Informed Choices?

On this blog I mostly write about alcohol or drug policy, as my academic research has focused on ‘binge’ drinking and my current main job involves commissioning drug and alcohol treatment services.

However, for a couple of years between 2009 and 2011, I worked for the Russell Group.  I’m somewhat ambivalent about this.  I enjoyed some elements of the job, and felt I could make a positive difference on, for example, immigration policy.  For whatever reason (and I was grateful for it), I mostly focused on access to university, community engagement and immigration.  Other elements (fortunately those I was less involved in) made me feel uncomfortable – tuition fees, for example, or business engagement to a certain extent.  And of course the Russell Group is a lobbying organisation, so we’d always be keen to present our institutions in the best light.  Given the title of this blog is ‘Thinking to Some Purpose’, and my passion is for clear, open, honest policy debate, you can imagine my discomfort with that.  And I’m no salesman.

One of the biggest benefits of the work was acquiring some expertise on higher education policy.  Given that I work at a university some of the time now, having that perspective can be useful.  (Although most of my detailed knowledge has faded and become out of date anyway.)

HE policy is one of those areas where ‘thinking to some purpose’ is in short supply.  There’s all sorts of posturing that goes on, and a lack of clarity around issues like student finance.  One of these areas is school qualifications, and it’s this issue that brought back my work on ‘widening participation’, as access to university is called – and prompted me to write this post.

On Saturday, I spotted Stephen Jones tweeting about an article reporting Michael Gove wondering whether the definition of ‘facilitating subjects’ at A-level is too narrow.  The concern seemed to centre around one particular subject: economics A-level is not on the list of ‘facilitating subjects’.

Of course, this raises the question of what on earth is a ‘facilitating subject’.  Well, the definition seems to come from the Russell Group’s guide to A-level choices: Informed Choices.

[Now I should declare an interest here.  I was involved in responding to lots of queries concerned parents and teachers (and indeed university staff) sent through to the Russell Group when Informed Choices was first published.  And in fact, I get a credit in the acknowledgements, although I only really remember proof-reading the document.]

Importantly, the guide is fundamentally a summation of the entry requirements and recommendations of different courses at Russell Group universities.  People often misunderstand the idea of facilitating subjects, when it’s all very clearly laid out in the guide.  They are not ‘hard’ subjects; they are subjects that keep open the most opportunities at university.

It’s for this reason that History and Maths make the list, but Economics doesn’t.  To take an example, the closest thing Oxford has to Economics (Economics and Management) doesn’t require Economics A-level; it does require Maths.  OK, so you’re only ‘highly recommended’ to study History A-level to study the subject at Oxford, but the E&M page doesn’t say that about Economics.  And we know that Maths is required for any number of university courses.  (I’m not going to put links here; it only takes a quick browse of entry requirements for a few courses.)

Basically, choosing Maths over Economics at A-level keeps open more options for university study – and that’s all that Informed Choices is telling people.  Informed Choices states that it’s not making a hard/soft distinction between A-level subjects, and in fact explicitly chooses economics as an example of a subject that lots of people would consider Economics a ‘hard’ subject.

This idea that not being on the ‘facilitating’ list is somehow a slight on that subject is a complaint I remember from a whole range of school and university staff (mostly about their own particular subject).  Quite often it was possible to point the university staff to the entry requirements set out by their own department.  Religious Studies, for example, isn’t on the list because (again, taking Oxford for consistency) it isn’t required to study Theology at university.

Of course, there’s an argument that the entry requirements of universities are too narrow, but that’s not the same as saying the list of facilitating subjects is too narrow.  And it would be hard to make that argument for Economics, given that Maths is definitely more helpful for university Economics – and certainly for all those science subjects that Economics wouldn’t help with much at all.  I say this as someone who did Economics A-level myself (which is only of relevance because in the Evening Standard article Michael Gove is quoted as saying it was his only A-level as he mostly did Scottish Highers).

