Nation of drunks

Many say Scotland makes the best whisky; it also has some of the worst rates of alcohol-related problems in Western Europe. Scots drink a fifth more than their counterparts in England and Wales, with related hospital admissions quadrupling since the 1980s. Furthermore, this isn’t a fixed, historical culture, but a fairly recent phenomenon. The nineties in particular saw a surge in cheap alcohol which led to a corresponding rise in chronic liver disease and cirrhosis.

First Minister Alex Salmond was recently criticised for using the phrase ‘nation of drunks’ in a GQ magazine interview. The rise respresents “social change for the worse”, he said, and “we do have to do something about it.”
In June 2012 Scotland became the first country in the UK to adopt a policy of controlling pricing of alcohol per unit, when parliament passed the Alcohol (Minimum Pricing) (Scotland) Act 2012. The price was set at 50p per unit of alcohol.
However, the Scotch Whisky Association (SWA), alongside other manufacturers’ trade bodies, has fought the legislation in the courts, and it has now been referred to the European Court of Justice by the Court of Session in Edinburgh because there were “several complex issues” involving EU law on free trade.
Although the referral will delay further implementation of the policy, Health Secretary Alex Neil remains optimistic. “I welcome the referral to the European Court of Justice. Scotland is leading the way in Europe. While it is regrettable that this means we will not be able to implement minimum unit pricing sooner, we will continue our ongoing and productive dialogue with EU officials,” he said.
It is thought nine other member states, including Spain, France and Bulgaria, whose low-budget wine would be affected, oppose the idea.
The SWA has argued minimum pricing has been against European trade law from the outset. The EC indicated last year the law may contravene Article 34 of the Treaty on European Union, which covers free movement of goods.
“Our view reflects the views of big European states like France and Italy that trade barriers might be put in place,” says David Williamson, Government and Communications Director of SWA.
Over 90 per cent of Scotch whisky is exported, and is perceived as a high-end product. This was the context to Salmond’s comments to GQ. “I promote whisky; I do it on the argument that it’s a quality drink, has a worldwide cachet, and that its recent great success in markets like China is about social emulation and authenticity, not cheapness. My argument is that if you are promoting it as authentic and of great worth, you cannot promote it from a nation of drunks,” he said, adding “actually, I do not believe the Whisky Association’s motivation is about whisky, it is about cheap vodka. They say not, but I do not find their arguments convincing.”
Williamson insists the organisation is not acting on behalf of its membership’s cheaper products. “No, our sole responsibility is to promote and protect Scotch whisky and the export market. The Scottish Government’s own figures show two thirds of whisky would be affected, 85 per cent of blended whiskies.”
Price distribution of alcohol sold through the off-trade in Scotland in 2012 shows 83 per cent of vodka was sold below 50p per unit, and 64 per cent of whisky. A 50p per unit minimum price would increase the price of a 70cl bottle of whisky to £14. Whilst this will impact on the lower-end blends and supermarket own-label malts, the premium products are unlikely to be directly affected.
Scots now drink 40 per cent more vodka than whisky, but it isn’t the only cheap alcohol which has seen phenomenal growth since the nineties. Cider is also a big factor, with 75 per cent sold below 50p per unit in 2012.
Dr Peter Rice, chairman of Scottish Health Action on Alcohol Problems (SHAAP), was a consultant psychiatrist in Tayside and a member of a group of doctors who drove the pricing agenda forward. He started working for an alcohol problem service in 1990 and saw the shift with his own eyes. “Super lagers absolutely dominated the clinic. It was what people were drinking. Then over a period of 18 months in the mid-nineties, white cider appeared and it just shifted,” he says.
Favourable excise agreements for cider meant it could be sold much cheaper. “Don’t ask me why it wasn’t until the mid-90s that somebody twigged they could do well out of that, but that was kind of what happened, and so that sector started to grow. It really brought home to me the importance of affordability and cheapness,” says Rice.
The other concurrent shift was toward home drinking. “We’re seeing fewer and fewer pub drinkers, and more and more home drinkers. In purely health terms, it doesn’t matter particularly where you drink your 30 units of alcohol that day, but I think people are getting socially isolated more quickly than they used to,” he says.
