Solving Scotland's Alcohol Problem

By Ellie Robins 11/22/15

Poor Scots are six times more likely to die from alcohol misuse than wealthy ones. A new study could explain why.


When the Global Alcohol Policy Conference met in Edinburgh in early October, Scotland’s First Minister Nicola Sturgeon didn’t mince her words about the scale of the challenge the country faces: “Scotland isn’t unique in having a problem in terms of our relationship with alcohol,” she told delegates from more than 50 countries, “but unfortunately, we are unusual, certainly among Western European countries, in the severity and the extent of that problem. Alcohol consumption in Scotland is almost one-fifth higher than it is in England and Wales. Our rates of liver disease and cirrhosis are the highest in Western Europe.”

She went on to discuss the high national rates of hospitalization and death resulting from alcohol abuse, and concluded: “These consequences affect some sections of the population far more severely than others. We know that people in the most deprived parts of our country are six times more likely to die from alcohol misuse than those who live in the most affluent parts of the country.”

A recent study from Scotland’s Centre for Research on Environment, Society and Health has provided a new key to understanding those inequalities: researchers have found that Scotland’s most deprived areas have up to twice as many shops selling alcohol and tobacco as wealthy ones.

The researchers say greater availability of booze and cigarettes is just the tip of the iceberg in these disadvantaged neighborhoods: the shops are likely to change local cultures, raising awareness of tobacco and alcohol brands, creating a competitive local market that drives costs down, and influencing the social norms around consumption.

Dr. Niamh Shortt, a geographer at the University of Edinburgh and one of the authors of the research, told The Fix it’s time to prioritize public health rather than profit alone, and challenge the libertarian arguments with which alcohol and tobacco companies tend to defend themselves in conversations about health. “The argument we hear most often is that our bodies are our own and we should be free to do what we want with them,” she said, “even if this means harm. However, such arguments are misdirected when we consider the powers held by Big Business, such as Big Tobacco and Big Alcohol, who hold the balance of power and capital.”

Asked whether she believed that alcohol and tobacco companies are deliberately targeting deprived neighborhoods, Dr. Shortt said: “We did not look at the mechanisms through which more outlets were concentrated in more deprived areas, but we cannot ignore the possibility. [...] There is, however, evidence from the States to show that the tobacco industry has targeted inner city, low-income areas with heavy marketing.”

And in an interview with The Student, Professor Richard Mitchell of the University of Glasgow, a co-author of the report, said: “If you look at responses from the industry over the last few days they say, ‘We just go where the market is,’ which of course is a bare-faced lie—it is their business to create the market. They try to rubbish any science that comes out which kind of argues against their industry. They hide behind ultra-libertarian arguments. They’re very well resourced and they’re very clever. But ultimately what they’re trying to do is make money.”

A representative from the major Scottish brewery Tennent Caledonian denied that the company targets disadvantaged communities, telling The Fix: “We obviously can’t comment on the industry at large but this absolutely does not apply to Tennent’s or [parent company] C&C.” And Rosemary Gallagher, head of communications at the Scotch Whisky Association (SWA), said: “The long-term decline of alcohol-related deaths suggests measures in place to tackle misuse are working. But we agree more can be done and we want to see effective and targeted measures in place to combat misuse.” The SWA awards £100,000 a year to organizations across Scotland to tackle alcohol misuse.

But if the presence of alcohol and tobacco remains disproportionately higher in the country’s poorest areas, measures to tackle misuse in these communities will automatically be at a disadvantage. The authors of the study report that policymakers have been receptive to their findings, but it remains to be seen whether that will translate into policy changes. And of course, there are already measures in place to protect public health against the harmful effects of alcohol and tobacco—like licensing laws, for example, though as Dr. Shortt told The Fix, “Around 96% of applications for alcohol licenses in Scotland are granted. We need to approve fewer and we need to be brave and use the population's health as a reason not to approve applications.”

The report adds fuel to an incendiary moment in Scotland’s relationship with drinking. The Scottish government has already shown that it’s prepared to square up to the alcohol industry as it works to reduce the harm caused by alcoholism. Back in 2012, the country’s parliament introduced a minimum unit pricing act, setting the lowest permissible price of a unit of alcohol at 50 pence (around 80 cents). The act was intended to tackle low-cost, high-alcohol drinks and promotions that account for a significant proportion of the country’s problem drinking, but it met legal opposition from the alcohol industry. Three years later, the government is still locked in court proceedings with trade bodies that dispute the act’s legality.

Exemplifying the kinds of libertarian arguments to which Dr. Shortt and her colleagues object, the SWA released a statement back in 2012 stating, among other things, that “minimum pricing is a regressive policy that will hit responsible drinkers and, in particular, those on lower incomes at a time when household budgets are under extreme pressure.” The statement neglected to mention that it’s precisely Scots on lower incomes who are disproportionately affected by death and illness as a result of drinking. 

Perhaps unsurprisingly, minimum unit pricing met widespread public opposition; it’s logical to assume that stricter regulations on the distribution of alcohol and tobacco shops would be similarly unpopular. As it strives for a “cultural transformation” in attitudes to drinking, the Scottish government will likely once more find itself in the unenviable position of battling powerful alcohol companies in order to enact unpopular legislation. But a cultural shift on the scale Scotland needs will require a multi-pronged approach that—the authors of this study contend—must include measures that limit supply. In the words of Dr. Shortt and her colleagues: “The links between deprivation and addiction are well known. In seeking solutions to that problem, governments often—and not wrongly—look for ways to address the particular challenges of poorer communities. Those efforts are valuable and necessary. But this study suggests that it could be equally valuable and necessary to simply change supply.” 

Back in early October, Nicola Sturgeon told delegates at the Global Alcohol Policy Conference: “The first responsibility of any government is to the health of its population.” This study could prove invaluable to the Scottish government as it works to fulfill that responsibility—but it’s unlikely to win them any popularity contests.

Ellie Robins is a writer, translator and Londoner currently based in Los Angeles.

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Ellie Robins is a writer and translator based in Los Angeles. Find out more about Ellie on Linkedin. You can also follow her on Twitter.