Scotland's MESAS evaluation shows impact despite no minimum pricing

The final Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS) report has been released, exploring the likely extent to which the strategy has impacted on alcohol harm in Scotland. See supporting infographics here.

The report acknowledges the complex range of factors that influence alcohol consumption and harms, but suggests the Scottish Government’s alcohol strategy has had a positive impact over the past 5 years. However external factors, especially socio-economic influences, have also contributed to the declining harms, and that improvements may have stalled in recent years.

The report also warns that alcohol harm in Scotland remains at a high level, and the failure to date to implement minimum unit pricing (MUP) has hindered the strategy's impact. Scotland has of course won praise from many public health and academic experts for its evidence based approach, particularly comparing to other UK nations.

The report assesses key aspects of the strategy, with headline findings including:

• The impact of the Licensing Act has changed practice, although challenges in implementation and data meant assessing the impact on licensing decisions and affect on availability is limited.
• Delivery of alcohol brief interventions (ABIs) increased as a result of a national performance target, national co-ordination and investment. ABIs as such have been embedded into routine practice in Primary Care, which combined with other settings has reached an estimated 43% of harmful and hazardous drinkers over seven years, although the quality and impact of delivery is unknown.
• A tripling of investment in specialist treatment and care services has improved the availability and quality of services. Waiting times reduced and the 2012 ratio of prevalence of alcohol dependence to service users (PSUR) estimated 1 in 4 accessed specialist services.
• The Alcohol Act, which included the ban on multi-buy discounts, was introduced in October 2011 and was associated with a modest reduction in off-trade sales, driven by a reduction in off-trade wine sales. This does not appear to have had a measurable, short-term impact on deaths or hospitalisations entirely caused by alcohol. Its effect on wider alcohol attributable conditions was not examined.
• Evidence of knowledge and attitude change amongst Scots was mixed. No consistent change in knowledge about units or attitudes to drunkenness or the social role of drinking was apparent, but there appeared to be increased recognition of the harm caused by alcohol
• Minimum Unit Pricing (MUP) is subject to a legal challenge and has not yet been implemented. As such other than the ban on multi-buy promotions, influences on affordability were 'external factors'.

Whilst the report suggests the national strategy has impacted alcohol harms, it emphasises the importance of external factors, including on the main measures of mortality and hospitalisation rates. The report says it is 'likely that rising and then falling incomes, especially for the poorest groups, over the 1990s and 2000s, explain part of the rise and fall in alcohol consumption and harms in Scotland over that time period'. A particular 'vulnerable cohort' were thought to be significant for a 'wave of alcohol-related mortality that increased in the 1990s and decreased from the mid-2000s as the cohort aged and died'.

Despite the improvements, mortality rates continue to be higher than in the 1980's and still higher than England and Wales, with alcohol still responsible for 22 deaths in Scotland each week. Recommendations in the report focus on continuing to pursue and implement evidence based approaches for the future, especially those that focus on reducing price, availability and marketing. Continuing to assess, evaluate and monitor activity is also recommended, alongside further research in a number of key areas.

The report received coverage from the BBC, Herald and the Daily Record. Two journal papers exploring the influences and impacts can be accessed here and here.

Alcohol Focus Scotland (AFS) and partners recently called on Scotland's politicians to pledge to do more to reduce children's exposure to alcohol advertising. SHAAP (Scottish Health Action on Alcohol Problems) released a 'top 20 manifesto' for action on alcohol ahead of the upcoming Holyrood Scottish Parliament election in May.