Minimum Alcohol Pricing Research Articles

Policy windows and multiple streams: an analysis of alcohol pricing policy in England

This article adopts a multiple streams approach to examine the failure to implement minimum unit pricing (MUP) for alcohol in England. It demonstrates that the multiple streams model provides a valuable conceptual tool for explaining how and why policies are, and are not, enacted. However, it finds that while problem streams and policy streams are useful heuristic devices, in practice they may overlap and be mutually constitutive. The case of MUP also highlights the potential for policy spillover between jurisdictions and different policy contexts, showing both limits to, and the complex nature of, these processes. It shows the need for high level political commitment in order to implement controversial policies, even when they are backed by strong supporting evidence. Furthermore, it highlights the importance of civil society actors not just in bringing policy issues onto the agenda, but in supporting governments in adopting measures to address them.

Offline: Failure, and why we should fear

6 years. 6 years of trying to persuade politicians and policy makers that liver disease and its proximal determinants—obesity, alcohol, and hepatitis—should be taken more seriously. Did we succeed? The Lancet Commission into Liver Disease, chaired by the doyen of global hepatology, Professor Roger Williams, launched its final report last month in the austere yet hallowed rooms of the UK's Royal Society. I believe we made progress. The Commission provoked, incentivised, and stimulated evidence gathering that built and sharpened an argument for action. The Commission united what began as a fragmented response to the growing national burden of liver disease. 6 years ago, primary care, public health, and clinical services worked independently of one another. The Commission brought them together to forge a comprehensive strategy for change. And the Commission delivered awareness, attention, advocacy, and accountability—national liver disease profiles, the financial case for action on liver disease, and understanding the importance of living well for longer. These were surely tangible achievements. So why was the ambience at the gathering so sombre? It has taken me several weeks to try to understand. Roger Williams was blunt. We failed. We failed because there are still 1·2 million admissions to UK National Health Service (NHS) hospitals for alcohol-related illnesses. One in five patients drink harmful amounts of alcohol. One in ten are alcohol dependent. The total cost of alcohol-related ill health to the NHS is £3·5 billion annually. We failed because the continuing challenge of obesity has driven 4·7 million people into type 2 diabetes, at a further cost to the NHS of £6·1 billion. And we failed because specialist care for patients with liver disease remains appallingly inadequate. These are “unacceptable failures”. Should we not be hanging our heads in shame? Yes, but perhaps there are signs of hope. Karen Turner is Director of Prevention for NHS England. She pointed to a commitment in the latest NHS Long Term Plan to the creation of Alcohol Care Teams for hospitals with the highest rates of alcohol-dependence-related admissions. These teams could make a big difference. They will enable early intervention and access to comprehensive treatment for excessive alcohol use. They will educate staff about the dangers of alcohol. And they will reduce alcohol-related admissions and readmissions by identifying dependent drinkers and by engaging them in treatment. Even better, there will be additional money and services for the early identification and treatment of cirrhosis. But the truth still remains that the UK Government is unlikely to act at the root cause—the easy affordability of alcohol. Without tougher regulation of alcohol advertising, the implementation of a minimum unit price for alcohol, and controls over the place of sale of alcohol, there can be little prospect of making serious inroads into dangerous alcohol use. An even more important issue is obesity. There are few reasons to be hopeful when it comes to tackling today's epidemic of overnutrition. The most visible consequence of the obesity burden is a surge in cases of diabetes—there are 3·8 million people living with diabetes in the UK today, an intolerable pressure on society and the most serious challenge yet to the sustainability of the health system. Harry Rutter conjured up a formidable image. Envision the policies needed to quash obesity as being a 500-piece jigsaw puzzle. Today we have only 30 of those pieces in place. There must now be a direct attack on the commercial determinants of health. There must be a shift away from the individualising of risk. There must be an end to endless consultations, an end to short-term solutions, and an end to the moralising language of “sin taxes”. As Rachel Batterham emphasised, obesity is a disease, not a lifestyle choice. Obesity is a normal response to an abnormal environment. Unless we tackle that environment, we will continue to fail. So what should we conclude from this paradoxical mix of advances and disappointments? That unless countries follow the example of Singapore and implement whole-of-society approaches to urgent health predicaments—Singapore's “war on diabetes” being a shining example—there can be no hope for progress against obesity and its consequences. One feels forced to observe that in most western nations there is no prospect of such pan-society action. So yes, our Commission tried, but it did indeed fail. Yet honourably, I hope.

