MINIMUM UNIT PRICE COMES OF AGE

There is a wealth of evidence to support the association between alcohol affordability, alcohol consumption and alcohol related harm [1]. However, despite the well-documented global burden of alcohol-related disease, countries such as the UK have stood back over decades as the figures for health and societal damage have soared while the price, in real terms, has dramatically fallen. At a time when the political will to take action seems to be growing in some countries, Stockwell and colleagues [2] enhance the accumulating evidence base to support the need for minimum alcohol pricing as a strategy to tackle alcohol harms. While there are many reasons to favour setting a minimum price according to alcohol content, the majority of evidence to date has relied on retrospective studies or mathematical modelling, and therefore concrete data from a study such as this are really valuable in reinforcing that minimum unit alcohol pricing (MUP) can substantially reduce alcohol consumption. Armed with this evidence from a province in Canada, this is surely the time to raise the issue more strongly in the countries making up the United Kingdom and press governments to take action. Alcohol is responsible for over one million hospital admissions in England [3], 13 000 new cases of cancer in the UK [4] and one in four deaths in young men in the EU (aged 15-24) every year [5]. Stockwell and colleagues show a demonstrable reduction in alcohol consumption with MUP, longitudinal estimates suggesting that a 10% increase in the minimum price of an alcoholic beverage reduced its consumption relative to other beverages by 16.1% [2]. There will need to be further follow-up to confirm that this translates into reduction in harm. We certainly know the impact on health of making alcohol cheaper—Finnish data demonstrated a 17% increase in alcohol-related sudden deaths (equivalent to eight additional alcohol-related deaths per week) when alcohol excise duty was reduced by an average of 33% (in order to avoid cheap imports from abroad) [6]. Calculations in England suggest that a MUP of £0.50 would decrease alcohol consumption by 6.9%, and lead to 3393 fewer deaths, 97 900 fewer hospital admission, 45 800 fewer crimes and 296 900 fewer sick days [7]. The Scottish National Party (SNP) has led the debate in the UK and, with their recent working majority (from May 2011), they are committed to pursuing a MUP. The previous Scottish coalition government failed to muster a majority and were bedevilled by arguments about breaches of European competition law and accusations from the alcohol industry about introducing a ‘nanny state’. Preliminary discussions between Scotland and the European Commission about the legal status of MUP are now encouraging. There have also been concerns over the increased revenue from MUP staying with the producers and retailers rather than going to government, to be ploughed back into public services. However, plans are advanced in Scotland to introduce a levy on supermarkets to claw back the lost revenue. Encouragingly, there are also commitments in both Northern Ireland and the Republic of Ireland to advance policy on MUP. The devolved government of Wales has expressed public interest in pursuing a MUP, but this would require Westminster support. This would provide welcome support for Scotland both in the European courts, if the policy is challenged there, and in managing the expected resistance from sectors of the drinks industry. There are also important issues in these countries of taking public opinion on the journey. In England, the Government rejected attempts to introduce minimum pricing in 2009 [8]. However, there has been an acknowledgement by the present coalition government in England that cheap drinks are, in part, responsible for the alcohol related problems [9]. In January 2011, UK ministers proposed plans to control alcohol pricing by imposing a ban on selling alcohol for less than the combined tax and duty paid on it [10]. This sets a welcome principle but fails in practice, as this level is inadequate to effect significant change [11], and was estimated by the Guardian newspaper to hit only 1 in 4000 alcohol sales. However, in advance of an awaited alcohol strategy for England, there has now been confirmation that a MUP strategy will be introduced in England and Wales. This would fall in line with recommendations from, among others, the immediate-past Chief Medical Officer of England [12], the Health Select Committee [13], The National Institute for Health and Clinical Excellence [14], the Academy of Medical Sciences [15] and the Royal College of Physicians [16]. As always, more research is needed across different settings and cultures, as alcohol consumption is different in various social contexts. MUP has been demonstrated as a valuable tool in the developed world setting, but it is only one factor in the equation and behavioural changes are also needed to change social constructs. Those who call for a change in culture rather than in price need to be reminded, however, that price is a valuable tool in culture change. None.

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