Minimum unit pricing for alcohol clears final legal hurdle in ScotlandBMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5372 (Published 21 November 2017) Cite this as: BMJ 2017;359:j5372
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Minimum Pricing Surely Heralds Culture Change in ScotlandRe: Minimum unit pricing for alcohol clears final legal hurdle in Scotland
Minimum Pricing Surely Heralds Culture Change in Scotland
I agree with Meier that the Supreme Court's go-ahead for minimum alcohol pricing will trigger change internationally, not just Scotland. Scotland is, moreover, aiming to shift the culture around alcohol. The estimated 120 lives per year saved by this policy is valuable but small compared with the potential.
In 2016 there were 867 deaths related to alcohol in men, and 398 in women. In 12 months over 2015/2016, 23,431 people were admitted for alcohol-related conditions to acute hospitals in Scotland.
Culture influences alcohol intake. For the period 2001-2010 we published statistics by ethnic group showing large variations. (1) The rate of disease is notoriously high in White Scottish people, but in Irish men living in Scotland the rate of hospitalisation/death was more than doubled, and in White Irish women almost doubled compared with the White Scottish population. By contrast, in Pakistani and Chinese men and women the rates were about half those of the White Scottish population. Sadly, Indian men and women were similar to the White Scottish population.
Culture matters greatly. In Scotland, being drunk is still a matter to boast about, and that has to change. Minimum pricing is one catalyst to change but we have a long journey ahead.
1 Bhala N, Cézard G, Ward HJ, Bansal N, Bhopal R; Scottish Health and Ethnicity Linkage Study (SHELS) Collaboration. Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study. Alcohol Alcohol. 2016 Sep;51(5):593-601. doi: 10.1093/alcalc/agw018. Epub 2016 May 6.
Competing interests: No competing interests
The apparent unqualified support for minimum unit pricing for alcohol by Meier et alia in their editorial seems misguided in terms of principle and in terms of the evidence-base.
The principle of fairness is breached because minimum unit pricing for alcohol will cost individuals in lower socioeconomic groups proportionally more of their income than individuals in higher socioeconomic groups, i.e. the pricing is regressive, all other things being equal. Accordingly inequality of access will widen.
The evidence-base cited by Meier et alia draws extensively on their modelling which is open to many challenges particularly regarding the links of the models to the real world of individual behaviours and sociocultural contexts (Duffy & Snowdon, 2012; Griffith & Leicester, 2010). The observational studies from the Canadian provinces are not cited perhaps due to their weaknesses (Giesbrecht et al., 2016; Zhao et al., 2013).
Research into alcohol is fraught with controversies notably regarding research methodologies, protective versus harmful effects, price elasticity, inter alia (Gray, 2013; Roerecke & Rehm, 2012). If there is concern about harmful drinking by a minority of people of any age then the appropriate qualitative research should take place to investigate the reasons.
It is disappointing to see the support for legislation for putative public health benefits. The editorial would have been more persuasive if it had addressed policy initiatives aimed at promoting responsible alcohol consumption.
Competing interests: Declaration: I am an elected member of the BMA’s Welsh Council. The views and opinions in this letter are mine and not those of the BMA’s Welsh Council.