'Tied up in a legal mess': The alcohol industry's use of litigation to oppose minimum alcohol pricing in Scotland.

This article examines the alcohol industry's legal challenges to minimum unit pricing (MUP) in Scotland through the stages heuristic of the policy process. It builds on previous studies of alcohol pricing policy in Scotland and across the UK, and of the use of legal challenges by health harming industries to oppose health policy globally. Having failed to prevent MUP passing into law, industry actors sought to frustrate the implementation of the legislation via challenges in the Scottish, European and UK courts. However, the relevance of legal challenges is not limited to the post-legislative stage of the policy process but was foreshadowed in all earlier stages of the policy process. The potential for a legal challenge to MUP, and the alcohol industry's clearly articulated intention to pursue such action, was used by industry actors to seek to prevent the adoption of MUP in the agenda setting, policy formulation and legislative stages and created significant ‘regulatory chill’ in other areas of Scottish and UK alcohol policy. Litigation, and the prospect of it, was thus part of a coherent and integrated long-term strategy which adapted to changes in the political climate and to different stages in the policy process. While both the rhetoric and reality of litigation failed to prevent policy implementation, it succeeded in causing a delay of six years, imposing significant costs on the Scottish government and creating policy inertia in Scottish alcohol policy subsequently. Moreover, the inclusion of a ‘sunset clause’ in the legislation, requiring ongoing evaluation of the policy's effects, presents additional opportunities for the industry to reverse MUP. Thus, industry strategies to undermine MUP and delay further alcohol policy developments require ongoing attention by policy actors and scholars.

The Scottish case: minimum unit pricing for alcohol

Abstract There have been longstanding social and public health concerns about the levels of harmful alcohol consumption in Scotland. The Alcohol (Minimum Pricing) (Scotland) Act 2012 targets all alcohol sold through licensed premises in Scotland by ensuring it cannot be sold below a set minimum unit price. The pricing policy is currently set at 50p per unit of alcohol. Following a legal challenge and a vote in the Scottish Parliament, minimum unit pricing was implemented in Scotland on 1 May 2018. The aim of the Scottish alcohol policy has been to reduce the adverse public health consequences of alcohol consumption. It has also been identified as a potential measure for reducing health inequalities since alcohol-related harms are strongly socially patterned. The Scottish alcohol policy is important case to consider for a number of reasons. First, the nature of the policy differs. Rather than the introduction of a variable floor price, which may encourage switching in consumption from one product to another to maintain alcohol intake, minimum unit pricing introduces a price threshold that is uniform across all alcohol products. Second, minimum unit pricing is being introduced into a competitive commercial environment with strong vested interests, rather than a government-controlled monopoly. Third, the policy has been framed as a public health intervention, rather than primarily for revenue-raising reasons. Research on its development and evaluation will be considered to inform broader discussions on policy advocacy. Here we show a visualisation of the minimum unit pricing policy network to highlight how the public health community could work in more coordinated manner to support alcohol policy interventions.

Comparison of stakeholder coalitions across pricing policies designed to improve public health, as represented in UK newspapers: a discourse network analysis study

