The Cost of Alcohol: The Advocacy for a Minimum Price per Unit in the UK Martin Hagger Curtin University, Australia Adam Lonsdale University of Nottingham, UK Rob Baggott, Demontfort University Gillian Penny, Northampton University Matt Bowen, OurLife

Alcohol, price and health Annual cost to taxpayers of excessive alcohol consumption is estimated £7.3 billion (DoH, 2009) Price increases have been shown to be effective in reducing alcohol consumption (Wagenaar et al., 2009) Focus on price has been oriented toward increased duty and leads to uniform rise in price Disparity between prices at high and low end of the alcohol market Heavily discounted/low-cost alcohol sales prevalent Discounting trends in the retail industry (e.g., BOGOF, happy hours) Changes in drinking patterns (e.g., binge drinking, pre-loading) Patients with alcohol-related harms purchased more of their weekly consumption very cheaply compared to wider drinkers

Alcohol, price and health Pricing policy based on ‘strength’ has been proposed – price based on ‘units’ of alcohol A minimum price of 50 pence-per-unit (ppu) would reduce consumption by 6.9% (Brennan et al., 2008) Estimated savings of £9.7 billion in costs associated with excessive alcohol consumption Minimum price also has support from medical community (Donaldson, 2009) and advocacy groups (NICE, 2010) Proposal of 45ppu tabled in Scottish Executive Little evidence on public perceptions of minimum price

The Present Research Research consistently shows public support for treatment and information rather than price change (Greenfield et al., 2004) Public likely to be opposed to minimum price No formal investigation to date on public attitudes and beliefs toward the policy Aims Investigate knowledge, attitudes and beliefs with respect to minimum price Under what conditions are people more likely to endorse minimum price?

Method Research Design: Qualitative investigation using focus groups Participants: N = 217 in 28 focus groups from one of ten target groups: Sixth form students University students Blue-collar workers White-collar workers Unemployed Older adults African-Caribbean South-Asian Rural community ‘Hazardous’ drinkers Procedure: Semi-structured ‘interview’ schedule with a facilitator (90-mins typical length) Explanation of policy Generate discussion of pertinent issues Opinions on minimum price and implementation All participants encouraged to contribute

Method Data analysis: Qualitative analysis using inductive thematic content analysis of transcribed interview data NVIVO software used to categorise and organise data Main emergent themes and sub-themes identified Multiple readings using an iterative approach until ‘theme saturation’ achieved Theory building rather than theory testing Advantageous in areas where little knowledge known/available

Results: Themes Minimum price is unlikely to be effective “Where there’s a will, there’s a way” Won’t work for heavy or dependent drinkers Perceived failure of previous pricing policy Minimum price will have only a limited effect Change people’s choice of drink Affect ‘binge drinking’ Affect young people Short-term reductions Long-term effects

Results: Themes Dislike for minimum price policy Punishing the moderate or ‘sensible’ Restriction on personal freedoms Unfairly targets the poor “There’s more to alcohol reduction than price” “There must be a better way than this” Suspicion of government motives Support for minimum price Need to curb excessive alcohol consumption Improved public health “It doesn’t bother me, I don’t drink that much”

Results: Major Findings Major Finding 1. Participants expressed largely negative views of a minimum price per unit policy: Scepticism of its effectiveness Disliked it – ‘unfair to sensible drinkers’ Might create or exacerbate other existing social problems (e.g., crime and drug abuse) Misconceptions surrounding the policy Major Finding 2. A number of participants accepted that a minimum price per unit might be necessary tackle excess alcohol The need for action Prospect of improved public health particularly in the young Perceived not to have significant effect on their own habits

Results: Major Findings Major Finding 3. Suggested ideas that would make ‘minimum price’ more acceptable Introduce as part of a broader package of policies to address excessive alcohol consumption Revenue generated by higher prices should be used to fund other interventions Little evidence that participants’ views of minimum price and its acceptability varied across gender and age groups.

Summary and Conclusion Participants were largely sceptical of the minimum price policy and expressed doubts regarding its effectiveness The policy would be more acceptable if introduced as part of a wider strategy Participants’ objections were the result of 4 main issues: Misunderstanding of the policy itself Equating the policy with other pricing policies (e.g., duty) Failure to recognise the public health significance of small reductions in alcohol consumption Preoccupation with the effects on heavy and dependent drinkers Policymakers introducing a minimum price policy should Focus on dispelling the misconceptions Highlighting the key features of the policy Introduce in conjunction with other measures