Thursday 17 July 2014

Kidults and the old school beer

Phil Mellows yesterday pointed out one of the latest Portman Group judgements, which had to decide whether the names and labels of various beers were in breach of the code.  The names were: Cat Piss; Dog Piss, Bullshit; Dandelion & Birdshit; Big Cock; Grumpy Git; Arse Liquor; Lazy Sod; Puke; Shitfaced; Yellow Snow; and Knobhead.

I could just leave you with the link to the judgement (which also shows the labels), and allow you to giggle – or snort, as Phil did.

However, one bit of wording in the judgement caught my eye, given the one-trick-pony nature of my academic work at the moment.

“The Panel was concerned, however, that frequent references to scatological humour, defecation, urination, genitalia, vomiting and other bodily functions could prove particularly attractive to under-18s.”

If you added violence to this, it’s basically a description of the carnivalesque, which characterises Rabelais’ work, which is then drawn on by Bakhtin, and in turn drawn on by people like me (or this research team) to describe current town centre drinking.  (Flippant, but I don’t see young people eagerly reading Rabelais…)

I don’t want this post to turn into a detailed discussion of the codes used by the Portman Group and Advertising Standards Agency in relation to alcohol, but after reading this I started to flick through other recent judgements.

Perhaps unsurprisingly, a common feature of these is the feeling that products are appealing to children.  This isn’t just in a simple way, such that bright colours or fruit flavours are condemnedA school has been condemned for brewing a beer to commemorate its 100th anniversary – since there was then an unavoidable association between alcohol and the education of children.  Most bizarrely, the judgement stated: “while acknowledging that the school had taken steps to conceal the product from the pupils during school hours, it could not control children seeing the product if it was taken home by a parent.”

To me, this highlights the inconsistency of the Portman Group approach.  Public Health advocates complain that advertising and licensing ‘normalise’ alcohol consumption, and worry about alcohol being available in locations they feel it’s unusual and unnecessary, like cinemas.  It’s exactly this sort of worry that lies behind the condemnation of associating a school with beer – and yet the Portman Group represents manufacturers who do precisely this, and would argue that normalising isn’t a problem – alcohol is perfectly normal, but should be drunk ‘responsibly’; it’s only the errant individuals that need to be targeted.*

Obviously this isn’t an original or particularly interesting thought.  The strange role of the Portman Group is acknowledged by both (self-defined) ‘sides’ of the alcohol policy debate.  I just found the condemnation of a celebratory beer very strange – particularly when it’s an industry-related body doing the condemning.

The more general theme of complaints to the Portman Group  – as in the case of ‘Cat Piss’ beer – is that the drinks themselves would be appealing to children.  However, this is a line that is increasingly hard to draw, when UK drinking culture is carnivalesque (with the world turned upside down you can leave responsible adulthood behind) and where ‘kidult’ themes are common.

“Halloween is widely recognised as a children focused evening, in particular with dressing up and trick or treating. The presentation of this product alongside the promotional posters, table talkers and mobiles would resonate with U18’s and make the product attractive towards them.”

But this isn’t simply about the evil alcohol industry appealing to kids. 
This distinction is hard to draw.  Is childhood the first thing young adults think of in terms of Halloween?  Possibly not; it’s probably now dressing up and parties.  There it is again – the kidult theme.

As we are in a culture where lots of the things adults are attracted to are child-like, the assumption behind this is that we need to encourage a culture that is sensible, staid and certainly sober.  I’m not sure I want to live in that world.  There are all sorts of problems with kidult themes – not least the way it potentially works both ways, with children wanting to be adults as well as adults wanting to be children – but to see it as a problem when alcohol simply reflects the society we already live in seems like backwards logic to me.

It’s noticeable that the Portman Group rejected the claim that the WKD cauldron was appealing to children (though it noted that alcohol content of any drinks in it would be unclear) while the school anniversary beer was condemned.  I’m not sure which way I’d have preferred the decision to go.  Maybe the answer is that neither should be condemned, and alcohol shouldn’t be seen as the carrier of all moral value.  Just something to think about.

