Ending Prohibition May Have Cost More Lives Than It Saved

New research shows how easy access to alcohol has real downsides.

At approximately the same time women across the United States were organizing for suffrage, many activists in that movement set their sights on reining in easy access to alcohol. They viewed women as among the primary victims of the bottle, as intoxicated men would frequently abuse their spouses and families.

Susan B. Anthony, the social reformer known for her campaigns against slavery and for voting rights for women, was also one of America’s most famous agitators for banning alcohol. Along with Elizabeth Cady Stanton, Anthony founded the Women’s State Temperance Society in upstate New York.

She soon came to link the cause of women’s suffrage to that of Prohibition, telling the Anti-Saloon League that their only hope for success “lies in putting the ballot into the hands of women.”

In 1919, these activists won their biggest fight by passing the 18th Amendment, which banned the manufacture, sale, and transportation of liquor at the federal level. Until 1933, when the amendment was repealed, the United States embarked on a grand experiment.

Today, that experiment is largely viewed as a failure. Prohibition merely empowered organized crime, the narrative goes, while doing little to meaningfully reduce alcohol consumption or improve human outcomes.

But new research complicates this narrative.

Researchers David Jacks, Krishna Pendakur, and Hitoshi Shigeoka looked at some of the quantitative effects of Prohibition, starting with a review of alcohol consumption during that time. Interestingly, their review of the literature shows that Prohibition actually reduced the level of consumption of alcohol considerably; it took decades for consumption to return to prior levels:

As with anything that effectively functions as a large tax on a product, there was a sizeable impact on consumption due to Prohibition. Contrary to public opinion, total alcohol consumption per person fell by 63% from 1910 (the high-water mark of pre-Prohibition drinking activity) to 1934 (the first full year of repeal). And while illegal sources of alcohol were indeed available prior to and even after 1934, it took until 1973 for apparent per-capita alcohol consumption to recover from the shock of Prohibition. 

The researchers note that some individual counties continued to keep restrictions in place after the federal repeal of Prohibition, which gave them an ample data set to compare and contrast outcomes.

They found a pair of outcomes that shine some light on the costs and benefits of repealing Prohibition. First, they discovered a significant increase in infant mortality:

We find that repeal was associated with equivalent and significant increases in infant mortality in both counties that chose to allow for the sale of alcohol (wet counties) and in neighbouring counties that chose not to (dryish counties), suggesting a large role for cross-border policy spillovers. In other words, some people in dry counties found the temptation of alcohol just across the border too tempting to resist.

Cumulatively, we estimate that 4,493 annual excess infant deaths could be attributed to the repeal of federal Prohibition. We have some evidence that this was due to an increase in maternal alcohol consumption by problem drinkers during pregnancy, but other mechanisms are possible.

They also found a reduction in urban deaths, associated with fewer homicides and accidents:

When we combine our estimates with the timing of these transitions by cumulating homicides and other accidents by wet status, a back-of-the-envelope calculation suggests an annual reduction of 3,418 urban deaths (565 fewer homicides plus 2,853 fewer other accidents) that could be attributed to the repeal of federal Prohibition.

Over email, Jacks pointed out to me that “homicides were not all that high even during Prohibition (maybe 12k per year) versus tens of millions of births.”

It’s very likely, then, that repealing curbs on alcohol consumption had on the whole negative effects on public health — it cost more lives than it saved.

That isn’t by itself an argument in favor of Prohibition. Denying people the freedom to consume what they wish is in and of itself a cost, and there are philosophical arguments against prohibiting alcohol consumption (or the consumption of other drugs) that are generally well-received in a country as libertarian as ours.

But the research does show that the Prohibition era was not exactly as it was commonly portrayed. Alcohol consumption went down, and we did see fewer deaths during this period.

Coming to terms with this need not necessarily lead us down the road to another 18th Amendment. There are ways to discourage excess alcohol use, like increasing taxes on liquor. You don’t have to be in favor of Sharia Law to acknowledge, as one other recent study did, that alcohol consumption is fundamentally harmful to our bodies, and that it has real public health costs.

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