Minimum unit price deters heaviest alcohol purchasers

Alcohol use is one of the leading risk factors for non-communicable diseases and intentional and unintentional injuries, contributing to an estimated 3 million deaths each year.1Rehm J Gmel Sr, GE Gmel G et al.The relationship between different dimensions of alcohol use and the burden of disease—an update.Addiction. 2017; 112: 968-1001Crossref PubMed Scopus (416) Google Scholar, 2WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar Setting a floor price on alcohol is considered by WHO to be one of the most cost-effective means to prevent and reduce the harmful use of alcohol and associated health issues.3WHOWHO launches SAFER alcohol control initiative to prevent and reduce alcohol-related death and disability. World Health Organization, 2018https://www.who.int/substance_abuse/safer/launch/en/Date accessed: April 13, 2021Google Scholar By use of large-scale panel data on alcohol purchasing obtained through product barcodes, Anderson and colleagues4Anderson P O'Donnell A Kaner E Llopis EJ Manthey J Rehm J Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analyses.Lancet Public Health. 2021; (published online May 28.)https://doi.org/10.1016/S2468-2667(21)00052-9Summary Full Text Full Text PDF PubMed Scopus (8) Google Scholar provide strong evidence that the introduction of a minimum unit price (MUP) might reduce off-trade alcohol purchases (eg, from shops or online) and consumption, seemingly despite COVID-19-associated changes, and that the effect is considerably concentrated in households that generally purchase the most alcohol. Anderson and colleagues looked at trends in differences in units of alcohol purchased and price per unit spent per household on alcohol between sites with and without MUP, comparing Scotland with northern England and Wales with western England. They find that, in Scotland, initial relative reductions in alcohol purchasing after the introduction of MUP in 2018 have been maintained in 2020, and, in Wales, purchases also decreased in relative terms following the introduction of an MUP in March, 2020. The findings of the report by Anderson and colleagues need to be put into the context of the COVID-19 pandemic and its associated measures. The advent of lockdowns, which closed pubs and restaurants in Scotland on March 20, 2020, and a stay-at-home order for Wales on March 24, meant that off-trade purchasing, including internet purchasing, became the main source of alcohol. During this period, off-trade alcohol purchases associated with MUP could not be offset by increased on-trade purchases. Anderson and colleagues' findings could, therefore, be interpreted as evidence that the effects of MUP on off-trade purchasing apply for purchasing of alcohol in general. However, this interpretation is complicated by potential changes in underlying alcohol consumption during lockdowns. A survey of UK adults, commissioned by the charity Alcohol Change UK on April 7–9, 2020, found that only 21% of respondents reported drinking more often, compared with before the lockdown, whereas 35% reported drinking less or having stopped drinking altogether.5Holmes A Drinking during lockdown: headline findings. Alcohol Change UK.https://alcoholchange.org.uk/blog/2020/covid19-drinking-during-lockdown-headline-findingsDate: 2020Date accessed: April 16, 2021Google Scholar If the first UK lockdown was accompanied by reduced alcohol consumption, then extrapolation of Anderson and colleagues' findings to non-pandemic periods could be more difficult. Because on-trade purchases and consumption are not included in the dataset, this result still leaves uncertainty as to MUP's effect on total alcohol consumption. The impact of MUP on off-trade versus on-trade alcohol purchasing probably differs somewhat, because the price of a drink in a restaurant or bar is generally already higher than those purchased off-trade, because greater staffing and operating costs are included. In normal times, MUP will thus affect the relative cost of drinking on-trade and off-trade, so that some off-trade drinking might move on-trade. Another concern is that the impact of COVID 19 might not be fully captured in the model due to the relatively short period that this study continued beyond March, 2020. The effectiveness of MUP needs to be reassessed or reviewed regularly during and beyond the COVID-19 pandemic to enable adjustment for extraordinary events and increases in income or inflation.6Jiang H Livingston M The dynamic effects of changes in prices and affordability on alcohol consumption: an impulse response analysis.Alcohol Alcohol. 2015; 50: 631-638Crossref PubMed Scopus (21) Google Scholar A key question about MUP is whether the MUP can effectively reduce alcohol consumption among heavy drinkers, who might not be sufficiently susceptible to price increases for it to make a substantial difference to their consumption. A further concern is that low-income groups might be unfairly penalised, or that they might spend more money on alcohol, increasing social inequalities.7Hilton S Wood K Patterson C Katikireddi SV Implications for alcohol minimum unit pricing advocacy: what can we learn for public health from UK newsprint coverage of key claim-makers in the policy debate?.Soc Sci Med. 2014; 102: 157-164Crossref PubMed Scopus (53) Google Scholar Findings of this study showed that MUP had produced greater reductions in quantities purchased in households that purchase larger amounts of alcohol, with no increase in alcohol expenditure among most low-income households. The study also shows that MUP can achieve similar reductions in different jurisdictions. Because MUP targets cheaper off-trade alcohol, it may help to reduce drinking particularly in those households that purchase higher volumes of cheaper alcohol. This paper presents persuasive evidence in favour of the introduction of MUP based on comparative and time series analyses of natural experiments in different parts of the UK. The MUP is an effective option to reduce off-trade alcohol purchasing, particularly for the groups that purchase the most. The effectiveness of MUP has been seen in several countries in addition to Scotland and Wales, including several provinces in Canada,8Zhao J Stockwell T Martin G et al.The relationship between minimum alcohol prices, outlet densities and alcohol-attributable deaths in British Columbia, 2002–09.Addiction. 2013; 108: 1059-1069Crossref PubMed Scopus (97) Google Scholar the Northern Territory in Australia,9Taylor N Miller P Coomber K et al.The impact of a minimum unit price on wholesale alcohol supply trends in the Northern Territory, Australia.Aust N Z J Public Health. 2021; 45: 26-33Crossref PubMed Scopus (8) Google Scholar and some countries of the former Soviet Union.10Neufeld M Bobrova A Davletov K et al.Alcohol control policies in Former Soviet Union countries: a narrative review of three decades of policy changes and their apparent effects.Drug Alcohol Rev. 2021; 40: 350-367Crossref PubMed Scopus (7) Google Scholar Compared with increasing alcohol taxes, the MUP is likely to be welcomed by on-trade venues, because the MUP would mainly affect prices of off-trade alcoholic beverages. The past decade has seen decreases in alcohol consumption in many high-income countries (eg, Australia, the UK, the USA, and many European countries), but this decrease has been offset globally by the increased consumption in many Asian countries, particularly those that have weak alcohol control regulations, such as China and India.2WHOGlobal status report on alcohol and health 2018. World Health Organization, Geneva2018Google Scholar Compared with restriction of trading hours and outlet density and tax increases, the introduction of MUP could be more cost-effective and more affordable for low-income and middle-income countries to stem the tide of increasing consumption. Although this study shows that MUP affects alcohol purchasing, future studies should expand their remit to assess effects on alcohol consumption and associated harm. We declare no competing interests. Impact of minimum unit pricing on alcohol purchases in Scotland and Wales: controlled interrupted time series analysesThe evidence base supporting the positive, targeted impact of MUP is strengthened by the comparable results for Scotland and Wales. The short-term impact of MUP in Scotland during 2018 is maintained during the first half of 2020. MUP is an effective alcohol policy option to reduce off-trade purchases of alcohol and should be widely considered. Full-Text PDF Open Access

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