Friday, 20 June 2014

Does Total Consumption matter?

It’s always nice when I get an opportunity to write about something on this blog that actually fits with my original aspirations for it: to discuss clarity of thinking around policy.  On the negative side, as usual I’m writing about something inspired by Chris Snowdon and/or James Nicholls rather than writing on my own initiative.

In this case, it’s a response to an exchange between the two of them, where they discussed the Total Consumption Model and alcohol policy.  I felt there was a lack of clarity in the exchange (though I wasn’t able to listen to the original LBC audio).  James accused the original IEA report that prompted the debate as being misleading in characterising the Total Consumption Model as being the ‘cornerstone’ of government alcohol policy.  I don’t want to go into the rights and wrongs of this debate here – there’s plenty of that on Twitter and Chris’ blog.

More than this, though, Chris seemed to be inconsistent in terms of considering problems and solutions.  There isn’t any necessary link between the Total Consumption Model and whole population approaches to alcohol policy.  There are all sorts of reasons for identifying a whole population solution even if you know the problems are caused by individuals.

Sometimes this might be about the ease of administering a policy.  For example, we place fixed age limits on alcohol consumption, even though potential drinkers mature physically and mentally at different rates, and won’t all be equally well prepared to deal with alcohol at the same age.

Sometimes this might be about equality.  There’s something attractive about the idea that all units of alcohol should be treated (and taxed) in the same way, rather than differentiating on the basis that more problems are associated with a particular drink.

Finally, support for a whole population approach might be political (or perhaps more accurately moral).  Kettil Bruun supported a population-wide approach partly because he felt it might avoid stigmatising dependent drinkers.

That is, population-level approaches needn’t have the Total Consumption Model as their cornerstone.  More importantly, though, population-wide policies aren’t the ‘cornerstone’ of the Total Consumption Model, as Chris also seems to suggest on his blog.  The TCM might prop those policies up, but it would be back-to-front thinking to have the solutions explaining a problem.

This is all a bit reminiscent of the industry objections to MUP dressed up as concerns regarding its effectiveness.  Chris’ problem with the Total Consumption Model is that it (apparently) supports population-wide policies, which he says are likely to be ineffective, but we haven’t even agreed on how that potential efficacy might be judged.  I’m sticking my neck out here, because this isn’t quite the reasoning he offers on the blog, but I have a suspicion that the reason he doesn’t like population-wide policies is because they might affect people whose drinking impinges on no-one but themselves.  However, as I’ve noted, there are lots of other arguments in favour of population-wide policies other than the TCM.

Moreover, MUP may affect the majority of drinkers, but it wouldn’t ‘target’ them (as Chris put it on his blog).  All drinkers might all be somewhat affected by MUP, but there’s no doubt that people wouldn’t be equally affected by the policy.  One good way of seeing this is to watch Nick Sheron’s presentation about the drinking habits of the people he sees with serious liver conditions: they drink a disproportionate amount of cheap alcohol, and would be disproportionately affected by MUP – whether that would reduce their consumption or simply lead to a financial hit.

There’s also something misleading in Chris’ discussion of risk and health in the context of population-wide policies.  It’s perfectly correct to point out that an individual won’t be much affected by a small reduction in their consumption, particularly if they’re not at the top end of the consumption spectrum.  However, this is to misunderstand how population-level policies work: they don’t aim to make everyone necessarily live longer by a day or so; they aim to make an average population live longer, and affect some individuals significantly.  The nature of the prevention paradox is that an individual won’t be noticeably affected by the small reduction in risk their change in consumption habits produces.  These small reductions in risk, though, when aggregated across a whole population, can produce a notable reduction in overall mortality.

Of course it can perfectly reasonably be argued that pushing (not quite nudging) people towards certain choices is no business of the state – and that’s fundamentally where the disagreement here lies.  The IEA isn’t an expert in the effectiveness of health interventions; it’s a bit more clued up on political philosophy.

The real policy debate should be a clear discussion of what the problem is, and what an appropriate solution might be – which may not necessarily be the most effective solution, as that might not be acceptable for practical or moral reasons.

Whole population policies might or might not be a sensible approach to alcohol, but it’s misleading to focus on the idea that ‘The 'cornerstone policies' of the Total Consumption Model involve raising taxes, restricting advertising and limiting availability’, since these policies can be justified in a number of other ways.

If this is a debate about liberty and fairness, let’s have it.


  1. Not sure you have really dismissed Snowdon's argument in this blog.

    The TCM may not be the top headline in the government's alcohol policy statements but it is the implicit philosophical core in Health Department and Public Health attitudes to alcohol: the nation should drink less, and policies that bring that about are unquestionably for The Good Of The Nation.

    An analogy might be the relationship between the theory of capitalism (TCM) and separate policies on banking, taxing and retailing (population measures). No one states "we have this government policy on retailing because we are following capitalism theory". They simply have policies that only make sense within a capitalist framework.

    In regard to your point about population-wide policy changes that have very little benefit for the individual, but when multiplied across a population have measureable gains, I would point out that there is a measurement issue that biases towards the healthist side of the argument. This bias is that the nationwide health benefit is projected and captured in statistical estimations, but there are no nationwide projections and so capturing in the stats of the years and years of welfare loss by consumers.

    My concern is that you can justify any restriction on the population if you project very small possible gains per individual out across a large population over a long enough period of time. It will always show a benefit at the national level.

  2. I don't disagree with much of your conclusions, and I don't particularly advocate population-wide approaches. What I'm saying in the blog post is that population-wide approaches needn't be underpinned by the total consumption model, and so attacking that when the real target is the measures, not a potential underlying philosophy, is to me mistaken. Kettil Bruun would still advocate population-wide measures without the TCM. MUP isn't really advocated on the basis of the TCM. The conceptualisation of risk at a population level isn't (quite) the same as the TCM. (The extent of the reduction in risk might be debatable, but it does fit a J-curve model of harm.)

    Your point about 'welfare loss' is exactly where the argument should be taking place, therefore - and that has nothing to do with the TCM. Public health professionals will obviously advocate for policies that reduce overall deaths by everyone reducing their drinking slightly, because population health is their priority. That doesn't mean it's right - but the rights and wrongs in this case aren't really based on the TCM. The harm/risk approach comes from the J-curve model, but the reason you're opposed is a balancing of pleasure and health, to put it in simple terms. You'd presumably argue that in this case this isn't something the state should be influencing/deciding. The TCM therefore isn't the target.

    (Of course there's the debate that the public context for drinking is always in part the creation of the regulation put in place by government, and therefore it's already 'interfering', but that's an argument for another day.)

  3. There is no government departmental budget problem or much academic funding available for pushing the welfare loss side of the argument.

    The Health viewpoint is totally dominent in official alcohol policy.