Wednesday, 7 December 2016

Concern isn't research and reducing harm won't mean zero harm

This morning, the merger of Alcohol Research UK (ARUK) and Alcohol Concern has been announced.

I have some concerns about this, and they really hang on whether the two organisations do in fact have ‘virtually identical charitable objects’, as the press release suggests.

But I want to explain that in a bit more detail, and give some insight into the background and perspective I bring to this discussion, as I think that’s crucially important.  In commenting on this merger, I’ll be revealing my prejudices about Alcohol Concern, which are really twofold.

And I do mean prejudices: people and organisations come to alcohol issues with their own background and perspective.  One thing I’ve discussed with some people in the sector is the way in which people’s own views and experiences of drinking and drunkenness can shape their views of alcohol.  So people who don’t find alcohol or drunkenness particularly attractive or enjoyable will tend to take a view of indifference or bemusement to the drug, if not outright hostility – much in the way many people now do of tobacco, which I always think of one of the worst drugs around in terms of cost-benefit or risk analysis (and yet it’s still bizarrely attractive for all that).

My use of the ‘carnivalesque’ as a concept is deliberately positive and ‘constructive’ – as the standard sociological/anthropological approach to alcohol is.  If I could sum up my concern with the merger in one sentence, it would be that I don't think Alcohol Concern can comfortably take that approach of thinking of ‘constructive drinking’.  However, that might not be the role of Alcohol Concern/Research – or at least only insofar as we have to acknowledge the ‘real world’ of how people interact with alcohol.

But specifically, here are those two negative impressions of Alcohol Concern.

First, they have a particular reputation within the sector and the wider media, as a go-to organisation for ‘anti-alcohol’ stories.  I can see that some people would argue that we need that kind of contribution to the debate, given the way media discussions seem to be set up as adversarial (despite my personal discomfort with playing that game).

Second, and partly as a consequence, I worry about the accuracy and impartiality of their research and advocacy.  I’m still not persuaded on Dry January.  It’s not really a reminder of the health benefits of regular alcohol free days, and I worry that it encourages an on-off approach to alcohol that isn’t always healthy.  (See also the potential negative consequences of the Scottish drink drive limit leading to ‘strategically’ planned drinking.  If I'm ‘strategically planning’ my drinking, you can be confident I won't be drinking halves.)

When Alcohol Concern report on Dry January, which is a potentially important public health intervention to change drinking cultures, they’re not aiming to be the most accurate and impartial people in the discussion; they’re also thinking about boosting the numbers signing up for the next round.

Sometimes, I get the same impression I do of the police or the Amy Winehouse foundation going into schools to deliver things that are well-intentioned but potentially counter-productive – or at best inefficient.

So much for my concern about Alcohol Concern.  By contrast, I see ARUK as an organisation that has carved out a niche in terms of being relatively impartial and simply representing ‘the evidence’ (even if that itself is a questionable concept).

Now there are potential positives there, as ARUK could drag Alcohol Concern’s lobbying and advocacy to be more accurate.  If Dry January really is effective, great.  If it isn’t, the ARUK-style influence might push them towards other interventions.  And Alcohol Concern (and Dry January particularly) has a high profile, and ARUK does amongst a different group of people, so perhaps together there will be an organisation with a louder, more accurate voice contributing to the debate.

But the flipside is that potentially ARUK’s apparently neutral position to reduce harm (and of course nothing is ‘neutral’) could be tarnished.  Of course Chris Snowdon’s at this already.

Now it might be that this isn’t the case, and it’s certainly simplistic, but I fear that with people like (the other) Dave Roberts, Mark Baird, Chris etc already looking for holes in any alcohol-related research, this could dilute the influence attached to ARUK interventions.

Much as I like the idea of commentators having some kind of ‘skin in the game’, to reference Nassim Nicholas Taleb, I think this doesn’t look so good for commentators on ‘evidence’.  Public debate is still structured around this idea of independent evidence that can (or should) speak for itself.  I heard a PHE regional representative yesterday describe the alcohol evidence review in these terms, still talking very clearly in the language of ‘evidence based policy’.

Dave/Chris/Mark have started not only to attack the accuracy of the Sheffield model (which I think the ARUK-type voice could credibly counter), but also their very motivation – that they have a vested interest in claiming the model works, either as temperance advocates or because they’ve got economic and egoistic interests in being proved right.  Once you’re on that ground, there’s no need to even engage with the ‘evidence’ because of its source.

