MUP vs BBCS

So the government has 'shelved' minimum unit pricing (though Public Health England still insists it's under consideration, but won't tell us how - that would be a matter for the Home Office).

This isn't really a surprise, as it was clearly hinted at by Anna Soubry on 2nd July, and then basically confirmed on 12th.  And further back, the government had clearly already cooled on the subject even before the idea was excluded from the Queen's Speech earlier this year.

The government has instead gone back to the idea of a ban on selling alcohol 'below cost' - i.e. below the cost of duty and VAT - originally promised in the Coalition's Programme for Government.  This is despite saying just over a year ago in the Alcohol Strategy: "We do not currently intend to implement a ban on the below cost sale of alcohol (defined as Duty + VAT)."  But then this was also the document that said, unequivocally, "We will introduce a minimum unit price (MUP) for alcohol".  MUP could be said to be the policy centrepiece of the document.

Yesterday, David Cameron said the new (or should I say old) proposal was 'effectively a minimum price'.  Indeed, Jeremy Browne's statement is careful to frame the measure in these terms: "It will no longer be legal to sell a can of ordinary strength lager for less than about 40 pence."

Now, setting aside the point I would make in an academic setting (that it says something about the views of this government that they chose lager as the illustration), this sparked me thinking about what is different between the two proposals: MUP vs below cost pricing.

MUP has been rejected because the government does "not yet have enough concrete evidence that its introduction would be effective in reducing harms associated with problem drinking, without penalising people who drink responsibly".  However, if there's insufficient evidence about MUP, surely there's also insufficient evidence about setting what's 'effectively' MUP?

In fact, if we take at face value the statement from the Home Secretary that the measures are to 'curb excessive drinking', it seems clear that there's less evidence that a below cost ban will 'work'.  Today, the Sheffield Alcohol Research Group that did the modelling on MUP that's often cited have published a clear comparison of MUP and the below cost ban.  The evidence of the model* is that public health benefits of BBCS, as they call it (Ban on Below Cost Selling), would be tiny compared to MUP at 45p.

It's for this reason that the decision has been branded 'disgraceful', for example.

There's obviously something else going on here.

MUP is generally understood by public health campaigners as in line with a population model (explained by James Morris here).  That is, reduce everyone's consumption by a tiny average amount, and the difference to any specific individual in terms of risk might be almost negligible, but when you add all this up across a population, you get a noticeable fall in the total harm.

However, this is not how the government has portrayed MUP.  Generally, it has been presented as a targeted policy.  The 2012 Alcohol Strategy was very clearly presented as dealing with 'binge' drinkers, with the Prime Minister's foreword beginning and ending with a reference to them.  It is in this context that the promise of MUP was introduced, with an explicit reference to problems caused by 'pre-loading' (drinking alcohol bought from a supermarket/off-licence before you head out to a pub or club).  David Cameron on another occasion explained that MUP was a way of stopping families with a 'reasonable drinking habit' subsidising 'binge' drinkers.

I don't really know what this difference in understanding of MUP is caused by.  It could just be a way to 'sell' the policy to a wider public, using 'binge' drinkers almost as a cover.  It could be a genuine belief that this is how the policy could or should work.  It might, perhaps most plausibly, represent genuine confusion.  Or maybe it reflects the kind of wishful thinking that seems to dominate alcohol policy discussions: that despite the fact that there's a myriad of 'problems' associated with the substance, somewhere out there is a single policy or initiative that can deal with them all.  The debate around MUP seems to have taken this form, with it being seen as the solution to all ills.

I don't think this representation of MUP is any kind of cover.  I would suggest that the government genuinely believes that alcohol-related issues are caused by an 'irresponsible minority', and that those with a 'reasonable drinking habit' should be largely left alone.  The idea of a 'reasonable drinking habit' as something that should be seen sympathetically would certainly grate with a public health view of the world.

If this is true, then the government's ideal policy would not be population wide but something that's targeted.  And duty on alcohol is targeted (if in a slightly bizarre way), varying by drink type.  A key example of this is white cider, which is considered to be a particular problem by the government - so much so that legislation was introduced in 2010 in order to define it as a separate drink.  If my calculations are right, the below cost ban would make 3 litres of Frosty Jack's £7.65, compared to £2.75 in 2010, according to the Daily Mail.  Meanwhile, a bottle of wine will still be able to be as low as something like £2.20.^†  This is precisely the sort of targeting that I can imagine the government being in favour of.

UPDATE 18-07-13
John Holmes of the Sheffield team has informed me that in fact Frosty Jack's isn't taxed at the spirits rate.  That makes me confused about what exactly the 2010 duty change can possibly be doing.  I'm trying to find out what on earth its point is now by the questionable mechanism of Twitter.

In light of its shelving of standardised packaging for tobacco as well as MUP, the government is currently being characterised as in hock to big tobacco and alcohol, symbolised by Lynton Crosby's lobbying connections.  Just like with the Labour debates around union funding, I think it's a lot more complicated than that.

This could be linked to broader ideas of neoliberalism, and I think this helps understand where the government is coming from.  The targeting of individuals comes from the same place: the fundamental approach to government is that market forces should be allowed to roam free, and undesirable outcomes that arise are the fault of flawed individuals, rather than flawed structures.

