Scotland has raised the minimum price of a unit of alcohol, and researchers are now tracking whether this reduces drinking, hospital visits, and deaths. The policy sets a floor price below which alcohol cannot be sold, and this study evaluates the impact of the increase on consumption, ambulance callouts, hospitalisations, and mortality, as well as whether effects differ by age, sex, or income level. This matters because alcohol harm is unevenly distributed—heavier drinkers and deprived communities bear the brunt. Previous evidence from a lower minimum price showed some benefits, but the new, higher threshold may amplify those effects or create unintended consequences, such as financial strain on low-income households. If the research succeeds, it will give UK and other governments clear, quantitative evidence on how to calibrate minimum pricing to improve public health. The findings could directly shape future alcohol policy, potentially reducing alcohol-specific deaths and hospital admissions without requiring new legislation or enforcement infrastructure. For households under financial pressure, the study’s qualitative interviews will reveal how they actually experience and adapt to the price change—information that is currently missing from policy debates.
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Background: Minimum unit pricing (MUP) sets a floor price for a unit of alcohol below which retailers cannot sell alcoholic drinks. This natural experiment evaluation will investigate the public health impact of the increase in Scotland’s MUP from 50p to 65p in Sep 2024. Aim: To evaluate the impact of increasing Scotland’s MUP on levels of alcohol consumption, alcohol-related ambulance callouts, alcohol-specific hospitalisations and deaths, and associated health inequalities. Research questions (RQs), with reference to the work packages (WPs) below: RQ1: Has increasing the MUP led to changes in the level of alcohol consumption? (WP1, WP2) RQ2: Is any effect of increasing the MUP on alcohol consumption modified by age, sex, socio-economic deprivation, level of consumption and drink category? (WP2) RQ3: Has increasing the MUP led to changes in the level of alcohol-related ambulance callouts overall or (i) to those most likely to benefit from MUP (patients with chronic alcohol problems drinking off-trade alcohol), (ii) to deprived areas, and (iii) to patient subgroups? (WP3) RQ4: Has increasing the MUP led to changes in the level of: (i) alcohol-specific hospitalisations and (ii) alcohol-specific deaths, both overall and for acute or chronic reasons? (WP1, WP4) RQ5: Is any effect of increasing the MUP on alcohol-specific hospitalisations or deaths modified by age, sex and socio-economic deprivation? (WP4) RQ6: In identified cohorts of heavy drinkers, has increasing the MUP led to changes in risk of alcohol-specific hospitalisations and deaths? (WP1, WP4) RQ7: How do households in financial hardship experience and respond to the higher MUP for alcohol, including any perceived changes in affordability? (WP5) RQ8: What impact would alternative approaches to increasing the MUP in future have on health and economic outcomes? (WP1) Our evaluation consists of six interlinked WPs: WP0 will co-produce a theory of change with public and key partners, triangulate the diverse types of evidence arising from WP1-5, synthesise and interpret findings and key messages, and co-ordinate dissemination activity. WP1 will conduct new model-based analyses using the Sheffield Tobacco and Alcohol Policy Model to (i) inform short-term policy decisions about future increases to Scotland’s MUP and (ii) synthesise evidence from other WPs to estimate the long-term impacts of increasing the MUP. WP2 will use time series, panel and repeat cross-sectional study designs to examine impacts on alcohol sales, purchasing and consumption, and compare impacts across beverage types and population subgroups. This includes new analyses of the impact of the original MUP using survey data adjusted to account for known biases. WP3 will use time series methods to examine impacts on alcohol-related ambulance callouts. This includes updating our evaluation of the original MUP to incorporate analyses focused on the callout types and locations mostly likely to be affected by MUP. WP4 will use time series and novel retrospective cohort designs to examine impacts on alcohol-specific mortality and hospitalisations. WP5 will use qualitative interviews to examine responses to MUP among households under financial pressure, including those purchasing smaller and larger amounts of alcohol. Setting: Scotland with England as the control group in most analyses. Anticipated impact: UK and other Governments understand how to use MUP to achieve policy goals that improve public health.
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