Public health science and minimum unit pricing for alcohol: learning from Scotland

Abstract

BackgroundIn 2006, The Lancet published a landmark paper showing a substantial increase in liver cirrhosis mortality in Scotland in the 1990s. Faced with this major public health challenge, and coinciding with a shift to an outcomes-based approach to formulate policy, in 2009 the Scottish Government set out a long-term strategy to change Scotland's relation with alcohol. We draw attention to the crucial role that public health science played in the successful passing of legislation to implement a minimum unit price (MUP) for alcohol in Scotland. MethodsEvidence-informed logic models were developed to show that the long-term outcome of reduced alcohol-related harm in Scotland could best be achieved through a fall in population consumption, with pricing policies a key mechanism to achieve this outcome. The Monitoring and Evaluating Scotland's Alcohol Strategy (MESAS) programme of work was established to assess the effect of alcohol policy in Scotland and to identify unintended consequences. Indicators to monitor implementation and outcomes were identified. Few data to robustly measure alcohol consumption and price led to the purchase of data for alcohol retail sales for the periods 1994–1995 and 2000–2017. Analyses of these data, together with a portfolio of other in-house and commissioned studies, were undertaken. Regular engagement with the Scottish Government facilitated the production of outputs that were timely, relevant, and responsive to policy needs. FindingsThe use of alcohol retail sales data enabled the true scale of alcohol consumption in Scotland to be measured. In 2011, the volume of pure alcohol sold per adult in Scotland was 20% higher than in England and Wales. Indeed, enough alcohol was sold in Scotland in 2011 for every adult to exceed the recommended weekly drinking guidelines for men. Volumetric price distribution data showed that the difference between Scotland and England and Wales was driven largely by higher off-trade sales of spirits, particularly cheap vodka. A rightward shift in the price distribution between 2009 and 2011 indicated that at a specific pence per unit threshold, the proportion of alcohol sold below that threshold diminished over time. Outputs presenting MESAS findings achieved widespread media coverage and informed public debate on alcohol policy. They contributed to parliamentary processes and informed national decision making that resulted in the new MUP legislation. The reports have been widely cited and used to inform the setting of the 50 pence per unit MUP, and the proposal for review of the MUP threshold every 2 years. Crucially, the existence of MESAS and its assessment plans helped to inform the development of the review clause in the Alcohol (Minimum Pricing) (Scotland) Act 2012. This Act embeds in legislation the requirement for robust assessment of a new policy to inform future decisions, ensuring public health science continues to be at the heart of alcohol policy making in Scotland. InterpretationThe Scottish experience programme has shown that long-term engagement with national policy makers and other stakeholders, together with the publication of timely and relevant outputs based on robust data and analysis, is beneficial to ensure that research and assessment appropriately affect public health policy in Scotland. FundingThe Scottish Government fund the purchase of alcohol sales and price data.