*To be fair, the report linked to here isn’t an industry report, but it’s a good expression of the philosophy behind the approach that opposes population-wide interventions (like minimum unit pricing) in favour of targeted measures.

Friday 11 July 2014

The proportionate universalism of MUP

In the past few days I’ve been catching up with videos from two conferences earlier in the year I wasn’t able to go to – those of Alcohol Research UK (ARUK) and the New Directions in the Study of Alcohol Group (NDSAG).

One that particularly got me thinking was John Holmes at NDSAG talking about minimum unit pricing (MUP) and whether it can be considered an equitable intervention that helps address health inequalities.  I’ve written about the Sheffield research and the predicted effects of MUP on different socio-economic groups before, but this time I started to think more directly about alternative policies.

As far as I can work out, there are two key reasons why MUP is considered a superior policy measure to increasing tax on alcohol across the board.

(One key argument against MUP is that any increase in revenue would be for the industry rather than the government.  It’s the same worry that some people have raised regarding initiatives to make food production healthier.)

The first is that it wouldn’t affect the on-trade, like pubs and bars, as prices there are almost always already above the 45p/50p per unit proposed – usually by some distance.  This is considered a good thing, because of the community value of pubs, and the fact that drinking under some form of supervision (by the licensee or social norms) is generally considered safer, and possibly a better way for young people to learn ‘how’ to drink.

The second, and what I’m interested in here, is that MUP wouldn’t affect all drinkers – or at least not equally or significantly.  Although it might seem like a population-wide measure in one sense, MUP wouldn’t affect everyone – or even all drinkers – equally.

Nick Sheron has suggested that MUP is ‘exquisitely targeted’ at the most problematic drinkers, but actually it’s more complicated than that.  As the graph from the Sheffield research shows, when we look at harmful drinkers, those from the lowest income quintile get twice as much of their units from sub-MUP level drinks (40.6%) than the highest quintile (20.3%).  So this is a policy that will affect those on lower incomes more.

Of course, if what we’re concerned with is alcohol consumption, then taxes on alcohol are already ‘exquisitely targeted’ – in fact, better than MUP.  Those who consume the most alcohol will pay the most tax, regardless of their income bracket or their preferred drink.  This would especially be the case if we had a more straightforward system than currently, and just taxed each unit of alcohol at the same rate (as the IFS has recommended) – though for reasons I can’t fully understand, this isn’t currently possible under EU regulations.  (True, these taxes would also affect on-trade alcohol, but then there are other ways to make that industry more viable if that’s a genuine concern of policymakers.)

However, this brings us back to the question (implicit till now but almost inevitable in a post on this blog): what is the policy trying to deal with?  Alcohol consumption, I’m going to assume, is not an evil in itself.  The reason that public health policies aim to address it is that there are risks associated with certain levels of consumption.  Those risks relate to mortality and morbidity of various kinds.  So what MUP would (or should?) be trying to do is reduce health harm related to alcohol.

This means that, as John Holmes points out, the particular targeting of MUP needn’t be seen as a bad thing.  He calls this as a form of ‘proportionate universalism’, using the term coined by Michael Marmot, the doyen of health inequalities research.  It can be argued that the targeting only makes MUP a ‘regressive’ policy if the health effects of alcohol consumption are ignored.  If the assumption is that the aim of the policy is to improve health, the group with the most significant health harms from alcohol are the lowest quintile, and it’s their consumption that will be most affected by MUP – and therefore hopefully their health will improve most significantly.  That’s the proportionate universalism.

However, it could also be seen as a form of ‘seduction and repression’ to target those from lower socio-economic groups, who are assumed to be the ‘problem’ – as in David Cameron’s ’20 tins of Stella for a fiver’ claim.  (I’ve got an academic article coming out on this very topic in October – a mere 12 months after it was accepted for publication.)

