One of the first pieces of alcohol research I ever commissioned – back in 2010 – was a major review by Bangor and Glyndŵr Universities of the evidence from around the world on what influences drinking behaviours. Alcohol Concern – a predecessor charity of Alcohol Change UK – had opened its Wales office a year earlier and we were keen to have a solid evidence base for the work of our new team.
The researchers’ headline finding was unambiguous: “It is well established that the price and affordability of alcohol is the key determinant of the overall level of consumption amongst all groups in the general population. This is the strongest finding in the international literature”. It seemed simple enough: increase the price of alcohol to decrease consumption and therefore harm. Plus, there was already a simple option available to do just that: minimum unit pricing (MUP) – setting a baseline price for every UK unit (10ml) of alcohol sold in any kind of drink. Except, as always in public health, it’s not quite that simple.
Minimum unit pricing is a good example of what public health researchers call a “simple intervention in a complex system”. The intervention itself – MUP – has definite parameters. We can explain what it does and doesn’t do to drinks prices. We can predict its likely effects on a wide range of alcohol products. But this simple intervention is occurring in a very, very complex system: the whole human ecosystem of buying, selling and consuming alcohol. At play in that ecosystem are individual and collective desires, drinking habits and social norms, commercial profit and loss, and plenty more.
So, when MUP was introduced in Scotland in 2018, and Wales in 2020, it was clear that comprehensive multifaceted evaluations would be needed to understand what was happening over time, and why. That work is ongoing and has generated a series of fascinating research reports. The Welsh Government’s study of the impact of MUP on alcohol treatment service users and providers – published on 14 June this year – is the latest piece in the research jigsaw, and in the next few paragraphs I’ll be discussing its findings.
The report generated more media interest than previous MUP evaluation documents from Wales, possibly because it focussed on the people often considered most vulnerable to any adverse effects of MUP – people with severe alcohol problems. The following sentence in particular led some to brand MUP in Wales a failure: “Overall, there was a sense from the service providers that the introduction of [MUP] has had a detrimental effect on the health of their service users”.
As always, taking one sentence out of context can give a misleading impression. Looking more broadly, the evaluation team found that MUP has brought about a “substantial reduction in the availability of cheap alcohol, particularly ciders” – that’s the strong “white” ciders often favoured by street drinkers. They also found “minimal evidence” of people switching from alcohol to illicit drugs – one of the big concerns expressed prior to the introduction of MUP. And although there have been some reports of people going without food in order to buy alcohol, the researchers concluded that poor nutrition and a lack of self-care were often “related to alcohol consumption rather than to a lack of funds” and “cannot be directly attributed to the pricing policy”.
It’s also worth taking some time to weigh up the claim made when the report was published that “there have been more alcohol-related deaths since the [MUP] policy was introduced”. Data from the Office for National Statistics (ONS) shows that alcohol-specific deaths across the UK were 27% higher in 2020 than in 2019; and 7.4% higher in 2021 than in 2020. So, it is factually correct to says that alcohol-specific deaths have increased in Wales since the introduction of MUP; but they also increased in England – where MUP is not in operation – and increased in several English regions more sharply than in Wales. The generally accepted conclusion is that these tragic additional deaths were due to heavier drinking during the Covid-19 pandemic; and there is as yet no evidence that MUP was a cause.
Given all these complicating factors, the Welsh evaluators have rightly concluded that all they are able to do at this point is “frame early evidence around the early effects” of MUP, and that it is “not possible to detail with certainty the full impact of the policy”. As time goes on, we will get a clearer picture, but it is unlikely ever to be crystal clear. There will always be other influences that will tend to drive alcohol consumption up or down, and to promote or undermine good health. Because that is the complex reality of implementing and evaluating an apparently simple intervention like minimum unit pricing.
Written by Andrew Misell, Director for Wales, Alcohol Change UK.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.