THE fact that the number of people in Scotland dying due to alcohol has fallen since a peak in 2006 is welcome news for the nation’s health. However, the recent increase concerns us (“Alcohol abuse resulting in 20 deaths a week”, The Herald, August 21). It coincides with a flattening of the amount of alcohol sold per adult, which had also previously been in decline (“Sales data prompts renewed call for alcohol minimum unit prices”, The Herald, August 26). This has been driven by more alcohol being sold through supermarkets and other off-licences in 2014 compared with recent years.

A number of factors might explain these trends. The recovery from recession has meant a recent increase in disposable incomes in Scotland and alcohol duty changes have helped to keep the price of some alcohol low. In fact, the average price of alcohol sold through off-sales was the same as in 2013, the first time that the duty has stayed the same following an annual increase since 2007.

Although we can’t attribute any changes specifically to these factors, there is strong evidence to show that alcohol affordability – a combination of people’s income and alcohol price – is one of the strongest drivers of alcohol consumption and related harms. Minimum unit pricing, an opinion on which will shortly be offered to the European Court of Justice, would offer an evidence-based policy that would make the cheapest alcohol less affordable, lower consumption at harmful levels and provide the context to ensure that these worrying trends are only temporary.

Dr Mark Robinson, Clare Beeston, Dr Gerry McCartney,

Public Health Science Directorate, NHS Health Scotland,

Meridian Court,

NHS Health Scotland,

5 Cadogan Street, Glasgow.

I LARGELY agree with the practical measures suggested by Bill Brown (Letters, August 22) to address alcohol abuse and its consequences, but feel that while R Russell Smith's follow-up remedy – to charge those requiring police intervention of treatment at AS&E for those services - may hold a certain instant appeal to the perpetually outraged, they should be subject to rigorous scrutiny.

In the present political climate, where the basest reflexes of the "Great British tax-payer" are being routinely aroused by a feral right-wing press, charging those who require hospital treatment through their own stupidity and self-neglect may seem appealing. The question I would ask is how far would he like to extend this principle?

For instance, as we hear day and daily, rising obesity rates and all their resultant woes, while they may be multifactorial in origin, are quite obviously largely attributable to poor diet and general self-neglect. Yet after a good few decades of Government-backed public education programmes and ready access to ample layman-friendly health advice, many continue to eat deadly quantities of the most obesogenic foods they can lay their hands on with almost inevitable consequences. Are they to be charged for their hospital admissions, too?

And what about sporting injuries? The dangers of, say, rugby, are fairly obvious, never mind rock-climbing, hang-gliding, cycling, motor racing...need I go on? No need for any of it, but people indulge in these activities quite wilfully for their own selfish gratification, and quite right, too.

It might also be worth reminding indignant types that abusive drinkers already pay extra for their excesses in the form of alcohol duty - as do smokers, who earn the state considerably more than they cost it. They generally die younger, too, saving the state a fortune in pensions, never mind normal geriatric health care. Come to think about, why not charge those who through their own selfish efforts live into their nineties? These people cost us a fortune.

It is certainly infuriating, exasperating, maddening perhaps, to see complete idiots wasting public resources avoidably, but I also feel that way when people require expensive orthopaedic surgery after indulging in sporting activities which our governments promote but don't tax. A stomach pump and a few stitches are a bargain compared to spinal surgery.

The logical extension of Mr Smith's proposal would be to practically abolish the NHS, as with few exceptions there is not a medical condition known to man that could not, should somebody choose to forensically examine it, be attributable to conscious decisions taken by the patient. Where would it end once the principle is established?

Martin Morrison,

1a Kirk Road, Lochinver, Sutherland.