Scotland: Making Cheap Booze More Expensive
A study has found significant health benefits.

Outside the Beltway
By James Joyner
March 26, 2023

USA Today (“The argument for making alcohol more expensive: It could save lives, study suggests.”):

In 2018, the Scottish government made drinks more expensive if it contained more alcohol.

It was an effort to reduce drinking in Scotland, which has the highest rate of death due to alcohol consumption in the United Kingdom.

Now in a study published this week, Scottish public health officials reported its minimum unit pricing policy was associated with a 13% reduction in deaths from alcohol consumption since it was implemented.

That sounds pretty significant. Until the base rate is revealed:

That translates to about 150 deaths per year, according to the report published Monday in The Lancet.

Oh.

So, certainly, 150 fewer unnecessary or premature deaths is a good thing. But that has to be weighed against the additional costs borne by the entirety of society. It seems more a boon for the treasury than a major health initiative.

Researchers discovered the reduction in deaths was mainly due to long-term conditions, including an 11.7% decrease in deaths from alcoholic liver disease and 23% decrease from alcohol dependence syndrome.

The most significant impact was among people who lived in socio-economically deprived areas, where death rates are “more than five times higher compared to those living in the least deprived areas,” said Grant Wyper, public health intelligence adviser at Public Health Scotland.

So, again, that’s good! But another way of looking at it–indeed, my initial reaction when I saw the headline–is that we’re simply making it harder for poor people to drink. Those more well off will simply grumble at the increased cost but most aren’t going to change their lifestyle over it. The policy essentially punishes the poor for making choices society doesn’t approve of while allowing those who can afford it to carry on.

A minimum unit price for alcohol sets a floor price per unit of alcohol, according to the Scottish government, which means a drink will be more expensive if it contains more alcohol.

The minimum unit pricing in Scotland was set at 50 pence, or about 70 cents, per 8 grams of alcohol. One standard drink in the U.S. contains about 14 grams of alcohol. There is no national minimum unit pricing in the United States, though some states do have their own policies.

Unlike other alcohol policies, minimum unit pricing targets cheap alcohol typically consumed by heavy drinkers or young people.

“People who buy a lot every day tend to look for the best bargains,” said Tim Stockwell, former director of the Canadian Institute for Substance Use Research at the University of Victoria.

“Cheap alcohol is sought out by vulnerable people, young drinkers, heavy drinkers, people with alcohol dependence.”

So, sure, that makes sense. Why, I myself will stock up if I happen to be near the DC Costco or if there’s a sale at the local state-run liquor store. But, again, the policy is aimed at those whose behaviors can be governed by price controls.

Previous studies have shown how minimum unit pricing on alcohol has impacted sales and consumption, experts say, but few have shown how it directly impacts health outcomes, like death.

“Deaths from alcohol is the final arbiter,” Stockwell said. “It’s the most exact measure of the effectiveness of the policy compared to all the other studies indicating benefits.”

The study shows how minimum unit pricing impacted Scotland’s most vulnerable population, he said, something opponents of the policy have long debated.

“Any argument about whether it’s affecting heavy drinkers cannot be sustained,” Stockwell said. “The biggest effect was in socioeconomic regions of Scotland with the lowest incomes, so it’s a strategy that reduces health inequities.”

That’s an interesting way to frame it! The policy is intentionally regressive but thereby helps poor people!

Few states, like Connecticut and Oregon, have implemented a version of minimum unit pricing for alcohol, Stockwell said, and it may be a while before more states catch on.

“It takes decades for policy to follow research,” he said. “Alcohol producers want to make a profit, retailers want a profit, and consumers want a bargain.”

In a 2022 report, the World Health Organization outlined the benefits of minimum unit pricing, recommending pricing and taxation policies on alcohol. Some countries like Canada, Australia, and Ireland have joined Scotland in instituting such policies.

As more data shows the benefits of minimum unit pricing and how it reduces harm in vulnerable populations, experts hope that more countries will follow suit. Along with such policies, leaders must also work to address systemic issues that make this population particularly vulnerable to alcohol-related harms and diseases.