Minimum Unit Pricing
Minimum Unit Pricing
In recent weeks the Scottish Government won a historic court battle against the alcohol industry to enable it to bring in minimum unit pricing (MUP) in Scotland, whilst the Welsh Government suffered a set back to their plans to introduce MUP when Westminster refused to devolve the relevant powers to the Senedd. It seems the amount we pay for our booze is an emotive issue.
Why are the two sides (health gurus versus the alcohol industry) getting so worked up about it? Well, studies show, quite clearly, that alcohol sales are inversely proportional to cost (Tighe, 2003). The more it costs, the less you sell. Simples. From the industry‚Äôs point of view, therefore, the objection is, fairly obvious. They‚Äôd make less money. On the health side the argument is equally straight forward – bring in MUP and less people suffer alcohol-related harms. The question to be answered then is, have the health guys been making this up or is there actual evidence to support the claims?
Relatively speaking, alcohol is more affordable now than in 1980 (Health and Social Care Information Centre, 2016) and the expansion of off-trade premises, primarily supermarkets, means that it is increasingly more available as part of the routine weekly shop (MESAS, May 2016). At the same time, alcohol accounts for 10% of the UK burden of death and disease, making it one of the top three lifestyle morbidity and mortality risk factors (Alcohol Concern, 2016). Evidence also shows that the biggest contribution to alcohol-related harm comes from very cheap alcohol products (The University of Stirling, 2013). Between April and May 2016 Alcohol Health Alliance UK surveyed 480 alcohol products on sale, focussing on those products beneath the proposed 50p MUP (Alcohol Health Alliance UK, 2016). Alarmingly they found that the average child‚Äôs weekly pocket money of ¬£5.75 could purchase more than double the weekly recommended limit for an adult. And this is not just at dubious corner stores – the top four UK supermarkets were all selling alcohol at less than 25p per unit.
In particular they found that high-strength white cider products, those known to be predominantly drunk by dependent and underage individuals, could be bought for as little as 16p per unit. These super strength drinks have overtaken heroin and crack cocaine as being one of the biggest causes of death in the homeless population (Thames Reach statement, 2016).
The University of Sheffield modelled the potential effects in England of introducing MUP of 50p revealing that, after one year there would be 50,700 fewer crimes and 192 fewer deaths. After ten years alcohol-related hospital admissions would have reduced by 35,100 per year and the quality of life gains achieved would be equivalent to ¬£5.1 billion (Smith and Foster, 2014). In fact, these outcomes have already been demonstrated in Canada where MUP is already established in certain parts of the country (Stockwell et al, 2012; Stockwell et al, 2013; Zhao et al, 2013; Stockwell et al, 2015).
The opponents of MUP often quote a lack of evidence of health benefits; the data quoted above clearly silences that argument. They also claim that, with less alcohol sold, there will be less tax pouring into the public purse and that in itself will have a knock on effect on the health service. The reality is that, since 2012, the UK Government has systematically reduced the duty paid on alcohol, with beer duty falling by 14% and cider and spirits duty falling by 6%. Those cheap cans of cider (the alcohol that would be most affected by MUP) are taxed the lowest of all alcohol products attracting less than a third of the duty of a can of similar strength beer. Once cannot help but feel that argument is also invalid.
Then they launch their ultimate argument. That MUP will disproportionately disadvantage those on lowest incomes. Well, bearing in mind that, with a MUP of 50p you can still purchase your weekly limit of 14 units for ¬£7, the introduction of MUP would not affect moderate drinkers. So, the only argument that the drinks industry could have is that MUP will have a significant impact upon excessive drinkers and, pardon me for quoting the great Homer Simpson but ‚Äúdoh‚ÄĚ! Isn‚Äôt that the point? And if the drinks industry thinks we shouldn‚Äôt be trying to reduce the amount of money that dependent drinkers are pouring into the their coffers then, is that not as good as admitting that they make money out of creating substance dependency?
This is not an attempt by the devolved governments to create unfair trading conditions for one particular industry. This is an attempt by the policy makers to protect some of the most vulnerable members of our society. Any objection to that borders on corporate exploitation.
Dr Julia Lewis – MBBS, MRCGP, MRCPsych, MSC, MD
Julia is Consultant Addiction Psychiatrist and Medical Director of Pulse Addictions, a leading provider of training, consultancy and clinical management for those working in the field of substance misuse and associated areas. For further details, visit Pulse Addictions
Tighe, A. (ed.) Statistical Handbook 2003. Brewing Publications Limited: London
Health and Social Care Information Centre. Statistics on alcohol 2016. London: HSCIC, 2016
Monitoring and Evaluating Scotland ŐĀs Alcohol Strategy. MESAS alcohol sales
and price update. Edinburgh: MESAS, May 2016. www.healthscotland.com/documents /27345.aspx
Alcohol Concern. Statistics on alcohol. 2016 www.alcoholconcern.org.uk/help-and-advice/ statistics-on-alcohol/
Health First: An evidence-based alcohol strategy for the UK. The University of Stirling, 2013.
Alcohol Health Alliance UK. Cheap alcohol: the price we pay. 2016
Thames Reach statement as quoted in: Alcohol Health Alliance. Our policy position on alcohol taxation. 2016 Budget submission. London: AHA, 2016
Smith K, Foster J. Institute of Alcohol Studies. Alcohol, health inequalities and the harm paradox: Why some groups face greater problems despite consuming less alcohol. London: IAS, 2014.
Stockwell T, Zhao J, Giesbrecht N et al. The raising of minimum alcohol prices in Saskatchewan, Canada: Impacts on consumption and implications for public health. Am J Public Health 2012;102:103‚Äď10.
Stockwell T, Zhao J, Martin G et al. Minimum alcohol prices and outlet densities in British Columbia, Canada: Estimated impacts on alcohol attributable hospital admissions. Am J Public Health 2013;103: 2014‚Äď20.
Zhao J, Stockwell T, Martin G et al. The relationship between changes to
minimum alcohol price, outlet densities and alcohol-related death in British Columbia, 2002‚Äď2009. Addiction 2013;108:1059‚Äď69.
Stockwell T, Zhao J, Marzell M et al. Relationships between minimum
alcohol pricing and crime during the partial privatization of a Canadian Government alcohol monopoly. J Stud Alcohol Drugs 2015;76:628‚Äď634.