Better Health For All

By Dr Lesley Graham, Associate Specialist, Public Health for Alcohol, Drugs and Health in Justice, ISD, National Services Scotland, and Faculty of Public Health Representative, SHAAP. Dr Harpreet S Kohli, Retired DPH, Co-opted Member, SHAAP.

The UK Supreme Court has  unanimously ruled that the Scottish Government’s legislation on Minimum Unit Pricing is legal. This is a landmark moment for public health and the end of a long journey. However, it also marks the start of a new journey to implement MUP to reduce alcohol-related harm in Scotland. When implemented this will mean that no alcohol can be sold in Scotland for less than 50p per unit.

Although the Alcohol (Minimum Pricing) (Scotland) Act 2012 was passed 5 years ago by the Scottish Parliament without opposition, global alcohol producers headed by the Scottish Whisky Association took the Scottish Government to court. There followed a lengthy and costly battle (in terms of lives lost, time, and money) all the way to the European Court of Justice and back to the highest court in the UK. This victory has been a huge collaborative effort from many players with public health at the heart of it.

Just over 10 years ago, an alcohol advocacy group, Scottish Health Action on Alcohol Problems (SHAAP) was set up and we were the Faculty of Public Health representatives. SHAAP was established due to concerns about the epidemic levels of alcohol harm in Scotland being driven by increasingly cheap alcohol.

Our report, Price Policy and Public Health was the first public call for action to introduce a minimum price for alcohol. The incoming SNP Scottish Government took up that call. As well as targeting the Scottish Parliament, SHAAP reached out to build alliances at global levels. By 2010, WHO (World Health Organisation) were recommending MUP as a policy ‘Best Buy’.

The broad scope of the role of public health has allowed us to contribute in a variety of ways, including:

• Production of routine national statistics
• Policy development
• Advocacy
• Research
• Evaluation of the implementation of MUP in terms of what alcohol-related harm means for health boards in Scotland such as service provision

Here are some of our reflections of that journey

First, the importance of a sound evidence base. Although MUP had never been tried and tested before, we had based the rationale on the evidence of the relationship between price, consumption and harm. The more price falls, consumption rises and so does harm. That sound evidence base proved its worth in the sometimes stormy debate that was to follow.

Second, we had ‘reframed’ the problem with a public health paradigm, if average population consumption would fall, so would harm. This helped move the narrative away from being the problem of a minority of individuals or one of anti-social behaviour.

Thirdly, those from the most disadvantaged backgrounds experienced greater levels of alcohol related harm, indeed, those inequalities were widening. It was a matter of social justice. We had champions, both political and public health who went out and campaigned hard and did not give up.  Other countries now are poised to follow Scotland’s lead.

Lastly, we think it is more than about alcohol policy. It shows that public health can trump private profit and the alcohol industry. A great moment indeed!