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.
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