If we’re trying to deal with alcohol consumption per se, then we know tax is a more straightforward and ‘equitable’ way to do this.  If we’re trying to address health harms amongst the poorest in society – and remember this is the only way that MUP can be justified as equitable – we know that even where these harms are apparently related to alcohol, there’s something more going on that we don’t yet understand.  In this context, pinning our hope on MUP when we don’t even understand what’s going on seems a bit premature.

MUP might be, for some people, the best policy available, and perhaps that explains why it seems to have been the only show in town in terms of alcohol policy over the past 5 years.  However, I can’t help but think sometimes that it seems to be a solution searching for a problem – and a whole range of people see it as a solution to the problem they’re most concerned with: ‘binge’ drinking, ‘harmful’ home drinking, health inequalities, and so on.

As usual, I’m not arguing that we shouldn’t introduce MUP, but if it’s really an intervention to address health inequalities, perhaps we should return to Michael Marmot’s analysis and think about the broader ‘determinants of health’ – and not just make alcohol more expensive for a specific group within society, who already have little income to spare.  Otherwise, it looks a bit too much like this is a policy that ‘targets’ those of the heaviest drinkers who have the lowest incomes, even if this targeting might also ‘benefit’ them.

Monday 7 July 2014

Neoliberalism again

A long time ago now, I wrote an academic article about how alcohol policy under both Labour and the Coalition can be characterised as neoliberal.  The current advice for people who publish in academic journals is to get the ideas out to the widest audience possible using a variety of means.  I of course tweeted about the article, and emailed it to a few people who asked, and this blog post is a further attempt at getting the message out.

One of the things that I knew would happen, but still bizarrely surprised me when it inevitably did, was that after the initial publication, the world kept turning, government policy didn’t change, and not very many people even noticed I’d published anything.  Maybe writing this will go some way to making me feel a bit better about that.  More people are likely to read this blog than the article, at any rate.

The point of the analysis was to challenge the assumptions of some academics and public health professionals that alcohol policy has betrayed a certain ‘hypocrisy’ since the 2003 Licensing Act, or even before, with the market gradually becoming less regulated but the concern around alcohol – and ‘binge’ drinking specifically – increasing.  How can the government complain if people respond in the predictable way when an environment is established that makes them feel they have been ‘invited to binge’?*  This is the argument of the research group I think of as beginning with Hs: Hall, Hadfield, Hobbs, Hayward (and Winlow and Lister).

My response – this obviously fantastic article that you should download here (I can send a limited number of free electronic copies if you email) – is that in fact this is all perfectly consistent when considered as part of a ‘mentality of government’ called neoliberalism.  I’ve written about neoliberalism before, but I thought it worth thinking it through again given that some people I’ve spoken to about it haven’t really followed what I mean.

Unfortunately, neoliberalism isn’t a very clear term (in that sense, it’s got a certain affinity with ‘binge’ drinking already).  Mostly, people associate it with a slightly fuzzy idea that global banking and big business have been allowed to run riot over the past 20-30 years.  It’s got its origins in genuine political philosophy and economics as a policy framework, endorsed by people like Hayek.

However, that’s not quite how I’m using it.  In the context of social policy, it’s developed a slightly different meaning, as it’s used to apply to detailed analysis of how public policy has operated in practice, not as a theoretical ideal.  The key point is that recent social policy has not been liberal in the sense of genuinely believing that (for most people) an individual’s way of ordering their own life is by definition the best, since they will know their own desires and dislikes – and yet the solutions put in place to the perceived problems have tended to operate at the level of the individual (education, building resilience) rather than reshaping structures and environments (the ‘free’ markets are left as they are even when they are acknowledged to be producing undesirable outcomes).

I’ve suggested that UK alcohol policy (since 1997 at least) is a classic case of this approach.  While the Beer Orders were (at least by the Monopolies and Mergers Commission) justified as getting a fairer deal for consumers, the 2003 Act was justified for a myriad of reasons, but never as fostering the unconditional good that people should be able to drink when they want.  That was a conditional right: you had to drink in a particular way to be considered to be exercising this right ‘responsibly’.

