Harmful alcohol consumption significantly contributes to the global disease burden and is responsible for many deaths worldwide. In 2021, the UK reported the highest number of deaths from alcohol-specific causes on record. Within the UK, health harms from alcohol are disproportionately higher in Scotland and strongly patterned by socioeconomic deprivation.
To address this issue, Scotland became one of the few countries to implement minimum unit pricing (MUP) for alcoholic drinks sold directly to the public. MUP sets a legal minimum price below which alcohol cannot be sold and has the potential to positively tackle inequalities in health harms and reduce harms in subgroups at the most significant risk. Previous international studies have estimated the effect of increasing alcohol pricing to reduce alcohol-attributable harms.
A recent study published in The Lancet found a significant reduction in deaths wholly attributable to alcohol consumption following the implementation of Minimum Unit Pricing (MUP) legislation in Scotland. The study found that there was a 13% reduction in deaths attributable to alcohol consumption, which equates to an average of 156 deaths avoided each year. The study also found that there was a corresponding 4% reduction in hospitalizations for conditions wholly attributable to alcohol consumption, which equates to an average of 411 hospitalizations avoided each year.
The study, which took place over 32 months, found that the most significant reductions were estimated in Scotland’s 40% most socioeconomically deprived areas. This suggests that the implementation of MUP has positively tackled deprivation-based health inequalities in alcohol health harms. The positive impact of MUP legislation was observed in both males and females and across the age groups of 35-64 years and 65 years and older. However, the study could not evaluate change in the 16-34 age group due to the relatively small number of deaths for this group.
Potential indications that MUP was associated with worsening acute outcomes for deaths and hospitalizations wholly attributable to alcohol consumption. These findings are in contrast to findings from previous observational studies. One identified plausible mechanism was that some subgroups reduced their spending on food or lowered their food intake due to the financial pressures of the policy being implemented, which might have led to faster intoxication or poisoning.
Findings from another study offer another potential explanation, reporting evidence of switching consumption from lower to higher alcohol-by-volume products (e.g., cider to spirits), which could lead to quicker intoxication. These findings underscore the importance of ensuring timely, accessible services for those dependent on alcohol to coincide with the implementation of population-level policies.
The study estimated that reductions in chronic outcomes, particularly alcoholic liver disease, drove changes in total outcomes, offsetting the potential adverse consequence on acute outcomes. Combining these findings indicates that implementing MUP has had a net benefit in reducing deaths and hospitalizations wholly attributable to alcohol consumption.
The study outcome definitions are wholly attributable to harmful levels of consumption of alcohol and have been coded using internationally agreed definitions. High-quality data sources of individual deaths and hospitalizations with recorded person-specific demographic attributes were used. Both UK countries under study have a universal healthcare system free at the point of use, so there was minimal sampling or recruitment bias risk.
The study is also significant in providing evidence of MUP legislation’s effectiveness in reducing deaths and hospitalizations wholly attributable to alcohol consumption, particularly in areas of high deprivation. It also highlights the importance of ensuring timely, accessible services for those dependent on alcohol to coincide with the implementation of population-level policies.
