5. Supporting views
This chapter presents themes evident in responses to Q3 in support of continuing MUP or increasing the minimum unit price. These include the effectiveness of MUP, expressions of support for the policy, agreement with the need to increase the minimum unit price over time and with the proposed price of 65 pence per unit, the positive impacts on public health and the lack of other negative impacts.
Evidence shows MUP has been effective
Many respondents felt the available evidence showed that MUP has been effective. All these respondents, around three quarters of whom were organisations, felt the policy should continue, with the majority supporting an uplift in price. This was the most prevalent theme in responses from organisations and the most prevalent supportive theme overall.
Respondents commonly highlighted the findings of the PHS evaluation of MUP in their response, as well as global research findings and World Health Organisation (WHO) and OECD (Organisation for Economic Co-operation and Development) recommendations. Many of these comments focused on the evidence of a positive impact on public health, which is explored separately below.
“There is clear evidence in the PHS report that MUP has reduced alcohol-related deaths and hospitalisations.” – Individual
“The World Health Organization cites pricing policies as amongst the most successful and cost-effective measures to reduce alcohol-related harms. MUP in Scotland has achieved its aim of reducing said harms – this has been clearly presented throughout the Public Health Scotland monitoring and evaluation of the policy.” – SHAAP
Some highlighted that the evaluation resonated with their observations or echoed the findings of their own research.
“In Glasgow Royal Infirmary, we documented a significant reduction in hospital episodes related to alcohol-related liver disease after MUP.” – Individual
“We know MUP works – it was noticeable to gastroenterologists in 2018 when it was brought in.” – Individual
“Local Glasgow City data on alcohol-specific deaths indicated a fall in the number of deaths after the introduction of MUP in 2018 and 2019. The greatest fall was seen in those from the most deprived quintile by SIMD [Scottish Index of Multiple Deprivation].” – Glasgow City Alcohol and Drug Partnership
Some organisations, all of whom supported continuing MUP, suggested that the available evidence shows that MUP has been effective in reducing consumption among hazardous and harmful drinkers to more moderate levels and, in particular, reducing consumption of cheap, high-strength alcohol. While the coordinated response from public health organisations also stressed this positive impact, these organisations stated that people with alcohol dependence are a separate group who require more intensive support.
“Some anecdotal feedback from nursing staff is that MUP supported a switch to a lower percentage of alcohol for those most dependent drinkers.” – Glasgow City Council
“Dependent drinkers and hazardous and harmful drinkers – It is important to understand that hazardous and harmful drinkers are entirely separate groups to dependent drinkers. MUP was not designed to target dependent drinkers. MUP has succeeded in reducing the consumption of cheap, high-strength alcohol products, which were disproportionately consumed by people drinking above the low-risk guidelines (hazardous and harmful drinkers) prior to the implementation of MUP.” – Public Health Directorate, NHS Highland
Coordinated responses by members of the European Alcohol Policy Alliance highlighted the legal challenges to MUP posed by the industry. They argued that these had further strengthened the evidence-based approach to implementing and monitoring MUP and that the high quality of evidence enabled the policy to withstand legal challenges at the European Court of Justice and the UK Supreme Court.
Support for MUP
Support for MUP was expressed in two ways; explicit support for continuing the policy and more general comments about the value of MUP.
Explicit support for continuing MUP
Many explicitly commented that MUP should continue; around three quarters were organisations. This was the second most prevalent supportive theme overall. These comments were generally brief but consolidated and emphasised other points raised in comments to ensure there was no doubt they supported MUP and wished it to continue.
“The Association fully supports the retention of Minimum Unit Pricing in Scotland to avoid a return to the days of deep discounting and irresponsible promotions which were particularly seen in Supermarkets where alcohol, on some occasions, was being sold cheaper than bottled water.” – The Scottish Licensed Trade Association
“In conclusion, the public health case for continuing MUP is very strong and we believe it should therefore continue. Finally, a decision to discontinue MUP would lead to a drop in price, a likely increase in consumption, and subsequent increases in hospitalisations and deaths.” – School of Health & Wellbeing, University of Glasgow
“The focus group was in agreement on maintaining the Minimum Unit Pricing for alcohol. MSYPs saw Minimum Unit Pricing as a deterrent for binge drinking and potentially reduce binge drinking in young people as the high price point for drinks with a high alcohol percentage can be prohibitive.” – Scottish Youth Parliament
A few individuals stated MUP should continue, but qualified their comments. Examples include assertions that it should continue but the minimum unit price should not be increased for a few years, it should continue if the evidence proves it is effective, or it should continue if the ban on multibuy discounts is removed.
“If you are clear that the data show that deaths and hospitalisations have decreased and that this is unequivocal, then this MUP policy should definitely continue.” – Individual
“MUP has been beneficial in Scotland and must continue after the current sunset clause.” – Individual
General support for MUP
Supportive comments were provided by several respondents, all of whom indicated at Q1 that they wished MUP to continue. These respondents expressed their view that the policy was worthwhile, successful, and a good idea and should continue. Respondents frequently highlighted public support for MUP and stated that it is a useful and effective measure to reduce alcohol consumption at a population level.
