A major evaluation of the Scottish Government’s alcohol strategy has been published this week by NHS Scotland. It is the final report of Monitoring and Evaluating Scotland’s Alcohol Strategy (MESAS), established to assess the role of national policy in reducing alcohol-related harms.
The 2009 Strategy marked a departure between the Scottish and Westminster Governments on alcohol policy. It introduced measures aimed at reducing consumption across the whole population (rather than only targeting ‘harmful’, ‘binge’ or ‘dependent’ drinkers), and focussed on tackling both the availability and price of alcohol. It also established targets for the delivery of brief interventions in primary care across Scotland and increased investment in specialist services.
Key findings from the MESAS report show:
- The 2005 Licensing Act has improved some aspects of licensing activity, but there are still challenges in supporting the role of public health in the process. Poor licensing data collection meant it was difficult to measure the impact of these changes on availability or harm.
- Performance targets for embedding brief interventions in NHS practice were exceeded. However, lack of data meant the precise impacts on alcohol consumption could not be established.
- There have been significant improvements in the delivery of specialist services for heavy and dependent drinkers across Scotland.
- There is no clear evidence on whether the Strategy has changed attitudes to alcohol or knowledge of alcohol unit, though there are signs understanding of potential harms is improving.
The MESAS report suggests a ban on multibuy offers (e.g. buy two bottles, get one free), introduced under the 2010 Alcohol Act, was associated with a fall in wine sales. However, both overall consumption and alcohol-related mortality began to decline in the mid-2000s, shortly before the Strategy was implemented. Therefore, when looking at the bigger picture, it is difficult to separate policy effects from wider social, economic and cultural factors.
The report suggests two possible reasons why alcohol consumption and harm peaked in the mid-2000s and declined thereafter. Firstly, the economic downturn, elements of which appear to have affected very poor communities somewhat earlier than others, made alcohol less affordable. Secondly, de-industrialisation in the 1980s may have created a ‘vulnerable cohort’ of people who were linked to high rates of harm in the 1990s, but who aged and, in many cases, died – leading to a fall in later years.
Overall, the report shows some strong successes in the implementation of a radical alcohol policy agenda in Scotland. Of course, the flagship policy – Minimum Unit Pricing – remains delayed by legal action. Furthermore, a lack of reliable outcome data, and the complex role of wider social factors in driving a more general decline in consumption, means evidence on the specific impact of the Strategy on behaviour remains modest. However, policy evaluation of this kind remains critically important and the findings demonstrate that continuing research is needed to help us fully understand which policies work best in the UK context.