In this context, I worry about schools minister David Laws – an economics graduate – who finds the fact that Economics isn’t on the facilitating list ‘perplexing’.

However, the complaint of the student cited in the Evening Standard article is broader than this.  Kiki Ifalaye is quoted as suggesting: “Because economics is not a facilitating subject it inclines students to steer away from it. [The list] doesn’t take into consideration their skills and individuality and aspirations. It should be broader.”

In this question, we get to the heart of the matter, and why I’m posting on this blog: what are A-levels for?

The facilitating list is only there to facilitate a wide range of options for university study.  It’s written by a set of universities, not schools, employers or the government.  However, it is now used bygovernment as a way of ranking schools.  Given that the list is only about university access, judging schools by it only tells you about the choices and achievements students make in terms of getting into university.

But schools don’t simply exist to provide universities with students.  Although it could be argued that a higher proportion of 18-year-olds are going to university now than in the past, a higher proportion of young people stay in education to age 18, and so A-levels and other post-16 qualifications can’t simply be seen as entry exams for university.This is particularly relevant given that universities are set to have a much larger role in setting A-levels.  The right choices to get into a Russell Group university might not be the right choices for someone leaving education after A-levels.

Moreover, they might not even be the right choices to get into other universities – many of which I’d see as considerably better choices, especially for certain subjects.  It’s the old unease about the Sutton Trust concentrating on Oxbridge.

Therefore, although some students might be wise to be guided by Informed Choices, it’s not even relevant for all university applicants, let alone all A-level students.  It should not be seen as the gold standard of study.

And this is where the complaints of the Economics, Religious Studies and Sociology teachers make sense.  Personally, as a sociologist of sorts I’m sometimes inclined to think sociology should be a mandatory subject at school – and I’d do all I could to encourage people to study sociology (though I don’t know very much about the A-level course in practice, having only browsed through some online study specifications).

If Informed Choices is discouraging people from studying subjects they’re interested in and would likely serve them well in the future, then that’s a bad thing.  But I don’t know that this is the Russell Group’s fault.  If anything, it’s the government’s fault for playing on the old ‘hard/soft’ subject stereotypes.  As with so much Coalition policy, what’s favoured is what the politicians are familiar with, rather than looking at the broader picture and the evidence available.

Alcohol or soma

This week, David Nutt has garnered considerable attention for his idea of ‘hangover-free’ alcohol.  Phil Mellows has, as ever, written brilliantly about this on his blog.  I’ve been thinking about some of these ideas for a few days now, and I haven’t got anything neat to say on the subject, but there are a few thoughts bubbling round my head that I wanted to get down.  I just hope some of them are interesting…

Phil talks about how Nutt misses the point a little by thinking of alcohol solely as a psychoactive substance – not all drinking is to get drunk.  And more than that, even the drunkenness people might be aiming for isn’t a simply chemical reaction; it’s socially constructed, to use an awful phrase.  Being ‘drunk’ doesn’t mean the same thing to every person.

Phil’s point is partly that there’s all sorts of elements of elements of drinking that aren’t just about alcohol as a chemical, so Nutt’s safe intoxicant couldn’t really directly replace alcohol.  He argues that alcohol is linked with broader taste, and is central to the ‘connoisseurship’ surrounding drink.

There’s something to this that I hadn’t quite appreciated before (partly because my research has tended to focus more on drinking to get drunk than connoisseurship).  You can think of the act of drinking as more ‘natural’ than various other ways of taking drugs (smoking or injecting, for example), but it isn’t just that – you could still drink a David Nutt ‘cocktail’.  Rather, the alcohol we drink only exists through the drink.  This sounds like sophistry, but there’s a serious point.  We (mostly) don’t make alcohol in a lab and then add it to cocktails.  Instead, the alcohol is generated through wine-making or brewing and so forth.  The alcohol in wine doesn’t exist separately from the wine.

