2008, new excise rates were introduced on 1 January 2009 and value-added tax (VAT) was reduced from 20% to 12%. Small increases in vodka excise rates were introduced in 2003 and 2008 (effective from January 2009). The highest excise increase was introduced in 2013, when rates for most types of alcoholic beverages were increased by 50% (Table 2). In 2014, the excise rate for vodka and liquors was increased by 50%, for low-alcohol beverages by 100%, and for beer by 17%. 4Table 2. Actual excise rates for alcoholic beverages set by the Kyrgyz government (in som per litre) Beverage type Government order No. 366 No. 495 No. 19 No. 735 No. 392 No. 547 No. 139 No. 49 No. 255 No. 109 19 July 2001 25 July 2002 20 Jan 2003 30 Dec 2008 15 July 2011 6 Aug 2012 18 Mar 2013 23 Jan 2014 13 May 2014 17 Feb 2017 Ethyl alcohol, undenatured and >80%, or denatured – – – – 70 – – – – – Vodka 15 – 18 21 – 26 40 60 – 70 Liquors 15 – 18 21 – 26 40 60 – 70 Fortified beverages 15 – 18 21 – 26 40 60 – – Cognac – – – – 27 – 42 – – – Low-alcohol beverages – – – – 15 – 30 60 – – Wine – 4 – 6 – – 9 – – – Sparkling wines – – – – 22 – 34 – – – Wine materials – – – – – 2 3 – – – Beer – – – – 8 – 12 – 14 – Source: Central Databank of Law Information of the Ministry of Justice (5) Alcohol excise revenue From 2009 to 2011 excise rates for vodka and liquors did not change, and respective revenues were lower in 2011 than in 2009 (Table 3). Excise rates for vodka and liquors were increased in three stages, in 2012, 2013 and 2014 (see Table 2), and by late 2014 these rates were almost three times higher than they had been in early 2012. In 2014 domestic revenues were 2.8 times higher than the average annual revenue in 2009–2011 (Table 3). In 2015–2016 excise rates were not changed, but revenues started to decline because of a sharp fall in taxable volumes of vodka and liquors. Through the government order No. 139 of March 2013, which came into effect in April of that year, the excise rate for wine increased by 50% (see Table 2). After the tax rate increase, the average annual wine revenue was almost twice as much as it had been in previous years (Table 3). Beer revenues substantially increased after the excise rate hikes in 2011, 2013 and 2014 (see Table 2). The excise rate was increased by 75% in 2013–2014, and annual total beer revenues in 2014 and 2015 were 68% higher than in 2012. In 2015–2016, when excise rates did not change, beer revenue declined slightly. Increases in alcohol excise rates, introduced in 2012, 2013 and 2014, substantially increased government alcohol revenues. No excise rate increases were introduced in 2015–2016. Wine and beer revenues remained fairly stable in 2015–2016 as taxable sales of wine and beer did not change much. According to the forecast of the State Tax Service, no increase in excise rates and revenue was expected in 2017 (Table 3). 5Table 3. Alcohol excise revenues in Kyrgyzstan, by beverage type and origin (in million som), 2009–2017a Year 2009 2010 2011 2012 2013 2014 2015 2016 2017 Domestic alcohol Vodka, liquors and cognac 331 263 313 403 597 758 523 486 436 Wine 16 17 14 14 25 30 25 32 27 Beer 78 72 139 173 261 358 377 357 372 Total domestic 425 352 467 590 884 1146 925 875 835 Imported alcoholb Vodka, liquors and cognac – – – 85 108 145 98c 79c – Wine – – – 8 17 14 6c 9c – Beer – – – 143 178 176 150c 139c – Total imported – – – 236 303 335 254 227 – Total domestic and imported Vodka, liquors and cognac – – – 487 705 903 621 565 – Wine – – – 22 42 44 31 41 – Beer – – – 316 439 534 527 496 – Total domestic and imported – – – 825 1186 1481 1179 1102 – a The forecast for 2017 is taken from the State Tax Service (15). b Data on revenue from imported alcohol before 2012 are not available. c Data on import revenue were corrected with data on imports from the Eurasian Economic Union (EAEU) countries in 2015 and 2016. Alcohol sales and recorded consumption Fig. 2 shows sales of alcoholic beverages in Kyrgyzstan between 2002 and 2015, as reported by the National Statistics Committee (16, 17). Between 2002 and 2007 spirits and beer sales increased, while sales of wine decreased. Between 2007 and 2015 reported sales were fairly stable for all three kinds of alcoholic beverage. The turnover of alcoholic beverages (production plus import minus export) for 2006–2016 was calculated using data from the National Statistics