The Welsh Government has announced plans to see Minimum Unit Pricing (MUP) introduced by law as part of a 'comprehensive strategy to tackle harmful and hazardous drinking by tackling the availability and affordability of cheap, strong alcohol'.
The news comes as the long awaited verdict from the UK Supreme Court on Scotland's 2012 legislation is expected imminently. In England, fifty health bodies and other figures including MPs have called on the Government to follow suit and enact UK wide minimum pricing, describing MUP as a 'highly effective tool'.
The Public Health (Minimum Price for Alcohol) (Wales) Bill proposes to introduce MUP via the Welsh Assembly next week, but has not yet stated the intended price level. In 2014 modelling by the Sheffield Alcohol Research Group (SARG) estimated a 50 pence per unit MUP would result in 53 fewer deaths and 1,400 fewer hospital admissions in Wales each year. As a result the policy could save the NHS in Wales more than £130m over 20 years and a total of £882m to the Welsh economy by reducing alcohol-related illness, crime and workplace absences.
The Chief Medical Officer for Wales, Dr Frank Atherton, said:
“As alcohol has become more affordable, consumption has increased. As consumption increases, harm increases. All alcohol-attributable deaths are avoidable deaths, demonstrating the urgency for further preventative action.
“It will have a small impact on moderate drinkers. The most substantial effects will be experienced by harmful and hazardous drinkers, who are more likely to consume cheaper and higher-strength alcohol products.”
All eyes on the Supreme Court
Whilst Scotland awaits what is expected to be the final episode of a long drawn out legal challenge from sections of the alcohol industry, in England Government Ministers have been sketchy on the issue following the infamous 2013 U-turn. Westminster have largely insisted they have not ruled out the policy whilst Ministers have also suggested they have been taking action to address some of the cheapest drinks, firstly via the below-cost ban and more recent consultation on white cider duty. Health groups though have been dissatisfied, not least because of the negligible effect - if any - of the below cost ban, but particularly due to the ending of the alcohol duty escalator in 2014 and subsequent budget duty decisions.
However Scotland's proposed 50 pence MUP was legislated for in 2012, and inevitably any effect of a 50 pence MUP would be lessened if implemented some five years or more after intended. Indeed charges of 'delaying tactics' have been made against those opposing MUP, with comparisons to strategies of the tobacco and other industries reportedly seeking to undermine public health policies. Of course a range of other arguments are made by opponents of MUP, including charges that it will 'punish responsible drinkers' or those on lower incomes, as tweeted by new 'grassroots' consumer body Drinkers' Voice.
Notably public opinion on MUP appears fairly evenly split, but groups such as the SARG and others have sought to highlight that MUP is targeted at the heaviest drinkers. In Wales, around a quarter (26%) of adults reportedly drink nearly three-quarters (72%) of all the alcohol consumed.
Dependent drinkers: a legitimate concern?
One impact where health groups and MUP opponents may be seen to broadly agree is the need to consider the potential impact on heavily dependent drinkers, an area where further research is due to be undertaken for both Scotland and Wales. In a BBC report, a former problem drinker took the not uncommon view that dependent drinkers would 'try to get alcohol by any means necessary'. Such arguments may be intuitively appealing, particularly when the nature of addiction itself is often perceived as continuation of a behaviour despite its harm.
However whilst research has indicated that even very heavy drinkers are still price sensitive, the exact effects on those with severe dependence following MUP will be closely monitored. Severely dependent drinkers though represent a small proportion of those who MUP is targeted at. In England, recent prevalence data suggests a little over 100,000 people have severe dependence, a fraction of the 10.4 million Public Health England say drink above the low risk guidelines.
As such, MUP advocates often highlight the prevention paradox, by which small changes across large numbers can add up to a significant effect; less observable in behaviour at an individual level rather than annual national figures. Moderate drinkers though, according to Welsh modelling, would only be predicted to pay an extra 5 pence per week and few bar, pub or restaurant prices would be affected. Nonetheless, price jumps in many supermarket and off-trade drinks would certainly be noticeble as some reports sought to highlight, and indeed the existence of high alcohol low price categories such as white cider may well come to an end under MUP. Whilst health economists may be confident on an overall beneficial impact of MUP, many important further questions will be the focus of researchers, policy makers and campaigners alike.
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