This condemnation wasn’t only related to cases where genuine crimes were committed; government was swift to condemn ‘binge’ drinking even where there was no real harm (apart from offence) done to anyone apart from the drinker.  In fact, the harm even then seemed to be understood as shame more than anything else – the 2008 ‘Would You?’ campaign seems more like a lesson in how to behave as a respectable member of society than how to drink without engaging in crime and disorder.  (I'm not certain that the state should be too concerned about whether I've ripped my jacket or broken my CD player.)

The current government has suggested (wrongly, I’d argue) that the 2003 Act and other bits of Labour policy have produced serious problems.  However, the solution of the Coalition has not been to significantly change that environment, but to keep it broadly the same.  We haven’t actually had minimum unit pricing, and despite a consultation about ‘Rebalancing the Licensing Act’ the most notable changes mooted were actually to make it easier to sell alcohol, by loosening regulation of ‘ancillary’ sales (e.g. at hairdressers) and getting rid of the personal licence – something I’d suggest suits big companies most of all, which are precisely the organisations that commentators generally worry have made the night-time high street an unhealthy drinking environment.

You may or may not agree with this analysis (though I’d recommend you read the article in full first, before criticising!) – but I hope my motivation for writing it will seem reasonable.  I’m not necessarily convinced that all the things government worries about regarding alcohol are genuine problems, or that the state specifically should be addressing them.  However, given it has these concerns and makes policy based on them, we should have a sensible approach to devising solutions.  With the article I wanted to highlight the assumptions behind policymaking that mean the solutions proposed to the perceived ‘problems’ surrounding alcohol are (unnecessarily) limited.  That is, even though the outcomes produced under the current set-up aren’t what the government wants, it only really looks at solutions that address individuals.  I think we’d make better policy if we opened up the whole range of options that have existed through history.  In the article I mention the Central Control Board, as always, but that’s just by way of example; there’s all sorts of initiatives that could be on the table, but currently aren’t.

I’d like to think that the article and this post can contribute in a small way to opening up that debate.  And readers could always contribute by leaving a comment mentioning your favourite policy ideas that don’t currently get an airing…

*It's possible to argue that this idea that things have got worse as a result of looser licensing is misleading, but it's certainly the way that the current government portrayed the situation in the 2012 Alcohol Strategy.  This is partly possible to argue in the face of declining alcohol consumption because successive governments have defined 'binge' drinking simply as the sort of drinking they don't like, with norms different from everyday life, rather than based on quantity consumed alone.

Thursday 3 July 2014

A middle ground on drug policy?

Last week, I was invited onto BBC Radio Solent to talk to Simon Jupp about cannabis scratch and sniff cards – designed to educate the public about the smell of cannabis being cultivated, and therefore make them more likely to spot and report cannabis farms to the police.

Because I have a streak of vanity and egotism, you can listen to the brief excerpt below.  The only positive, really, is that I managed to get in my usual caveat when asked whether the scheme would work: well, of course that depends what you’re trying to achieve…  I tried to point out that, in itself, spotting and reporting an individual house being used to grow cannabis isn’t going to do much to address the key issues that surround illicit drug use in Britain today.

However, this interview isn’t something to boast about – it’s certainly not my finest hour, as I haven’t actually seen and played with one of these cards, and I don’t know how effective they’re likely to be.

Also, the discussion didn’t quite go the way I was expecting.  I had thought, given that this was on the day when Russell Brand and others were demonstrating next to Parliament, that we’d quickly progress onto broader issues of drug control, and so I’d had a bit of a think about that, and noted how many US states have legalised marijuana for medical and/or recreational use.

I’d made some quick, simple notes, therefore, about the arguments about drug regulation/legalisation.  I’ve been thinking about these this week too, having seen an article by Kathy Gyngell on The Conservative Woman blog, and something in The Economist about how decriminalisation should only be seen as a step on the way to the rational policy on drugs: regulated legalisation.

This is my attempt at what I said in a recent post academics should do: not just offering a critique of current policy, but suggesting a constructive alternative.