Committee (8) and the State Customs Service (9). In August 2015 Kyrgyzstan joined the EAEU, and since that time the Customs Service has not reported import data from EAEU countries. For this reason, alcohol export data from the Russian Federation, Armenia and Kazakhstan from 2015 and 2016 are used to estimate the total volume of imports. Taxable sales (excise revenue divided by excise rate) for 2012–2016 were estimated using data on revenues for specific alcoholic beverages (see Table 3) and excise rates (see Tables 1 and 2).1 In 2012–2014 the turnover and taxable sales figures were very similar. In 2015 the turnover was slightly higher, probably as a result of underreporting of revenues from imported alcohol after Kyrgyzstan joined the EAEU. While the turnover (Table 4) and the taxable sales are very similar, they differ substantially (especially for liquors and wine) from the reported sales figures (see Fig. 2). 1 Calculations of taxable sales are available on request. 6Fig. 2. Trend in reported sales in Kyrgyzstan by beverage type, 2002–2015 0 10 20 30 40 50 60 Beer Wine Vodka, liquors and cognac 20152014201320122011201020092008200720062005200420032002 M ill io n lit re s Source: Nati onal Stati sti cs Committ ee (16, 17) Table 4. Turnover of alcoholic beverages (in million litres), 2006–2016 Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Producti on Vodka, liquors and cognac 14.9 14.7 15.5 14.3 13.0 16.5 16.4 17.0 14.0 9.7 8.3 Wine 2.7 2.0 1.6 1.6 1.8 1.6 0.7 1.8 0.8 1.6 1.8 Beer 11.0 14.0 15.4 15.2 18.0 21.2 21.9 23.9 27.1 26.3 23.9 Import minus export Vodka, liquors and cognac 1.1 1.9 3.8 2.4 2.1 3.2 3.5 2.9 3.0 1.5 1.3 Wine 0.7 1.5 1.5 1.7 1.8 1.3 1.9 1.8 1.4 1.7 1.8 Beer 24.5 30.2 31.0 26.3 20.7 21.5 17.5 15.9 13.9 10.7 9.4 Turnover (producti on plus import minus export) Vodka, liquors and cognac 16.0 16.6 19.3 16.7 15.1 19.7 19.9 19.9 17.0 11.2 9.6 Taxable vodka, liquors and cognac – – – – – – 20.2 20.0 17.0 10.6 9.7 Wine 3.5 3.5 3.1 3.2 3.3 2.9 2.6 3.5 2.2 3.3 3.6 Taxable wine – – – – – – 2.6 3.6 3.0 1.8 2.4 Beer 35.5 44.2 46.4 41.5 38.7 42.7 39.4 39.8 41.0 37.0 33.3 Taxable beer – – – – – – 39.5 39.9 41.1 34.8 35.5 Alcohol turnovera 8.7 9.4 10.6 9.3 8.6 10.4 10.3 10.4 9.1 6.8 6.0 Source: Author’s calculati ons using data from (6–8) a In pure alcohol. 7Alcohol turnover increased between 2006 and 2008, declined in 2009–2010, and then increased again. After excise tax hikes in 2012–2014, alcohol turnover stabilized and then declined in 2014–2016. There are two probable explanations for the decline in alcohol turnover: (i) legal alcohol consumption was replaced by illicit consumption, as legally available vodka became too expensive after the excise increases (18); and (ii) alcohol consumption really declined because alcohol became less affordable after the excise increases. Prices The National Statistics Committee publishes monthly data on average prices for selected alcoholic beverages (Table 5) (19). Sharp shifts in vodka and red wine prices in January 2011, compared with December 2010, are probably due to changes in the procedure for calculating the average price, as there were no changes in alcohol taxation at that time. Table 5. Average annual prices of alcoholic beverages (in som), 2003–2016 Year 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Vodka 0.5 L 34 34 35 37 42 50 56 62 111 121 145 158 169 173 Cognac 0.5 L 116 117 130 149 170 183 213 234 253 277 295 338 382 395 Red wine 0.7 L 65 63 62 64 65 68 79 92 186 217 227 194 180 203 White wine 0.7 L 110 108 117 130 140 146 155 170 178 194 203 205 211 231 Sparkling wine 0.7 L 91 92 91 107 125 129 137 138 142 153 165 176 187 200 Beer in bottles 0.5 L 17 17 20 23 24 29 32 34 39 42 45 50 54 55 Beer in cans 0.33 L 26 26 21 20 21 24 25 26 29 31 34 37 40 40 Source: National Statistics Committee (19) The excise share in the average price in 2016 was fairly low: 17% for vodka, 3% for wine and 13% for beer (based on calculations using data from Tables 2 and 5). Fig. 3 shows the CPI for alcoholic beverages and for all goods and services (an indicator of inflation). Between 2003 and 2011, alcohol prices rose above the level of inflation only in 2009. However, from 2012 to 2016, alcohol prices remained above the level of inflation in every year except 2015. In the five years from 2012 to 2016, alcohol prices rose by 48% while inflation in the same period was 26%. 