Manifesto for the 2021 Scottish Parliament Election - SCOTTISH HEALTH ACTION ON ALCOHOL PROBLEMS
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Manifesto for the 2021 Scottish Parliament Election SCOTTISH HEALTH ACTION ON ALCOHOL PROBLEMS www.shaap.org.uk
About SHAAP SHAAP is a partnership of the Medical Royal Colleges in Scotland and the Faculty of Public Health and is based at the Royal College of Physicians of Edinburgh (RCPE). SHAAP provides the authoritative medical and clinical voice on the need to reduce the impact of alcohol-related harm on the health and wellbeing of people in Scotland and the evidence-based approaches to achieve this. Our manifesto This manifesto calls on all parties and candidates to recognise that alcohol-related harm has implications for multiple other areas of physical and mental health1, and to commit to policies that will help tackle Scotland’s alcohol problem. Doing so will not only ensure that fewer people die each year because of alcohol, but will also strengthen the long-term resilience and responsiveness of our NHS and care services, and provide the foundation for a strong wellbeing economy in the future. In 2018, 1,136 people in Scotland died from a cause wholly attributable to alcohol – that’s an average of 22 deaths every week
Tackling Scotland’s alcohol problem
Scotland is an international leader in advancing evidence-based alcohol policies In 2018, WHO launched the SAFER initiative – a comprehensive policy
that protect people’s health. Yet, despite the commitments and achievements of the action package with five priority ‘best buy’ approaches known to reduce
the harmful use of alcohol9. These are:
20092 and 20183 Alcohol Frameworks, levels of alcohol harm in Scotland remain
high. The COVID-19 pandemic has transformed life in Scotland since March 2020. 1 strengthening restrictions on alcohol availability;
For alcohol, the pandemic has accelerated the long-standing trend towards home 2 advancing and enforcing drink driving counter measures;
drinking, which involves additional potential risks. So far, research indicates that the 3 facilitating access to screening, brief intervention and treatment;
heavier drinkers have increased their consumption.
4 enforcing bans or comprehensive restrictions on alcohol
In 2018, 1,136 people in Scotland died from known to reduce the harmful use of alcohol. In advertising, sponsorship and promotion, and
a cause wholly attributable to alcohol – that’s Scotland we have a clear framework for tackling 5 raising prices on alcohol through excise taxes and pricing policies.
an average of 22 deaths every week4, and a alcohol harm that draws on many of the policies
number that does not include deaths where embedded in these approaches. However, the
alcohol has contributed, such as suicide, road reality is that we have not yet gone far enough
accidents and a wide range of diseases. In in implementing them.
2015 alone, it was estimated that 3,705 deaths
were attributable to alcohol5, with more than Reducing alcohol-related harm in Scotland
one in four of those (28%) due to cancer6. requires maintaining a focus on alcohol
These statistics, while stark, do not begin to as a priority, as well as understanding the
capture the devastating impact that alcohol can significance of alcohol to other areas of health
have on individuals, families and communities. and social policy. SHAAP recognises that
There are also stark inequalities to alcohol- we currently face unprecedented challenges
related harm in Scotland. Although more to public health in Scotland, and immense
people living in affluent areas drink more than pressures on public finances. However, as we
is recommended than people living in the most approach the Scottish parliament election of
deprived areas, it is the latter who are more 2021, it is more important than ever that we
The COVID-19 pandemic has
likely to come to harm from alcohol. Indeed, you do not lose sight of long-term public health
are 7 times more likely to end up in hospital and measures that can improve the health and
4.5 times more likely to die because of alcohol if wellbeing of everyone in Scotland, build the
transformed life in Scotland since
you live in one of the 10% most deprived areas, resilience of our NHS and local care services,
compared to the least7. and benefit the economy. Problematic use of
alcohol cost the Scottish economy £3.56 billion
March 2020. For alcohol, the
All deaths from alcohol are preventable, and in 2007 alone8. Now is the time for bold action
it has been clear for some time what actions on alcohol problems if we are to achieve our
need to be taken to reduce them, as well as the long-term public health goals and create a
pandemic has accelerated the
health and social harms that alcohol causes in fairer Scotland for the future.