For example, BMA Scotland noted they had been a long-term supporter and had been vocal in their belief that MUP would deliver results, whilst the Co-operative Group believed the current 50 ppu was widely understood by retailers and the public, for whom 50p is seen as a round number.
“Whilst Scotland lacks some of the devolved powers necessary to implement all of the WHO’s recommended interventions, it continues to hold the power to raise alcohol prices through pricing policies such as MUP and continue to enforce such policies.” – SPECTRUM Consortium
“It is notable that public support for Minimum Unit Price has grown in Scotland over the period of debate and implementation of the policy, showing that the public understands the need for effective alcohol controls and that this is not something which should be left to an unregulated market.” – Alcohol Justice
“As a hepatologist, I see the adverse health effects of alcohol every week at work. The majority of those coming to harm are not dependent and population-based measures are an essential part of addressing that harm.” – Individual
Support for a price increase to 65 pence per unit
This section outlines three themes which were commonly raised among those who supported an increase in the minimum unit price; agreement with the proposed price of 65 pence per unit, a recommendation that the minimum unit price should increase over time, and comments explicitly in support of an increase.
Agreement with 65 pence per unit
Many respondents felt the proposed price of 65ppu was correct, or stated that it should be ‘at least’ 65ppu. Over two thirds of respondents who expressed this view were organisations, including the coordinated responses from public health organisations and members of the European Alcohol Policy Alliance. This was the third most prevalent theme in responses from organisations.
Reasons given for agreement included:
- Inflation eroding the value of MUP;
- 50p already having been too low when introduced due to delays;
- Additional health benefits arising from a higher price per unit;
- Changes in consumption patterns;
- MUP being an evidence-based approach;
- That this amount would not overly impact those on low incomes.
“The effect of having the minimum unit price set at 50p per unit has been significantly eroded by the steep rise in inflation since the legislation was passed in 2012. We support the proposed uprating of MUP to a minimum of £0.65 per unit, to match inflation and not to impact those on the lowest income.” – WithYou
“The proposed uprate of MUP to 65 pence per unit, adjusted for inflation and economic changes, is a necessary step to maintain the policy’s effectiveness.” – Nordic Alcohol and Drug Policy Network (NordAN)
“The Scottish Government should therefore uprate MUP to at least 65p to mitigate high inflation and the long-term effects of the pandemic on drinking behaviour, and optimise the beneficial impacts of the policy. In order to optimise the benefits of MUP, the policy must be renewed and price uprated, given the context of the COVID-19 pandemic and rising inflation.” – Alcohol Health Alliance UK
“The PCC is hugely supportive of the Scottish Ministers’ proposal to continue and uprate MUP and would recommend a level of at least 65 pence per unit based on the work of the Balance North East Alcohol Office and AHA… An MUP of 65p would make good inflation and modestly increase the benefits of the policy.” - Durham Police and Crime Commissioner
A few cited the Sheffield Alcohol Research Group findings to justify their response.
“Additionally, when compared to a MUP of 60 pence per unit (ppu), modelling carried out by the University of Sheffield Alcohol Research Group has shown a 65ppu MUP could avert an additional 60 deaths in the first year of implementation and 774 fewer hospital admissions. The number of hazardous drinkers is estimated to fall by 15,742 and the number of harmful drinkers fall by 11,403, compared to 60ppu.” – The Association of Directors of Public Health
Minimum unit price should rise over time
A recommendation that the minimum unit price should rise over time was made by many respondents. All supported the continuation of MUP, and four fifths were organisations. Most commonly, it was suggested that the minimum unit price should rise automatically in line with inflation. Some respondents called for the Scottish Government to introduce additional legislation to provide an automatic uprating mechanism to ensure MUP rises in line with inflation, noting that this would be in line with WHO advice. This was primarily to ensure its value did not decrease over time. However, it was also argued that this could minimise future challenges from affected sectors and free up policymakers' time.
“Could there be a formula for the cost per unit? It could use other data such as the retail price index, the current tax on alcohol, etc. This might save parliamentary time as the price would automatically adjust, maybe yearly.” – Individual
“The Scottish Government should uprate MUP in line with inflation (RPI) annually and set a suitable mechanism for doing so. Putting in place this mechanism will help to protect the value and effectiveness of the policy. Failure to do so would lead to its erosion. The WHO recommends linking MUP to measures of affordability (such as inflation) in order to maintain its public health impacts.” – Alcohol Change UK
“Eurocare would strongly encourage the Scottish Government to develop a regular uprating mechanism for Minimum Unit Price to maintain effectiveness. This has been shown to be achievable and effective for other health-promoting fiscal interventions, notably in the tobacco field. The UK Government implemented this approach for alcohol duties in the Duty Escalator from 2008-12. Commercial interests can be expected to oppose this approach, preferring to retain the prospect of lobbying on an annual basis for cuts and freezes to tax and other price mechanisms.” – European Liver Patients’ Association
Some also discussed the need for a periodic review of MUP, with suggestions that this could be undertaken by a body external to the Scottish Government. PHS was the agency most commonly suggested.
