As alcohol-specific deaths in England continue to rise, evidence is clear that setting minimum unit pricing – or ‘MUP’ – for alcohol saves lives and reduces alcohol-related harm.
An evaluation of the policy in Scotland – where a minimum price of 50p per unit has been in force for five years – found that it reduced consumption and led to fewer alcohol-related deaths.
Following this evidence, the Scottish government voted last week to continue the policy and at an increased price of 65p per unit from September this year. With Wales and the Republic of Ireland also recently introducing the measure, England is becoming an outlier with no national alcohol strategy for more than a decade.
Alcohol consumption is a driving factor behind more than 200 illnesses and injuries. Misuse of alcohol is the greatest risk factor for death, ill-health, and disability in people aged 15-49, and one of the leading preventable risk factors for death and disability among all adults.
Since 2019, the number of deaths due to alcohol has risen by more than a third in England and alcohol is well known for increasing the risk of some of the major conditions keeping people ill and off work, such as cardiovascular disease, cancers including breast, mouth and bowel cancer, and mental ill health.
And yet, our neighbourhoods are saturated with alcohol adverts and cheap drinks, with alcohol availability being highest in poorer areas.
The burden of alcohol-related harm is not felt equally. Despite drinking less on average, people living in the most deprived communities experience the greatest harms and bear the greatest costs – the ‘alcohol harm paradox’. Death rates from alcohol in the most deprived areas of the country are twice that of the most affluent.
This is likely due to the interplay between a range of social factors including differences in drinking patterns, access to health care, poverty and stress. MUP can help tackle these inequalities – the reduction seen in alcohol-attributable deaths in Scotland was greatest in more deprived communities.
Alcohol is also hugely costly to the health system and wider society, accounting for nearly 350,000 hospital admissions each year in England and costing the NHS an estimated £3.5 billion annually. Government estimates of societal costs such as reduced employment, lower productivity, increased crime, and harm to family and friends date back to 2003 when they were estimated at £21bn a year. The figure today is likely to be far higher.
Why then, in light of well-documented concerns around the impact on health, the NHS, and public finances, has England not published an alcohol strategy in more than a decade?
A policy vacuum
England’s most recent alcohol strategy is from 2012 where David Cameron’s government proposed wide-reaching plans – including MUP – to address harmful drinking. But the policy was dropped, with ministers arguing a lack of ‘concrete evidence’ of its impact on problem drinking.
There has been no coordinated approach to alcohol since and, even now as alcohol-related deaths rise, pre-election conversations across the political spectrum are devoid of reference to alcohol harm.
In March 2020, the government said it would “continue to monitor the progress of MUP in Scotland and will consider available evidence of its impact.” With that evidence now available, will England rethink its position?
So far, despite a growing list of evidence-based, preventative interventions, the focus of alcohol policy in England has remained on treatment services for those dependent on alcohol. While this support is vital, a wider strategic approach is needed to help prevent excess consumption in the first place, including among the estimated 10 million adults exceeding the Chief Medical Officer’s drinking guidelines.
We cannot help but question what is shifting the domestic conversation away from the regulation we know to work.
We have learnt, through decades of tobacco industry policy interference and Scotland’s five-year legal battle with the whiskey industry on MUP, that there are significant vested interests in government regulation.
Giving industry a seat around the table will only serve to dilute the perceived need for state intervention and over-emphasise individual responsibility – as we are seeing play out now in England, including the recent announcement of continued freezes to alcohol duty. Ministers must hold firm in following the evidence for most effectively tackling alcohol-related harm.
England is in desperate need of a coherent alcohol strategy. One that takes strong national action – including MUP – alongside bolstering support for those living with alcohol dependency.
Health Foundation/Ipsos polling shows that two-thirds of people in England think the government has a responsibility for reducing alcohol-related harm, with 48 per cent supporting the introduction of MUP and only 27 per cent opposed. Here too, we can learn from our Scottish neighbours, where public attitudes towards MUP have become more favourable over time.
This week’s figures on alcohol deaths clearly indicate that now is the time for the government in England to learn from the evidence and take bold national action on alcohol policy.
- Talia Boshari is Public Health Specialty Registrar and Adam Briggs is Senior Policy Fellow for The Health Foundation
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