Asset Based Approaches in Scotland

The latest edition of Scottish Anti Poverty Review has an excellent article by Lynne Friedli on the rise of asset based approaches to tackling poverty in Scotland.

This is critical study that while recognising some of the strengths of this approach, cautions against solely relying on it as this quote highlights:

"It also means keeping the focus on the root causes of poverty. Persistently asking: ‘what are the social structures that result in and maintain profound inequalities in the distribution of assets in Scotland?’ The failure to ask this question is the primary weakness of the assets movement. Like complexity theory and other ecological explanations for social problems, assets approaches are based on the view that achieving positive social change is essentially ‘an organic, collaborative and apolitical process in which different stakeholders contribute to an agenda that benefits everyone’ (Greenhalgh 2009). What are missing from these accounts are vested interests and the political struggle which is required to achieve both fairer distribution and ‘lines of accountability for the factories of social injustice’ (Birn 2009)."

Dr Lynne Friedli is the keynote speaker at a Social Health Association meeting on the subject 'Health Inequality - Mental and Physical'. It will be held on Saturday 9 June11am - 4pm at Edinburgh Quaker Meeting House  7 Victoria Terrace, EH1 2JL.

Scottish Labour conference motion

This is SHA Scotland's contemporary motion to the 2012 Scottish Labour Party conference.

Alcohol (Minimum Pricing) Bill

This conference notes that the Alcohol (Minimum Pricing) Bill is currently being considered by the Scottish Parliament. The Bill seeks to introduce a price at which a unit of alcohol cannot be sold below with the aim of reducing alcohol consumption and related harms.

Conference recognises that Scotland has one of the fastest growing rates of chronic liver disease and cirrhosis in the world. There are more than 42,000 hospital discharges due to alcohol related illness and injury and mortality as a direct result of alcohol has more than doubled since the early 1990s. Alcohol is a contributory factor in 1 in 20 deaths in Scotland.  49% of Scottish prisoners (including 76% of young offenders) and two-thirds of those accused of homicide said they were drunk at the time of their offence. Alcohol misuse costs Scotland an estimated £3.56bn per annum. Scottish consumption of alcohol is now 23% higher than in England.

Conference accepts that there are legitimate concerns about the legislation. The measure can be viewed as unfairly penalising the majority of moderate drinkers and disproportionately affecting low income groups who tend to pay less for a unit of alcohol. There is also a concern that if alcohol prices increase, problem drinkers with a low income may use spending from elsewhere in their budget to maintain their consumption levels to the detriment of families. The legislation may also be incompatible with EU law. However, we have to accept the evidence of the relationship between price and consumption.

Conference recognises that taxation could achieve the same benefits, with the added advantage that revenue would go to the state rather than the retailers. However, excise duty is a reserved power and there are no indications that the UK Government is prepared to act. A compensatory levy, similar to the recent 'Tesco Tax', could cover this point.

Conference believes that for Scottish Labour the impact on reducing health inequalities by reducing the harm caused by alcohol is a key issue. People living in our poorer communities carry a disproportionate share of alcohol-related health and social harm. Alcohol mortality rates are six times higher in the most deprived areas. Our primary concern should therefore be to introduce alcohol policies which are in the public health interest and will be effective in reducing the high levels of alcohol harm in Scotland.

Conference recognises that minimum unit pricing is widely supported by the medical and public health community and also by the police, children’s charities and a wide section of civil society. While we recognise concerns over the effectiveness of the measure there is an overwhelming need to take action.

Conference therefore believes that we should be prepared to consider supporting the Alcohol Minimum Pricing Bill as one measure in a more comprehensive plan to reduce alcohol harm, subject to a detailed evaluation process including fully assessing adverse effects particularly on poorer communities, families, and individuals; extension of the compensatory levy, and a corresponding sunset clause.

Health Inequality - Mental and Physical

The Social Health Association has organised meeting on the subject 'Health Inequality - Mental and Physical'. It will be held on Saturday 9 June11am - 4pm at Edinburgh Quaker Meeting House  7 Victoria Terrace, EH1 2JL.

The keynote speaker is Dr Lynne Friedli.

Dr Lynne Friedli works across Europe to support the development of public mental health, as well as delivering training and policy advocacy within the UK.  Her report for WHO Europe and the Mental Health Foundation on Mental health, resilience and inequality was published last year.  She is currently working on an action framework for public mental health, also for WHO Europe, drawing on the work of Amartya Sen on capability and social justice.
 She will be followed by Dr Gerry McCartney who is the Head of the Public Health Observatory Division, NHS Health Scotland and a Public Health Consultant.