8Fig. 3. Annual consumer price indices (CPI) for all goods and services and for alcoholic beverages (previous year = 100), 2003–2016 95 100 105 110 115 120 125 20162015201420132012201120102009200820072006200520042003 CPI all items CPI alcoholic beverages CP I Source: Nati onal Stati sti cs Committ ee (8) In January 2013, the government set a minimum price of 70 som for a 0.5-litre bott le of vodka (20). In June 2014, the minimum price was increased to 90 som. However, the minimum prices were well below the average prices (see Table 5). Between 2012 and 2014 the excise rate for vodka increased from 21 to 60 som per litre (corresponding to an increase of 19.5 som per 0.5–litre bott le) (see Table 2). However, the average price increased by 47 som from 2011 to 2014 (Table 6). Alcohol producers increased their (net-of-tax) part of the price to a much greater extent than the excise increase. Between 2012 and 2016 the net-of-tax price of vodka increased above the level of infl ati on. Table 6. Average price of vodka (in som per 0.5 litre), December 2011–2016 Year 2011 2012 2013 2014 2015 2016 Excise 11 13 20 30 30 30 VAT 12 14 16 18 18 19 Net-of-tax price 94 104 115 116 124 127 Price (excise plus VAT plus net-of-tax) 117 131 151 164 172 176 Source: Nati onal Stati sti cs Committ ee (8) Alcohol aff ordability Price increases correlate with a reducti on in the harm caused by alcohol, but only when alcohol becomes less aff ordable. One of the main determinants of alcohol consumpti on and alcohol-related harm is aff ordability, a composite measure of the price of alcohol relati ve to the price of other goods, adjusted for income. The European acti on plan to reduce the harmful use of alcohol, 2012–2020 recommends using the aff ordability of alcohol (measured by comparing the relati ve alcohol 9price index against the real household disposable income index) as an indicator of alcohol taxation policy (3). Table 7 shows alcohol affordability in Kyrgyzstan for the years 2006–2015 (for the calculations used, see Methods above). Table 7. Alcohol affordability in Kyrgyzstan (in som), 2006–2016 Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 CPI for all itemsa 105.6 110.2 124.5 106.8 108.0 116.6 102.8 106.6 107.5 106.5 100.4 CPI for alcohola 102.6 105.2 117.6 109.8 106.4 107.1 109.2 112.3 109.1 106.4 103.7 Relative alcohol price index 97.2 95.5 94.5 102.8 98.5 91.9 106.2 105.3 101.5 99.9 103.3 Disposable per capita household income (som per month) 1112 1417 2029 2312 2494 2936 3216 3336 3958 4075 – Changes in household incomea – 127.5 143.1 114.0 107.9 117.7 109.5 103.7 118.6 103.0 – AAI–income – 21.2 21.7 3.8 1.4 9.9 0.3 –7.6 8.7 –3.2 – GDP per capita changea 102.0 107.5 107.4 101.6 98.4 104.7 98.3 108.7 102.0 101.4 – AAI–GDP 5.0 12.6 13.7 –1.1 –0.2 14.0 –7.5 3.2 0.5 1.5 - a Previous year = 100. If the AAI has a negative value, it means that alcohol became less affordable than in the baseline year, and alcohol consumption is expected to fall. From 2006 to 2008 relative alcohol prices fell, while income was rising. Alcohol became more affordable and some increase in alcohol turnover (especially beer) was observed between 2006 and 2008 (see Table 4). In 2009–2010 alcohol affordability did not rise as in previous years because income growth stagnated during the economic recession. In 2011 relative alcohol prices fell and income started to rise again, so alcohol affordability increased. Such changes in affordability could explain trends in alcohol turnover during these years: a decline in 2009–2010 and an increase in 2011 (see Table 4). In 2012, 2013 and 2014 relative alcohol prices increased (see Table 7) mainly as a result of the increase in excise rates, and alcohol affordability fell as well as alcohol turnover. The decline in alcohol affordability between 2012 and 2016 was fairly small for the population as a whole. However, there is evidence that people in low socioeconomic groups are even more responsive than other groups to changes in the affordability of alcohol, probably because expenditure on alcohol constitutes a greater proportion of their income (21). Trends in alcohol-related harm Morbidity According to national health reports (22, 23), the number of individuals diagnosed with alcoholism and alcohol psychoses was fairly stable between 2005 and 2011, but then fell sharply between 2012 and 2014 (Fig. 4) (24). By 2014 this number had fallen to half the annual average in the period 2006–2011. From 2005 to 2012 the number of people treated for alcoholism and alcohol psychosis increased by 38%, but from 2012 to 2015 it fell by 26%. Research conducted in Poland (26), the Russian Federation (27) and Belarus (28) indicates that the incidence of alcohol psychosis is closely correlated with total alcohol consumption. This suggests that the incidence of alcohol psychosis can serve as an indicator of the burden of alcohol-related problems. 