Of course, in terms of drug policy we can take the sensible position of the Irishman in the old joke: I wouldn’t start from here.  However, as Virginia Berridge points out so powerfully, simply thinking in the abstract doesn’t automatically generate sensible, workable policy.  We do need to start from here.

(At the same time, it’s worth understanding where we are, and this recent paper from the International Drug Policy Consortium highlights how the fact that some ‘drugs’ are legal and some illegal in the UK today is something of a historical accident.)

The crucial starting point is my old issue (and I make no apologies for sounding like a broken record): what are we trying to achieve with drug/alcohol policy?  Kathy Gyngell’s article focuses on individual users, and the risks they might face.

Some of these aren’t as clear-cut as she suggests – for example, the issues with the current criminal market doesn’t simply apply to drug possession offences, and the prison population doesn’t represent all those engaged with the criminal justice system, especially not for drug-related offences, where a Drug Rehabilitation Requirement (DRR) will often be a more appropriate solution.

Moreover, she presents the links between mental health and cannabis use as clear-cut, when they are anything but.  Just last week research was published that suggested both cannabis use and schizophrenia seem to be associated with a particular gene.  That is, the same genetic trait that fosters cannabis use might also predispose a person to have schizophrenia – and this might explain why they’re clustered, rather than a simple one-way linear relationship.

However, these individual arguments aren’t the only issue around there being a criminal market in drugs.  As I say in the interview, there are links with organised crime.  But this isn’t just about the example of trafficking that I managed to give in the interview; it’s also about the general instability of producer nations – as the Economist article notes.

This is in fact, for me, one of the most concerning points most about the current situation – and is likely to be how some of the greatest harm occurs.  However drug markets are controlled or regulated, there are likely to be ‘addicts’ of some kind – people currently benefit from treatment for issues with the legal drugs tobacco and alcohol as well as heroin.  An argument might be made that there are more heavy drinkers than illicit drug users in the UK, but that doesn’t necessarily imply greater health and crime costs.  I’m yet to be convinced that a cost-benefit analysis that looked at the global situation would conclude that greater damage is done by alcohol than drugs, if the way in which the illicit trade destabilises whole nations was taken into account.

One of the odd patterns in current drug policy is how greater regulation of tobacco is occurring at the same time as liberalisation of cannabis.  Admittedly, this is taking a global view, but as US states legalise cannabis – even for recreational consumption – Australia has introduced plain packaging for tobacco, and Britain is seriously considering this.

However, this doesn’t seem to strange if we take the perspective of Transform, an organisation that campaigns for liberal drugs policy.  It argues that there’s a U-shaped curve when harm is modelled against level of regulation.

That is, a completely free market in drugs would lead to high levels of harm – but so does attempted complete prohibition.  According to this interpretation, therefore, the most appropriate solution is a strongly regulated but legal market – somewhere in the middle.  Perhaps this approach appeals to me simply because of my tendency to see both sides of an argument, but it’s certainly worth thinking about.

What’s more, the current global trend suggests that this might be the direction we’re heading in anyway: both plain packaging and legalisation of cannabis for recreational use could be argued to sit somewhere in the middle of this graph.

There are arguments about whether highly regulated legality – through the Central Control Board for alcohol, for example – amounts to a middle ground.  Some see them as interfering with the market so much that they’re approaching prohibition.  This isn’t how I see them, however.  For illicit drugs, from the position we’re at currently, there would have to be decriminalisation before we even approached this level of controlled legality.  Licensed consumption locations for products that are quite clearly not ‘ordinary commodities’ seems perfectly sensible, and it’s also perfectly reasonable to imagine that certain conditions might be laid down in how those properties are arranged and run.

This trend isn’t necessarily the result of conscious planning – and my experience of policymaking is that these sorts of trends are more complicated than that.  We might be stumbling towards this policy mix thanks to an accidental ‘synthesis’ resulting from a whole range of groups including public health or tobacco control lobbyists as well as campaigners for drug legalisation.  This is precisely my view of how policy should be made.

So maybe there’s reasons to be cheerful after all, despite the shortcomings of scratch and sniff cards and Kathy Gyngell.

