The Scottish government has published a new alcohol framework 2018, outlining 20 key actions that seek to 'reduce consumption and minimise alcohol-related harm arising in the first place'.
The strategy has three key themes including 'reducing consumption', 'positive attitudes, positive choices' and 'supporting families and communities', and coincides with the latest figures on alcohol-related hospital admissions in Scotland of 35,499 in 2017/18.
The strategy follows on from the implementation of Minimum Unit Pricing (MUP) earlier this year after a long running legal challenge by sections of the alcohol industry. The Ministerial foreword says that while MUP "will contribute towards the step-change we need to see in Scotland’s levels of alcohol-related harm, we have always been clear that it was not a ‘silver bullet’".
MUP will be reviewed after 5 years as part of a 'sunset clause', but the framework also includes a new announcement that the 50 pence MUP level will be reviewed in 2020. The intention to review the MUP level after two years of operation is likely to reflect predicted effects of different price levels as modelled by Sheffield Alcohol Research Group. Indeed with MUP legislation first passed in 2012, some had felt a higher level of 60 pence may have been more appropriate, though the availability of initial evaluation findings by 2020 will allow the government to 'ensure the minimum price level remains appropriate'.
A multi-compenent approach
Other key actions set out include investigating the impact of telephone and online alcohol sales, reviewing the licensing system at large, and pressing Westminster to enable Scotland to protect children and young people from pre-9pm TV advertising. A national marketing campaign to promote the revised CMO weekly drinking guidelines will be launched in 2019, as well as pressing producers for better labelling and packaging, and work to raise awareness of the link between alcohol use and cancer. A commitment to review Alcohol Brief Intervention (ABI) delivery is also made including efforts to assess their quality.
A series of actions also relate to reviewing and developing resources and activities relating to education and information for children and young people, and an over-arching commitment to put their voices 'at the heart of developing preventative measures'. Work relating to the theme of supporting families and communities will also include prevention of the harm caused by alcohol use and pregnancy, including improved awareness, prevention and diagnosis of Foetal Alcohol Spectrum Disorder (FASD).
Question marks?
Scotland's past alcohol policy has been largely applauded by public health groups, particularly when compared to to Westminster's approach favouring themes of local partnerships and self-regulation. However several issues were raised on Twitter following the release. One rather important point was made in relation to the use of the framework's identification of 'higher risk' drinking as a consumption level above the CMO guidelines of 14 units, despite 'higher risk' having been used widely by Public Health England (PHE) and NICE as equivalent to harmful drinking; in consumption terms defined as 35 units or more per week for women or 50 or more for men. As such higher risk has existed as a level categorised as distinctly above increasing risk or hazardous drinking.
Speculation may be made that the decision reflects recent evidence related to there being 'no safe level' of alcohol consumption, thus a level above 'lower risk' could be argued as 'higher'. However debates about determining and communication of individual level risks has seen a number of public health roles express concerns over 'no safe level' messages and the use of population based risk calculations and their translation for drinkers at an individual level.
A key issue of contention for alcohol policy in the current age relates to the role industry interests or organisations should have. For many public health roles, recognising the role of industry in the delivery of certain actions (such as labelling) is to be distinguished from any involvement in policy making. The framework states the Scottish government 'will work with the alcohol industry on projects which can impact meaningfully on reducing alcohol harms, but not on health policy development, on health messaging campaigns, or on provision of education in schools or beyond the school setting.'
This may be seen like a legitimate position to many in the alcohol field, albeit with a question raised over what 'meaningfully' may constitute. Indeed a recent PHE campaign partnering with indsutry funded body Drinkaware caused a significant degree of controversy, though the PHE evaluation of the Drink Free Days campaign is now planned to include an assessment of the impact of the partnership.
England to follow?
A new national alcohol strategy is reportedly in development for England and Wales, though there have been few signs that calls for it to follow a more evidence-based approach will be heard. Minimum pricing appears to be off the table according to a recent parliamentary answer stating "the new strategy will not include a commitment to introduce minimum unit pricing in England at this time", but that PHE would review the impact in Scotland following its introduction this year, despite Wales and Ireland taking steps to implement MUP.
Earlier this month the Health Secretary Matthew Hancock said people should take greater personal responsibility for their health to take pressure off the NHS, provoking dismay from behaviour change academics and alcohol groups. Hope that the strategy will halt the 'crisis' facing treatment services may be one area where advocacy groups will continue to focus efforts on.
Comments