10 Fig. 4. Individuals treated for alcoholism and alcohol psychosis, and newly registered cases of alcoholism and alcohol psychosis (per 100 000 populati on), 2005–2015 0 100 200 300 400 500 600 700 800 0 10 20 30 40 50 60 70 20152014201320122011201020092008200720062005 Individuals treated New cases registered 53 63 61 661 687 545 589 627 58 59 718 742 54 56 751 727 674 557 49 31 27 24 nd iv id ua ls tr ea te d New cases registered Source: Nati onal Stati sti cs Committ ee (22–24) Mortality Mortality due to mental and behavioural disorders declined sharply in 2009–2010; it then increased slightly in 2011 and declined every year between 2012 and 2015 (Fig. 5). Death due to alcohol poisoning declined steadily between 2006 and 2016, with sharper falls in 2009, 2013 and 2016. Mortality due to alcohol poisoning has some limitati ons as an indicator of alcohol consumpti on. A study from the Russian Federati on, which analysed autopsy records, found lethal or potenti ally lethal blood concentrati ons of ethanol in an excepti onally high proporti on of cases where death had been att ributed to cardiovascular disease; this suggests that these deaths were due to alcohol poisoning rather than cardiovascular disease (29). A substanti al proporti on of cases of alcohol poisoning were misclassifi ed as cardiovascular deaths, perhaps to reduce the social sti gma involved. Mortality from external causes was fairly stable between 2006 and 2010 (with a fall in 2009) and then declined in each successive year to 2016. 11 Fig. 5. Mortality due to various alcohol-related causes (per 100 000 population), 2006–2016 0 10 20 30 40 50 60 70 80 0 1 2 3 4 5 6 7 8 9 20162015201420132012201120102009200820072006 External causes of death Alcohol poisoning Mental and behavioural disorders 73.6 71.2 71.6 64.0 72.2 65.5 61.9 55.1 53.2 52.2 45.7 7.7 6.9 6.5 5.2 5.8 5.4 5.3 4.7 5.0 5.1 4.1 2.4 2.3 2.1 1.6 1.3 1.4 1.2 1.0 0.8 0.7 Source: National Statistics Committee (22, 23, 25) Alcohol-related mortality and alcohol morbidity in Kyrgyzstan followed opposite trends between 2006 and 2011, but from 2012 to 2014 both fell. This indicates that alcohol consumption in Kyrgyzstan declined in the latter years. Alcohol taxation policy in Kyrgyzstan and the EAEU Kyrgyzstan is a member of the EAEU. The draft agreement on principles for alcohol and tobacco excise tax policy implementation in the countries of the EAEU was published in October 2015 (30). Article 4 proposes indicative, minimum and maximum excise tax rates for some alcoholic beverages in the period 2016–2020, expressed in euro (€). According to the agreement (31), Kyrgyzstan should have excise rates for 1 litre of vodka (40% ABV) which exceed €1.54 (116 som) in 2017; €2.08 in 2018; €2.52 in 2019; and €3.2 (240 som) in 2020. The current excise rate is 70 som (€0.93 euro), so to meet the minimum EAEU rates it should be increased by 66% in 2017 and by 243% by 2020. Currently, Kyrgyzstan has a lower excise rate for vodka than its neighbours (Table 8). According to the Kazakhstan Statistics Committee, in February 2017 the price of 1 litre of vodka in Kazakhstan was 2169 tenge (36) (equivalent of 477 som), while in Kyrgyzstan it was 352 som (19). In 2016, the excise rate for vodka in Kyrgyzstan was 60 som (see Table 2); if the excise rate was increased to the minimum EAEU level of 116 som (an increase of 93%), the excise burden per litre would increase by 62 som (56 som excise plus 6 som VAT), and the average retail price of a 0.5-litre bottle of vodka would increase from 176 som to 207 som, or by 18%. A recent meta-analysis estimated that the world average price elasticity for spirits is –0.55 (35). Even if we assume that the price elasticity in Kyrgyzstan is almost twice as high (–1.0), the taxable turnover for vodka and liquors will also decrease by 18%: from 10 million litres (the average annual level in 2015–2016) to 8.2 million litres. The projected annual revenue will then be 8.2 x 116 = 950 million som, while the current annual revenue is only about 700 (10 x 70) million som. However, excise tax increases should be accompanied by government efforts to reduce the illicit alcohol market and tax avoidance. 