BackgroundNew methodological innovations are needed to better understand the role of complex stakeholder networks in gaining support for contested health policies. The news media provides a valuable setting for stakeholders to present arguments for and against such policies. We used two examples of UK policies, minimum unit pricing (MUP) for alcohol and the soft drinks industry levy (SDIL), to assess the value of discourse network analysis in comparing the competing discourse coalitions evident in the UK news media. We aimed to assess the similarities and differences in the composition and structure of policy discourse networks, and to find out whether public health advocates could use network insights to counter industry opposition to health policies. MethodsExisting discourse network analyses for MUP and SDIL were harmonised in Visone to allow direct comparison. We applied a common tie-weight threshold to reduce ties to robust argumentative similarities and used the Girvan-Newman edge-betweenness community detection algorithm to identify clusters of stakeholder subgroups with argumentative similarities within the discourse networks. We calculated network measures of size, density, and E-I index and used them to compare the principal coalitions in each network. FindingsBoth networks involved a similar range of stakeholder types and formed two discourse coalitions representing proponents and opponents of the policies. The SDIL network was larger (175 stakeholders) than the MUP network (87), particularly the proponents’ coalition (109 stakeholders for SDIL compared with 33 for MUP). The same concept (“policy is supported by the evidence”) was the most polarising concept in both networks. We were able to identify tight discourse coalitions of manufactures and commercial analysts acting in opposition to policy supporters in both debates. Public health actors appeared to be siloed in their areas of interest. InterpretationDiscourse network analysis enabled a novel direct comparison of the discourse coalitions across two highly contested pricing policy debates, allowing visualisation of the complex network of actors and relationships operating to potentially influence policy-making through the media. This method shows promise for better understanding of the common tactics used by different unhealthy commodity industries to disrupt public health policies and how public health actors could better work across policy and commodity arenas. FundingSH, CB, GF are funded by the UK Medical Research Council/Chief Scientist Office of the Scottish Government Health Directorates, and TH and PL by the University of Glasgow.

Public Health and the NHS at 70: Fit Enough for the Challenge of New Enemies in a New Landscape? An Example of Public Health Measures to Address Alcohol Consumption

Health for the many, and particularly the health of the poorest, has often been vulnerable to the commercial interests of powerful actors such as corporations and industry. This is exemplified by the efforts of the alcohol and tobacco industries to fight public health policies aimed at curbing alcohol and tobacco consumption: through the publishing of poor science, political lobbying and finally through legal action at national and international levels. There is clear evidence that better public health cannot be achieved solely through the promotion of healthy behaviour but also requires active efforts to counter those powerful entities with vested interests in commercial profit. The manner in which the British government’s commitment to introducing a minimum unit price (MUP) for alcohol in England and Wales saw an extraordinary U-turn has been described as a cautionary tale of the power of the alcohol industry to influence public health policy. In Scotland, where the bill was passed, legislative success was followed by a five-year legal battle with alcohol industry trade bodies. MUP as a policy exposed just how strategically and earnestly industry will fight to preserve its profits and its interests at the expense of public health.

Evaluating possible intended and unintended consequences of the implementation of alcohol minimum unit pricing (MUP) in Scotland: a natural experiment protocol

IntroductionScotland is the first country to carry out a national implementation of minimum unit pricing (MUP) for alcohol. MUP aims to reduce alcohol-related harms, which are high in Scotland compared...

Understanding public opinion to the introduction of minimum unit pricing in Scotland: a qualitative study using Twitter

ObjectivesOn 1 May 2018 minimum unit pricing (MUP) of alcohol was introduced in Scotland. This study used Twitter posts to quantify sentiment expressed online during the introduction of MUP, conducted...

A "buck a beer," but at what cost to public health?

Alcohol use leads to a substantial number of hospitalizations, and to increased health and social harms as well as economic costs in Ontario and across Canada. The effects of alcohol price changes on consumption and resulting harms have been firmly established; changes in the minimum price of alcohol have the greatest effect on consumption among people who for reasons of affordability consume low-priced alcoholic beverages, typically adolescents, people with lower socio-economic status, and people with harmful alcohol use. Decreases in inflation-adjusted minimum pricing in British Columbia from 2002 to 2006 have been associated with increases in deaths wholly attributable to alcohol. Furthermore, decreases in alcohol prices have been previously associated with increases in drink-driving, decreases in life expectancy, increases in road traffic injuries, violence, and alcohol poisonings, and long-term increases in deaths from infectious diseases, circulatory diseases, and digestive diseases. Based on the findings of previous studies, lowering the cost of alcohol will negatively impact the health of Ontarians and further strain a healthcare system with limited resources. Accordingly, Ontario should be strengthening alcohol policies to improve public health, including raising the minimum price of alcohol, rather than weakening alcohol policies.

