Associate Feature: A year to remember?

The Scottish Parliament has built an international reputation for bold action on public health.

Certain years are etched into the mind of campaigners, particularly 2006, when the ban on smoking in public places was introduced, and 2018, the year Minimum Unit Pricing (MUP) of alcohol was implemented. Both drove down deaths and ill-health.

Could 2024 be the next landmark year? After fears that ministers were pulling back from key measures last year following the SNP leadership contest, a raft of important policies are back on track. 

There is urgent need for comprehensive action, say public health experts, with life expectancy dropping and health inequalities widening.

But questions remain about whether the Scottish Government will follow through on its latest promises – and how quickly. 

Public health campaigners are urging them to do so without delay.

David McColgan is chair of the Non Communicable Diseases (NCD) Alliance Scotland, a coalition of leading health charities and medical royal colleges campaigning together for action on the commercial determinants that drive people to consume health-harming products. He says: “In the middle of last year, there was significant concern about the Scottish Government’s approach to public health policy and how much industry influenced it, a good example being alcohol marketing. 

“Ministers were very supportive of putting evidence-based limits on alcohol advertising but then industry started objecting and it disappeared off the government’s agenda very quickly.
“Now we are in a much more positive space, but as ever with the Scottish Government, it’s not final until it’s final.

“This could be a big year for public health, the year when we reverse the trend of worsening health.

“We’ve got a Scottish Parliament where there is enough cross-party support to move these things forward, but we have to keep the momentum up.

“The big risk is that if we get significantly beyond the turn of the year, then we are getting close to the next Scottish Parliament election and progress could grind to a halt.”

Deaths related to alcohol have increased since the pandemic, when those who already drank more to begin with were likely to have increased their consumption. Deaths would have been higher still without MUP, according to evidence from Public Health Scotland. 

Alison Douglas, chief executive of Alcohol Focus, says: “Almost a quarter of people in Scotland regularly drink above the chief medical officers’ low-risk drinking guidelines, placing them at increased risk in the short-term of being involved in an accident or in violence, and over the longer-term at greater risk of cancer and stroke. 

“We have a long way to go to turn the tide of alcohol harm and we must use all the tools available to us.”

Campaigners are keen that MUP is uprated from 50p to 65p, its effectiveness having been eroded by inflation, and also that ministers press ahead with restrictions on alcohol advertising.

If MUP is not uprated, there will be an estimated 800 more deaths and almost 10,000 additional hospital admissions over five years, according to research from Sheffield University.

Elinor Jayne, director of Scottish Health Action on Alcohol Problems (SHAAP), stresses that policymakers “should not succumb to the intense pressures from alcohol industry lobbyists”, adding there is “no time to lose” in taking forward policies that will save lives. 

She says: “It is vital that our politicians vote on the overwhelming evidence that MUP has been a success in reducing alcohol harms, and thus needs to be maintained and optimised at a higher level.

“The alcohol industry continue to make unfounded scaremongering claims around the potential impact of MUP, as well as offering ineffective alternatives. We saw this the first time around, and policymakers should be aware that none of their claims came to pass.” 

Douglas agrees. Research in the journal Addiction in 2018 on the links between heavy drinking and alcohol industry profits, based on data in England, found the alcohol industry appeared to be highly financially dependent on people drinking over the guidelines. “They have a fundamental conflict of interest in helping to reduce consumption, which is why both the World Health Organization and Scottish Government recognise the industry should not be involved in formulating public health policy on alcohol,” says Douglas. 

Scotland’s decision to implement MUP was a world first, but delays in taking forward other policies, like restricting the marketing and advertising of alcohol, has led to countries such as Ireland and Estonia overtaking Scotland. 

Public health experts and campaigners want ministers to restrict advertising of alcohol outdoors and in public places; phase out alcohol sponsorship of sports and events; and reduce the visibility of alcohol in shops and supermarkets by creating separate alcohol areas within stores. They would also like to see health warnings displayed on bottles and cans.

Campaigners stress that measures like these need to go alongside better, more accessible treatment and support services for those with existing alcohol problems. 

Obesity is another major drag on health. The Scottish Government is consulting on restricting price promotions of unhealthy food and drink, like multibuy deals, and limiting the promotion of unhealthy foods in particular places, like checkout areas and the ends of aisles. It is the fourth such consultation in five years.

Jennifer Forsyth of Obesity Action Scotland says we now need “bold and urgent action” from the Scottish Government to make the much-discussed but long delayed proposals a reality.

She says: “We know that simply focusing on individuals and personal responsibility is not effective. We have been doing this for years, and our health outcomes are continuing to worsen. We need regulations and legislation to change the food environment and create a new, healthy level playing field for business and the consumer. Healthy food is currently not affordable or accessible for many people and this is driven by the food environment they experience.

“Price and location promotions are key drivers of the purchase and consumption of food and drink products high in fat, salt and sugar. Price promotions don’t save customers money; they encourage consumers to purchase on average 20 per cent more than they intended and increase consumption as a result. 

“We would like the restrictions to be a comprehensive package, including as many types of price and location promotions as possible.”

The proposals ministers are consulting on go further than regulations in England, but not far enough, says Forysth, since they include exemptions for certain businesses and also products, like loose bakery items, which could allow promotions to be shifted to other product types and locations rather than eliminated.

She adds: “More than two-thirds of our adult population are now living with overweight and obesity, and a third of our children are at risk of overweight and obesity, the highest level recorded since 2011. Failure to act now will only worsen this situation.”

Progress towards making Scotland smoke-free (where fewer than five per cent of the population smoke) is way off track. Cancer Research UK recently estimated that Scotland is around 16 years off the Scottish Government’s 2034 smokefree target date.

Scotland, along with the other UK nations, is moving to ban single-use vapes and Scotland was the first of the four nations to lay regulations on it.

Proposed UK-wide legislation will also prevent anyone born on or after 1 January 2009 from being sold tobacco. A new tax has been announced on e-cigarettes and a UK-wide consultation is expected on the flavours and packaging of e-cigarettes.

Scotland could easily take further action on its own, though, campaigners stress. Regulations tightening rules on the advertising and promotion of vaping products in Scotland were consulted on and the responses published in 2022, but progress has stalled.

Sheila Duffy, chief executive of ASH Scotland, says: “With the alarming upsurge of children across Scotland using e-cigarettes being a cause for great concern, ASH Scotland has been calling for the strong implementation of the proposed regulations which would restrict marketing strategies, advertising displays (including retail and street marketing); brand-sharing; free samples and nominal pricing; as well as sponsorship deals promoting nicotine and non-nicotine e-cigarettes.”

ASH Scotland is calling on public health minister Jenni Minto to lay those regulations, adding it can be done “relatively rapidly, unlike most of the proposed UK-wide legislative measures that could take several years”.

McColgan stresses that MSPs have an opportunity before them. “These long-standing promises must be turned into reality,” he concludes. “If MSPs uprate MUP, restrict alcohol marketing, limit promotions of unhealthy food and drink, and tighten rules on the promotion of vapes, 2024 will be a truly momentous year that will bring a change in Scotland’s public health for good.”  

This article is sponsored by NCD Alliance Scotland

https://www.bhf.org.uk/what-we-do/in-your-area/scotland/ncd-prevention-report