12 Table 8. Excise rates for alcoholic beverages in Kyrgyzstan, Kazakhstan, Tajikistan, Uzbekistan and the Russian Federation, 2017 Vodka, per litre Vodka, per litre of pure alcohol Beer, per litre Wine, per litre Country National currencya Euro National currencya Euro National currencya Euro National currencya Euro Russian Federation – – 523 8.50 21 0.34 18 0.29 Uzbekistan 8907 2.35 – 5.87 641.6 0.17 635.8 0.17 Kazakhstan – – 2000 5.88 39 0.11 35 0.10 Tajikistan – – 2.5 2.50 0.1 0.10 0.25 0.25 Kyrgyzstan 70 0.93 – 2.33 14 0.19 9 0.12 Source: (32–35) a National currencies: Russian Federation – ruble; Uzbekistan – Uzbek som; Kazakhstan – tenge; Tajikistan – somoni (but excise rates are set in euro); Kyrgyzstan – Kyrgyz som. Excise rates hikes for beer and wine in 2013 and 2014 in Kyrgyzstan substantially increased excise tax revenue from beer and wine in those years because the turnover of these beverages decreased by a much smaller amount than the excise rate increased (see Tables 2–4). As the share of excise tax in the beer and wine price is very low, even a large increase in excise rates will not significantly increase their prices, and this can lead to an increase in government revenues. 13 Discussion Kyrgyzstan is a predominantly rural country with a population of 6 million (as of 2016), of which 73% are ethnic Kyrgyz, 15% Uzbeks and 6% Russians. Ethnic Russians in Kyrgyzstan have higher recorded mortality rates, despite their assumed advantageous socioeconomic status relative to the native ethnic groups (38). In various populations around the world, subgroups with a higher socioeconomic status tend to have lower mortality rates; the fact that the opposite has been found to be the case in many post-Soviet countries has been termed the “Russian mortality paradox” (39). Guillot et al. (38) found that excess mortality among adult Russians in Kyrgyzstan is probably not due to data artefacts or migration effects; rather, they came to the conclusion that the higher rates can be explained by important ethnic differences in cause-specific mortality. Although many causes of death contribute to the observed differences, alcohol has been identified as a major factor, especially for males (38). Levels of adult mortality in Kyrgyzstan are lower than in the Russian Federation, and a recent study (40) showed that the observed mortality gap between the two countries is overwhelmingly attributable to causes strongly related to alcohol consumption. The drinking pattern among Russians (or, more generally, among Slavs) is a specific set of practices that involves binge- drinking of hard liquors (vodka, in particular) and is an inherent part of many social rituals, such as birthdays, weddings and other celebrations (41). In contrast, alcohol consumption is a much less inherent part of social rituals in central Asia, where the social stigma attached to drunkenness appears to be greater (42). The extent to which this is directly due to the influence of Islam and its prohibition of alcohol consumption is not clear. Although the influence of Islam on everyday life in contemporary Kyrgyzstan is relatively small, it is increasing, and in many communities the sale of alcoholic beverages is prohibited. Kyrgyz and Uzbeks have been influenced to some extent by drinking habits which were historically common in the Soviet Union, so the health benefits of low alcohol consumption for Kyrgyz and Uzbeks may disappear without strong policies relating to alcohol. WHO identifies availability, marketing and affordability of alcohol as the areas where control measures have the strongest potential to contribute to a reduction in the burden of noncommunicable diseases (4). There is a total ban in Kyrgyzstan on selling alcohol to children and young people under 18, and it is now prohibited to sell alcohol products near schools, other educational institutions and health facilities. New restrictions on advertising alcohol have been introduced. The Kyrgyz Ministry of Health has been taking steps towards developing and implementing a