Introducing a minimum unit price for alcohol in Scotland: considerations under European Law and the implications for European public health

Katikireddi, Srinivasa Vittal; McLean, James A.

doi:10.1093/eurpub/cks091

Cited by 18 publications

(15 citation statements)

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“…Because similar alcohol consumption exerts greatest harm among more disadvantaged groups, the effect of population-based prevention efforts on health inequalities have the potential to be larger than previously anticipated. This outcome is especially relevant because of the planned implementation of minimum unit pricing in Scotland, which has been delayed substantially after legal challenges from the alcohol industry34, 35—the beneficial effects in terms of reduced health inequalities could be even greater than currently expected.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data

Katikireddi

Whitley

Lewsey

et al. 2017

The Lancet Public Health

261

241

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SummaryBackgroundAlcohol-related mortality and morbidity are high in socioeconomically disadvantaged populations compared with individuals from advantaged areas. It is unclear if this increased harm reflects differences in alcohol consumption between these socioeconomic groups, reverse causation (ie, downward social selection for high-risk drinkers), or a greater risk of harm in individuals of low socioeconomic status compared with those of higher status after similar consumption. We aimed to investigate whether the harmful effects of alcohol differ by socioeconomic status, accounting for alcohol consumption and other health-related factors.MethodsThe Scottish Health Surveys are record-linked cross-sectional surveys representative of the adult population of Scotland. We obtained baseline demographics and data for alcohol consumption (units per week and binge drinking) from Scottish Health Surveys done in 1995, 1998, 2003, 2008, 2009, 2010, 2011, and 2012. We matched these data to records for deaths, admissions, and prescriptions. The primary outcome was alcohol-attributable admission or death. The relation between alcohol-attributable harm and socioeconomic status was investigated for four measures (education level, social class, household income, and area-based deprivation) using Cox proportional hazards models. The potential for alcohol consumption and other risk factors (including smoking and body-mass index [BMI]) mediating social patterning was explored in separate regression models. Reverse causation was tested by comparing change in area deprivation over time.Findings50 236 participants (21 777 men and 28 459 women) were included in the analytical sample, with 429 986 person-years of follow-up. Low socioeconomic status was associated consistently with strikingly raised alcohol-attributable harms, including after adjustment for weekly consumption, binge drinking, BMI, and smoking. Evidence was noted of effect modification; for example, relative to light drinkers living in advantaged areas, the risk of alcohol-attributable admission or death for excessive drinkers was increased (hazard ratio 6·12, 95% CI 4·45–8·41 in advantaged areas; and 10·22, 7·73–13·53 in deprived areas). We found little support for reverse causation.InterpretationDisadvantaged social groups have greater alcohol-attributable harms compared with individuals from advantaged areas for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity, and smoking status at the individual level.FundingMedical Research Council, NHS Research Scotland, Scottish Government Chief Scientist Office.

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Section: Discussionmentioning

confidence: 99%

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data

Katikireddi

Whitley

Lewsey

et al. 2017

The Lancet Public Health

261

241

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“…MUP builds on these initiatives by linking the lowest price paid for alcohol to its content of pure alcohol, defined on the basis of ‘units’, where one unit equals 8g of ethanol [7]. The policy was first introduced into legislation in Scotland in May 2012 but its implementation has been delayed as a result of industry-initiated legal challenges [8], [9].…”

Section: Introductionmentioning

confidence: 99%

Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

et al. 2014

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BackgroundMinimum unit pricing of alcohol is a novel public health policy with the potential to improve population health and reduce health inequalities. Theories of the policy process may help to understand the development of policy innovation and in turn identify lessons for future public health research and practice. This study aims to explain minimum unit pricing’s development by taking a ‘multiple-lenses’ approach to understanding the policy process. In particular, we apply three perspectives of the policy process (Kingdon’s multiple streams, Punctuated-Equilibrium Theory, Multi-Level Governance) to understand how and why minimum unit pricing has developed in Scotland and describe implications for efforts to develop evidence-informed policymaking.MethodsSemi-structured interviews were conducted with policy actors (politicians, civil servants, academics, advocates, industry representatives) involved in the development of MUP (n = 36). Interviewees were asked about the policy process and the role of evidence in policy development. Data from two other sources (a review of policy documents and an analysis of evidence submission documents to the Scottish Parliament) were used for triangulation.FindingsThe three perspectives provide complementary understandings of the policy process. Evidence has played an important role in presenting the policy issue of alcohol as a problem requiring action. Scotland-specific data and a change in the policy ‘image’ to a population-based problem contributed to making alcohol-related harms a priority for action. The limited powers of Scottish Government help explain the type of price intervention pursued while distinct aspects of the Scottish political climate favoured the pursuit of price-based interventions.ConclusionsEvidence has played a crucial but complex role in the development of an innovative policy. Utilising different political science theories helps explain different aspects of the policy process, with Multi-Level Governance particularly useful for highlighting important lessons for the future of public health policy.

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“…It is a key component of the Scottish Government's policy to address alcohol-related harms ( Scottish Government, 2008 ), and has been considered elsewhere in the UK ( HM Government, 2012 ). Legislation to introduce the policy has been passed in Scotland ( Scottish Parliament, 2012 ) but its implementation has been delayed following industry-instigated legal challenges ( BBC News, 2012 ; Katikireddi & McLean, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews

Katikireddi

Hilton

2014

Drugs: Education, Prevention and Policy

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Aims: To explore how policy actors attempted to deliberately frame public debate around alcohol minimum unit pricing (MUP) in the UK by comparing and contrasting their constructions of the policy in public (newspapers), semi-public (evidence submissions) and private (interviews). Methods: Content analysis was conducted on articles published in ten national newspapers between 1 January 2005 and 30 June 2012. Newsprint data were contrasted with alcohol policy documents, evidence submissions to the Scottish Parliament's Health and Sport Committee and 36 confidential interviews with policy stakeholders (academics, advocates, industry representatives, politicians and civil servants). Findings: A range of policy actors exerted influence both directly (through Parliamentary institutions and political representatives) and indirectly through the mass media. Policy actors were acutely aware of mass media's importance in shaping public opinion and used it tactically to influence policy. They often framed messages in subtly different ways, depending on target audiences. In general, newspapers presented the policy debate in a “balanced” way, but this arguably over-represented hostile perspective and suggested greater disagreement around the evidence base than is the case. Conclusions: The roles of policy actors vary between public and policy spheres, and how messages are communicated in policy debates depends on perceived strategic advantage.

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Introducing a minimum unit price for alcohol in Scotland: considerations under European Law and the implications for European public health

Cited by 18 publications

References 0 publications

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data

Socioeconomic status as an effect modifier of alcohol consumption and harm: analysis of linked cohort data

Understanding the Development of Minimum Unit Pricing of Alcohol in Scotland: A Qualitative Study of the Policy Process

How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews

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