MUP in England: myths and facts

Alcohol Health Alliance UK | November 2019 | 8 minutes

Policy proposal: Introduce Minimum Unit Pricing in England following the lead of other home nations.

The Alcohol Charter, produced jointly by the Drugs, Alcohol & Justice Cross-Party Parliamentary Group and the All-Party Parliamentary Group on Alcohol Harm, sets out effective and workable policies to reduce the damage to society caused by alcohol misuse. The proposals above are two of 16 evidence-based policy proposals laid out in the Charter.

The Alcohol Health Alliance UK is one of more than 30 organisations that endorse the Alcohol Charter. Here, they outline their reasons for supporting these proposals.

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A minimum unit price (MUP) is one of those relatively rare policies where simplicity and efficacy align. However, as with any contentious policy its discussion generates a lot of confusion, some of which almost seems wilfully constructed. MUP works to reduce alcohol harm, and does so far more effectively than many other policies.

What MUP is (and isn’t)

MUP does what the name suggests: sets a minimum price, per UK unit, below which alcohol cannot be sold. In Scotland that minimum price is 50 pence. So, a pint has a minimum cost of around £1, and a large glass of wine can’t be sold for less than £1.50. As is instantly apparent, MUP would have almost no effect on any drink sold in a pub. Where MUP has the most impact is on the cheapest, strongest alcohol available in some off-licences. A single 3L bottle of high-strength white cider can be bought for under £4; this particularly dangerous product contains the equivalent of 22 shots of vodka and would see its price rise to around £11 with a 50p MUP.

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Examples of MUP and its effect on different products

MUP works

The World Health Organisation recommends increasing the price of alcohol as one of the most effective ways to reduce alcohol-harm, and we have seen MUP reduce consumption levels of certain products in Scotland. Even amongst other price measures, MUP stands out as effective. This is largely because it targets those who consume the most, and thus are at the most risk of harm. It does this for two reasons. Firstly, those who drink more tend to spend a higher proportion of their income on alcohol – this makes them more sensitive to changes in price. Secondly, while those drinking at higher levels are spending more overall they tend to buy cheaper individual products, the very same products that MUP most affects.

This targeting is borne out by what we have observed in Scotland. The figure below is adapted from a recent paper, which compared the changes in purchasing behaviour of alcohol in Scottish households (with MUP) to English households. Scottish households are arranged, left to right, from those that purchase the least (left) to the most (right). The effect of MUP on their purchasing is shown by the size of the bar, with negative numbers indicating reduced purchasing levels. This data clearly shows that MUP’s effects have been targeted to the heaviest consumers. We have not yet seen this change in behaviour filter through to an observed improvement in health outcomes. But since health follows behaviour change, a lag is to be expected.

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The biggest change in consumption was amongst those consuming the most. All data is adjusted by a comparison to English households over the same period, increasing purchasing from left to right, and the y-axis is change in spending (grams of alcohol per week). This image has been reformatted from the original. For the original see the source: O’Donnell A. et al. Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18 BMJ 2019; 366 :l5274

Does MUP have negative consequences?

All policies represent trade-offs, however two plausible consequences of MUP are often misrepresented. The first myth is that MUP is bad for pubs. As discussed, MUP has almost no effect on the majority of drinks served in the on-trade. If anything, it is plausible that MUP might be beneficial for pubs, as it targets one of their biggest competitors: cheap off-licence alcohol. The second is that MUP disadvantages people on low incomes. However, the effect in reality is far more nuanced. Despite drinking less, those with lower incomes experience more alcohol-related harm. This counter-intuitive and unjust situation is termed the ‘alcohol harm paradox’. It’s the status quo which is disadvantaging those on low incomes. While it is true that the group whose behaviour is changed the most by MUP are those with both low incomes and high alcohol purchasing, this does not represent an injustice but demonstrates that MUP acts to improve existing inequalities. Furthermore, the research and modelling of MUP’s overall impact on those with low incomes finds that it does not cause an undue burden or impact upon this group as a whole.

England needs MUP

Scotland has MUP, Wales and the Republic of Ireland will introduce MUP soon, and Northern Ireland expressed its intent to do so prior to the dissolution of Stormont. England is increasingly alone on the British Isles. MUP will save lives, particularly amongst the least well off. We can talk about the economy, and the costs that our NHS can’t bear, but fundamentally this is about people. In England, MUP is predicted to save 525 lives annually at full effect. That’s thousands of parents, children, and partners who won’t have lost someone they love. We must not let England fall behind.

The Alcohol Health Alliance UK is a coalition of more than 50 organisations working together to reduce the harm caused by alcohol.

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