This is different from saying that nicotine is part of tobacco.  In other examples the drug exists in the product prior to any processing (nicotine in tobacco) or is deliberately created in itself (in chemically derived products like the new ‘legal highs’).  Grapes aren’t alcohol until they’re fermented, and in fact when they’re fermented they’re not alcohol, they’re wine as a whole.

It’s this relationship that allows for the connoisseurship apparently completely unrelated to intoxication.  And it’s for this reason that the connoisseur requires the alcohol, because without the alcohol there is no wine or beer.

On the other hand, although one can prefer one type of e-cigarette to another, it’s hard to elevate the debate above the most pleasurable mode for delivering a drug.  You can almost – but not quite – say the same thing for tobacco.

And here’s where we run into trouble.  Phil’s point holds when he’s talking about beer and wine in particular, but as he notes it’s not so applicable to cocktails.

On the other hand, given that sensations of taste will be affected by other substances in the mix, and taste, preference and intoxication are all affected by wider surroundings and beliefs, it’s still hard to draw that line between natural and unnatural intoxication.

What the whole debate does do is highlight some people’s discomfort with the very idea of intoxication, regardless of whether it can be seen as natural.  I was most taken by Graeme Archer writing that the ‘whole point’ of alcohol is the hangover.  Now there’s obviously some (not very) poetic licence going on here, but the logical hole is astonishing.

He argues that hangovers are necessary for people to grow up and become proper adults who moderate their drinking.  His primary problem with drinking seems to be ‘crowds of rowdy drunks’.  To begin with, although it’s not uncommon, I never cease to be frustrated by such failures to pick on things that are actually problematic to society, rather than simply being personal irritations.

And this is where the issue lies.  Archer worries that ‘guilt-free, hangover-free inebriation would deliver squadrons of such anti-beauty’.  But it’s not clear why hangover-free should equate to guilt-free – unless, of course, that person has done nothing wrong…

One should feel guilt if one has done something with negative consequences.  Bizarrely, Archer thinks that without the hangover, there will be no such negative consequences, and therefore drinking will be problematic:

Such lessons (of self-control) cannot be learnt if choices become consequence-free: to drink must be to volunteer oneself for risk.

If drinking is consequence-free, then I don’t really see any need to be worried about it.

It could be argued that there are negative consequences that aren’t immediately apparent from alcohol – particularly long-term health damage – and the hangover acts as a warning for these.  However, this doesn’t seem to be Archer’s problem.  He’s more concerned that we make an appointment with reality, which we won’t do if we become intoxicated, which implies becoming ‘infantilised’.

That is, it’s not about negative consequences at all; it’s about the intoxication.  This is bad in itself.

Once the drug is stripped of its ‘connoisseurship’, and laid bare for all to see as an intoxicant, it’s seen as problematic.  Far nobler to live in a reality that isn’t ‘cushioned’.

And here’s the point.  This article, with its (self-confessed) inconsistencies and gaping logical holes, highlights the background noise to alcohol policy discussions.  Although the talk is about, in Archer’s words, the idea that ‘drinking is bad for the individual and for society’, possibly with reference to health and crime, this is often a debate about whether it’s acceptable to get drunk.

Hangovers aren’t a reminder that you’ve done something terrible the night before, or even much of a warning of future health problems; they’re simply a sign that you drank some alcohol, and probably got intoxicated.  And what’s so wrong with that?

And actually, I find that the hangover’s over by Monday – but guilt (where my actions have actually had negative consequences) doesn’t disappear so quickly.  I just can’t see how waking up without a hangover would stop us ‘being forced to live with the consequences of our actions’.

Who is responsible for alcohol policy?

I know I’ve written about the involvement of the alcohol industry in policymaking before, so as with most of my posts, there’s a risk of repeating myself – at least in some of the themes I’ve discussed.  However, I do think there’s something to add.

