Taking bold action to improve health: what can we learn from Scotland?

I shared a perspective from Scotland at The King’s Fund’s recent conference on health inequalities on how we at Public Health Scotland have been working to improve health. 

It can be tempting to focus on the challenges, with healthy life expectancy in decline and large inequalities remaining. However, action has been taken in the past to tackle these challenges. It’s vital that we learn from what has worked. 

Minimum unit pricing became policy in Scotland in 2012 after a long campaign involving charities, health campaigners, medical professionals and researchers. The policy aims to reduce alcohol-related harm by setting a minimum price at which a unit of alcohol can be sold. Minimum unit pricing therefore makes alcohol less affordable – particularly if it is high strength or previously sold very cheaply – and, unlike a tax, the additional revenue goes to retailers. 

After a five-year legal challenge by industry representatives, MUP for alcohol was finally enacted by the Scottish Parliament in 2018, and Public Health Scotland was commissioned to undertake a five-year evaluation of the policy. The outcome of the work showed that minimum unit pricing was estimated to have prevented around 150 deaths and 400 hospital admissions in less than three years of implementation. The policy had a significant impact on those living in the areas of greatest deprivation.

The policy faced fierce criticism from within the alcohol industry and industry-funded bodies who argued that minimum unit pricing would restrain competition and negatively impact business. Over time, many of the criticisms have been shown not to be valid. The Public Health Scotland evaluation showed that there was little economic impact on the alcohol industry, and little impact on social outcomes such as increased drug use or rates of crime.  

We have never claimed that one policy on its own is sufficient. The most recent alcohol consumption and harms data, published by Public Health Scotland today, show that while total alcohol sales continue to decline, alcohol harms remain relatively high and wide inequalities remain. In the 10% most deprived areas in Scotland, alcohol specific deaths and hospital admission rates were almost 6 and 7 times higher respectively, compared to the 10% least deprived areas. Minimum unit pricing needs to be part of a package of measures to reduce the harm from alcohol.

The World Health Organization recommends ‘best buy’ policies to reduce alcohol harm, focusing on attractiveness, availability and affordability. These approaches require collective, evidence-based action, with early intervention and good support available for those already experiencing harm. At the same time, we need to address other areas – tobacco, vaping, drugs and unhealthy food.

There’s some important learning from our minimum unit pricing journey in Scotland that can be applied across the UK.

First, we need to take action to protect health even where the evidence is not absolutely clear cut.

We were confident that MUP would be effective – it had worked elsewhere and modelling work suggested the likely positive outcomes if introduced in Scotland. Doing nothing in the face of growing levels of avoidable ill-health and death is risking more lives, rather than risking a policy decision.

Second, we need to evaluate our policies and intensify the ones that work.

 The Public Health Scotland evaluation was widely supported by experts in improving health.  A letter in the Lancet said ‘The Public Health Scotland approach of emphasising population-level findings is the right one for assessing population-level interventions, such as minimum unit pricing.’ On the basis of the evaluation, the minimum price was raised from 50p to 65p in September 2024.

Third, we should be quick to adopt and adapt policies that are working elsewhere in the UK. 

 Wales has followed Scotland with minimum unit pricing, and it would be great to see this introduced in England and Northern Ireland too. Action across the UK would further help reduce harm, such as agreement on areas like alcohol advertising, sponsorship and labelling would help reduce harm across the UK, and strong action to improve the healthiness of the food that surrounds us. And we must ensure that industry voices do not disproportionately influence debate and do not delay policy decisions.

At the start of a new Parliamentary term in Scotland, I’m hopeful that we will be willing to learn from elsewhere too. We need to continue to take bold action on alcohol, tobacco, drugs and obesity. We can draw on the range of innovative proposals that now exist to transform our food environment making healthy food more available and affordable, we can learn from the approach taken to outdoor advertising by Transport for London and Sheffield City Council, and consider the effects from the focus on prevention in Greater Manchester. 

We have carefully named our new Public Health Scotland strategy ‘Together we can’. None of us can do it alone. By collaborating and applying learning from across the UK and beyond, we can change the future direction of health.