Minimum Alcohol Pricing: Balancing the ‘Essentially Incomparable’ in Scotch Whisky

This note contrasts the approaches taken by the Court of Justice of the European Union and the UK Supreme Court in the high‐profile litigation which preceded the introduction of minimum alcohol pricing in Scotland. The case of Scotch Whisky Association and others v The Lord Advocate and another hinged, ultimately, on the necessity of minimum pricing to achieve important public health goals. The notably differing viewpoints adopted by the domestic and Union courts, however, both illustrate the elusiveness of the proportionality criterion, and expose tensions between domestic and supranational control in the context of internal market regulation.

Political views of doctors in the UK: a cross-sectional study

BackgroundLittle is known about the political views of doctors in the UK despite doctors' importance in the functioning of the National Health Service (NHS).MethodsThis is a survey-based, cross-sectional study in...

Minimum unit pricing: the way off Gin Lane?

Nursing Lecturer at the University of West London, looks at the advantages and the pitfalls of controlling minimum alcohol prices

Household purchasing of cheap alcohol: Who would be most affected by minimum unit pricing?

Minimum unit pricing of alcohol has been proposed as a more effective policy for reducing alcohol-related harms than general taxation. Growing international evidence points to its effectiveness in targeting high risk drinkers, but concerns about the impact on low risk drinkers and those on low incomes remain. This paper uniquely models the potential effect on both low risk and low income purchasers in a Scottish subsample of UK panel data from introducing a minimum unit price and addresses the impact of missing income data on the results. Weekly household purchases of cheap off-sales alcohol from Kantar Worldpanel (2008-2010) are analysed using Hausman-Taylor, Tobit and OLS models. Explanatory variables include economic and demographic characteristics of the households, average alcohol purchasing level for all off-sales alcohol, and characteristics of alcohol products purchased. The number of cheap alcohol units purchased are predicted by income group and purchasing level. Results indicate that the amount of cheap alcohol purchased is positively associated with the average purchasing level for all off-sales alcohol. Lower occupational group is associated with purchasing more units of cheap alcohol. Type of alcohol and purchasing alcohol on promotion are also highly significant. Predicted quantities of cheap alcohol purchased are not higher for the low-income group. Households in the top decile of alcohol purchasing level are predicted to purchase between 18 units of cheap alcohol weekly (low income) and 24 units (intermediate income). There was no evidence of bias due to missing income data. Minimum unit pricing for alcohol will have most impact on households purchasing the most alcohol, at all income levels. Restrictions on promotions should be considered as these are also associated with increased purchasing of cheap alcohol. Published: Online April 2018.

The effect on emergency department visits of raised alcohol minimum prices in Saskatchewan, Canada

The province of Saskatchewan, Canada introduced minimum prices graded by alcohol strength in April 2010. As previous research found this intervention significantly decreased alcohol consumption and alcohol-attributable morbidity, we aim to test the association between the intervention and the rate of emergency department (ED) visits in four alcohol-related injury categories [motor vehicle collisions (MVC), assaults, falls and total alcohol-related injuries]. Data on ED visits in the city of Regina were obtained from the Saskatchewan Ministry of Health. Auto-regressive integrated moving average time series models were used to test the immediate and lagged effects of the pricing intervention on rates of alcohol-related nighttime. ED visits and controlled for daytime rates of ED visits, economic variables, linear and seasonal trends, and auto-regressive and moving average effects. The implementation of an alcohol minimum pricing strategy in Saskatchewan was associated with decreased MVC-related ED visits for women aged 26 and over after a 6 month lag period (-39.4%, P < 0.001). There was no significant abrupt effect of this intervention on ED visits of four injury types in any of four gender-age categories; however, rates of ED visits among young males for MVCs and assaults decreased substantially during this study. The minimum pricing policy change led to a lagged decrease in motor vehicle-collision-related ED visits for women older than 25. Of note, there did not appear to be an instantaneous effect on the rate of alcohol-related injury ED visits immediately after the policy implementation nor lagged effects for other gender-age groups.

