Friday, 17 May 2013

Plain packaging versus minimum pricing

This is a new thing for me: an attempt to write a genuinely short blog post.  (We'll see how that goes...)

Andrew Brown over at Mentor has written a blog post about a YouGov survey looking at various attitudes people have at the moment, which includes some stats on plain (in fact most likely standardised) packaging for tobacco and minimum unit pricing (MUP) for alcohol.

Andrew wonders whether this is to do with the messages around the values behind Public Health, or that tobacco control messages have been around for longer, or simply that people think plain - sorry, standardised - packaging doesn't have a (direct) cost to them, the consumer, where MUP would.

So many thoughts occurred to me that I thought rather than leaving a comment or trying to condense things into a tweet or two, I'd do my usual and expand this out into a rambling post.  I would stress that these are just some thoughts, and I'd love comments or feedback via comments below or Twitter.

My immediate thought was: have they controlled for whether people are smokers/drinkers?  We're obviously going to care more about a policy that directly affects us, so that's quite important.  I can't see any evidence that they have, and this brings us onto a couple of wider points about cultural attitudes.

First, more people in the UK drink than smoke - pretty much the same proportions of men smoked at all as drank at twice the recommended limits in 2011.  That means (and reflects the fact) that drinking is more commonplace than smoking, which is reflected in (and the result of) wider aspects of society.  There's something about the place of alcohol in society and British history that is telling, and this is reflected in literature, for example. I can immediately think of plenty examples of drinking and literature (my personal favourites being Alan Sillitoe and Thomas Hardy), where the only example of smoking taking a prominent role in literature that occurs to me straightaway is Tolkein.  More substantively, we have pubs but we don't really have smoking clubs (at least, not in the aftermath of the ban).

Second, there's an idea of 'safe' drinking, which is crucial.  Despite in my view it being a mistaken and unhelpful position to take, it's not uncommon to hear it voiced that, for example, smoking 'brings nothing but bad breath disease & death'.*  The common argument in favour of the smoking ban over the years is that there is no safe level of (second-hand) smoke.  Contrast this with the impression (sometimes challenged) given by the 'recommended' limits that there is a 'safe' level of drinking.

Drinking, therefore, is not seen as an unequivocal vice.  There is an elusive practice called 'responsible drinking'.  This might be, as Andrew suggests, because anti-tobacco lobbying has been around for longer, but it's also about the importance of alcohol in our culture even before this.  Nights out, venues, 'keying' of time, have long centred on alcohol, and never really on tobacco.  Alcohol is associated with good times and bad.  Weddings and funerals would be (almost) unthinkable without alcohol for many in Britain; the same couldn't be said for tobacco and many social situations.

This takes on crucial importance when we think about how the measures described - plain packaging and MUP - are universal.

I've written previously about how MUP is understood (or at least portrayed) by the Coalition - or more specifically Cameron - as a targeted measure.  James Morris has persuasively argued that the logic of MUP is based on a population model of public health, but equally the debate continues as to who the measure will affect and how hard.

The point here is that these aren't 'Booze ASBOs' or sobriety orders, which target those who are seen to have transgressed.  Under MUP everyone who buys alcohol would do so in a regulated market (and everyone who smokes would have to smoke cigarettes bought in plan packets - though perhaps the market for cigarette cases would boom?).  That is, whether or not there would necessarily be a material effect on all drinkers, which is still debatable, the starting position is that alcohol is by definition problematic.  This isn't an easy fit with ideas of 'responsible drinking'.

In my research, I found that even amongst those going out drinking on a Friday night on the night-time high street, who might be classed as 'binge' drinkers, there was an amazing tendency and ability to distinguish oneself from those 'other' drinkers who were the real issue.  People might drink a lot but they're not about to start a fight.  They might end up drunk, but they'd never drink to get drunk; they drink for the taste and the drunkenness is just an almost irrelevant byproduct.  And so on.

I've argued before that attempts to govern by concepts ('responsible', 'moderate', 'binge', 'excessive') is difficult, because people have a tendency to want to justify their own behaviour to themselves and others, whether consciously or not.  Give them an idea of responsible drinking, and a particular model of irresponsible drinking, and most people won't see themselves in the irresponsible camp.  (And conversely, for those that do, this is often seen as amusing and precisely what's being aimed for: trangression of norms established by perceived authorities such as governments.)

So what's my answer to Andrew's question of why we tend to see MUP as unacceptable?  I think it's because MUP hints that, actually, for every single one of us, alcohol is no ordinary commodity, and, although that's its primary attraction, it's also something we don't really want to hear.

(And there we go, I didn't keep it short.) 

Addition, 17th May 2013
Partly because it doesn’t so directly relate to the public’s perception of drinking versus smoking (though it’s crucial in the background) I’ve forgotten to mention here one of the key points that I’ll often bore people with.  Public Health often draw the key comparison between the two practices, citing how smoking has declined considerably over the past 40 years, and how alcohol policy and harm reduction should learn from anti-smoking campaigns (and sometimes other behavioural changes, such as seat belt use).  (I noticed this at the recent Alcohol and British Society conference, for example.)  The key difference is the idea of passive smoking.  The smoking ban was able to gain public support not as a paternalistic measure, but as a liberal one, in line with JS Mill’s harm principle: your smoking would not just harm yourself, but me too.  Despite this, it is still judged on whether it has lowered general smoking prevalence, and this is partly where the difficulty for the smoking-drinking analogy lies.  Passive drinking, despite the efforts of Liam Donaldson, hasn’t caught on as a concept.  Of course all these aspects of the culture are mutually reinforcing: this difference is partly what allows alcohol to have such a central role in British society, but it’s also that central role that makes us less likely to accept Donaldson’s point.  And so on. 

*I think we have to acknowledge the pleasures of intoxication and trangression, which includes the very thing that motivates Wollaston: smoking kills.  Smokers know this, and this is partly why it is transgressive and offers a devil-may-care allure.  If we ignore these points, then we can't possibly build an effective harm reduction strategy.

**Personally, I think that even the Sheffield work has neglected the fact that pricing policies aren't solely based on cost: if your £3.50 wine becomes £4.50, the £4.50 wine isn't going to stay at the same price; there's an incentive for there to be a differential.  Looking at how tobacco pricing strategies have coped with increased taxes, there's sure to be some complicated dynamics regarding the pricing strategies for the lower and higher ends of the market, but it's certainly hard to say that people currently consuming above the MUP floor won't be affected.

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