Taxation of traditional rums in French overseas territories and public health: The example of Reunion Island

Background. - France has a complex system for the taxation of alcoholic beverages. In the French overseas territories (FOT), the system includes little-known specificities whose purpose is to preserve the sugar-cane-rum sector, a pillar for the weak economies in these territories. Taxes are reduced for traditional rums produced and sold locally. This favors the marketing of alcoholic spirits at low prices. In metropolitan France, on the contrary, spirits are heavily taxed drinks and their share in consumption is minor. Reunion Island (RI) is a FOT confronted with significant socioeconomic precariousness and with one of the highest national morbidity and mortality rates associated with alcohol abuse. Spirits account for half of the total consumption of pure alcohol, with a strong predominance for local traditional rums. These products are preferentially consumed by vulnerable subjects, often affected by an alcohol-use disorder. Methods. - This study consists of three parts. First, a comparative analysis of alcoholic beverage prices between RI and mainland France. Second, an analysis of the bibliography on the consequences of preferential consumption of spirits. Third, a literature review on the impact of taxation on alcohol-related morbidity and mortality. Results. - In France, the cheapest gram of pure alcohol is found in the FOT. The preferential consumption of spirits is associated with more frequent and more rapid complications. It is correlated with the level of alcoholic psychoses. Taxation is effective in reducing damage caused by the abuse of alcoholic beverages. The World Health Organization recommends the application of a minimum price for alcohol and tax increases. Conclusion. - The reduced taxation of the traditional rums of the FOT does not take into account public health data. Its purpose is economic. In RI, it contributes to a high level of consumption of spirits and encourages excess mortality through alcohol abuse. It constitutes an inequality of health for these populations. Changes in this tax system is desirable in order to reduce the harm caused by alcohol. It should be closer to the tax system in force in metropolitan France. Alcohol lobbies and lack of political courage have so far inhibited this change to the detriment of the health of the populations. (C) 2017 Elsevier Masson SAS. All rights reserved.