3 years after Scotland became the first country in the world to introduce minimum unit pricing for alcohol, a new analysis published in The Lancet Public Health corroborates that it is an effective option to reduce the off-trade purchase of alcohol. Compared with northern England, which is both geographically close and considered to be similar in culture to Scotland, there was a price increase of 0·741 p per gram of alcohol (a 7·6% increase) and a purchase decrease of 7·063 g per adult, per household, per day that an alcohol purchase was made (a 7·7% decrease) in 2020. The introduction of minimum unit pricing in Wales on March 2, 2020, has also shown some short-term results, with a price increase of 0·841 p per gram (an 8·2% increase) and a purchase decrease of 7·052 g per adult, per household, per day that an alcohol purchase was made (an 8·6% decrease), compared with western England. These findings are reassuring in two ways: first, that the short-term effects of minimum unit pricing in Scotland that were observed in 2018 seem to be evident in the longer term; and second, that similar short-term effects are also starting to be seen in Wales.

For Scotland in particular, analysis of the effects of minimum unit pricing is crucial to determine whether it should continue beyond its current expiration date of April 30, 2024. But one of the main caveats to analyses of the effects of minimum unit pricing on purchasing of alcohol is that the data used are often recorded from purchases brought back into the home, which do not account for alcohol purchased and consumed outside of the household. Alcohol purchases in the latter category, including by people who have no fixed address or who live communally, can also be under-reported, compounding the issue. Consequently, the effects of minimum unit pricing on these populations will be harder to gauge but they are crucial to broader efforts to reduce alcohol-related harms in the general population.

Furthermore, the case for continuing with minimum unit pricing in Scotland rests not just in changes in the amount of off-trade alcohol purchased, but also, more broadly, in whether it helps to reduce alcohol-related harms. Evidence of the effects of minimum unit pricing on health outcomes is still being generated by ongoing research: modelling suggests that over the first 20 years of minimum unit pricing, there would be 2036 fewer alcohol-related deaths and 38 859 fewer alcohol-related hospital admissions in Scotland. Data from the Canadian province of Saskatchewan, where minimum alcohol pricing was introduced in 2010, also showed beneficial effects on crime and health-care use. These initial results and modelling data have been sufficiently promising to prompt change elsewhere. In addition to Wales, Ireland will now introduce minimum unit pricing on Jan 1, 2022. By contrast, in England the idea has been met with reluctance and, ultimately, resistance from the government. Indeed, at the time of writing, the UK Government has no plans to introduce minimum unit pricing in England; instead, efforts to tackle issues surrounding the harmful consumption of alcohol will be led by the new Office for Health Promotion, which is planned to launch by the autumn of 2021. With an emphasis on prevention rather than cure, alcohol consumption should surely be a major focus of this Office, but it remains to be seen just how alcohol-related harms in particular will be addressed. While targeted efforts have been effective elsewhere, the remit of this new Office is so broad that it is currently unclear how forthcoming initiatives will be tailored to effectively help those most in need.Raising prices on alcohol, whether by excise tax or pricing policies such as minimum unit pricing, is only one of several approaches proposed by the WHO SAFER initiative to reduce alcohol-related harms and alcohol consumption. Other approaches include restrictions on alcohol availability, enforcement of drink-driving measures, increased access to screening and treatment, and restrictions on the advertisement of alcohol and sponsorship by alcohol manufacturers, but minimum unit pricing is seen by some as a potential targeted approach since it mostly affects drinkers who consume large amounts of strong, cheap alcohol.

As empirical evidence accumulates, the case for minimum unit pricing is strengthening. A clear, consistent, national effort is needed to implement alcohol policies that have potential long-term benefits for all. Scotland has led by example: it is time for others to follow.

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DOI: https://doi.org/10.1016/S2468-1253(21)00229-6

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© 2021 Elsevier Ltd. All rights reserved.

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