Scotland. In 2018, WHO launched the SAFER
initiative - a comprehensive policy action
long-standing trend towards home
package with five priority ‘best buy’ approaches
drinking, which involves additional
potential risksWhat we are asking Affordability, availability and attractiveness
We are asking all parties and candidates to commit to four focus areas in which Population-wide preventative measures targeting alcohol’s affordability, availability,
we need to push harder and go further if we are truly to tackle Scotland’s alcohol and attractiveness are cost-effective and have a strong evidence-base for success.
problem, achieve our long-term public health goals, and create a healthier This includes in tackling health inequalities, because these policies help create
Scotland for the future. Within these four areas, we identify key policies that need environments within which all citizens are supported to make healthy choices10.
to be implemented immediately to reduce alcohol-related harm. For those policies Though the Scottish Government has adopted many of the alcohol policy ‘best
that have not already been considered for adoption by the Scottish Government, buys’ endorsed by WHO, we could do more to implement these. The challenges
a serious conversation about doing so needs to begin now. These commitments of COVID-19 have made it more important than ever that we take bold action to
are more important than ever in the context of COVID-19, given the potential for reduce alcohol-harm. To do this, SHAAP recommends the following actions:
growing health inequalities.
• Where devolved powers exist to do so, Require the alcohol industry to help
•
enforce total restrictions on alcohol reduce alcohol harm by sharing their
advertising, sponsorship and promotion. knowledge of sales volumes and patterns
Our four focus areas Create an independent body to monitor and the influence of marketing campaigns.
and enforce alcohol advertising and
1 Affordability, availability and attractiveness marketing regulations and ensure that • Undertake a review of the minimum
nutritional and health information, including unit price for alcohol (MUP) linked to
2 Investing in and improving treatment and support services pregnancy warnings, appears on products. affordability, and raise it if necessary. More
There is a particular need to improve ambitious targets for reducing alcohol-
3 Supporting recovery and reducing health inequalities regulation of direct and indirect online specific deaths and alcohol-related
alcohol marketing. hospital admissions by 2023, linked to
4 Protecting children and young people MUP, should also be introduced.
Strengthen restrictions on alcohol’s
•
availability. The off-trade sector should • Work with the UK Government to introduce
be the priority for regulation, given that an alcohol duty structure that is
alcohol sales have long been moving from proportionate to the harm caused by
pubs to stores. Alcohol-only outlets should alcohol, scaled to ensure that stronger
be established, and alcohol should be drinks cost more, consistent within
strength categories and up-rated to
1
removed from the shelves of supermarkets
and convenience stores. The potential for maintain health and social benefits and
a government monopoly on alcohol sales revenues.
should be seriously explored. There is good
Population-wide preventative evidence that supports these systems in
other countries, including Sweden and
Canada.
measures targeting alcohol’s
affordability, availability, and
attractiveness are cost-effective and
have a strong evidence-base for
successInvesting in and improving treatment and support services Supporting recovery and reducing health inequalities
The onset of COVID-19, and the necessary public health measures taken to The recovery community in Scotland – the 12-step movement (e.g. Alcoholics
contain the pandemic have shone a light on the patchy and often disjointed nature Anonymous) and the visible recovery movement (e.g. Scottish Recovery
of our existing alcohol treatment, support and recovery services. Twenty-five years Consortium) – is vibrant and growing. Recovery groups played a vital role in
ago, the European Charter on Alcohol stated that all people have the right to supporting people in and entering recovery during the COVID-19 lockdown,
accessible treatment and care for alcohol problems11. In Scotland, we are still not ensuring that programmes and communities could remain virtually available, even
as close to achieving this ethical principle as we should be in the face of the closure of other services. It is important that this contribution is
With the threat of economic recession looming, and the potential that this will acknowledged and built upon post-lockdown. To do so, SHAAP is calling for all
impact alcohol-related harm, it is essential that alcohol treatment and support parties and candidates to:
services are not overlooked. There is an urgent need for a comprehensive • P
lace lived and living experience at • Invest in recovery communities,
review of and increased investment in alcohol treatment and support the centre of policy-making. In order to particularly in more remote and rural areas
services in Scotland. In addition, SHAAP is calling for the following: be effective, service providers must treat where it may be harder for people to access
people with lived experience as equal the help and support they need.