“The appropriate level for the MUP threshold is a political judgement, and the factors informing that judgement, such as the scale of alcohol harms, the characteristics of the alcohol market and the wider economic situation, may all change over time. As such political judgement on the appropriate level of the MUP may change over time. It is therefore important that there is a periodic review of the MUP level to allow for these factors to be considered and adjustments made as is deemed appropriate. This should be over and above any automatic uprating mechanism, which would seek to simply maintain the effective level of the MUP. It may be appropriate for this review to be undertaken by an independent or semi-independent body (e.g. Public Health Scotland) with clear terms of reference that could then inform any decision to adjust the MUP level.” – Sheffield Alcohol Research Group, The University of Sheffield
“To maintain its effectiveness, the Minimum Unit Price must also be uprated in line with inflation. We support Alcohol Focus Scotland’s proposal for automatic uprating with additional periodic review by Public Health Scotland.” – Diabetes Scotland
Explicit support for an increase in the minimum unit price
Some respondents explicitly agreed in their comments that the minimum unit price should increase. Within this group, all bar two supported the recommendation to increase the amount to 65ppu in Q2. Church of Scotland (Public Life and Social Justice Programme Group) supported an increase but answered ‘no’ in Q2 as they felt 65ppu was too high. Scottish Drugs Forum did not answer Q2, arguing the Scottish Government should determine the level after considering the available evidence and how best to maintain positive outcomes and a reduction in harms.
Others stated that they supported the proposed increase mainly because inflation had eroded the benefits of MUP.
“The MUP threshold would need to be raised to over 61p in October 2023 prices to return it to its real-terms level at the point of implementation in May 2018 (using CPIH or 67p using RPI). Inflation remains significantly above the government target of 2% and is forecast to remain above 3.5% until the middle of 2024. This will further erode the real-term value of the 50p MUP threshold and should be considered when assessing any increase in that threshold. This reduction in the real-term value of the MUP threshold is likely to have a corresponding erosive effect on the impact that the introduction of MUP has had on alcohol consumption and harm. Our recent modelling estimated that alcohol consumption in Scotland will be 2.2% higher in 2023 than it would have been if the MUP level had been increased in line with inflation each year since 2018, and this is estimated to increase to 3.4% by 2040 if the level remains at 50p until then. We estimate that by 2040 this would lead to an additional 1,076 deaths, 14,532 hospital admissions, 37,728 years of life lost and an additional cost to the NHS of £17.4million.” – Sheffield Alcohol Research Group, The University of Sheffield
“Inflation will erode its impact over time. Our evaluation demonstrated that MUP consumption reduced the most in the drink categories that increased most in price i.e. the way MUP worked was related to its value. Maintaining the value is essential to maintain effectiveness. Increasing the price of MUP to keep pace with inflation is important to its effectiveness as a policy.” – PHS
Positive impacts on public health
Many respondents, particularly public health and third sector organisations, and a few individuals, highlighted that policies aiming to reduce alcohol consumption, including MUP, can lead to positive improvements in health and wellbeing. Across their responses various overlapping themes emerged, which detailed how reducing alcohol consumption can:
- Improve public health.
- Address health inequalities.
- Help to protect public services.
- Improve other, non-health-related, aspects of quality of life.
- Support early intervention and prevent future hazardous and harmful drinking.
This section presents an analysis of each theme. Some organisations, particularly those with a public health remit, left detailed and similarly worded comments in Q3 which included some or all of these themes. These reflected their expertise in the area, and frequently referenced either their own data or evidence from PHS’ evaluation of MUP in their responses.
Improving public health
The relationship between alcohol consumption and public health was noted by many respondents, all of whom responded in Q1 that MUP should continue. This was the second most prevalent theme in responses from organisations. Respondents frequently outlined a range of public health issues linked to alcohol consumption to illustrate the importance of policies to reduce hazardous and harmful drinking in Scotland.
The coordinated response from public health organisations, as well as PHS, NHS Grampian Public Health Directorate & Aberdeen City Licensing Forum, and The Royal College of Psychiatrists in Scotland, all stated that “the latest alcohol death figures from the National Records of Scotland (NRS)… show an increase from 1,245 alcohol-specific deaths in 2021 to 1,276 in 2022. Additionally, in 2021/22, there were 35,187 alcohol-related hospital stays. This means that every day in Scotland, more than three people lose their lives, and almost 100 more are hospitalised because of alcohol.”
Some, including The Stroke Association, British Liver Trust and World Cancer Research Fund, described how alcohol contributes to multiple health conditions, including cancer, liver disease, obesity, cardiovascular disease, and alcohol-related brain damage. A few cited alcohol as a causal factor in over 200 different diseases and injuries. These respondents argued that reducing overall alcohol consumption in Scotland could lead to many instances of these conditions being avoided.
