Public health or politics: what drives alcohol policy across the UK?

As we publish our ‘Four Nations’ report, Niamh Fitzgerald (University of Stirling) and Colin Angus (University of Sheffield) discuss how and why alcohol policy has diverged in the different jurisdictions of the UK.

The Conservative government in Westminster have threatened to cut funding for public health and shows no sign of committing to effective action to tackle alcohol-related harm, which places a huge burden on the NHS and emergency services and is a major contributing factor to health inequalities across the UK.  Notoriously the previous coalition government backtracked on an earlier commitment to implement minimum unit pricing for alcohol (MUP).  In so doing, it set its policy apart from that in Scotland, and later Wales and Northern Ireland all of which support MUP.  The UK Government cited a lack of evidence as the reason for the U-turn, despite having earlier cited ‘strong and consistent evidence’ in favour of the policy.

The divergence of alcohol policy in the four nations of the UK since devolution has allowed us to compare and contrast how evidence is used in alcohol policy and the extent to which current policies across the UK are supported by scientific evidence.  In our new report ‘Four Nations‘, we discovered substantial differences between the 4 nations in the way that alcohol problems are framed and policies implemented.  These differences appear to reflect the level of activity within each country, with alcohol framed as a minority issue affecting only a small group of dependent drinkers at the UK level, while the more active devolved administrations tend to view or portray alcohol problems as a whole population issue (see Northern Ireland, or Scottish strategy).

In the UK, Scotland has the strongest approach to evidence-based alcohol policy overall, in terms of its clear focus on outcomes and evaluation, and the greatest alignment with the recommendations of Health First, an independent model alcohol strategy for the UK developed by experts and based on the latest available scientific evidence.  Notably the Scottish Government has legislated for MUP, a policy which is subject to a lengthy and costly (both in financial and public health terms) legal challenge brought by the alcohol industry.  Both Wales and Northern Ireland have strong alcohol policies in some areas (not necessarily the same ones) and weaker or no policies in others.

The UK government rates poorest on almost all alcohol policy measures, with inconsistent use of evidence, and an evaluation strategy with obvious conflicts of interest (for example letting the alcohol industry evaluate the success of their own actions).  Not only is Westminster failing to take effective policy action, but recent budgets for the UK have cut the price of alcohol via taxation changes, a policy that even the government’s own impact assessment states is likely to increase alcohol consumption.  Regulation on marketing and promotion is a matter reserved to the UK parliament, which favours industry self-regulation, but the devolved administrations have repeatedly called for stronger action.

The UK Government also has the highest level of engagement of the alcohol industry in policy, through the UK Public Health Responsibility Deal and their chosen framing of alcohol problems as a minority issue, mirror those of the industry.  Having said this, there is a level of alcohol industry involvement in policy design and implementation across all four administrations, which is thought to be more likely to undermine public health and promote weak or ineffective policies.  This is borne out by independent evaluations that do indeed suggest that the pledges made by industry under the Responsibility Deal did not reflect best evidence on effective strategies to reduce alcohol-related harm, did not achieve their stated commitments and are likely to reflect action that the industry was already taking.

One explanation for the differences in approaches between the 4 nations may be that political ideologies, perhaps about personal responsibility and the role of government in society may be more important than scientific evidence in dictating policy.  Politically, action on public health is seen as interventionist and is more commonly associated with left-leaning administrations, rather than the smaller government, market-led approaches favoured by the political right.  To hold such ideologies is not problematic in principle but when that leads to policies that do not address, and may even exacerbate, the problems that they are proposed or claimed to solve – in this case alcohol-related harm – that has serious consequences for public health and wider society.  It is important that civil society holds governments to account – to demand honesty about the reasons for policy decisions (including U-turns), mature conversations about evidence and a genuine commitment to policy evaluation.

Niamh Fitzgerald is a Lecturer in Alcohol Studies at the Institute for Social Marketing, University of Stirling. Colin Angus is a Research Fellow at the Sheffield Alcohol Research Group, University of Sheffield.  The Universities of Stirling and Sheffield are part of the UK Centre for Tobacco and Alcohol Studies.



Views expressed are the author’s own and do not necessarily represent those of the Alliance for Useful Evidence. Join us (it’s free and open to all) and find out more about the how we champion the use of evidence in social policy and practice.