The Alcohol Health Alliance UK was launched 15 years ago.
Across the four nations, there have been great policy successes and pitfalls over that time. In this blog series, we look back on the progress that has been made to help reduce alcohol harm across the UK and reflect upon what needs to happen next.
In this edition, Alison Douglas, Chief Executive of Alcohol Focus Scotland, examines how alcohol policy has changed in Scotland during the lifetime of the AHA.
Scotland’s alcohol problem
Back in 2007 health professionals became concerned about the increasing harm being caused by alcohol in Scotland. Alcohol related deaths had doubled in fifteen years and were twice the rate of our English and Welsh neighbours, whilst liver disease rates had increased three-fold in ten years. Harms were, and continue to be, concentrated in our poorest communities.
There may be underlying reasons why Scotland, and Glasgow in particular, was particularly vulnerable to ‘diseases of despair’ such as alcohol use disorders. However, one of the most obvious reasons for the increase in consumption and harm was the increased supply of cheap alcohol. Competition amongst supermarkets, who used alcohol as a means of attracting consumers, pushed prices down and encouraged a shift towards drinking at home where Scots drink three-quarters of all their alcohol.
The shocking impact on health was accompanied by other social harms such as violent crime and marital breakdown. The total societal cost in 2007 was estimated at £3.6 billion, or £900 for every adult. It was clear that this was no longer a marginal issue, affecting only a small minority of people. One in three men were estimated to be drinking over the recommended limits and one in four women. But non-drinkers were also suffering the consequences and footing the bill.
Radical action needed to turn the tide
Ministers recognised that something radical needed to be done to turn the tide. They decided that a “whole population”, evidence-based approach was required given the scale and impact of harmful and hazardous drinking in Scotland.
Since then, there have been a whole array of measures introduced to try and curb Scotland’s unhealthy relationship with alcohol.
Influenced greatly by campaigning activity led by former Scottish Health Action on Alcohol Problems (SHAAP) Director and then AFS Chief Executive, Evelyn Gillan, minimum unit pricing (MUP) and a ban on discounting were included in a consultation paper issued by the Scottish Government in June 2008 on its new alcohol strategy.
Although MUP was a cornerstone of the strategy, the Scottish Government made more than 40 other commitments. Notably they banned multi-buy discounts such as ‘3 for the price of 2’, reduced the drink driving limit to 50mg/100ml blood, and established a programme of alcohol early brief interventions.
A significant change to the licensing system was also implemented. Historically alcohol licensing focused on preventing or controlling drunkenness and disorder but the Licensing (Scotland) Act 2005, which came into force in September 2009, introduced the protection and improvement of public health as one of the five objectives of licensing. This recognised that licensing was an important means of controlling the availability of alcohol and therefore reducing health harms.
Has it made a difference?
The road to MUP was not smooth; with the alcohol industry fighting every step of the way. The legal challenge of the Scotch Whisky Association delayed the introduction of MUP by five years, with the policy eventually being implemented in May 2018.
Four years on from the introduction of this life-saving policy we have seen positive effects. In the first year there was a 3.5% reduction in off-trade sales per adult, the lowest level of consumption in 26 years, and 10% fewer alcohol-specific deaths. At the end of the first two years, we also saw a small reduction in hospital admissions from alcoholic liver disease.
However, in 2020 we received a stark reminder that we cannot afford to take our eye off the ball where alcohol harm is concerned. Deaths from alcohol during the COVID-19 pandemic increased by a devastating 17% – the highest since 2008.
Scotland has made good progress in addressing the problems we have with alcohol, yet the impact of the pandemic threatens to undermine this.
Minimum unit pricing is subject to a ‘sunset clause’, meaning that the Scottish Parliament must vote for the policy to continue. We need to make sure it not only continues but remains effective. To ensure this, we are urging the Scottish Government to increase the minimum unit price to at least 65p and to link it with inflation going forward.
While pricing policies are one of the most effective in reducing alcohol harm, we also need to consider it alongside other measures.
The Scottish Government have already committed to a consultation on alcohol marketing, expected later this year. We hope this will be followed by statutory restrictions and we are keen that these include banning outdoor advertising and sport sponsorship and introducing health warnings on alcohol products.
Together with measures to reduce the ready availability of alcohol, these policies could not only save lives now, but help to improve the lives of thousands of Scots by preventing problems developing in the first place. These benefits will be felt most by those who currently experience the greatest burden of alcohol harm – those in our poorest communities.
Written by Alison Douglas
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.