Obesity Action Scotland and Diabetes Scotland noted how excess sugar and calorie consumption from alcohol can lead to obesity and conditions such as type 2 diabetes. The British Dental Association and Consultants in Dental Public Health / Chief Administrative Dental Officers’ Group noted that excess alcohol consumption is an important risk factor in oral, head and neck cancer, dental trauma and facial trauma. Another organisation highlighted the impact of alcohol consumption on young people and resulting from parental consumption including greater exposure to Adverse Childhood Experiences, increased mental health problems and greater risk of Fetal Alcohol Spectrum Disorders.
“GPs in Scotland are acutely aware of the profound effects that alcohol has on the health of our communities. In Scotland, an average of 700 people are hospitalised, and 24 people die each week from illnesses caused by drinking alcohol. For GPs, it is a daily occurrence that consultations involve people who are impacted by harmful alcohol use; some of our patients are unaware of the extent of the damage that alcohol can cause to their current and future health, and we also treat others who are all too aware and desperate to stop.” – Royal College of General Practitioners Scotland
Several directly noted the positive impact of MUP on public health as part of their calls for it to continue, or increase to 65p. A few, including SHAAP, Alcohol Focus Scotland and the Royal College of General Practitioners Scotland, specifically noted impacts such as:
- Within 32 months of implementation, MUP contributed towards reducing deaths wholly caused by alcohol by 13.4%, or 156 fewer deaths every year.
- MUP reduced deaths and hospital admissions rates due to alcohol from conditions where alcohol is not the sole cause (such as cancers and cardiovascular disease), averting a further estimated 112 deaths and 488 hospital admissions per year. A small number of other organisations cited a 4.1% reduction in alcohol-related hospital admissions since MUP was introduced.
- MUP may have mitigated some of the Covid-19 pandemic’s negative effects, as the rise in deaths since the pandemic in Scotland has not been as sharp as in England (22% rise in Scotland from 2019 to 2021, compared to 30% in England).
“The Special Interest Group for Alcohol is of the view that we are facing a public health crisis with alcohol and that decisive action is called for now. Every death from alcohol is avoidable and the Special Interest Group for Alcohol urges the Scottish Government to continue with MUP and to increase the cost per unit to at least 65p.” – The Special Interest Group for Alcohol
“MUP confers significant population health benefit and must be continued as one of our approaches to reducing alcohol-related harm.” – NHS Tayside
“Change is happening, and the primary lesson we should learn from these first five years is that we should not take a single step backwards in fighting for measures that tackle the deep-rooted health problems we face in Scotland. The current, and hopefully continued, success of minimum unit pricing should be a rallying call to go further and save more lives.” – BMA Scotland
“An MUP of 65p would make good inflation and modestly increase the benefits of the policy. Compared to increasing to 60p per unit, an increase to 65p per unit would reduce consumption by an estimated 2.7%, leading to an estimated 60 fewer deaths and 774 fewer hospital admissions in the first year alone.” – NCD Alliance Scotland
“There is very strong evidence (in the quantitative studies collated by Public Health Scotland) that MUP reduces deaths directly caused by alcohol consumption. Scotland still has the highest level of alcohol-related deaths in the UK, and a decision not to continue with MUP would be extremely detrimental to public health.” – Research Centre for Health (ReaCH), Glasgow Caledonian University
“The evidence for reduced morbidity and mortality is clear and, having read the documents, it seems clear that the health benefits are greater with the price increase with no associated costs to the economy.” – Individual
“The public health case for continuing MUP is very strong. Its implementation has been linked to a reduction in alcohol-related hospitalisations and deaths in a robust large-scale natural experiment study comparing trends in Scotland and England.” – School of Health & Wellbeing, University of Glasgow
“There is no ‘safe’ level of alcohol use, and even drinking small amounts of alcohol increases the risk of developing cancer. Given the significantly positive findings for community health and wellbeing resulting from the minimum unit price for alcohol in Scotland, we strongly support the proposal to continue the measure and increase the price to 65 pence per unit of alcohol to ensure it keeps pace with pricing changes and delivers appropriate health benefits.” – Cancer Council
“Despite the positive impact of MUP, changing drinking habits during the pandemic, combined with reduced access to services, led to a tragic 25% rise in alcohol-specific deaths in Scotland between 2019 and 2022, reaching the highest level in 14 years. This resulted in the Scottish Government declaring a public health emergency. Unfortunately, this increase in harm is likely to continue well into the future. By 2040, there will be an estimated additional 663 deaths and 8,653 hospital admissions, even if drinking returned to pre-pandemic levels by 2023. This rises to an estimated 7,536 additional deaths and 72,140 additional hospitalisations should these changes in consumption persist into the long term. At a time when life expectancy is reducing in Scotland, and health inequalities are widening, we urgently need policies which address the key drivers of non-communicable diseases like cancer and cardiovascular disease. MUP has been shown to be such a policy.” – UK Liver Alliance
“The effect of MUP on hospital admission episodes in Glasgow was assessed in a study of discharges related to alcohol-related liver disease from the Gastroenterology wards at Glasgow Royal Infirmary. This showed a reduction in discharges with this diagnosis in 2018 and 2019 after the introduction of MUP compared with the preceding 3 years. Public Health Scotland Hospital Statistics data to acute hospitals for Glasgow City show an initial reduction in admissions for alcohol-related liver disease but subsequent increase during the COVID pandemic. Admissions due to Mental and Behavioural Disorders have tended to fall since the introduction of MUP. Conclusion: there was evidence of reduced alcohol-related hospital episodes after the introduction of MUP in Glasgow.” – Glasgow City Council
A small number noted that the first five years is not necessarily long enough to establish the impact of MUP on non-alcohol-specific mortality.