This is pretty close to my discomfort with the Alcohol Concern advocacy/research/campaign work (which is why I call it a bit of a prejudice). To be fair, though, alcohol and tobacco academic researchers do this with industry-related work – though this does mean that some commentators are, as so often, having their cake and eating it.

And this comes back to that point of the moral or personal preference baggage you bring with you, and why Alcohol Concern has rubbed me up the wrong way.  They seem to come from a position where alcohol consumption is bad in itself.

I challenged former Chief Exec Jackie Ballard at an event about alcohol use and older people where she suggested that we should be telling older people they’ll get cancer or other diseases if they drink at certain levels.  This wasn’t what the research we’d just been hearing about showed.  In fact, it showed almost the opposite: that there are plenty of people who drink at pretty high levels who don’t suffer harm.  That’s precisely the challenge in communicating risk.  We can’t offer a credible message that is apocalyptic.  Jackie’s response to me could have been read as not understanding the nature of risk, but I felt it was something more than that; it was wanting to be able to make the case that all alcohol consumption is harmful (or bad).  I’ve written before about how that makes me feel uncomfortable.

Although the mission statements of the two organisations are remarkably similar, I think this difference in approach is shown by just one word: ‘no’.  The press release announcing the merger notes that ‘Alcohol Research UK works to reduce levels of alcohol-related harm’ and ‘Alcohol Concern works throughout England and Wales towards our vision of a world where alcohol does no harm’.

Reducing harm is not the same as seeing the ideal as a world where alcohol does no harm.  Of course, there are arguments for setting unachievable aspirations – as in ‘outcomes based accountability’, for example.  But in relation to practical policymaking, it feels a little awkward and utopian.

More importantly, though, it suggests a genuine difference of approach between the two organisations.  Given the nature of risk, the only way to ensure Alcohol Concern’s vision of ‘a world where alcohol does no harm’ is to reduce alcohol consumption to zero.  This is not just a quantitatively, but qualitatively, different aim from ARUK’s ‘reduce levels of alcohol-related harm’.  Even if this zero consumption world will only ever be an aspiration, it makes for a very different approach, and betrays a very different fundamental approach to this multifaceted substance.  (It’s not quite, but nearly, back to that old debate of whether we’re concerned with consumption or harm.)

Some of this response to the merger is inevitably personal, but I think it’s no less important for that – and commentators in general could be a bit more open about their own perspective.  If I were to write about my gut reaction, it would be the same as this slightly intellectualised response to the words ‘no’ or ‘zero’: I feel ARUK are probably ‘like me’, where I don’t think that of Alcohol Concern.

Of course, it could be that the influence of ARUK overcomes my concerns on all of this, and I’d genuinely welcome that, because of the frustrations outlined above – but I think the merger will pose a significant PR challenge for the new organisation.

There will always be tensions in merging what could simplistically be described as a ‘doing’ organisation in Alcohol Concern – with its research, consultancy and advocacy – and a ‘thinking’ organisation in ARUK.  But maybe those distinctions are breaking down in a world where research must demonstrate ‘impact’ – and perhaps that’s a good thing.

Saturday, 3 December 2016

Identity? Culture? Economics? It's all about power

On this blog I tend not to write about politics directly, but it’s hard to ignore politics today – even discussions of cannabis regulation include a nod to Donald Trump. Although I’ve mostly focused on issues of alcohol and drugs on the blog, the original intention was to discuss any public policy issue where I felt there was a lack of openness or clarity.

This often means that posts are reflective, or detached, questioning the terms of an argument as much as the conclusions, and this post is no exception.  I’m not going to come up with my own analysis of ‘why Trump won’, or why people voted for Brexit; there are other people far more knowledgeable and intelligent than me to do that.  What I want to do is suggest that in the post-mortems of the past year’s political developments, we seem to be approaching the analysis with the same kind of superficial thinking that characterised debate and commentary in the lead up to both elections.

Much of the debate I’ve seen has focused on whether ‘the left’ took a wrong turn after the 1980s, eschewing materialist politics for identity politics, where the focus was on respecting minorities and cultural difference, rather than dealing with economic inequality.  (At this point, I just want to emphasise that this is by no means a new academic debate – I’m re-reading Redistribution or Recognition, which is well over 10 years old, and the issue felt a little stale even back then given all the political sociology on ‘post-materialist’ politics.)

On one side, people like Imogen Tyler have suggested that votes for Trump were precisely an embodiment of this kind of identity politics – only the identity was of white men, rather than the minorities this approach tends to be associated with.

Others, like Simon Winlow and Steve Hall responded to this position by suggesting that in fact if only politicians had taken working-class materialist concerns seriously, the voters would never have been seduced down the blind alley of identity politics.  These commentators are concerned that the white working class is being labelled as racist when in fact they’re concerned about their economic security, which has been undermined by decades of neoliberal social and economic policy.

