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On 5 September 2014, following the EPHA Annual Conference, the seminar on Scotland’s innovative Alcohol Policies successfully brought together representatives from Scottish health professionals with around 80 European colleagues and industry representatives to discuss the minimum unit pricing (MUP). This event highlighted the fact that different stakeholders are urging EU Member States and the European Commission to support the Scottish policy on alcohol. MUP is opposed by a consortium of multi-national
alcohol producers who, inaccurately, have tried to frame this as a health sector versus industry issue, rather than as a vital lifesaving measure.

This side event of EPHA’s annual conference clearly showed that the MUP policy is also supported by representatives from the Scottish industry. Paul Bartlett from the C&C Group, which has around 50% share of the beer market in Scotland, stated that it was essential that drinks companies should take a step forward to help address the increase in deaths through liver disease. “Minimum unit pricing for us is a key step in that battle.” he stated.

The Scottish Government passed legislation to introduce MUP to tackle the problems caused by cheap alcohol in 2012. The Scotch Whisky Association (SWA) and other European wine and spirits producers took action against the proposal claiming that it breaches the UK’s European Union (EU) treaty obligations. The Court of Justice of the EU (ECJ) was asked to give its opinion on this complaint. Within this context, SHAAP (Scottish Health Action on Alcohol Problems) is urging other Member States and the Commission to support the Scottish policy.

Dr. Pieters Rice from SHAAP, explained that nowadays around 70% of consumed alcohol is being bought in supermarkets and shops. Furthermore, alcohol in Scotland is in real terms 60% per cent cheaper than it was 30 years ago. According to Mr Rice, it was therefore very clear where the source of the problem was lying and that it should be targeted effectively.

Deaths from liver disease has gone up more than 500% since 1970. Professor Nick Sheron from the Royal College of Physicians explained that in order to reduce liver mortality, one has to tackle population level alcohol consumption. He further clarified that the impact of the MUP policy is exquisitely targeted at the heaviest drinkers:

“If you’re affected by minimum unit price, effectively you’re drinking too much.”

Within the subsequent discussion, Donald Henderson from the Scottish Government highlighted that the Scottish case before the ECJ is potentially a fundamentally important case for public health in the Union, that will affect the next generation and beyond on any public health issue. The crucial question is whether the Court will approve the use of price as an instrument to control consumer behaviour. This is of great importance because many modern illnesses are strongly related to human behaviour.

Lastly, he once more emphasised that MUP policy does not aim at zero alcohol consumption, but at rebalancing consumption in a way which maximises the benefits to health.

Full event summary

– The presentations of the event are available on the Eurocare website

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Alcohol related harm in the EU
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The cost of alcohol-related harm to the EU’s economy has been estimated at €125 billion for 2003, equivalent to 1.3% of GDP. Alcohol is causally related to over 60 different medical conditions and it is estimated by independent academics that the Scottish policy would save 60 lives in its first year, rising to 300 lives per year after 10 years. The actual spending on alcohol-related problems across the EU is estimated at about €66 billion. Specific examples of indirect harms include:

  • Lost economic productivity for employers through staff absenteeism;
  • Costs to institutions through poor health or criminality in their workforce;
  • Unemployment or low employability of users and the impact on their families and related costs;
  • Crime, in particular violent crime; [[Sivarajasingam V, Matthews K, Shepherd J. Price of beer and violence-related injury in England and Wales. Injury. 2006;37(5):388-94.]] [[Boreham R, Cronberg A, Dollin L, and Pudney S (2007) The Arrestee Survey 2003-2006. Home Office Statistical Bulletin. London: Home Office RDS Directorate]]
  • The association between alcohol consumption and domestic violence; [[Humphreys C, Regan L, River D and Thiara RK (2005a) ‘Domestic Violence and Substance Abuse: Tackling Complexity’, British Journal of Social Work 35(8):1303-1320]] [[Moore TM and Stuart GL (2004) ‘Illicit substance use and intimate partner violence among men in batterers’ intervention’, Psychology of Addictive Behaviours 18(4):385-9 ]] [[Chermack ST and Blow FC (2002) ‘Violence among individuals in substance abuse treatment: the role of alcohol and cocaine consumption; Drug and Alcohol Dependence 66:29-37 ]]
  • Risky sexual activity, potentially impacting on an individual and their partners’ sexual health, sometimes resulting in sexually transmitted diseases, [[Teenage Sex, Drugs and Alcohol Use: Problems Identifying the Cause of Risky Behaviours20 (with Robert Kaestner). Journal of Health Economics, 23(3): 493-503, May 2004 ]] and
  • unplanned pregnancy. [[Murgraff, V., Parrott, A.C., Bennett, P. (1998) Risky single occasion drinking amongst young people: definition, correlates, policy and intervention, A broad overview of research findings. Alcohol and Alcoholism, 33, 1-12.]]

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Evidence behind MUP
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Of all alcohol policy measures, the evidence shows that the impact of price on alcohol consumption and alcohol-related harm is strongest. [[WHO Europe, Handbook for Action to Reduce Alcohol-related Harm, 2009]] The Scottish legislation sets a Minimum Unit Price (MUP) based on the unit content of the product and, therefore, applies to all products equally, and also does not discriminate between domestic or imported products. Products already on the market in Scotland will need to comply with MUP, but the legislation does not require the producer to change the characteristics of those products, nor does it prevent such change if the producer prefers. Real-world evidence and economic modelling indicates that MUP would be effective in reducing hazardous and harmful alcohol consumption. [[Tim Stockwell, PhD, Jinhui Zhao, PhD, Norman Giesbrecht, PhD, Scott Macdonald, PhD, Gerald Thomas, PhD, and Ashley Wettlaufer, MPH Published online October 18, 2012 | American Journal of Public [[Health]]

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MUP and health inequalities
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In terms of reducing health inequalities, a minimum pricing scheme could help to reduce the burden of disease and alcohol-related harm for people in low-income households The effects of MUP would be different for different subgroups of the population with smaller effects on moderate drinkers, particularly those with low incomes. It would not affect all alcoholic drinks (most on-licence sales would be unaffected), but would increase the price of those alcoholic beverages that are currently relatively under-priced or discounted. Drinks like own brand vodka or gin, strong white cider and super strength lager will be affected. It will not affect pubs, clubs and restaurants.

There is a growing body of evidence which shows that price increases can have a substantial impact on reducing consumption, and consequently on alcohol-related harm, and that is why EPHA President Peggy Maguire counted on the support of EU Member States for this vitally important Public Health issue in Scotland in her recently published open letter: – [->6168]

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