It took the Scottish Government a significant amount of time to implement its minimum unit pricing policy for alcohol. Minimum Unit Pricing, as the name suggests, applies a fixed cost for each unit measured in an alcohol-based drink such as wine or beer. The levy set by the Scottish Government back in May 2018 was 50 pence per unit of alcohol.
The delay in implementing this policy was due to the way the alcohol industry fought its introduction, taking legal action in an effort to thwart the Scottish Government’s plan. Although unsuccessful, this delayed the introduction of the policy by several years.
The alcohol industry knows that its most loyal customers are those that consume the greatest quantity of alcohol. Any policy intervention that aims to reduce sales to this group is viewed as a threat to their business.
The Scottish Government introduced this policy in an attempt to reduce the harm to health caused by alcohol. Scotland has the highest rate of deaths due to alcohol in the UK, with 22.4 deaths per 100,000 people (ONS, 2021).
As you’d expect there has been a lot of interest in this policy intervention and particularly to see whether it has had the intended impact by reducing overall consumption of alcohol in Scotland’s population. Despite this scrutiny, no studies had investigated whether the policy had any impact on mortality. This inspired the authors of a new paper (Wyper et al., 2023) to explore the data and see if the policy had any significant impact on alcohol-related deaths in Scotland.
Scotland has the highest rate of alcohol-related deaths in the UK compared to other regions.
Methods
The authors used routinely collected data on alcohol and deaths in England and Scotland, using England as a control group. They used a controlled interrupted time series that captured monthly figures on deaths due to alcohol. The time series started prior to the introduction of the policy, gathering data from January 2012 through to April 2018, the point of the policy introduction. They then gathered 32 months of data following the introduction of the policy, from May 2018 to December 2022.
This type of method provides a useful visual as well as statistical way of checking whether an event such as the introduction of minimum unit pricing had any impact on a variable in this case mortality.
Results
- In the 32 months following the introduction of minimum unit pricing for alcohol in Scotland, there was a 13.4% decrease in deaths due to alcohol. This equates to 156 lives saved by the policy intervention.
- They also found a 4.1% reduction in hospitalisations directly due to alcohol consumption over the same time period.
- These deaths are not spread equally as lower socio-economic areas have rates that are five times higher compared to those from higher socio-economic areas.
The introduction of minimum unit pricing for alcohol in Scotland led to a 13.4% decrease in alcohol-specific deaths and a 4.1% reduction in hospitalisations.
Conclusions
The authors provide a compelling analysis of the impact of the minimum unit pricing policy introduced by the Scottish Government. Rarely do policy interventions receive the attention that this one did, and many are not evaluated to see whether they achieved their goals or not.
Despite the importance of these policies, it is not only shameful but a waste of public money that they are often not followed up. Without analysis and evaluation, we are often left with no intelligence as to what works and what doesn’t in policy interventions. This is particularly troubling when it comes to individual and population health and specifically mortality.
It is to their credit that the Scottish Government introduced minimum unit pricing for alcohol as they faced formidable opposition from the alcohol industry. Perhaps that resistance signals the fact that they knew how effective the policy would be. If that is the case, it is not just a legal loss for the industry but a moral one too. To oppose a policy that can save lives in the pursuit of profits is cold, callous, and calculated.
This study suggests that at least 156 lives have been saved following the introduction of the new alcohol policy by the Scottish Government.
Strengths and limitations
The main strength of this study is the use of time series analysis as this fits well with the research question of whether minimum unit pricing had an impact on mortality. The authors included sufficient data points prior to and following the introduction of the policy in May 2018. As a result, this should minimise any random or coincidental findings.
That said, the authors flag up the issue of the COVID-19 pandemic which occurred during the study period. This matters as access to alcoholic drinks were in place as pubs and other outlets were closed during periods of the pandemic. In an attempt to mitigate this effect, the authors carried out a sensitivity analysis, but are clear that they can’t be sure how much the pandemic impacted the results.
The COVID-19 lockdowns may have impacted the findings to some degree, as people could not access alcohol in public places like pubs.
Implications for practice
Although there are many things individual practitioners can do to reduce the potential harm that alcohol can cause there are some things that lie outside their control – with the price of alcohol being one such thing. This requires government intervention and in this case, determination to see the idea being implemented.
One obvious piece of intelligence for practice is the clear link between social deprivation and risky alcohol consumption. As with other aspects of health, it is those that have the least that pay the greatest price including mortality. Knowing that alcohol consumption is elevated in this group could help target resources locally as practitioners and teams will have the knowledge of where these individuals are and aim to make access to treatment as easy as possible. However, given the continuing real-term decrease in treatment budgets, that could prove to be an ambition rather than the reality.
If funding is available, practitioners can be aware of social groups at higher risk of heavy alcohol consumption and tailor their service support to prevent negative outcomes.
Statement of interests
The author has no conflict of interest.
Links
Primary paper
Wyper, G. M. A., Mackay, D. F., Fraser, C., Lewsey, J., Robinson, M., Beeston, C., & Giles, L. (2023). Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: A controlled interrupted time series study. The Lancet, 401(10385), 1361–1370.
Other references
Office for National Statistics (2021). Alcohol-specific deaths in the UK: registered in 2021.
Photo credits
- Photo by Connor Mollison on Unsplash
- Photo by Kelly Sikkema on Unsplash
- Photo by CA Creative on Unsplash
- Photo by Linpaul Rodney on Unsplash
