Alcohol anxiety and the Scottish Effect

Mellows: "SNP's decision to focus on alcohol as a cause rather than a symptom is not a good sign"

Scotland, or at least the Scottish Government, is proud to find itself at the cutting edge of global alcohol policy. The decision to pioneer minimum unit pricing is a symbol of that, as much as a practical measure.

Why has this burden fallen to Scotland? Perhaps the governing Scottish National Party feels less restrained by past political baggage than parties with more experience of office.

But a bigger reason is the Scots’ special relationship with alcohol - a specially unhealthy one. Or so it’s perceived. The political anxiety about this, the need to act on it, is clear from the 2009 Framework for Action in which, as well as measures such as minimum pricing, deputy first minister Nicola Sturgeon calls for cultural change, a collective effort of will to “rebalance” the relationship.

Now, whenever I hear the word ‘rebalance’ I reach for the safety catch on my Kalashnikov. Just think of Westminster’s determination to ‘rebalance’ a perfectly well-balanced licensing regime.

There is something devious in implying that a policy is merely returning us to some natural state of harmony.

But I mustn’t be distracted by doublespeak. Underlying the Scottish anxiety are genuine problems, highlighted by a doubling of alcohol-related mortality over the last 15 years.

Drink is a key player in the debates around what’s become known as the Scottish Effect, a question that’s been confounding academics for a while. Why is life expectancy markedly shorter in Scotland than in other European countries? And why is it worse still for Glasgow?

The main determinant of a lower life expectancy is deprivation. But deprivation, by the usual measures, is no more severe in Scotland than it is in other parts of the UK where you can expect to live rather longer.

So is alcohol the answer? Is there something in the Scottish drinking culture that’s making the deadly difference?

A new report, featured in the journal Public Health suggests not. It examines no fewer that 17 potential factors in the Scottish Effect from climate and sectarianism to “boundlessness and alientation” and including health behaviours such as drinking.

“Usually, the higher mortality is attributed to higher rates of smoking, greater alcohol consumption and poorer diet, which is, of course, true – as far as it goes,” the authors concede. “However, such an explanation is not sufficient to understand why the mortality picture in Scotland is so very different from that of other, seemingly comparable, areas.”

They argue that we must look further “upstream”, to what determines those “negative health behaviours”. Indeed, “Scotland had lower alcohol-related deaths than the rest of Europe until around 1990”.

It seems the stereotype of the hard-drinking Scot has a shorter history than we might think. And according to the report it is rooted in de-industrialisation forced through by the Thatcher government accompanied by what it terms “political attack”.

It is probable, the authors suggest, that negative health behaviours are “linked to an intensifying climate of conflict, injustice and disempowerment” best explained by “neoliberal policies implemented from 1979 onwards” which “disproportionately affected the Scottish and Glaswegian populations”.

“From 1980 onwards, the higher mortality is most likely to be accounted for by a synthesis which begins from the changed political context of the 1980s, and the consequent hopelessness and community disruption experienced.”

Ironically, the rise of the SNP is one legacy of this. But the report concludes that its emphasis on individual behaviours, rather than “the most ‘upstream’ determinants of health, including those to be confronted in economic, social and political history” is a mistake.

“Any analysis which only refers to tobacco use or alcohol, or even to ‘early years’, massively significant as these factors undoubtedly are, will inevitably fail to identify the overall causality of this profoundly troubling phenomenon, and will be liable to generate, at best, partial policy interventions, which are, in turn, most liable to prove disappointing in their outcomes.”

Although it’s going to be hard to tell. Alcohol consumption is in decline even before the SNP’s alcohol policy has been implemented and, according to the latest statistics from Scotland, there has also been some improvement in alcohol-related hospital discharges.

But these statistics also tell us that the gap between rich and poor, as measured by alcohol-related discharges, is widening. Scots in the most deprived fifth of the population are now 7.6 times more likely to find themselves in hospital because of drink than the least deprived fifth – who tend to consume more.

The “political attack” initiated by Margaret Thatcher continues under David Cameron’s austerity drive. Whether the SNP can mount any sort of a defence this time around remains to be seen. But its decision to focus on alcohol as a cause rather than a symptom is not a good sign.