Today marks the first anniversary of the introduction of minimum unit pricing for alcohol. The policy had a stormy journey through Parliament and questions are now being asked about what it is achieving. It is also subject to a ‘sunset clause’ which means that it will come back to Parliament in 2024 for Members to vote on whether or not it should continue. NHS Health Scotland is leading on the evaluation which will inform this vote and therefore we invited them to discuss what they have planned.
As with all guest blogs, what follows are the views of the author, not those of SPICe or indeed the Scottish Parliament.
Why do we need action on alcohol?
Alcohol harm is a significant public health issue. In Scotland in 2017 there were an average of 22 deaths per week caused wholly by alcohol. The harm caused by alcohol is worse in our poorest areas. We need to reduce alcohol harm if we are to improve the health of the people of Scotland and reduce health inequalities, and have a fairer, healthier Scotland.
Minimum Unit Pricing (MUP)
There is good evidence that the affordability of alcohol influences how much alcohol people drink and the amount of associated alcohol harm. The World Health Organisation lists alcohol taxation and pricing policies as among the most effective and cost effective interventions to reduce the harmful use of alcohol[1] and reports that increasing the price of alcohol is the most promising policy intervention to reduce social inequities in alcohol-related harm.[2]
Minimum unit pricing (MUP) is one way to reduce the affordability of alcohol by setting a floor price of alcohol based on strength below which alcohol can’t be sold. It therefore reduces the availability of low cost high strength alcohol. MUP came into force in Scotland on 1st May 2018 and applies to all licensed premises.
MUP has the potential to improve our relationship with alcohol in Scotland and reduce the harm it causes. But MUP in the form we have it in Scotland hasn’t been put in place anywhere before. That’s why it’s so important to gather evidence of the impacts of it here, both positive and negative, through a robust and comprehensive evaluation that moves beyond describing the intervention and provides evidence of what difference it is making and to whom.
Evaluating MUP
The Alcohol (Minimum Pricing) (Scotland) Act 2012 has a sunset clause that requires the Scottish Parliament to vote before 1 May 2024 on whether or not MUP will continue. The legislation also recognises the importance of reviewing the impact of a policy like MUP. It requires a Review Report providing an assessment of the impact of MUP on:
- the five licensing objectives, which cover preventing crime, securing public safety, preventing public nuisance, protecting and improving public health and protecting children and young people from harm[3]
- producers of alcoholic drinks and alcohol licence holders
- different population groups (e.g. by age, gender, social and economic deprivation and alcohol consumption)
NHS Health Scotland are leading the evaluation that will form the basis of this Report. This work is part of the well-established Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) programme of work. Over the next 5 years, we will work to understand the impact MUP has made on the level of alcohol-related harm in Scotland, and the extent to which some people and businesses are positively or negatively impacted more than others. The plan we have to do this is comprehensive and is based on the outcomes that MUP might influence (see figure 1).
Figure 1: Theory of Change for Minimum Unit Pricing for Alcohol
We want to assess not only the impact of MUP on sales, consumption and alcohol- related harm, but also other potential consequences. These include how it affects alcohol producers and retailers, and whether or not some people find another source of alcohol unaffected by MUP or switch to other drugs.
The evaluation is being delivered through a portfolio of studies (see figure 2). NHS Health Scotland is undertaking or managing a number of these studies. We are also supporting other researchers to obtain funding from other sources for additional studies.
Figure 2: Timeline of evaluation studies
Timelines
Reports from individual studies will be published when they are finished. When drawing our conclusions in the final report, due late 2023, we will draw on the findings from all the studies in the portfolio. Full details of our plan, including the publication timeline, can be found on our website.
The first step in the chain of outcomes in Figure 1 is compliance and we will publish our study exploring this shortly. The ‘theory of change’ suggests that if MUP is complied with, alcohol below 50ppu will no longer be available and, if MUP works as intended, consumption will go down.
We will publish our descriptive analysis of the 12 months post-MUP sales data later this year. This will report on the volume of pure alcohol sold per adult in Scotland, a measure that ensures changes in the size of the population and the strength and volume of products sold are taken into account.
Some articles in the press have reported data that show an increase in the volume of products sold in Scotland after MUP but it is important to note that this was not the volume of pure alcohol, but rather the total natural volume of the products. The data also did not show how sales in alcohol compare with those in a similar geographical area. This is important given that in 2018 we had a hot summer and a men’s football world cup – both things that are associated with higher alcohol consumption.
We will also show what is happening with alcohol sales in England and Wales where minimum unit pricing is not in place. Later, we will undertake full statistical analysis that takes account of underlying trends and include a comparison with data from England and Wales. This study will be published in 2022.
The importance of independent and robust evaluation
It is absolutely imperative that this evaluation is robust, impartial, credible and transparent. This is right and proper for any research, but especially when it is research on something that has the potential to affect so many people’s lives and when the world is watching to see what happens in Scotland. We have therefore taken great care to set up a strong governance structure to oversee the design and delivery of the evaluation.
The MESAS Governance Board (MGB) includes members from academia and strategic delivery partners such as the NHS (addiction services and Public Health), Local Government, Police, Alcohol Drug partnerships and the third sector. The MGB ensures that the overall evaluation framework is robust, that the evaluation meets the needs of the legislation, takes account of a wide variety of perspectives, and that the portfolio is carried out using rigorous and appropriate research and evaluation methods.
In addition, Evaluation Advisory Groups (EAGs) have been established to provide individual studies or groups of studies with scientific advice, to help identify data sources and to understand the context in which studies are taking place. Representatives from the NHS, the Police, local government, academia, the alcohol industry including retailers, community justice and the third sector are all involved in relevant EAGs.
Good evaluation is wide-reaching and seeks to engage as many stakeholders as possible. As such, we have developed an evaluation plan that will ensure we speak with a wide range of participants, including representatives from health, crime, social work, education, alcohol producers, licence holders and children and young people as we set out to assess the impact of MUP.
Everything we do in the Public Health community should be about ensuring a Scotland in which all of its people and communities have a fairer share of the opportunities, resources and confidence to live longer, healthier lives. This requires us to understand the impact of important policies such as MUP. This is not just about doing excellent science, it is about using it to make a difference to the people of Scotland.
Clare Beeston is a Public Health Intelligence Principal and lead for the MUP Evaluation in NHS Health Scotland.
For more information on the Evaluation of MUP, visit the Evaluation pages on our website, and follow @MESAS_NHS on Twitter.
[1] https://apps.who.int/iris/bitstream/handle/10665/44395/9789241599931_eng.pdf;jsessionid=E6861BA3D49C20A3143CEE0BF887EF89?sequence=1
[2] http://www.euro.who.int/__data/assets/pdf_file/0003/247629/Alcohol-and-Inequities.pdf