Professor David Kerr, of cancer medicine from the University of Oxford, discusses an article that's appeared recently in The Lancet. It looks at the impact of minimum unit pricing for alcohol on alcohol-related deaths and hospital admissions in Scotland, my home country. Why is that important to me as a cancer doctor? We know that alcohol underpins epidemiologically a whole range of different tumor types.
Anyway, it's a really interesting experiment. It also looks at the impact of governments and health policy. In 2018, the Scottish Government introduced a minimum unit pricing for alcohol of around $0.60 per unit of alcohol. The idea was that if you drive up the price of getting access to alcohol, that should reduce harm, deaths, and hospital admissions.
Wyper and colleagues did a rather nice controlled, time-interrupted series. The legislation was introduced in 2018, so they looked at our public-health databases, hospital admissions, deaths, and so on for the time span from 2012 to 2018, then for about 3 years after the introduction of legislation in 2018. They used England as a control. England — our old enemy when we think about how the Union works together.
They showed that there was a reduction in fully alcohol-attributed deaths by 13.4% in Scotland, and a reduction in chronic hospital admissions related to alcohol by almost 10%. It works.
What was also interesting was that the benefits were confined to the lower socioeconomic classes. One could argue, whether intended or otherwise, that this was a health-policy intervention targeted at the lower socioeconomic classes. Perhaps, one would hope as a consequence that this would reduce the health equity gap.
What's really interesting is something I hadn't realized about what's called the alcohol-harm paradox. When you look at drinkers across the socioeconomic spectrum, including wealthy and poor drinkers, even for those who have exactly the same consumption of alcohol, there seems to be significantly more harm done to the poor than to the wealthy.
There may be some behavioral explanations for this, but they don't explain all the difference. More work needs to be done there. It's a really interesting story and I think a brave policy put forward by the Scottish Government, which has returned rewards and is something that one would consider replicating around the world to see what other benefits might accrue from it.