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

Abstract

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.

‘Black magic’ and ‘gold dust’: the epistemic and political uses of evidence tools in public health policy making

“…large health charities and representatives of health professionals). Although these individuals are not formal policy actors, they are active in policy debates and can play an important 'mediating' role between research and policy (see Katikireddi et al, 2014;and Smith, 2013). We note, at this point, that whilst we have tried to be clear about the kinds of actors we included in our primary research (whilst maintaining the anonymity of interviewees), one problematic aspect of much of the published literature on 'evidence tools' that we identified employed less sector-specific terms to describe interviewees (such as 'Health Impact Assessment practitioner'), making it difficult (and sometimes impossible) to ascertain the professional location of interviewees.…”

Heavy Drinkers’ Perspectives on Minimum Unit Pricing for Alcohol in Scotland

“…At the time of writing, this process is ongoing, and the outcome, and therefore any implementation date for the Act, remain uncertain. An account of the Act's development and the policy context can be found in Katikireddi, Hilton, Bonell, and Bond (2014) and .…”

UK substance use policy research should think local

“…Katikireddi et al (2014) bring together the insights of three models to better understand the formation of MUP in Scotland: 'multiple streams', 'punctuated equilibrium' and 'multi-level governance'. Alternatively, established models -such as Kingdon's 'multiple streams' -can be developed, as Nicholls and Greenaway (2015) have recently done, arguing that policy debate is affected by the following categories of issue: definitional; ideological; systemic; and evidential.…”

“…Nicholls and Greenaway (2015) draw on qualitative interview data, as do Katikireddi et al (2014), and the work of the same team on newsprint coverage also helps illuminate the more public aspect of policymaking . This combination of interview data and publicly available policy, media and historical documents was used in what is possibly the clearest example of an analysis of local policymaking in relation to alcohol or drugs: the history of alcohol policy in Nottingham written by McGregor and Berridge (2011).…”