“There are also a number of other conditions, such as some cancers and stroke, in which alcohol negatively contributes and it can take 20 years to see the full effects of changes in alcohol consumption on other health-related conditions. Therefore, retaining and strengthening MUP will play a much wider role in preventing disease and protecting population health beyond saving lives directly resulting from alcohol and requires to be a long-term policy commitment.” – NHS Ayrshire and Arran
“We recently co-authored a systematic review of the impact of minimum pricing on alcohol-related hospital outcomes. This review found that natural experiment evaluation studies were consistent with modelling studies in finding that MUP could reduce alcohol-related hospitalisation and health inequalities. Further, the review found that modelling studies estimated that MUP could reduce alcohol-related admissions by 3%–10% annually and the majority of real-world studies demonstrated that acute alcohol-related admissions responded immediately and reduced by 2%–9%, and chronic alcohol-related admissions lagged by 2–3 years and reduced by 4%–9% annually. In the same review, we found that minimum pricing could target the heaviest consumers from the most deprived groups who tend to be at greatest risk of alcohol harms, and in so doing, has the potential to reduce health inequalities. Using the Bradford Hill Criteria in the review, we inferred a ‘moderate-to-strong’ causal impact of MUP on reducing alcohol-related hospitalisation. In the longer term, MUP, and particularly a higher MUP, may reduce the prevalence or severity of dependence amongst the Scottish population.” – Institute for Social Marketing and Health
“In Scotland, the policy achieved its aim of reducing consumption at the population level, reducing alcohol sales by 3%. Continuing with MUP and uprating it to at least 65p will reduce longer-term, cumulative and chronic impacts of alcohol, such as liver disease and cancer, which can take many years to emerge.” – Alcohol Change UK
Reducing health inequalities
The potential for MUP to reduce health inequalities was highlighted by several respondents, almost all of whom noted this in addition to describing the link between alcohol consumption and public health more generally. Some public health organisations all noted that: “Alcohol contributes to Scotland’s major health inequalities, as those living in the most deprived communities are worst affected: there are 4.3 times as many deaths from alcohol-specific causes in the most deprived communities as in the least deprived and anyone living in one of our most deprived areas is six times more likely to be hospitalised because of alcohol-related conditions.” Other groups, including individuals with poor mental ill health, women, children and young people, were also noted as being more likely to experience direct or indirect harm as a result of alcohol.
Respondents commented that evidence, particularly PHS’ evaluation, indicated that the largest health impact of MUP was for men and those living in the most deprived areas, and therefore argued that MUP reduces consumption in these communities and will contribute to reducing alcohol-related health inequalities. Some specifically mention that alcohol-related health inequalities will be reduced further with an increase in the minimum unit price.
“Modelling from Sheffield University estimates that rises in MUP lead to the greatest reductions in alcohol harm in the most deprived groups in Scotland. In contrast, reducing or removing MUP would lead to disproportionately more harm in the poorest communities, with rises in hospital admissions and mortality increasing to the greatest extent in the most deprived population groups in Scotland.” – Alcohol Change UK
“Impact of MUP on Alcohol-specific Deaths – Local Glasgow City data on alcohol-specific deaths indicated a fall in the number of deaths after the introduction of MUP in 2018 and 2019. The greatest fall was seen in those from the most deprived quintile by SIMD. However, again, the impact of the COVID pandemic is evident. It can only be inferred from the Public Health Scotland analysis that this pandemic-associated increase in alcohol-specific deaths has been mitigated by MUP. Conclusion: there was evidence of a reduction in alcohol-specific deaths after the introduction of MUP, especially amongst those from the most deprived areas of the city.” – Glasgow City Council
“There is evidence that a minimum unit price (MUP) for alcohol has achieved reduced alcohol-related harm across the population in Scotland. Health inequalities that reflect wealth and income inequalities are prevalent in Scotland and a key driver of Scotland's poor health outcomes. MUP has had a positive impact in reducing health inequalities as it has reduced alcohol consumption most in the poorest communities in Scotland. These are the two significant arguments for the retention of MUP.” – Scottish Drugs Forum
“Robust evaluation has shown that MUP has reduced alcohol-specific deaths by 13.4% and alcohol-related hospital admissions by 4.1% since its introduction, with the greatest benefits being seen among people living in the most deprived areas of Scotland. People in these areas are not only at greater risk of alcohol-related harm, but also face a 70% higher risk of obesity, significantly poorer mental health, and twice the risk of type 2 diabetes than those in the least deprived areas. This makes their health a priority for us at Diabetes Scotland, and we applaud MUP for its positive impact in this regard.” – Diabetes Scotland
“Alcohol contributes to Scotland’s major health inequalities, as those living in the most deprived communities are worst affected: there are 4.3 times as many deaths from alcohol-specific causes in the most deprived communities as in the least deprived and anyone living in one of our most deprived areas is six times more likely to be hospitalised because of alcohol-related conditions. MUP helps to reduce inequalities by saving lives in Scotland’s most disadvantaged communities. The lives saved by MUP so far have predominantly been among the 40% of people living in the most deprived areas, meaning that the policy is reducing alcohol-related health inequalities.” – Scottish Health Action on Alcohol Problems (SHAAP)
Protecting public services
Some respondents, particularly public health organisations, noted that declining alcohol consumption could reduce the burden on public services; arguing that lower incidences of health issues among the general population would reduce demand for health services. A small number specifically noted that reducing hazardous and harmful drinking would decrease the number of alcohol-related hospital admissions. A few others noted that the benefits of reduced alcohol consumption extend beyond the NHS to include reductions in costs to social care and policing.