A couple of weeks ago, the journal Addiction published an editorial arguing that the alcohol industry should be limited in its involvement in public health policymaking – or at least that’s what the article claimed to be saying.  It was suggested that if the industry feels it should be an equal partner in public health policymaking, then the public health community should surely be able to influence winemaking, business practices and so forth.

The editorial itself includes some questionable points, such as citing alcopops as a prime example of ‘product innovations that have high abuse potential’, given that this isn’t really supported by the evidence I’m aware of.*

However, I’m concerned with some more fundamental and general issues.

It could be argued that the ‘us and them’ characterisation of policy positions isn’t helpful – I’ve suggested before that particularly at a local level (and partly because ‘the industry’ isn’t a monolith) this sort of confrontational approach is unhelpful.

There’s something else here too, though.  Throughout the editorial, it’s unclear whether the focus is ‘public health policy’ or ‘alcohol policy’.  The two are not synonymous.  If we understand ‘policy’ as something that government does (whether at a local or national level), the broad view is that it applies when things could be better – when there are perceived problems otherwise.  This position doesn’t require a liberal perspective; rather, it’s simply stating the obvious: government has a policy on the basis of something it would like to see (almost by definition).

In the case of alcohol, as I never tire of pointing out, there is a myriad of (perceived) problems that policy might be looking to address.  Some relate to health, some to disorder or crime, some to nuisance or littering, some to moral offence.  (And that’s not an exhaustive list.)  Note that health is only one of these elements, and even then it’s not always clear whether concerns with alcohol consumption are appropriately classified as public or private health issues.

The regulation of alcohol, therefore, is not (solely) public health policy.  It is also economic policy, community policy, justice policy and so on.

Where policy discussions have, to my mind, failed in recent years is the tendency to look for a single solution, namely minimum unit pricing (MUP).  Although it might be viewed as a classic public health policy, with its population-wide approach affecting availability, it has not been presented as such by the government.  Both in the 2012 Alcohol Strategy and in other statements, MUP was presented as a targeted measure to address ‘binge’ drinking.  ‘Binge’ drinking, as defined in these instances, is not about health so much as crime and disorder – it’s about drunkenness, not long term health effects.

This makes a broader point, which I promise is not intended to be facetious.  Alcohol is a cross-cutting issue.  There is no single government department that can or should take complete ownership of it.  Although the challenges posed by alcohol for policymakers can sometimes seem unique, this particular issue at least is universal in the sense that all policies have an influence beyond the boundaries of their parent ministry.  Education policy does not only affect schools; agricultural policy does not only affect farming.

So, health is not the only aim or concern in alcohol policy, and even a policy with only health aims will influence other spheres such as the economy.  It is unhelpful to simplify alcohol policy as a ‘struggle’ between industry and health, ignoring other policy interests and stakeholders.  The question is not simply one of profit versus health.  To use the wording of the Addiction editorial, ‘the heart of and soul of alcohol control policy’ is much more complex than that.

*You could stretch the point and suggest that perhaps alcopop marketing attracts young people to alcohol, and they only choose cheap beer, white cider or vodka because those are cheaper.

NOTE

I should add the caveat that I had mostly written this post before reading this somewhat misleading article by spiritsEUROPE, which states that someone’s level of ‘consumption per se is not the problem - behaviour is.’  This is misleading because both total amount consumed and the pattern in which this is consumed are relevant.  There also seems to be some confusion in the article about whether individuals’ consumption is being discussed, or average consumption across a population (which I’ve talked about before).  This article, unsurprisingly, sees a role for the alcohol industry – but as I’ve written before (and flagged up to spiritsEUROPE) this shouldn’t imply this sort of tactic of misdirection around the evidence base for public health interventions.

The point in the editorial that industry actors may seek to deny the effectiveness of restrictive policies is therefore well made.  I don’t want to suggest that the industry is well placed to comment on control policies; simply that control policies, even if alcohol is viewed only in a negative light, are not simply the realm of public health alone – most obviously the criminal justice system has a clear interest in shaping these.