Scotland became the first country in the world to introduce minimum unit pricing – which sets the lowest price a unit of alcohol can be sold for - when the policy came into effect back in 2018.
Saving 150 lives a year
The aim of minimum unit pricing - which in Scotland sets the lowest price at 50p per unit - is to reduce the harm caused by alcohol (prior to the introduction of MUP, Scottish government figures noted 22 alcohol-specific deaths and 697 hospital admissions per week).
The policy was intended to mostly impact low-cost high-strength alcohol and to reduce alcohol consumption in the heaviest drinkers.
A new study – carried out by researchers from Public Health Scotland and the University of Glasgow – finds there was a 13% reduction in deaths from alcohol consumption in the two years and eight months following the implementation of the policy, compared to an estimate, using data from England, of the deaths that would have occurred had the legislation not been implemented.
The 13% reduction is equivalent to avoiding around 150 deaths per year.
“Scotland has the highest rate of death due to alcohol consumption in the UK, with those living in the most socioeconomically deprived areas in Scotland experiencing death rates more than five times higher compared to those living in the least deprived areas,” said Dr Grant Wyper, Public Health Intelligence Adviser at Public Health Scotland, and lead author of the study.
While previous studies have looked at the effect on sales, they had not yet looked at the reductions in alcohol-specific deaths and hospitalizations.
“The minimum unit pricing policy aims to tackle this inequality by reducing alcohol consumption, and therefore harms to health, in the heaviest drinkers who tend to buy the least expensive alcohol.
"Our findings indicate the policy is having a positive impact on public health - its implementation is associated with fewer alcohol-specific deaths in men and those living in the 40% most deprived areas of Scotland who are disproportionately dying of alcohol related harms.”
Impact of other factors
The researchers looked at data from Scotland and England on alcohol-specific deaths and hospitalizations prior to the introduction of MUP legislation (January 2012 to April 2018) and two years and eight months afterwards (May 2018 to December 2020).
Data from England was used to form a control group as a part of the UK where the legislation was not implemented.
The researchers compared the change in deaths and hospitalizations in the two periods across the two countries while accounting for various other factors such as the level of government restrictions during the COVID-19 pandemic.
While the policy was associated with a 13.4% decrease in deaths due to alcohol consumption, a 4.1% decrease in hospitalizations due to alcohol consumption (equating to 411 hospitalizations a year) was not deemed statistically significant.
The authors suggest the overall reduction in alcohol-specific deaths is driven by a decrease in deaths from long term conditions caused by alcohol consumption.
MUP implementation was associated with a 11.7% reduction in deaths due to alcoholic liver disease and a 23% reduction in deaths from alcohol dependence syndrome.
Financial pressures could have an impact
However, the study also found that MUP was also associated with an increase in the rate of deaths and hospitalizations due to short-term conditions caused by alcohol consumption - such as alcohol poisoning - although these findings were not statistically significant.
With short-term conditions only contributing to around 5% of alcohol-specific deaths in Scotland, these estimates therefore have a large degree of associated uncertainty.
“One identified plausible mechanism was that some subgroups reduced their spending on food or lowered their food intake due to the financial pressures of the policy being implemented, which might have led to faster intoxication or poisoning,” notes the study.
“Findings from another study offer another potential explanation, reporting evidence of switching of consumption from lower to higher alcohol-by-volume products (eg, cider to spirits), which could lead to quicker intoxication.
“These findings underscore the importance of ensuring timely, accessible services for those dependent on alcohol to coincide with the implementation of population-level policies.”
However, the reduction in chronic outcomes (such as alcohol liver disease) offset any potential adverse consequences on such acute outcomes, highlight the authors.
“Taking both of these findings together indicates that the implementation of MUP has had a net benefit in reducing deaths and hospitalisations wholly attributable to alcohol consumption."
The authors acknowledge some limitations to the study, including that there was an impact on hospital capacity and attendance during the COVID-19 pandemic, which increases the uncertainty of the study findings related to hospitalisations.
Worsening impact of alcohol
Published estimates have indicated an overall recent worsening in alcohol-specific mortality in both Scotland and England recently - which were not covered by the study.
But the researchers say this is unlikely to change their main findings.
“In 2021, there were 1,245 alcohol-specific deaths in Scotland, the highest number since 2008. Over the last decade, there has been a decrease in improvements in life expectancy, with evidence of increasing inequalities, potentially further worsened due to the COVID-19 pandemic and the ongoing cost-of-living crisis," said Ms Lucie Giles, Public Health Intelligence Principal at Public Health Scotland.
"Our study provides the best evidence to date to link minimum alcohol pricing in Scotland with a significant reduction in deaths from alcohol consumption in people living in the most socio-economically deprived areas in Scotland."
Wider evidence on the impact of MUP will be president to members of the Scottish Parliament ahead of a parliamentary vote on the future of MUP in Scotland in 2024.
The country is also exploring other regulations for alcohol: such as wide-reaching advertising restrictions.
Source: 'Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study' The Lancet, March 20, 2023.