“Additionally there has been a reported 4.1% reduction in hospital admissions directly caused by alcohol use. This particular figure is crucial at a time when Scotland’s NHS is struggling to cope with the level of demand placed upon it. It demonstrates the potential for public health measures to make a real difference to demand on services. It frees up vital clinician time to see more people who desperately need their help. This is something worth celebrating.” – BMA Scotland
“44% of violent crime in Scotland is alcohol-related; and 41% of prisoners report being under the influence of alcohol at the time of their arrest. The evidence that MUP is effective in reducing consumption in those drinking hazardously is also positive in this context.” – NHS Ayrshire and Arran
“Alcohol harm also has major impacts on public services and the Scottish economy. Alcohol consumption is a causal factor for more than 200 disease and injury conditions and puts an immense strain on our overstretched NHS. Alcohol harm is estimated to cost the Scottish economy £5-10 billion every year. MUP reduces hospitalisations – Within 32 months of implementation, MUP reduced hospital admissions wholly caused by alcohol by an estimated 4.1% – equivalent to 411 fewer hospital admissions per year. This relieves pressure on our overstretched health services.” – Scottish Health Action on Alcohol Problems (SHAAP)
A few respondents explicitly supported increasing the minimum unit price above 50ppu to maintain the positive impacts highlighted above. Conversely, a small number of others supported an increase because they believed the positive impact on some public services has yet to be felt, highlighting a need for more stringent policy on alcohol consumption.
“The potential impact of MUP on harms in Scotland is likely attenuated by erosion over time in the effect of a static MUP at 50ppu due to background price inflation. The original 50p MUP has not yet shown benefits in terms of impact on emergency department visits, ambulance callouts, or road traffic accidents. Yet, these are all areas where there is still significant harm from alcohol. Our research on the impact of MUP and alcohol on the ambulance service in Scotland provides a stark reminder of the need for stronger alcohol policy, including a higher rate of MUP, to relieve pressure on emergency services.” – Institute for Social Marketing and Health
“An MUP of 65p would make good inflation and modestly increase the benefits of the policy. Compared to increasing to 60p per unit, an increase to 65p per unit would reduce consumption by an estimated 2.7%, leading to an estimated 60 fewer deaths and 774 fewer hospital admissions in the first year alone. There would also be a reduction in NHS hospital costs of £5m in the first 5 years, rising to £16.4m over 20 years. The most deprived groups would benefit the most from an increased MUP, experiencing the largest reductions in health harms.” – Balance
Improving quality of life
The impact on the non-health-related welfare of those who consume alcohol was mentioned by some. They noted that hazardous and harmful alcohol consumption can negatively influence mental wellbeing and social interactions, particularly for people with alcohol dependence. These respondents asserted that reducing alcohol consumption could lead to improved quality of life and extend to families and communities through lower levels of crime and improved child welfare and community safety.
“But importantly, behind the statistics are real people, who now have the chance to live fulfilling lives which they [may] not otherwise have done. They are families who get more time – better quality time – with their loved ones.” – BMA Scotland
“The statistics mask the damage and pain caused in the lives of people who are living with an alcohol problem, as well as that in the lives of their loved ones and in wider communities.” – Scottish Directors of Public Health
“The harm of alcohol is multi-faceted & has been shown to be impacted positively by MUP. As well as health harm, there’s social harm too – impact of addiction, family based violence, problematic behaviour & crime etc. Personally I have a potential to be dependent on alcohol, so price helps – too cheap & it is too easy for me to drink too much. I was affected by childhood trauma as a consequences of my father’s drinking and domestic violence, MUP, along with other measures, might have helped then. Now we know more and should support current & future generations to have a healthier relationship with alcohol. The benefits are clear.” – Individual
Supporting early intervention and prevention
The role of MUP in early intervention and prevention was noted by some respondents, who suggested that the policy plays an important deterrent role, preventing moderate drinkers from drinking at hazardous and harmful levels in the future. In turn, they observed this could help to prevent many of the health issues outlined above.