national policy on alcohol consumption. In order to protect public health, alcohol taxes may need to be adjusted to ensure that alcohol does not become more affordable. The existence of a substantial illicit or informal market for alcohol can complicate formulation of policy concerning alcohol taxes. In such circumstances, tax increases should be accompanied by government efforts to control these markets (3). Kyrgyzstan implemented a fairly strong alcohol taxation policy in the period 2012–2014 (see Table 2), which reduced alcohol affordability in the country (see Table 7) and led to a decline in alcohol turnover (see Table 4), alcohol consumption and alcohol-related harm (see Fig. 4 and 5). The reduced affordability of alcohol in 2009–2010 (see Table 7) may also have contributed to the observed decline in alcohol-related mortality over those years (see Fig. 5); however, the main factor in the reduction in affordability was income stagnation during the economic recession. This observation confirms that affordability is one of the main determinants of alcohol consumption and alcohol-related harm. Alcohol excise revenue increased substantially in the period 2012–2014 but then started to decline (see Table 3), mainly as a result of a sharp reduction in vodka turnover. The government did not change alcohol excise rates in 2015–2016, apparently anticipating that frozen excise rates would help to revive alcohol turnover and increase revenue. But this did not happen, and both vodka turnover and vodka revenue continued to decline in 2015–2016. However, alcohol excise revenue in 2016 was much higher than in 2011 and previous years, so in the long run the alcohol taxation policy of 2012–2014 was beneficial in both fiscal and public health terms. Vodka and liquor turnover declined by almost 50% in the period 2013–2015, and while alcohol consumption did fall, this cannot explain such a sharp decline in the recorded turnover. It is likely that various forms of tax avoidance were used by 14 alcohol producers and importers. Illicit vodka consumption increased, but this increase did not compensate for the decline in legal alcohol consumption, as mortality and morbidity statistics demonstrate. Excise rates for beer and wine were also frozen from 2014 (see Table 2), while their turnover decrease was rather small (see Table 4). Wine and beer excise revenues declined slightly in 2015–2016 after the sharp rise between 2012 and 2014 (see Table 3). Conclusions Kyrgyzstan implemented fairly strong alcohol taxation policies in the period 2012–2014, which reduced alcohol affordability in the country and led to a decline in alcohol turnover, alcohol consumption and alcohol-related harm. There is great potential for Kyrgyzstan to increase excise rates for all alcoholic beverages in the years to come; such increases are likely to be beneficial for both public health and tax revenues. However, tax increases should be accompanied by government efforts to control illicit alcohol markets. 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PloS One. 2013;8(10):e75314 (http://journals.plos.org/plosone/ article?id=10.1371/journal.pone.0075314, accessed 13 June 2017). 41. Cockerham WC. Health lifestyles in the Russian Federation. Soc Sci Med. 2000;51:1313–24 (https://www.ncbi.nlm.nih. gov/pubmed/11037219, accessed 13 June 2017). 42. Cockerham WC, Hinote BP, Abbott P, Haerpfer C. Health lifestyles in central Asia: the case of Kazakhstan and Kyrgyzstan. Soc Sci Med. 2004;59:1409–21 (https://www.ncbi.nlm.nih.gov/pubmed/15246170, accessed 13 June 2017). 43. Status report on alcohol and health in 35 European countries, 2013. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2013/status-report-on- alcohol-and-health-in-35-european-countries-2013, accessed 13 June 2017). 19 Annex 1 Trade codes for alcoholic beverages in Kyrgyzstan Beverage type Trade code Undenatured ethyl alcohol of an alcoholic strength by volume of 80% or higher; ethyl alcohol and other spirits, denatured 2207 Vodka 220860 Liquors 220830; 220870; 20890 Fortified beverages 220840; 220850 Cognac 2208201200-2208202900; 2208206200-2208208900 Low-alcohol beverages 2208906901; 2208906909 Wine 2204 (except 220410; 220430); 2205; 2206 Sparkling wines 220410 Wine materials 220430 Beer 2203 The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00 Fax: +45 45 33 70 01 E-mail: eucontact@who.int