• That alcohol treatment and support • That equity of access to alcohol services partners in service design and delivery, and
services adopt policies and be be promoted through incorporating the initiate peer-led support to reduce stigma.
resourced to encourage maintenance specific needs of diverse groups and
of contact. Measures should include the populations into service design and • Promote better collaboration, co-
establishment of alcohol care teams in delivery, including LGBT+ communities, ordination and integration between
acute hospitals, expanding the Navigator12 refugees and asylum seekers, older people NHS Scotland, local Alcohol and Drug
service in emergency departments, and rural communities in Scotland. Partnerships (ADPs) and the recovery
maintaining telephone contact with people community.
who have not attended appointments, and • That investment in alcohol services
offering intensive outreach to the most should correspond in scale to the level The COVID-19 pandemic has exacerbated problems associated with alcohol
vulnerable. of local need and disadvantage, following harms such as social isolation, mental health challenges and deprivation, and it is
a principle of proportionate universalism13.
likely that we are facing a period of economic downturn. These factors are all likely
• That services, including primary care
services, take a holistic approach to referral In addition, it is SHAAP’s view that all services to impact health inequalities. Earlier this year, a ten-year review of the Marmot
Report concluded that large funding cuts over the last decade had contributed to
2 3
and care, and that they communicate should exercise ‘professional optimism’. This
with each other across areas of focus – for means giving everyone who seeks help a life expectancy in England stalling for the first time since 190014. It is essential that
instance, in the case of mental health and supportive and positive environment to start
or continue the recovery journey, free from we do not allow a similar outcome in Scotland. SHAAP is therefore calling for:
addiction services.
stigma. The development of knowledge
• That the training, implementation and and skills regarding alcohol should be an • T
he introduction of a minimum income
monitoring elements of Scotland’s integral part of health and social care staff for healthy living15 to reduce poverty and
innovative Alcohol Brief Intervention development. health inequalities.
(ABI) programme be reviewed in line with
• The adoption of the Housing First
recent advances in knowledge to ensure it
strategy16, and the trialing of Managed
is effective and efficient. This review should
Alcohol Programmes, building on
include wider settings such as criminal
international experience with people with
justice and social care.
severe alcohol problems who require
housing support.
Sustained investment in youth services,
•
and the provision of activities for young
people so they can learn skills, develop
relationships and have fun in alcohol-free
environments.Protecting children and young people
It is imperative that Scotland
maintains progress on reducing
Figures from the Scottish Schools Adolescent Lifestyle and Substance Use Survey
(SALSUS)17 indicate that alcohol consumption among 15- and 13-year-olds in
Scotland has reduced considerably since 2004, though there appears to have been
a slight increase since 2013. However, 20% of 15-year-olds self-reported drinking
in the last week, and drinking was more common in the last week for both 15- and
alcohol consumption by
13-year-olds than smoking regularly or having used drugs in the last month.
It is imperative that Scotland maintains progress on reducing alcohol consumption by
implementing policies and
implementing policies and interventions that will protect children and young people.
Much of the harm to young people comes from the drinking of others and policies interventions that will protect
that positively influence adults will also benefit children. To support an alcohol free
childhood, SHAAP is calling for parties and candidates to commit to the following: children and young people
Enforce total bans on alcohol
• Promote awareness of the ‘No Alcohol,
•
advertising, sponsorship and promotion, No Risk’ message for people who are
especially in environments where children pregnant and/or trying to conceive,
and young people are likely to be exposed and improve screening and support for
to these, including at sporting events, or as people affected by Fetal Alcohol Spectrum
part of sporting activities. Disorders (FASD) in Scotland.