(My choices of commentators are sociologists, because of my academic background, not mainstream commentators – but this mirrors the general debate.)

It won’t surprise regular readers of this blog to find out that I think this is too black and white a reading of the issue.

The neatest explanation of this I’ve seen is this one, which notes that racism, sexism, and any other form of discrimination have economic effects.  They are not simply about ‘identity’.  There is no pure market where people interact without identity markers, without prejudice, where they are only interested in the cash nexus.

But if this has all been explained so well already, what can I add in a blog post several weeks after the event?  Well, I want to suggest that this comes down to taking a nuanced, complex understanding of the world.

It can be argued that at the heart of any area of thought on human behaviour – whether sociology, psychology, politics, health, economics – there is a concern with power or control.  What happens, and why?  Who or what influences what happens?

And without being facile, power is a complicated thing.  As any student of political sociology will tell you, it’s even very difficult to define as a concept, let alone trace and understand in real life.

My contention, which again won’t be surprising to regular readers of the blog, is that power isn’t simply economic.  I’m not going to go into that in detail here, but suffice to say that not all people from the same ethnic or gender group are equal, but equally neither are all billionaires: their influence will be shaped by not only their wealth and income, but also wider social and cultural capital.

With this idea of power as something more than economics or identity, it’s useful to make what seems like a trivial statement: these elections were about power.  I don’t mean simply that the electorate exercised its voting power; I mean that that people were voting to experience (as much as acquire) power and control, and this is reflected in the result.

Whether it’s about culture, economics, identity, or something else, people really did want to ‘take back control’.  And to decide which of these factors it was all ‘fundamentally’ about is to debate whether the chicken or egg came first.  On top of that, when you think of voters themselves, we’re not looking at one chicken and one egg and thinking which came first; there is a never-ending cycle of billions of ‘chickens and eggs’ across the world.

To stretch this analogy to breaking point, we should probably simply accept that chickens lay eggs and eggs hatch into chickens.  Culture, identity, economics, social connections – these are all elements of life, whether political or not.  They’re not going away, and will continue to shape power relations and politics.

Let’s think of this idea of power or control in more practical terms.  Control is of course related to money, finances, or however we want to label economic capital.  But people on the same salary are not – and do not see themselves – as being identical, equal, or even similar.  And that means that ‘the elite’ is not simply about money so much as culture.  This could be seen as an issue of ‘identity politics’ or soixante-huitard politics, but that genie is well and truly out of the bottle.  Practical politics is shaped by the here and now.  And indeed, for all that post-materialist politics is seen as a post-war phenomenon, there’s never been a neat and perfect correlation between class and political behaviour – otherwise there would be far fewer jobs in political sociology, and books like The Ragged Trousered Philanthropists and Felix Holt wouldn’t exist, for example.

To some extent, it’s a bit facile to suggest that explanations should acknowledge that there were lots of voters, each with various interacting influences and motivations.  But if it is facile, it somehow still seems to need saying.

Nassim Nicholas Taleb has criticised what he calls the ‘Intellectual Yet Idiot’ in polemic, sarcastic fashion, but there is a germ of truth in his analysis, which suggests that many people have been too quick to leap to single overarching explanations or views.  So just as they could not accept that Trump or Brexit were possibilities, so they now leap to a single certain position of whatever caused those votes.

My particular concern with this way of thinking is that it perfectly chimes with my experience of university education, where the emphasis was more on having a clear, forceful, eye-catching argument, rather than being accurate or ‘correct’.  And this isn’t confined to undergraduates – just think of Niall Ferguson.

That is, those who should be most likely to lead us in careful, nuanced thinking – academics – seem to be led themselves into definite, eye-catching statements (remember the claims that the Brexit and Trump votes are fundamentally about neoliberalism and economics).

People and life are complicated.  This seems, again, a facile statement, but it’s a truth that is far from universally acknowledged at the moment.  If this blog post is anything other than an incoherent ramble of frustration, it’s an expression of my wish for that truth to be more widely acknowledged by academics, commentators, policymakers, voters and (most of all) politicians.

Interestingly, politicians acknowledge the complexity of the world in drug policy, by pretending that things are simple.  If there’s something positive for me to cling to in today’s make-believe, black-and-white world of politics, perhaps it’s that behind the simple stories, there’s some complex understanding.  If that was campaigning in poetry, perhaps the governing in prose will make more sense.  However, I’m yet to be convinced.