WHO concludes there’s “no place for cheap alcohol” (excerpt)
Minimum unit pricing is an effective tool against alcohol harms
The BMJ
July 22, 2022
In late June 2022, World Health Organization Europe published a handbook on minimum pricing policies for alcohol.1 As described by one of the authors,2 the report is “everything you wanted to know about minimum pricing, in one place.”
Minimum pricing for alcohol sets a fixed price for a given volume (or number of standard drinks or units, in the case of minimum unit pricing), below which alcoholic drinks cannot be sold.
The new report summarises the evidence for minimum unit pricing: indirect evidence supporting the underlying theory; modelling studies; and direct evidence from evaluation studies. Six common objections to minimum pricing policies are tackled, including whether a minimum price is unfair to people on lower incomes. The rest of the report focuses on practical and legal issues, implementation, and evaluation, and how minimum pricing can complement alcohol taxes.
Like the systematic and rapid reviews before it,34 WHO’s report, No Place for Cheap Alcohol, concludes that minimum pricing is an effective part of the policy toolbox for reducing harm from alcohol.1 Currently, 22 jurisdictions in 13 countries have a minimum unit price for alcohol.1 Evidence of effectiveness has proliferated since the recent introduction of minimum unit pricing in Scotland and Wales and the Northern Territory in Australia.
Although not the first to introduce it, Scotland has become the poster child for minimum pricing. Alcohol Focus Scotland says minimum unit pricing is the most thoroughly evaluated policy in Scotland’s history, and it is no coincidence the WHO report carries a foreword by Nicola Sturgeon, the first minister of Scotland. The recent Scottish evaluation reported equivocal effects on people drinking at harmful levels and people with alcohol dependence.5 But the latest findings on alcohol sales per head in Scotland are much more encouraging,6 and some of the feared unintended consequences around cross-border shopping,7 switching to other substances,8 and drug crime 9 have not materialised.
Coherent strategy
Civil society and public health leaders must keep advocating for a coherent alcohol policy landscape; good evidence shows that pricing policies on alcohol and other unhealthy commodities can help improve public health. Minimum pricing is an underused policy globally, so from scientific and public health perspectives it is hugely positive that comprehensive evaluations such as that in Scotland are taking place.
Where minimum pricing is implemented, continued attention is needed so the set price remains relevant and effective. For example, today’s 50p price per unit in Scotland was first proposed 13 years ago, and last year campaigners called for an increase to at least 65p, to account for inflation.10
Minimum pricing has never been promoted as a panacea, so arguments that it does not singlehandedly eliminate harm from alcohol can be rejected. Proponents do not claim, for example, that minimum pricing is enough to reduce alcohol consumption and harm among people who are dependent on alcohol, for whom the wider healthcare and support needs are obvious. Minimum pricing is one policy in the toolbox, needed alongside others as part of a coherent strategy.
What would a coherent policy landscape look like? The healthcare system would offer a sliding scale of psychosocial and medical support for people with alcohol problems, suitably resourced, easily accessible, and equipped to manage comorbidities. Alongside this, population level policies to regulate alcohol pricing (such as minimum pricing and taxes), availability (where and when alcohol is available), and marketing (advertising, sponsorship, labelling) are the foundation of a coherent approach. The effectiveness of policies would be routinely monitored and evaluated.
WHO’s SAFER initiative to reduce harm from alcohol gives more detail on the policies and interventions that are cost effective.11 Following WHO guidance,12 policy making should also be conducted free of interference from alcohol industry representatives and other vested interests.
In Scotland, as the government’s review of minimum unit pricing draws continues ahead of the “sunset clause” (the policy expires in April 2024), the more equivocal findings have been cherry picked by opponents of minimum pricing policies. Longstanding activities of industry groups include influencing research and lobbying politicians so that evidence based policies are replaced by voluntary activities or self-regulation.13 This is a major challenge to any comprehensive and coherent approach. For example, the UK has announced a reform to the alcohol duty system, with improving public health as one of the stated objectives.14 Yet at the same time, freezes in rates of alcohol duty are being commended as part of a package of measures to tackle the cost of living crisis caused by high inflation.15
The evidence should be considered in a holistic way, and WHO’s report is an accessible and practical guide for policy makers and advocates on the wealth of evidence available on minimum unit pricing for alcohol.
Footnotes
- Competing interests: I have read and understood BMJ policy on declaration of interests and declare I work at the Institute of Alcohol Studies, which receives funding from the Alliance House Foundation, a charity with roots in the temperance movement.
- Provenance and peer review: Commissioned; externally peer reviewed.
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj.o1810 (Published 22 July 2022)Cite this as: BMJ 2022;378:o1810
- Sadie Boniface,
- head of research