Support and promote positive
•
alternatives to alcohol sponsorship of
sports teams. The partnership between
SHAAP and Scottish Women’s Football
(SWF) is one good example of such an
alternative and how this can be achieved:
http://bit.ly/SHAAPSWF.
4
1 Cf. IAS and Centre for Mental Health. 2018. Alcohol and Mental Health: 9 www.who.int/substance_abuse/safer/en/
Policy and Practice in England: www.ias.org.uk/uploads/pdf/IAS%20reports/ 10 Cf. Smith, K. E., Hill, S. (eds.). 2016. Health Inequalities: critical perspectives.
rp31042018.pdf Oxford University Press: Oxford
2 The Scottish Government. 2009. Changing Scotland’s Relationship with 11 WHO Regional Office for Europe. 1995. European Charter on Alcohol:
Alcohol: A Framework for Action: www.ias.org.uk/uploads/pdf/News%20stories/ www.euro.who.int/__data/assets/pdf_file/0008/79406/EUR_ICP_ALDT_94_03_
scotland-alcohol-report0209.pdf CN01.pdf
3 The Scottish Government. 2018. Alcohol Framework 2018: Preventing 12 Cf. www.svru.co.uk/navigator/
Harm – next steps on changing our relationship with alcohol: www.gov.scot/
publications/alcohol-framework-2018-preventing-harm-next-steps-changing- 13 Cf. Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady, M.,
relationship-alcohol/ Geddes, I. 2010. Fair Society, Healthy Lives: The Marmot Review:
www.instituteofhealthequity.org/resources-reports/fair-societyhealthy-lives-the-
4 Giles, L, Richardson E. 2020. Monitoring and Evaluating Scotland’s Alcohol marmot-review/fair-society-healthy-lives-full-report-pdf.pdf
Strategy: Monitoring Report 2020. Edinburgh: Public Health Scotland:
www.healthscotland.scot/media/3103/mesas-monitoring-report-2020.pdf 14 Marmot, M., Allen, J., Boyce, T., Goldblatt, P., Morrison, J. 2020. Health Equity
in England: The Marmot Review 10 years on: www.health.org.uk/sites/default/
5 NHS Health Scotland. 2018. Hospital admissions, deaths and overall burden files/upload/publications/2020/Health%20Equity%20in%20England_The%20
of disease attributable to alcohol consumption in Scotland. Public Health Marmot%20Review%2010%20Years%20On_full%20report.pdf
Information for Scotland: www.scotpho.org.uk/media/1597/scotpho180201-bod-
alcohol-scotland.pdf 15 Cf. Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady, M.,
Geddes, I. 2010. Fair Society, Healthy Lives: The Marmot Review:
6 Scottish Health Action on Alcohol Problems (SHAAP). 2019. Alcohol and www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-
Cancer Risks: A Guide for Health Professionals: www.shaap.org.uk/images/ marmot-review/fair-society-healthy-lives-full-report-pdf.pdf
Alcohol_and_Cancer_Guide.pdf
16 www.canada.ca/en/employment-social-development/programs/homelessness/
7 Giles, L, Richardson E. 2020. Monitoring and Evaluating Scotland’s Alcohol resources/housing-first.html
Strategy: Monitoring Report 2020. Edinburgh: Public Health Scotland:
www.healthscotland.scot/media/3103/mesas-monitoring-report-2020.pdf 17 Scottish Government. 2019. Scottish Schools Adolescent Lifestyle and
Substance Use Survey (SALSUS): National Overview (2018):
8 www.healthscotland.scot/health-topics/alcohol/alcohol-overview https://bit.ly/31J7iiRSHAAP - Scottish Health Action on Alcohol Problems 12 Queen Street Edinburgh EH2 1JQ Tel: +44 (0) 131 247 3667 Email: shaap@rcpe.ac.uk www.shaap.org.uk SCOTTISH HEALTH ACTION ON ALCOHOL PROBLEMS www.shaap.org.uk
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