Minimum alcohol pricing in England

Since the BMJ last highlighted the health harms of alcohol,1 there has been a welcome acknowledgement by government in England that cheap drink is an important factor in driving these harms. Ministers recently revealed plans to set a minimum price by imposing a ban on selling alcohol for less than the combined tax and duty paid on it. This would result in minimum prices of £0.21 (€0.25; $0.34) per unit of beer and £0.28 per unit of spirits, which equate to £0.38 for a can of weak lager, £2.03 for a bottle of wine, and £10.71 for a litre of spirits. Although, in principle, this is an important step, in practice the price floor has been set so low that it will have no effect whatsoever on the health of the nation⇓.

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Alex Segre/Alamy

On the positive side, for the first time recent statistics suggest an overall reduction in harm associated with alcohol, with a 6% decline in alcohol related deaths and 6% reduction in consumption in 2009.2 3 However, these are data from a single year on a background of marked increases in consumption and harm since the 1990s. Furthermore, the burden of alcohol to the United Kingdom remains substantial, with the latest data reporting 30 000-40 000 deaths a year, 863 300 hospital admissions a year, and alcohol related economic costs of £20bn-55bn a year.4 In addition, some key indices continue to worsen at a worrying rate—for example, hospital admissions in young people (16-24 year olds) are rising fast (www.hesonline.nhs.uk).

The recent fall in consumption may be one of the few benefits of the recession, but it highlights the strong association between economic affordability and alcohol consumption.5 This reinforces the need for alcohol pricing policies. International evidence strongly supports the notion that modulating price substantially reduces alcohol consumption and associated harms, but how is it best done? Increases in duty can be effective, but these increases particularly hit on-licence traders such as pubs. It is home drinking that has escalated, and big chain supermarkets can offset the effect of duty increases through discounting and special offers. Conversely, setting a minimum unit price can differentially affect the off-licence trade and has been supported by, among others, the last chief medical officer for England,6 the Academy of Medical Sciences,7 and the House of Commons Health Committee.4

The proposed targets set by the government are less than half the £0.50 a unit minimum recommended by health professionals. Recent UK estimates suggest that a £0.50 minimum price per unit would lead to 3393 fewer deaths, 97 900 fewer hospital admissions, 45  800 fewer crimes, 296 900 fewer sick days, and a total saving of £15bn over 10 years.8 It is estimated that 75-80% of alcohol is consumed by the 20-25% of people who misuse it. Any pricing policy will mainly target heavy drinkers, who buy 15 times more alcohol than moderate drinkers, spend 10 times as much a year, and pay 40% less per litre of pure alcohol through cheaper preferences.8 Concerns that minimum unit price might affect the average British family were allayed by recent calculations showing that the overall effect should be a reduction in average weekly supermarket bills for most people, who would no longer be subsidising alcohol purchases for the harmful and hazardous drinker.9

Several other proposed policy developments are worthy of note. Firstly, reduced measures of alcohol may be sold—for example, wine in measures of less than 75 ml and beer in two thirds of a pint.10 Secondly, the government intends to introduce a new additional duty on beers over 7.5% abv (alcohol by volume) to decrease the consumption of cheap, “super strength” lagers, which are primarily associated with hazardous drinking behaviours.11 Although the principle of differential duty by strength is sound, this strong beer accounts for a tiny fraction of beer sales, so the change will have little effect at the population level. Finally, the government plans to incorporate businesses into public health strategy decisions (including alcohol), to achieve positive societal change through “responsibility deals” incorporating the “nudge” theory. However, the history of voluntary partnerships with the drinks industry since the Alcohol Harm Reduction Strategy of 2004 has been at best disappointing.

Successive governments (with the notable exception of brave attempts in Scotland) have been reluctant to risk upsetting either the voter or the drinks lobby through championing evidence based regulation on price, availability, and marketing. They have failed to heed the advice of the House of Commons Health Committee report that stated “we are concerned that government policies are much closer to, and too influenced by, that of the drinks industry and the supermarkets than those of expert health professionals such as the Royal College of Physicians or the CMO [chief medical officer].”4 This risks leaving the most vulnerable in society—the under-aged and the poorest—exposed to cheap, available, and skilfully promoted offers. It is particularly crucial to target young drinkers to try to break the well documented cycle of transition to chronic alcohol abuse in later life. Let us hope that the new direction of travel, though unlikely to have any immediate effect on health, signals a move towards more evidence based policy. Health must be foremost in policy decisions and not take a back seat to commercial interests.