Wednesday, 6 November 2013

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.

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.

1 comment:

  1. Will, as ever I loved reading your blog posts.

    I would make one comment on the alcohol industry and evidence.

    When faced with evidence created for public health advocacy as described by Richard Horton (yes. the Lancet Editor) here,, I don't think the industry is obliged to stay out of the debate or to play fair.