The apparent situation forced Rice and others to take a step back and begin to evaluate the shift in culture, something many frontline staff wouldn’t have been able to do, he says. “If you’re working in an A&E department, it can just feel like alcohol is all around you, so you might not notice a shift from seven a night to 12 a night.”
In forming and presenting a case for price controls, Rice and others collated evidence. “The notion of ‘it’s always been like this’ was what we actually needed to shift, both among clinicians and amongst policymakers; that it wasn’t something that had been going on for generations, but we were in the process of marked change,” he says.
Change, SHAAP argues, isn’t made through focusing on individual psychology or popular culture, but on what drives it: the market. “There’s a nice phrase that I picked up: you’re looking for the ‘modifiable determinates’. You know, what are the levers here you can get your hands on? Also, what have been the modifiable determinates that have led to these changes? That’s not a change in the Scottish mentality, the kind of people we are. It didn’t transform from 1990 to 2000.”
Attitudes and behaviours follow regulation, says Rice, pointing to drink driving and seatbelt wearing as examples. “I was sitting on a bus from Perth down to Glasgow and the previous driver got up and walked up and down and said, ‘put your seatbelts on, it’s safer for you’ and everyone just sat there, didn’t move. Next guy came on and said, ‘it’s the law, wear your seatbelts’, and they just put them on. That was really interesting to me,” he says.
The alcohol market in the UK is comparatively deregulated, but it will be under scrutiny at the European Court of Justice.
Rice is frustrated with the speed with which the process is going through the courts but, like Neil, remains optimistic. “My feeling is every time we’ve taken the case to an audience, the more people look at this, the more they favour it,” he says.
Both sides of the dispute say the case in Luxembourg will be precedent-setting. The SWA points to an example in South Korea, where the government have sought to protect the local spirit, Soju, against import rivals by using its lower alcohol content to impose a ‘health tax’ on stronger spirits from abroad. Williams says: “The industry and European Commission would be unable to defend Scotch from such discrimination if the Scottish Government had successfully overridden normal trade rules for health reasons.”
Rice agrees the case represents an important test case for the EU, and will shape its sense of purpose in the future. “Does it have a health agenda, or is it a trade organisation at all costs? There hasn’t been a nice clear-cut test case about the balance of public health and free trade, which is what this is all about. So we think, and what we’re saying to our European partners is this is going to be an important test case for governments being able to use their very important levers of market mechanisms for health, be that in obesity, blood pressure, alcohol.”
One argument against price controls is it would disproportionately hit the poorest harder. Rice says as well as problem drinkers, the number of abstainers is highest among the lowest income groups, “I spent a lot of my career working right across income groups, but the lowest income groups are overrepresented. I’ve always found it a hard argument to listen to, that alcohol is doing favours for our most deprived communities. I just can’t see that,” he says.
Across the UK, the figures for alcohol harm have started to improve in the last few years. The SWA says this shows increased awareness, but for Dr Rice, it corresponds directly with a drop in disposable incomes, and proves the market is an important driver. “The improvement has been since alcohol prices have gone up. I think when we look at deaths, the biggest falls since 2007 have been in the lowest income communities. So actually, we’re seeing a narrowing of health inequalities on alcohol. Of course, we’re not going to argue that recession is good for health, but I think it has shown the key influence of affordability in the rates of overall harm we experience, and also that things improve really quite quickly.”
While minimum pricing may impact health, it doesn’t address the fact Scotland’s consumption outstrips England and Wales, which saw identical shifts in pricing and drinking at home. “There is something deep about Scotland’s relationship with alcohol that is about self-image – lack of confidence, maybe, as a nation,” Salmond said to GQ.
David Walsh from the Glasgow Centre for Population Health told Holyrood recently: “Alcohol-related deaths are twice as high in Glasgow as they are in Liverpool and Manchester, and people drinking at that level, it’s not just about slightly higher levels of consumption. That’s people drinking at the level that it kills you. That, obviously, begs the question, why is that?”