Tuesday 1 July 2014

Beer isn't cheaper than water

Twice in one month now, the opportunity’s arisen for me to write about exactly the issues I started this blog to discuss.  First, it was about the Total Consumption Model of alcohol harm; this time it’s about rhetorical flourishes in policy debates.

My favourite flourish of this kind in recent times is David Cameron’s claim that he wanted to stop 20 ‘tins’ of Stella being sold for £5.  I’d love to know where he saw that offer.  Today’s isn’t quite so eye-catching, as it’s a tired old formula, but I think it’s even more irritating as it hasn’t got the comedy value of the alcoholic equivalent of a politician not knowing the price of a pint of milk.

The Daily Mail (and apparently the Sunday Times) has picked up on a press release based on Channel 4’s Dispatches programme on the scourge of cheap alcohol to suggest that alcohol is being sold cheaper than water.

There’s all sorts of problems with this comparison, and I don’t want to labour them too much here.  Obviously, the claim isn’t referring to how most people get most of their water: out of a tap.  More than that, it’s comparing Perrier with Strongbow, Carling, Carlsberg and Fosters.

This immediately makes me think there’s been a misunderstanding here, and initially made me reach for my stock example about averages and distributions: I can’t run as fast as Marion Jones (I’m showing my age now) but that doesn’t mean women in general – or on average – run faster than me or men in general.  Or to take the gender split the other way round, it makes no sense to compare my salary to the Chief Exec of Dorset County Council and then start talking about how men are paid less than women.  What this observation tells us is that one brand of bottled water (sparkling, so slightly misleading even to just refer to it as water) is cheaper than a few brands of beer and cider.

In fact, neither the salary or running example conveys the oddness of this comparison when we’re considering low-priced alcohol, because I don’t know if the very slowest runner or lowest-paid worker is a man or a woman.  Instead, it’s like suits and shirts.  There’s a shirt at M&S that costs £99, and you can get a suit for £79.  But if we’re interested in comparing these items, we know that the cheapest thing to buy out of the two categories will invariably be a shirt – and by some distance.

It’s the same with drinks: the cheapest drink for me to buy in a supermarket will be own-brand bottled water rather than anything alcoholic.

So what does the comparison of water and beer illuminate?  The answer is nothing.  It’s an easy, quick story that gets repeated over and over.  It can’t help public understanding because I can’t imagine the price of Perrier is a way anybody weighs up decisions – I can’t even imagine very many people know the price of Perrier.

Comparing the two products suggests they’re comparable; I just can’t see how the two are.

The argument in favour of the comparison would be that it’s got media coverage, and plenty of people are debating alcohol policy as a result – including me.  However, it’s worth returning to L Susan Stebbing, whose book title this blog has shamelessly stolen.  Her key argument was that we’d be much more likely to get sensible, workable policies in place if we had a sensible, open debate about what should be done and why.

Commenting on the critical faculties of the voting public and the quality of public debate, Stebbing worried that ‘rhetorical persuasion will in fact be substituted for rational argument and for reasonable consideration of the difficulties that confront any democratic government.’  She lamented that ‘it is not surprising, however saddening it may be, that many of our statesmen do not trust the citizens to think, but rely instead upon the arts of persuasion.’

I’m not sure that alcohol is ‘too cheap’, or that there’s a neat solution to this apparent problem (which can only be a problem because of one or more of the myriad of potential issues associated with alcohol).  However, I could certainly be persuaded.

I won’t be persuaded by misleading claims that beer is cheaper than water though – and, like Stebbing, I wouldn’t want a policymaking environment where such laughable claims have any serious weight.

I’m not sure policymakers are persuaded either – in which case the use of such devices suggests that either the commentator doesn’t understand GCSE Maths, or thinks viewers of the programme – and voters – won’t.  Neither is very encouraging.

It would be nice if we could have a sensible debate.  It really isn’t that hard.

On the plus side, at least I can feel that this website, and the work of Stebbing, is still relevant.