title: Changing policy framing as a deliberate strategy for public health advocacy: a qualitative policy case study of minimum unit pricing of alcohol.
abstract: BACKGROUND
  Scotland is the first country in the world to pass legislation introducing a minimum unit price (MUP) for alcohol in an attempt to reduce consumption and associated harms by increasing the price of the cheapest alcohol. We investigated the competing ways in which policy stakeholders presented the debate. We then established whether a change in framing helped explain the policy's emergence.
  
  
  METHODS
  We conducted a detailed policy case study through analysis of evidence submitted to the Scottish parliament, and in-depth, one-to-one interviews (n = 36) with politicians, civil servants, advocates, researchers, and industry representatives.
  
  
  RESULTS
  Public- and voluntary-sector stakeholders tended to support MUP, while industry representatives were more divided. Two markedly different ways of presenting alcohol as a policy problem were evident. Critics of MUP (all of whom were related to industry) emphasized social disorder issues, particularly among young people, and hence argued for targeted approaches. In contrast, advocates for MUP (with the exception of those in industry) focused on alcohol as a health issue arising from overconsumption at a population level, thus suggesting that population-based interventions were necessary. Industry stakeholders favoring MUP adopted a hybrid framing, maintaining several aspects of the critical framing. Our interview data showed that public health advocates worked hard to redefine the policy issue by deliberately presenting a consistent alternative framing.
  
  
  CONCLUSIONS
  Framing alcohol policy as a broad, multisectoral, public health issue that requires a whole-population approach has been crucial to enabling policymakers to seriously consider MUP, and public health advocates intentionally presented alcohol policy in this way. This reframing helped prioritize public health considerations in the policy debate and represents a deliberate strategy for consideration by those advocating for policy change around the world and in other public health areas.
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow; NHS Lothian.
authors.forename: Srinivasa Vittal
authors.initials: SV
authors.lastname: Katikireddi
authors.forename: Lyndal
authors.initials: L
authors.lastname: Bond
authors.forename: Shona
authors.initials: S
authors.lastname: Hilton
mesh_terms: D000288:Administrative Personnel; D000434:Alcoholic Beverages / Q000009:adverse effects / Q000191:economics*; D003365:Costs and Cost Analysis / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000331:legislation & jurisprudence; D006801:Humans; D007407:Interviews as Topic; D007878:Legislation as Topic; D036301:Qualitative Research; D012606:Scotland
keywords: alcohol; minimum unit pricing; policy; public health