The development of minimum unit pricing of alcohol in Scotland: a policy case study

Background Awareness of alcohol as a public health issue has increased in the UK and elsewhere over recent years. Evidence exists to support the use of price mechanisms to address alcohol harms. While various Canadian provinces have used reference pricing to control off-license alcohol prices in state-run monopolies, no country has implemented a uniform minimum unit price (MUP) that applies to all alcohol sales. This policy is being actively considered in Scotland, with legislation likely to be passed this year. Studying developments in Scotland may therefore help those working in public health to improve their engagement with policymakers as well as being of use to other countries seeking to introduce MUP in the future.

Methods Political science theories can be used to identify potential explanations for the development of policy. We draw on a number of theories to allow a range of explanations to be identified (a ‘multiple-lenses’ approach). Punctuated-Equilibrium Theory (PET) suggests policymakers use their limited time to address a few issues in detail (which can experience major policy change), while paying little attention to most other policy areas. Alternatively, multi-level governance highlights the diversity of actors seeking to influence policy within different governmental levels (venues). The same policy issue can therefore be considered at European Union, Westminster Parliament or Scottish Parliament, for example. We utilise political science theories to provide explanations for the development of minimum unit pricing for alcohol as a public health policy in Scotland.

Results PET highlights the importance of redefining the policy problem so that it becomes a focus for policymaking. This therefore suggests reframing of alcohol as a public health problem amenable to a population-based solution has been instrumental in bringing about consideration of MUP. A multi-level governance framework suggests that the devolution of health (but not trade or taxation policy) to Scottish Parliament illustrates how public health advocates were able to ‘venue shop’ from Westminster to the Scottish Parliament. We also provide a necessary description of the process through which MUP has emerged.

Conclusion Political science theories are useful for understanding public health policy developments and could be more widely used by the public health community to inform advocacy or engagement with policymakers. This case study illustrates their value as well as providing more generalisable lessons for public health advocates (such as to seek opportunities for ‘venue shopping’ and an appreciation of the importance of framing of policy issues).