Friday 18 March 2016

Individuals, society and desirable drinking

I spent a great day on Wednesday at the annual Alcohol Research UK conference.  There was a huge amount of evidence on show, and discussion about the nature of evidence-based policy, how research can produce impact and shape policy.

The discussion really boiled down to whether there could be a common language, and genuine communication between researchers and policymakers.  There was consideration of all the usual themes of academics being cautious about their conclusions, and working over long timescales, where politicians want the 'killer' study that gives them a definitive answer to a policy problem.  In fact, there's a point to be made that researchers too are looking for that perfect answer.  We isolate factors, control for variables, and try to identify causes.

Tom Parkman got to the heart of things in the final session, raising the question of whether alcohol was the cause of various problems, or whether the drinking was the result of (for example) housing, employment or relationship difficulties.  He described this as the 'chicken or egg' conundrum, but that's really a shorthand for the fact that these issues are mutually reinforcing – as he suggested, once problems are established and chronic, is there any value in identifying which came first?  It might be more helpful just to get on with an intervention that addresses problems as they stand now.

And actually researchers aren't great at this.  We can trot out 'complexity', but still don't often manage to move constructively beyond that to conclusions or suggestions that are relevant to policymakers.  It's no good responding that things are more complicated than policymakers would like, unless we can offer an alternative interpretation or proposal.

How do we represent that complexity?  Often a quantitative study identifies the specific contribution of alcohol to a 'complex' problem, as if then a controlled intervention can singly address the alcohol issue, while some other intervention or organisation deals with the bit that relates to housing, or employment, or whatever else has been controlled for in a regression analysis.

Qualitative studies often conclude by metaphorically throwing hands in the air and suggesting (correctly, but not always helpfully) that 'it's a bit of everything'.  The problem is 'complex' or 'wicked'.  And we tend to invent our own terms to try to make sense of things.  There's any number of typologies of drinking patterns – but how have these been translated into interventions or policy?

Here's where the fresh eyes of a more quantitative team were helpful.  John Holmes described some new work from the famous Sheffield Alcohol Research Group analysing drinking diaries to identify particular forms of drinking occasion, offering much-needed contextual data (but in a systematic way) to the overall consumption data that tells us only amounts and frequency.  I can see their typology of drinking occasions being genuinely useful – taking the work of Mark Bellis' team to the next level.  It's an example of acknowledging the situation is complex, and can't be accurately addressed with a single 'killer' answer, but still providing something that you can imagine being communicated to a policymaker.

But John closed his presentation by raising another key issue.  We know that 'harm' isn't easily defined, and we know that even if we do define it very tightly, we can't make a totally straightforward link between consumption and that harm.  We need that contextual information, about quantity per occasion, and other factors such as whether food was present, family or friends, and so on.  That is, harm isn't simply dependent on consumption levels; it's affected by drinking cultures.

So if we're not going to simply aim for prohibition or zero consumption of alcohol – if we're prepared to accept, as most people in the room seemed to be – that there could be positive, or neutral alcohol consumption, we need to define what a 'desirable' drinking culture might be.  What 'should' policy be aiming for?

And in the context of references to sociology and social anthropology, that makes complete sense.  There is no doubt that drinking 'cultures' affect harm, as well as simply consumption levels.  Sociologists by definition are interested in studying society, as much as individuals.

But policymakers aren't all sociologists.  The analysis doesn't simply translate into policy, as we heard so often during the day.  In this instance, it's because of a frame that defines what is appropriate for government to do.  We could argue over what a desirable drinking culture might look like, but that's a second order question.  First we'd need to have agreement that government be in the business of fostering 'culture'.  This would sit at odds with Margaret Thatcher's reasonable (and selectively quoted) statement that 'there is no such thing as society'.  This plain statement was actually very sensibly qualified by the observation that there are individuals and families.  This is really a claim about the appropriate unit of sociological and policy analysis: should we look at groups of people (who are only 'latent' classes, to use the terminology of John's paper) or should we look at the individuals themselves.  (I'd quibble with Thatcher's assumption that families are not a concept that needs unpacking, but that doesn't challenge the overall approach.)

It is an unavoidably political discussion not just to define what an acceptable drinking 'culture' is, but to even suggest that government should be thinking at the level of 'cultures'.  Much as I'm sceptical of the utility of the term (although it's been very useful in getting me publications in academic journals), this is a questionable claim while (if?) we live in a neoliberal political environment.  According to that orthodoxy, the unit of analysis is the individual.

And in fact, that's an appropriate place to end and bring this post full circle.  An individual, as Bauman pointed out, originally means something that is indivisible.  And that individual, as Tom Parkman's research suggests, can contain plenty of interacting factors (housing, employment, physical health, personal relationships, mental health, drinking practices etc etc).  But they are indivisible.

And, echoing Wulf Livingston from Tuesday's symposium, perhaps that's where we should start and finish: what does desirable drinking look like, not to policymakers, or public health professionals, or academic researchers, but to drinkersand the wider public themselves.