“While some dependent drinkers reported reducing their consumption due to MUP, the policy’s greatest contribution to reducing alcohol dependence is by helping to reduce the risk of others becoming dependent in future.” – NCD Alliance
“We are also aware of the significant impact of the COVID pandemic on alcohol consumption levels and that it is likely to take several years to fully analyse the respective and combined impact of COVID and MUP on alcohol-related harm. We hope that objectives outlined in the Scottish government’s alcohol strategy, including those relating to pricing, will continue to drive reductions in consumption and improve access to treatment and support, leading to fewer hazardous drinkers moving into alcohol dependency and more serious harm in future years.” – Quaker Action on Alcohol & Drugs
Lack of negative impacts
In addition to the positive impacts on public health, other respondents expressed support for MUP either on the basis of a lack of negative impacts or unintended consequences since it was implemented, or the positive economic impact of the policy.
Little or no negative impacts of MUP
Some respondents, primarily health-related organisations, presented a similarly worded argument which stated that initial concerns about potential negative impacts and unintended consequences of introducing MUP have not come to pass. Respondents cited multiple early concerns, including: greater use of non-beverage or illicit alcohol; switching to or increased use of illegal drugs; increased theft, crime and disorder; and increased cross-border purchasing of alcohol. However, they suggested that these were either unfounded, not prevalent or that there is inconsistent or no clear evidence of these since the policy was introduced.
A small number further argued that MUP has not penalised moderate drinkers, having had little or no impact on the pricing of the alcohol products consumed by most moderate drinkers. A few respondents noted that some individuals, especially those with alcohol dependence, did experience social harms such as increased financial pressures. However, they suggested this was not prevalent or typical.
“Concerns were expressed about the weekly household spend being diverted from food or nutritional value of food into purchasing alcohol. Quantitative studies found no impact on household spend on food or nutritional value of food. There is some qualitative evidence of impact of MUP at an individual level, particularly for individuals with alcohol dependence who are financially vulnerable… [however] MUP was not designed to target this group who require targeted support for their recovery.” – Scottish Directors of Public Health
“We welcome the comprehensive analysis of MUP in Scotland, including the investigation of any unintended consequences of the policy. There is no population-level evidence of widespread harms caused by the policy.” – Alcohol Change UK
More specifically, some organisations argued that MUP has had limited or no impact on business or industry, particularly the alcohol sector. It was suggested that while there may have been a reduction in the total volume of alcohol being sold, this was offset by an increase in the average sale price and that applications for Licensed Premises continue, indicating sustained profitability of the off-sales trade. A few research organisations and retail organisations cited evidence of the lack of impact.
“The Public Health Scotland Report, Economic impact of MUP on Scotland’s alcoholic drinks, industry highlights there was no evidence of a significant economic effect on the Scottish alcoholic drinks industry through the implementation of Minimum Unit Pricing of Alcohol. The experience of retailers would correlate with that report. It was reported to us there was an overall shift in buying patterns, with smaller stores seeing a greater market share as larger stores could no longer offer as attractive promotions. Overall, though there appears to have been a fall in volumes which offsets the increased revenue through higher sales values. When the extra costs of implementation are included our view is retailers at best saw no revenue increase due to the policy.” – Scottish Retail Consortium
“Despite initial concerns, small retailers reported minimal disruption following the implementation of MUP, which was generally straightforward. Compliance was taken seriously and price calculations relatively manageable. Few/no negative reactions from customers were reported. Some felt that the measure enabled them to better compete with larger retailers/supermarkets and/or reported increases in revenue following the introduction of the measure. Concerns about MUP expressed by some trade bodies prior to implementation were largely not borne out in the experiences of small retailers.” – Institute for Social Marketing and Health
“On-trade (the supply of alcohol into premises where alcohol is sold for consumption on premise) has not been impacted as much by MUP. While the Scottish Government’s evaluation has provided no firm evidence of the negative/positive impact of MUP on wholesale specifically, anecdotal evidence from our members would suggest that at the current rate of 50ppu, to date, there has not been any substantial negative impacts to the wholesale business.” – Scottish Wholesale Association
“The introduction of MUP in Scotland in 2018 at 50 pence per unit (PPU) had limited impact on convenience retailers as alcohol sold in convenience stores was above the 50ppu MUP rate.” – Association of Convenience Stores
Positive economic impact
Some respondents argued that the reduction in harmful drinking due to MUP had wider economic benefits beyond saving money on public services. Multiple respondents who made comments in this vein, including Alcohol Focus Scotland, noted that alcohol harm is estimated to cost Scotland’s economy £5 billion to £10 billion each year, including £1.2 billion in labour and productivity losses. However, the British Dental Association cited a lower figure, of between £2.47 billion and £4.64 billion each year.
