This summer we received grim news: after some progress in reducing deaths caused by alcohol in Scotland, we not only ground to a halt but we took a giant step backwards. 1,190 people died directly from alcohol in 2020. This is devastating. Not only did those 1,190 people have to struggle with their addiction and with all the harms both caused by and contributing to their addiction, the people they left behind – colleagues, friends, family, partners – now have the burden of their grief to struggle with. And let’s face it, the journey that people who died from alcohol will have been on will most likely have been exhausting and damaging for them and for everyone in their lives – death is just the end of that journey.
So we can ask lots of questions about why things went so badly wrong – and sure, the fact that 2020 was the year of lockdowns will have been a huge factor – but what can we do now to stop the harms caused by alcohol, and ultimately reduce the number of people dying from alcohol.
Well there’s a lot in our armoury that the Scottish Government can choose from: as a nation we could de-normalise alcohol by restricting marketing and advertising; we could end the anomalous sponsorship of sport by alcohol brands; we could reduce access to alcohol by limiting the number of places or types of shop that can sell it; we could vastly improve access to – and quality of – treatment and recovery services; and perhaps it’s not a job for government, but as a nation we could treat each other with compassion and reduce the stigma and judgement that is so firmly attached to alcohol problems.
But there is one thing the Scottish Government could do now, and that’s to return to the thorny price of minimum unit pricing (MUP) of alcohol. This is a proven policy: upon introduction it immediately had an impact. It reduced consumption (though it’s still far too high: in 2020 enough alcohol was sold that if it was evenly distributed across all adults in Scotland we’d all have comfortably exceeded the 14 units per week low-risk guideline); less money is now spent on alcohol, particularly in those households that bought the most alcohol prior to MUP; there was a reduction in hospital admissions from liver disease and deaths caused by alcohol fell by 10% in the first full year of MUP.
When MUP was finally introduced after years of delay due to legal challenge by the alcohol industry, the Scottish Government committed to reviewing the price two years after implementation, i.e. by May 2020 but has not done so, understandably given the pandemic. But now is the time to increase it. The policy is a whole lot less thorny, with the public becoming increasingly supportive of it since its introduction, and MSPs have had time to recover from the battles of a decade and more ago and recognise the policy’s success for what it is. The legal challenges mean that nine years have passed since the policy was approved, to start at 50p, yet inflation was never accounted for and when it was introduced in 2018 we stuck with 2012 price of 50p. Not only that, Sheffield University modelling – which underpinned the case for MUP back in 2012 – carried out in 2016 found that a MUP of 60p would save twice as many lives and reduce hospital admissions by twice the level than 50p. So let’s increase MUP to 65p to not only take account of inflation but to give this hard-won policy the teeth it needs to make more of a difference.
One concern will always remain and that is whether MUP will force people who are alcohol-dependent in the poorest communities to choose between alcohol and food or other essentials. And that is why price – while the most effective way to drive change, as proven – will not overcome this challenge in isolation. We also need suitable treatment and recovery programmes that people can access easily, plus all the interventions mentioned above would ultimately reduce consumption which would help prevent people becoming dependent and being forced into such a situation where they must choose between alcohol and food.
So as a nation, while we can’t stop alcohol harm overnight, we must do what we can now – increase MUP to 65p – and then consider all the evidence on the policy interventions that will reduce alcohol harm and decide how to implement them in Scotland, and work towards bringing an end to Scotland’s problem with alcohol.
Elinor Jayne is Director at Scottish Health Action on Alcohol Problems (SHAAP)