Ranking alcohol pricing policies in Belgium: effectiveness, equity and feasibility

Background

Alcohol pricing policies including minimum unit pricing (MUP) and taxation are effective tools to reduce alcohol-related harm, yet their comparative effectiveness and feasibility in Belgium remain insufficiently systematically assessed. We developed a policy league table to rank pricing scenarios and support prioritisation under the Interfederal Alcohol Strategy (2023–2028).

Methods

Using a comparative risk assessment framework, we appraised pricing scenarios: MUP (0.40–0.75€/unit), excise tax increases (ad valorem, volume- and alcohol-content-based) and combinations. Product-level price changes were translated into consumption changes using beverage-specific elasticities and market shares, then linked via relative risk functions to estimate potential impact fractions and avoidable mortality. Scenarios were ranked in a league table, integrating effectiveness with qualitative appraisal of equity and political feasibility, informed by stakeholder consultation and conducted in collaboration with Ministry of Health to support ongoing policy discussions.

Results

A 10% ad valorem tax produced the largest population effect (up to 8.5% consumption reduction; ∼4000 deaths avoided), followed by high MUP levels (up to 6.4%; ∼2500 deaths). Combined MUP-tax scenarios yielded moderate gains (up to 4.4%; ∼2000 deaths). Lower MUP thresholds and increases in current alcohol- or volume-based taxes produced smaller effects (1.2-2.2%; ∼650-1000 deaths). Broad tax increases maximised population impact, while MUP targeted cheap, high-strength alcohol consumed disproportionally by heavier drinkers, offering greater equity potential.

Conclusions

Pricing policies in Belgium show distinct, complementary impact pathways. Broad taxation maximises population health gains, while MUP targets high-risk consumption. The league table framework translates these trade-offs into actionable guidance, supporting ongoing prioritisation of alcohol policy.

Key messages

• Broad tax increases generate the largest population health impact, while minimum unit pricing policies provide more targeted effects on high-risk drinking.

• League tables help translate complex modeling into an actionable policy strategy.