Minimum unit pricing: Main solution to problem drinking and alcohol-related deaths in Scotland lies beyond flagship policy – John McLaren
The latest Public Health Scotland review of minimum unit pricing (MUP) for alcohol in Scotland found that, overall, it had been of some benefit. It’s still early days to come to any such conclusion, especially with the pandemic occurring during the analysis phase, but even if this is correct, there remains a huge amount of ignorance over the impact of alcohol trends on the Scottish population.
The report illustrates alcohol-specific deaths from 2001, which just happens to coincide with their peak in Scotland, but what preceded that is of equal interest. The data goes back to 1979 and shows a fairly static position of around 400 such deaths a year until it shoots up between 1994 and 2002 to over 1,300, a more than three-fold increase in under a decade. There has never been a clear explanation for why this happened.
After peaking at this level for seven years, the number of deaths then fell, by about a quarter, to around 1,000 – again no clear explanation is available for this fall – before flattening out, then returning to a slow rise.
Unsurprisingly the position varies across Scotland. At its peak, Greater Glasgow and Clyde Health Board accounted for over a third of such deaths, followed by Lanarkshire and Lothian. These three health boards are pretty much the only ones to follow the national trend. Most others experienced the rise in the 90s but have seen little, if any, fall since. In other words, the national decline is largely a Strathclyde phenomenon.
The Public Health Scotland report suggests that the position relative to England is improving, which is true, but only because English deaths have been on the rise, not exactly what we’re looking for.
All this leaves us with some interesting questions. Why did the death rate shoot up in the mid to late 1990s and why did it fall back at the end of the noughties? The former in particular was a very big change which warrants an explanation. Have there been shifts in how such deaths are recorded over time and is there consistency across health boards and hospitals on this? I have never seen anything that reassures me with regards to this point.
How closely are these figures related to alcohol consumption levels? This question would be easier to answer if we had reliable stats in this field, but, in my estimation, we don’t. Alcohol consumption data is plagued with little-understood oddities. For many years, based on sales figures, Scotland’s per capita consumption was thought to be much higher than England’s, largely due to higher consumption of spirits. However, the differential has almost vanished in recent years, down from around 20 per cent higher in 2010 to five per cent in 2021.
Furthermore, this higher, sales-based, consumption has always been inconsistent with direct survey data on personal consumption, which typically shows Scotland very similar to England. While such surveys have bias issues relating to reporting accuracy, there is no reason to think these would be worse for Scotland. Perhaps crucially, such surveys are highly likely to omit problem drinkers who are living on the verges of society, where the core of the problem may well lie.
Successive Scottish Governments have highlighted alcohol as a problem area for the country and instigated various policy initiatives. But none have tried to get to the root of the problem by rigorously examining the data, improving the quality of it and honing in on who, where and why. As a result, there is little in the way of hard facts or an understanding of shifting patterns and causes over time.
What are the relevant concerns with regards to policymaking here? First, to provide citizens with the knowledge they need to make an informed decision over personal alcohol consumption levels. Second, to stop those in danger of developing an alcohol problem from succumbing to it. Third, to try and intervene with those who already have a severe problem with alcohol. Finally, to help lessen the impact of alcohol over-indulgence on others – by reducing violence, minimising use of hospital facilities, etc – and on the economy.
MUP may have a role to play here, but it doesn’t seem to be a major part of the solution. Its principal aim is to discourage drinking by the general populace. This is an invalid approach with respect to personal freedom but valid with respect to abuse of alcohol costing Scottish taxpayers in terms of the need for additional police and health funding.
The main solution to problem drinking and alcohol-related deaths lies beyond MUP. It is a stubborn problem and as such requires adequate and sustained funding in areas like mental health and the support of charities experienced at intervening.
Better analysis of the problem would also help, but, like the ambition of ‘eradicating poverty’, this is another area where the Scottish Parliament has been more interested in easy rhetoric than in truly grappling with the issues at hand. At present, I would find it difficult to state, categorically, that Scotland has a unique problem with alcohol. Consumption patterns may be higher than medics would recommend but not disastrously so.
However, Scotland’s relatively poor life expectancy, in both UK and international terms, remains a worrying concern and if alcohol is deemed to play a significant role in this underperformance then more effective policy needs to be introduced.
John McLaren is a political economist who has worked in the Treasury, the Scottish Office and for a variety of economic think tanks.
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