“Additionally, reductions in the cost associated with alcohol harms (e.g. health care, policing, economic productivity) and related gains in economic productivity will financially benefit all sectors of the Scottish economy.” – Highland Alcohol and Drugs Partnership
“Failure to renew and uprate MUP would result in even higher levels of alcohol consumption and harm, placing a substantial additional burden on our NHS and on our economy. Other sectors of the Scottish economy beyond the drinks industry are expected to benefit from reductions in alcohol consumption, both due to people switching their spending from alcohol to other products and due to the workforce becoming healthier and more productive.” – Alcohol Focus Scotland
MUP is world-leading
Some respondents, all of whom felt MUP should continue, commented that MUP demonstrated Scotland’s global leadership. Respondents viewed MUP as a progressive model of best practice to be replicated internationally. Those expressing this view were mainly third sector, public health or international organisations, including members of the European Alcohol Policy Alliance.
“This policy not only serves as a national model but also as a global beacon, demonstrating the impact of well-formulated alcohol control measures.” – Nordic Alcohol and Drug Policy Network (NordAN)
More specifically, some organisations presented a similarly worded argument that Scotland’s MUP legislation has influenced positive developments in alcohol policy across the UK, Europe and worldwide. Countries mentioned as drawing learning and inspiration from Scotland’s actions included: Wales, Jersey, Ireland, Lithuania, France, and Australia. A few respondents, including Cancer Research UK and The Stroke Association, also noted that the WHO has recognised the value of MUP in reducing alcohol-related harms. A small number expressed the view that Scotland should continue MUP, or increase the minimum unit price, to further legitimise efforts to introduce similar policies elsewhere and protect public health in other nations. A few others highlighted the risk to Scotland’s international reputation as a leader in tackling non-communicable diseases by discontinuing the legislation.
“Failure to renew and uprate MUP in Scotland has consequences not just for the health of our own nation but globally and could damage our international reputation.” – NCD Alliance Scotland
“This process was an example of best practice which laid the groundwork for other jurisdictions such as Ireland, Wales, Jersey, Northern Territory in Australia to take action on low-cost alcohol.” – Ehkäisevä Päihdetyö EHYT ry, EHYT Finnish Association for Substance Abuse Prevention
The Scottish Parliament’s resistance of alcohol industry pressure was identified as one reason for the high international regard for MUP. Alcohol Action Ireland, for instance, urged the Scottish Government to commit to the legislation to continue to favour public interest over business interests.
“Your action is an example of the best alcohol policies to implement in Europe, especially in Portugal, where the alcohol industry is dominant and promote high levels of alcohol intake in vulnerable populations. All states need to know that it is possible to protect the health and well-being of these persons from commercial tactics of alcohol industry.”- Centre for Advocacy, Treatment and Recovery (CATR)
“Legal action is frequently used by commercial operators to block and delay action on health harming products and to intimidate Governments into avoiding action. The Scottish Parliament deserves much credit for prioritising action on the price of alcohol and the Scottish Government deserves credit for holding to its intentions to ensure the measure was introduced.” – Institute for Research and Development (Utrip, Slovenia)
Another reason given by some for the international admiration and support for continuing MUP was the evidence-based approach to its development, and the use of robust evaluation to demonstrate impact.
“The development of the policy was approached in a systematic way, informed by local and international evidence on the impact of price on patterns of drinking and harm across the population and within key target groups such as heavy drinkers and people living in poverty.” – Addictions France
“Cancer Council works to encourage measures to address the price of alcohol in various jurisdictions throughout Australia and this work is, in large parts, informed by the Scottish Government’s evaluation of the policy as it is the most comprehensive evaluation of the policy to date.” – Cancer Council
65 pence per unit is too low
A small number felt the proposed increase to 65ppu was too low and argued for this to be increased. Suggested figures were 70ppu, 75ppu and 80ppu. The primary reason for supporting a higher level was to ensure the policy maximised its impact. The Scottish Community Safety Network indicated it would support a higher level if the money were rediverted to supporting those with alcohol dependency.
“QAAD’s preference would be for MUP to be raised to 70p. Our rationale is based on the differences in projected outcomes from SARG’s scenarios relating to reductions in alcohol-specific deaths over the next five years: 32.7% at 70p/unit compared with 21.6% at 65p/unit.” – Quaker Action on Alcohol and Drugs
“While 65p will reduce alcohol deaths and admissions below what they would otherwise be, it is unlikely to reduce them in absolute terms because of the projected effects of changes to consumption during the pandemic. If, as a nation, we wish to see an overall reduction in the number of alcohol deaths, a higher price would be required. AFS considers there is a strong case for this as higher MUP levels are estimated to lead to greater health impacts and, with that, a greater effect on reducing health inequalities. For example, increasing the proposed price to 70p is estimated to double the effect on consumption, deaths and hospital admissions of setting it at 65p per unit.” – Alcohol Focus Scotland
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