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 1990-2003
Liver Cirrhosis Death Rates 1950 - 2006
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.