Title: Appraising the effect of implementing local Minimum Unit Pricing under the Sustainable Communities Act on alcohol consumption and health in the North West of England
Funder: Department of Health and Social Care

Abstract: BACKGROUND Minimum Unit Pricing (MUP) for alcohol was considered by the UK government for implementation in England and Wales but was rejected, despite evidence estimating that it would be effective, with beneficial impacts on death rates and hospitalisations as well as economic outcomes for consumers, retailers, government tax revenues and NHS healthcare costs. A group of Local Authorities (LAs) in the NW region recently sought legal advice on the possibility of local implementation. This advice recommended a submission under the Sustainable Communities Act as the best option, noting that detailed new evidence to assess the local impact would need to be included with the submission. AIM To estimate the impact of MUP for alcohol in the NW region of England by adapting an existing alcohol policy model in order to provide the evidence for a core group of LAs to make a submission on implementing a local MUP provision under the Sustainable Communities Act. To provide additional estimates of impact for the 8 other GORs in England for comparison. DESIGN & SETTING The 18 month project has 3 phases: Phase 1: Evidence gathering and synthesis will bring together key datasets on alcohol consumption, patterns of purchasing and prices paid (including additional data specific to the geographic regions of interest that we have negotiated to purchase), upper tier LA level data on mortality from alcohol related conditions and hospitalisations related to alcohol. Phase 2: Impact assessment will adapt an existing national alcohol policy model to work at LA level to estimate the impact of MUP at 9 different levels (30p to 70p) for the NW region as a whole, for each LA within the region individually, and for the core group of LAs intending to make the submission. Phase 3: Engage with LAs and related stakeholders in the NW region to develop the evidence statements required for the submission, the supporting technical report, a peer review journal article, and materials summarising the methods and findings for the public and elected members of LAs. Conduct comparator analyses of impact for the 8 other Government Office Regions, including detailed analyses by LA in the North East region. INTERVENTION A locally implemented MUP for alcohol. This means that the price of alcohol would depend on strength and a product containing 10ml (one ‘unit’ of pure ethanol) would not be allowed to be sold below the threshold level. We will examine 9 threshold levels of 30p, 35p, 40p, 45p, 50p, 55p, 60p, 65p, 70p per unit. The comparator strategy is no change to existing price distributions. OUTCOMES Health impact for the adult population of the regions of interest including estimated reductions in morbidity and alcohol related hospitalisations, alcohol related mortality, and Quality Adjusted Life Years. Analysis of reductions in health inequalities. Economic impact for consumers in terms of changes in expenditure on alcohol, for retailers in terms of income, and for government in terms of changes to alcohol duty and VAT revenues. Economic impact on the NHS in terms of reductions in healthcare costs. All outcomes to be examined over a 20 year horizon. IMPACT The study will provide the evidence required by LAs to support a submission under the Sustainable Communities Act for a local MUP. If the subsequent submission were successful this would impact on health, NHS costs and health inequalities

Lay abstract: BACKGROUND Each year harms from alcohol cost the NHS £3.5 billion and wider society £21 billion. The UK Alcohol Strategy 2012 included a plan to introduce a policy called ‘Minimum Unit Pricing’ (MUP). Under MUP, the price at which alcohol can be sold is linked to the amount of pure alcohol (e.g. under a MUP of 50p per alcohol unit, a bottle of wine containing 10 units could not be sold for less than £5). Although research shows this policy would probably reduce the amount of alcohol drunk and the number of hospital admissions and deaths caused by alcohol, by 2014 the government decided not to introduce MUP. Local Authorities (LAs) are responsible for responding to alcohol harms in their communities. The North West (NW) region of England has a higher than average level of alcohol harms. As MUP was not introduced for England as a whole, there is a high level interest in the NW in introducing MUP locally. Expert legal advice says that one possible way to introduce MUP is for LAs to use a law called the Sustainable Communities Act to ask the UK government to allow them to set a local MUP. To do this, the LAs need to: 1) demonstrate local support for MUP, and 2) provide local evidence that MUP would be beneficial for the health of people in the NW. AIMS This project aims to address the second point above by providing evidence about what would happen if MUP was introduced by LAs in the NW. Specifically, what would happen to the price of different types of alcohol, what effect these price changes would have on how much alcohol people drink and on the number of hospital admissions and deaths caused by alcohol, as well as changes to quality of life and NHS costs. METHOD To test what would happen to the amount of alcohol drunk if MUP were introduced locally, we will take several steps: 1. We will combine survey and market research data (to be bought through this research grant) to work out how much alcohol of different types is currently bought and at what price 2. We will use national survey data to estimate how much people currently drink in each Local Authority 3. Using evidence from previous research on how people respond to price changes, we will work out how the amount of alcohol bought and consumed would change if there was a MUP. We will work this out for 9 different levels of MUP (30p, 35, 40, 45, 50, 55, 60, 65, 70p) Once we know what change there would be in the amount of alcohol drunk, we will be able to estimate what difference this would make to harms. We will: 4. Use hospital information about the number of patients with conditions caused by alcohol to work out how many fewer cases there would be 5. Use death records about the number of people dying of alcohol-related causes to work out how many fewer deaths there would be 6. Convert these estimates to quality-adjusted life-years (QALY) which is a measure of quality and quantity of life gained from introducing a particular health policy We will estimate what changes would occur under MUP for 20 years for different population groups (e.g. more or less wealthy, and for light, moderate and heavy drinkers) for each LA in the NW. We will also undertake comparison with 8 other regions. IMPACT Our work will provide evidence about the likely scale of impact of MUP in the NW region. The LAs, with whom we have engaged in developing this bid, plan to use this to make a submission under the Sustainable Communities Act.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL;STROKE