Alcohol (Minimum Pricing)(Scotland) Bill

The Alcohol (Minimum Pricing) Bill is being considered by the Health Committee who aim to report by the end of the month. There have been a number of evidence sessions, but as yet no sign of consensus.  

The Bill seeks to introduce a price at which a unit of alcohol cannot be sold below. The aim being to reduce alcohol consumption and related harms. The minimum price is not specified in the Bill, but studies undertaken for the Scottish Government indicate that 45p per unit is the likely initial figure.

The rationale behind the Bill is that price is linked to consumption, and that consumption is linked to alcohol related harms. The affordability of alcohol has increased over the years and so too have levels of alcohol consumption. Research appears to indicate that increasing the price of the cheaper brands prevents drinkers "trading down‟ to maintain overall consumption levels. At 45p per unit, population consumption is projected to reduce by 4.3% with consequent beneficial effects for alcohol related harms. Recent research from Canada, where they operate a version of minimum pricing, has found that a 10% increase in minimum prices led to a 3.4% reduction in alcohol consumption.

SHA Scotland broadly supported the last attempt by the Scottish Government to introduce minimum pricing. While we recognise that this measure on its own is not going to resolve the problem of alcohol misuse, some action is desperately needed.

Alcohol misuse has a significant impact on Scottish public services. There are more than 42,000 hospital discharges due to alcohol related illness and injury. Mortality as a direct result of alcohol has more than doubled since the early 1990s. Research has estimated that alcohol is a contributory factor in 1 in 20 deaths in Scotland with a quarter of male deaths and a fifth of female deaths in the 35 to 44 year old age group being alcohol attributable.  

Scotland has one of the fastest growing rates of chronic liver disease and cirrhosis in the world, leading the Chief Medical Officer to add alcoholic liver disease to the list of ‘big killers’ alongside heart disease, stroke and cancer. 49% of Scottish prisoners (including 76% of young offenders) said they were drunk at the time of their offence and two-thirds of those accused of homicide (and whose drug status was known) were either drunk or on drink and drugs at the time of their offence.

Alcohol misuse costs Scotland an estimated £3.56bn per annum  This includes £267.8m on health costs, £727.1m on crime costs and £865.7m on lost productivity. Scottish consumption of alcohol is now 23% higher than in England.
Evidence to the Health Committee has raised a number of issues. These included:

• Unfairly penalising the majority of moderate drinkers.
• Heavy drinkers tend to be less responsive to price.
• A regressive policy as it will disproportionately affect low income groups who tend to pay less for a unit of alcohol than higher income groups.
• Some dispute the link between price and harm arguing that alcohol related harms have been decreasing at a time when consumption has remained stable.
• A detrimental impact on Scotland's alcohol industry including a 14.5% reduction in whisky exports and an increase in cross-border trade and the consumption of illicit alternatives.  
• Concern that if alcohol prices increase, problem drinkers with a low income may use spending from elsewhere in their budget to maintain their consumption levels to the detriment of families.
• The compatibility of the measure with EU law has been questioned and a legal challenge seems likely. The price per unit will be important as the Government's defence will be that this is proportionate response to a public health problem.

For SHA Scotland the impact on reducing health inequalities by reducing the harm caused by alcohol is a key issue. People living in our poorer communities carry a disproportionate share of alcohol-related health and social harm. Alcohol mortality rates are six times higher in the most deprived areas.

We recognise that taxation could achieve the same benefits, with the added advantage that revenue would go to the state rather than the retailers. However, excise duty is a reserved power and there are no indications that the UK Government is prepared to act. A compensatory levy, similar to the recent 'Tesco Tax', could cover this point. 

SHA Scotland believes that the primary concern should be to introduce alcohol policies which are in the public health interest and will be effective in reducing the high levels of alcohol health and social harm in Scotland. Minimum unit pricing is supported by the medical and public health community and also by the police, children’s charities and a wide section of civil society. Opposition to minimum pricing comes mainly from sections (but not all) of the alcohol industry who, it could be argued, have a commercial vested interest in opposing measures which are likely to bring about a reduction in overall alcohol consumption.

We recognise that there are legitimate concerns over the effectiveness of the measure together with unintended consequences as well as doubts over its legality. Many of these could be addressed through a detailed statutory evaluation process and even a sunset clause. We would urge this approach on all MSPs.