Wyper, G. M. A., Mackay, D. F., Fraser, C., Lewsey, J., Robinson, M., Beeston, C., & Giles, L. (2023). The Lancet, 401(10385), 1361–1370. Read paper

The authors used routinely collected data on alcohol and deaths in England and Scotland, using England as a control group. They used a controlled interrupted time series that captured monthly figures on deaths due to alcohol. The time series started prior to the introduction of the policy, gathering data from January 2012 through to April 2018, the point of the policy introduction. They then gathered 32 months of data following the introduction of the policy, from May 2018 to December 2022.

In the 32 months following the introduction of minimum unit pricing for alcohol in Scotland, the authors found:

• 13.4% decrease in deaths due to alcohol, which equates to 156 lives saved by the policy intervention.
• 4.1% reduction in hospitalisations directly due to alcohol consumption over the same time period.
• These deaths are not spread equally as lower socio-economic areas have rates that are five times higher compared to those from higher socio-economic areas.

Commentary:

Scotland has the highest rate of deaths due to alcohol in the UK, with 22.4 deaths per 100,000 people (ONS, 2021). Minimum Unit Pricing, as the name suggests, applies a fixed cost for each unit measured in an alcohol-based drink such as wine or beer. The levy set by the Scottish Government back in May 2018 was 50 pence per unit of alcohol.

Despite this scrutiny, no studies had investigated whether the policy had any impact on mortality. The authors provide a compelling analysis of the impact of the minimum unit pricing policy introduced by the Scottish Government. Rarely do policy interventions receive the attention that this one did, and many are not evaluated to see whether they achieved their goals or not.

Despite the importance of these policies, it is not only shameful but a waste of public money that they are often not followed up. Without analysis and evaluation, we are often left with no intelligence as to what works and what doesn’t in policy interventions. This is particularly troubling when it comes to individual and population health and specifically mortality.

It is to their credit that the Scottish Government introduced minimum unit pricing for alcohol as they faced formidable opposition from the alcohol industry. Perhaps that resistance signals the fact that they knew how effective the policy would be. If that is the case, it is not just a legal loss for the industry but a moral one too. To oppose a policy that can save lives in the pursuit of profits is cold, callous, and calculated.

Although there are many things individual practitioners can do to reduce the potential harm that alcohol can cause there are some things that lie outside their control – with the price of alcohol being one such thing. This requires government intervention and, in this case, determination to see the idea being implemented.  One obvious piece of intelligence for practice is the clear link between social deprivation and risky alcohol consumption. As with other aspects of health, it is those that have the least that pay the greatest price including mortality. Knowing that alcohol consumption is elevated in this group could help target resources locally as practitioners and teams will have the knowledge of where these individuals are and aim to make access to treatment as easy as possible. However, given the continuing real-term decrease in treatment budgets, that could prove to be an ambition rather than the reality.

Ian Hamilton, Associate Professor, University of York

Other articles featured in this Clinical Update:

• Prevalence of dental disorders among people with mental illness: An umbrella review.
• Percentage of Heavy Drinking Days Following Psilocybin-Assisted Psychotherapy vs Placebo in the Treatment of Adult Patients With Alcohol Use Disorder A Randomized Clinical Trial.
• Experience and perpetration of intimate partner violence and abuse by gender of respondent and their current partner before and during COVID-19 restrictions in 2020: a cross-sectional study in 13 countries.
• Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress.

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