Minimum Pricing in Scotland Dr Evelyn Gillan, Chief Executive Alcohol Focus Scotland AFS is Scotland’s national alcohol charity working to reduce the harm caused by alcohol.

Overview  How did minimum pricing get on the agenda in Scotland.  Who were the influential voices in the policy process.  Where has opposition to minimum pricing come from.  What is the role of public health in advocating for policy in the public health interest.

ALCOHOL RELATED DEATHS IN SCOTLAND

Liver Cirrhosis Death Rates Updated for Scottish Alcohol Consultation. 2008

Political and Policy Context  Alcohol policy in Scotland broadly in line with Westminster policy i.e. reliance on policies with the weakest evidence base and problem framed as majority drink sensibly only a minority misuse alcohol.  Scottish Government/Alcohol Industry Partnership established 2006; Diageo employee seconded for two years to the Government’s Alcohol Policy Team.  Policy divergence in licensing legislation. Licensing Act 2003 (England and Wales) and Licensing Act (2005) have the same four licensing objectives but Scottish legislation has a fifth objective protect and improve public health.

Competing Frames  Normalisation of alcohol. Problems arise when individuals misuse it. Solution is to change the behaviour of the minority through education (industry frame).  Problem is not with the individual but with the product. Society’s whole relationship with alcohol matters - not just aberrant individuals. Solution is to make the environment less pro-alcohol and reduce per capita consumption (public health frame).

Evidence for Population Approach  Alcohol Control Policies in Public Health Perspectives [Bruun et al 1975] Higher the average amount of alcohol consumed in a society, the greater the problems - policies should reduce consumption and limit availability.  Alcohol Policy and the Public Good [Edwards et al 1994] Public health measures of proven effectiveness are available to serve the public good.  Alcohol No Ordinary Commodity [Babor et al 2003] Epidemiological research implicates alcohol as a leading risk factor for death and disability. Policies to reduce consumption needed to manage the threat that alcohol problems pose to public health and social well-being.

Why We Need Population Measures  Evidence directly links per capita alcohol consumption with the burden of harm in a population – the more alcohol a nation consumes, the greater the burden of harm it will experience. [Alcohol in Europe 2006]  Reducing overall consumption will have a positive effect on the whole population and will reduce harm in high risk groups.  A review of 32 alcohol policy measures found that the most effective alcohol policies are controls on price and availability, drink driving laws and brief interventions. [WHO 2005]

Minimum Pricing: Enabling Factors  New Scottish National Party (SNP) minority Government (May 2007) identifies alcohol as no.1 public health priority. Justice Minister makes tackling Scotland’s booze culture a personal political priority.  Increasing evidence base showing health indicators going in the wrong direction; Scots drinking more than previously thought; alcohol harm costing Scotland over £3 billion.  Advocacy coalition began to form in support of minimum pricing. Alcohol Focus Scotland, SHAAP, BMA, Health Scotland, and NHS QIS actively engaged in debate.

Public Health Advocacy  Re-frame the problem away from a focus on ‘problem’ drinkers and reliance on policies with the weakest evidence base towards a whole population approach.  Raise awareness of the evidence linking price, consumption and harm; call for a reduction in overall alcohol consumption and for alcohol control measures including action on price.  Methods – publicising research; using scientific experts; issuing media releases and disseminating briefings to politicians. Alcohol Price, Policy and Public Health (2007) calls for the implementation of minimum pricing in Scotland and a ban on quantity discounts in the off-trade.

Alcohol ETC. (Scotland) Bill (1)  Introduce minimum unit pricing  Ban on quantity discounts in off sales  Restrictions on location of drinks promotions in off sales  Provision regarding sale of alcohol to under 21s  Introduce social responsibility levy on licence holders.  “The Scottish Government considers the Bill will help reduce alcohol consumption in Scotland and reduce the impact that alcohol misuse and over-consumption has on public health, public services, productivity, and the economy as a whole.” Policy Memorandum, Alcohol ETC. (Scotland) Bill

Alcohol ETC. (Scotland) Bill (2)  10. Policy Objective: the objective of minimum pricing is to protect and improve public health by reducing alcohol consumption.  26. Policy Objective: The objective of restrictions on drinks promotions is to protect and improve public health by reducing alcohol consumption. The objective of conditions on the location of drinks promotions is to help emphasise that alcohol is not an ordinary commodity and to contribute to efforts to change Scotland’s alcohol culture. Policy Memorandum Alcohol ETC. (Scotland) Bill

Opposition to Alcohol Bill  Global producers and retailers led by trade bodies i.e. Scotch Whisky Association; Wine and Spirit Trade Association and the British Retail Consortium.  Publish industry-funded research (SAB Miller, ASDA); engage public affairs consultancies and undertake intensive lobbying of politicians.  Scottish Licensed Trade Association and the Campaign for Real Ale support minimum pricing as do the police, churches, children’s charities and other civil society organisations.  Opponents say minimum pricing will penalise moderate drinkers; is illegal; will impact on poorer households and put money into the pockets of retailers. 

Growing the Evidence Base (1) [Findings from analysis of data from the Food and Expenditure Survey 2007 undertaken by Professor Anne Ludbrook, Health Economics Research Unit, University of Aberdeen]  All income groups purchase low-price alcohol  Lower income groups do not purchase more low-price alcohol than other income groups  Low-income households are less likely to purchase any alcohol.  Middle income groups appear to purchase most of the alcohol between 30 and 50p per unit.

Growing the Evidence Base (2) [Findings from analysis of consumption patterns across different income groups, Analytical Services Division, Scottish Government, 2010]  Low income drinkers are most likely to drink nothing, very little or very heavily.  23% of the lowest income group don’t drink at all and 57% of the lowest income group drink on average 4.9 units per week.  Those with the highest incomes are more likely to drink hazardously but harmful drinkers in the lowest income group drink significantly more than harmful drinkers in the highest income group.

Scientific Support for Minimum Pricing  “There is extensive and consistent evidence that raising the price of alcohol reduces alcohol related harm.” [WHO Regional Office for Europe, September 2009]  “Minimum pricing should be introduced to reduce alcohol consumption as part of a wider policy aimed at changing attitudes to alcohol.” [UK Health Committee Alcohol Inquiry January 2010]  “There is extensive evidence (within the published literature and from the economic analysis undertaken to support this guidance) to justify the introduction of a minimum price per unit.” [National Institute for Clinical Excellence, 2010]

Current Situation  Alcohol Bill has passed Stage 1 and about to go into Stage 2 where amendments will be considered. SNP Government requires the support of the Liberal Democrats to get minimum pricing approved.  Conservatives and Labour have said they will oppose minimum pricing. Labour established their own Alcohol Commission which recommended a ban on selling alcohol below the cost of duty and VAT plus a ‘nominal’ cost for production as an alternative to minimum pricing.  Scottish Parliamentary elections May 2011 have influenced political party responses – the public health interest is being overshadowed by party political interests.

From Strategies to Action  If reducing alcohol harm is the desired outcome – then policy advocacy in members states, in Europe and globally should stay focussed on alcohol control measures.  This requires a shift away from focusing on ‘aberrant’ individuals and policies with the weakest evidence base towards whole population measures including action on price, availability and marketing.  Public health can learn from the tobacco control movement about building effective advocacy coalitions.