A timely piece of global relevance, but shouldn't we move towards more real-world studies of the effect of multiple policy interventions and ongoing monitoring of alcohol policy impacts?

Holmes [1] reviews a broad range of studies using different methodologies and data sources to evaluate the impact of minimum unit pricing (MUP) on alcohol consumption and harms in Scotland. This article is timely, coming out several months before the expected release of Public Health Scotland (PHS)’s anticipated final evaluation report on MUP. As such it provides a possible indication of what we might expect in the PHS report, although Holmes [1] includes data not included in the PHS evaluation.

With the risk of MUP enabling legislation in Scotland not being renewed after its automatic expiration at the end of April 2024 if the evaluation of the goals of implementing MUP in Scotland are not deemed to have been realized, this could affect not only the future of MUP in Scotland, but could also have negative ramifications for decisions around the implementation of MUP in other parts of the world, including the Western Cape, South Africa [2]. This is because the Scottish MUP ‘project’ is widely seen as one of the best case-studies for assessing the impact of MUP because it is one of a few examples where MUP has been directly linked to alcoholic content for its whole alcohol market, not just for certain drink types (such as spirits) and because of the breadth of research undertaken to evaluate it. Desired outcomes included decreasing consumption of alcohol by reducing overall consumption of alcohol, especially among people drinking at hazardous and harmful levels [3].

While much can be learnt from the emerging data on the effect of the introduction of MUP in Scotland, including the findings that reported ‘that MUP reduces alcohol sales by ~3.0 to 3.5%, with larger effects on cider and spirits than other beverage types’ [1], this may not provide a full picture of the impact of MUP in parts of the word such as Africa, where beer consumption is substantially higher than in the United Kingdom [4] and where there is a greater risk of drinkers moving towards unrecorded alcohol following the introduction of MUP.

There is tremendous value in research assessing the impact of single interventions such as the impact of MUP upon alcohol consumption and harm. However, these interventions occur in a context of changing socio-economic, political and other conditions, including other alcohol policy responses. It would have been useful for Holmes [1] to have situated the evaluation of MUP in Scotland in terms of these conditions. How might factors such as Brexit, the COVID19 pandemic and increasing energy prices have impacted the findings?

This review of evidence from multiple sources assessing the impact of MUP in Scotland, despite methodological weaknesses of some of the studies, is extremely useful, timely and broadly points to the value of MUP. However, the real impact of policies such as MUP, especially on heavy drinkers and high-intensity drinkers [5], may have to wait until we can see the findings of research studies investigating the impact of multiple interventions at the same time; for example, MUP and tighter controls on marketing of alcohol or MUP and reducing late-night on-consumption trading of alcohol. Holmes briefly alludes to this in the Discussion. These types of study are hard to conduct, because the interventions are beyond the scope of researchers to implement but depend upon policymakers implementing a range of alcohol policy reforms at approximately the same time as happened in Russia [6] and more recently in Lithuania [7].

Apart from raising the need for project-related research to assess the effect of multiple alcohol policy interventions, there is also a need for governments to begin to look at setting up ongoing monitoring of alcohol use and harms together with the status of key alcohol control measures. The World Health Organization (WHO) SAFER package of interventions [8] provides a useful set of strategies for countries to consider in moving forward pricing and other polices to reduce alcohol harms. Tools for monitoring implementation of the SAFER package of interventions are currently under development by WHO headquarters, and useful indicators for steering work in this direction have been developed by colleagues in the South-East Asia Regional Office of WHO (SEARO) [9], the Pan American Health Organization (PAHO) [10] and the International Alcohol Control (IAC) Study [11].

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No conflicts of interest are declared.