Offline: Time to act on minimum unit pricing of alcohol

Offline: Time to act on minimum unit pricing of alcohol

Minimum unit alcohol pricing works, MPs told

Minimum unit alcohol pricing works, MPs told

Mortality in Russia in light of the reduction in alcohol consumption

In the contemporary history of Russia, there have been three significant reductions in alcohol consumption associated with a decrease in mortality. The first, resulting from the anti-alcohol campaign of 1985, lasted 3 years, and the second, resulting from the impoverishment of the population and death of a large part of heavy drinkers, 4 years (1995-1998).&#x0D; In 2004 began the third decrease in consumption, often inexplicably linked with the anti-alcohol laws of 2005. However, the history of this decline goes back to the year 2000. It started with the creation of Rosspirtprom (RSP) and the anti-beer campaign, with Rosalkogolregulirovanie (RAR) taking over in 2009. The main activities of RSP and RAR involved the bankruptcy of several hundred enterprises of the alcohol industry. This and many other actions of the RSP and the RAR resulted in the instability, sometimes disruption, of the alcohol market. This could be a significant cause of the decrease in consumption and mortality in 2004. In fact, in 2000 the second anti-alcohol campaign started. The object of the first one had been the consumer, of the second - the alcohol market. The aim of the first campaign was to decrease consumption and improve the economy. The aim of the second was to fill the budget by suppressing the illegal market and moving consumers into the legal market. The methods of the first campaign consisted of a reduction of production and trade restrictions; the methods of the second one changed in the course of the campaign. The main goal was to squeeze small and medium-sized players out of the market, on the assumption that they were the principal suppliers of illegal products. The methods of the second campaign included the introduction of a Unified State Automated System, the growth of excise taxes and a minimum price for alcohol, as well as tough, sometimes criminal competition. The tool of the first campaign was administrative pressure. The main instruments of the second one were RSP and then RAR. &#x0D; As a result, there was neither an economic recovery in the first campaign, nor a filling of the budget thanks to alcohol in the second. The decrease in consumption and mortality in the first campaign was short-lived. The second campaign was in this regard more effective, due to the economic crisis and the growing budget deficit. Both campaigns led to increased consumption of illegal alcohol.

Readers’ panel - Should all of the UK adopt minimum pricing for alcohol?

Readers’ panel - Should all of the UK adopt minimum pricing for alcohol?

A discourse network analysis of minimum unit pricing for alcohol: mapping the discursive communities in UK newspaper coverage of the debate

BackgroundPrevious research on alcohol policy in general, and minimum unit pricing (MUP) in particular, has highlighted the importance of industry lobbying, political context, framing of policy arguments, and use of evidence, in the inception, development, and refinement of policies. Our study draws on network analysis approaches to map the discursive communities of key stakeholders represented in UK newspaper coverage of MUP. MethodsThe Nexis database was used to search 11 national UK newspapers, spanning political views and genres, to identify all articles relating to alcohol and pricing published between May 1, 2011, and Nov 30, 2012. Statements made by actors and organisations in the debate were inductively identified and coded with network analysis software to produce relational data to generate visualisations of discourse networks. Findings1435 statements made by 151 individuals from 87 organisations were coded in 351 articles. Visualisation of the network showed two broad discursive communities, one opposing and the other supporting MUP as an intervention. Links between communities were based on agreement around general frames such as “alcohol consumption is bad for public health”, whereas disagreement between the two communities existed around specific frames such as the drivers and extent of the alcohol problem, potential solutions, and consequences of MUP. Cluster analysis of the network showed smaller groupings and highlighted potential discursive coalitions that reflect a common focus on a particular aspect of the debate, especially where there were shared vested interests. InterpretationOur analysis provides the first visualisation, to our knowledge, of the MUP network by the frames presented by key stakeholders. The network highlights splits both within the UK Government and between universities, the dispersal of alcohol manufacturers, retailers, and trade associations across the two discursive communities, and the alignment of economic think-tanks with key industry actors. A complex, poorly-understood interdependency exists between the framing of policy evidence, media representations, and stakeholder influence. These insights could help public health advocates to develop more effective media advocacy strategies. FundingGF and SH are funded by the UK Medical Research Council (MC_UU_12017/15,) and the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU15).

Fiscalité des rhums traditionnels en outre-mer et santé publique : l’exemple de l’île de La Réunion

BackgroundFrance 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. MethodsThis 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. ResultsIn 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. ConclusionThe 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.