I've said before that there's a reason big tobacco gives to think tanks like the Adam Smith Insitute: it's not so much that they'll be easily swayed by the cash; it's more that they're already inclined to agree with the idea that the tobacco industry (like almost all others) should be free to operate in a largely unregulated market.

Similarly, at the moment both Coalition parties are led by individuals with a fundamental belief free market principles, and I'd suggest that the idea of banning below cost selling fits more neatly with a free-market worldview than a minimum price (above this level).  Of course in other contexts loss-leading is considered a legitimate tactic within the market.  But then maybe this could be justified by saying that alcohol is no ordinary commodity.  (The distinction here seems to be more one of an impression rather than substance, as the practical difference between the two interventions seems marginal.)

So my conclusion is that MUP has been shelved because the government simply doesn't have a public health philosophy (in terms of defining either the problem or the solution) and it is ideologically defaulted to protecting the free market and targeting apparently problematic individuals.

(As with the issue of the industry funding think tanks, we probably get closer to the heart of the Lynton Crosby issue if we start with the fact that Cameron is the sort of person who would hire a person like Lynton Crosby, who has all these sorts of alcohol and tobacco industry links.)

For public health campaigners this might seem like an unfortunate blow.  However, I want to end on a positive note, so I'll make two points.

First, public health concerns aren't the only issue in alcohol policy, as I've said before, and so we shouldn't expect them to trump everything else - and we should remember that MUP wouldn't have been a panacea for all alcohol-related issues in any case.

Second, and somewhat flippantly, it's nice to know that the population-wide model doesn't always win out at the expense of targeting.  One of my roles is in commissioning drug treatment, and the general approach of this - targeting a few thousand individuals in an area, rather than a few hundred thousand - sits somewhat at odds with the public health population-wide model.  Targeting can sometimes be helpful.  Unfortunately, it can also be stigmatising - but that's something for my next post.

*Some representatives of the alcohol industry would want me to point out that this isn't really 'evidence' according to their definition, as it doesn't look at something that's actually happened - it's 'only' modelling.

^†This is based on the figures on p.7 of the Sheffield report, which give spirit duty+VAT as 33.9p per unit, and wine as 24.5ppu, assuming 9 units in a bottle of wine and 22.56 units in a 3l bottle of Frosty Jack's.

E-cigarettes and a new culture of intoxication?

I've talked about e-cigarettes before, and they still fascinate me as a case study in intoxication, whether it's the comparison with alcohol and the idea that there might be a 'complex', 'premium' aspect to the product beyond the nicotine, or the comparison with medicines.

One of the ongoing issues with e-cigarettes is the possible 'gateway effect'.  That is: if they're not properly regulated, young people will be able to easily get their hands on them, and then they might develop a nicotine addiction and graduate to the hard (harmful) stuff, 'real' tobacco.

Clive Bates has challenged this idea on his blog, and I'm inclined to agree with much of what he says.  However, it led to an exchange on Twitter with Andrew Brown, who pointed out this brand of e-cigarettes, which particularly plays on the connection with 'real' cigarettes.  The packs look like cigarette packets, even down to mimicry of the paper seal you sometimes get, and the e-cigs themselves look almost exactly like 'real' cigarettes, with a 'filter' and a white main section.  The tastes and strengths are described by direct comparisons with certain brands of cigarettes, the word 'smoke' is used right across the website and branding, and the advertising slogan appears to be it's "OK [to] enjoy smoking again".[1]

Andrew has posted very promptly on this, following another Twitter exchange today.  Because he's sensible, thoughtful, and expresses himself clearly, he's careful to note that he's not actually sure what the right action might be.  I'm going to have a go at pinning down what I think, as the next step in what could hopefully be a helpful debate, but as a result this has been dashed off quite quickly, so apologies if it's not as neat and clear as it might be.

The issue here, placing ourselves in the position of all-powerful regulator, is working out what we might want e-cigarettes to do - and what we might not want to see.  So, one of the advantages to making e-cigarettes look like 'real' cigarettes is that they might be more attractive to current smokers, hopefully shifting them to what is generally understood to be a less harmful pastime.  However, the flipside of this is the fear about the 'gateway': if they're so similar, what stops someone (generally understood to be younger) shifting the other way?  And, regardless of age, there's concern from organisations like the BMA that e-cigs, particularly if 'vaped' indoors and in public, will re-normalise smoking, unravelling the apparent effect of the smoking ban that has made smoking seem abnormal.  I can see how this could be the danger with a poster that might seem to say it's OK to smoke again.

You'll probably have noticed by now that I keep referring to 'real' cigarettes, when I could have used a word like 'conventional' or 'traditional'.  This is deliberate.  If e-cigs are seen as a replacement, then the possibility is that they're forever be understood as an imitation, an echo, a shadow of the 'real' thing.

Attending the Under Control conference last weekend got me thinking about the pleasures of drug-taking.  (Well I did drink some ether and plenty of beer.)  So did reading this book chapter by Steve Wakeman about novel psychoactive compounds (NPCs) or as they're more commonly know, legal highs.  The point is, there's pleasure potentially associated with lot of aspects of taking what's seen as an intoxicating substance: the social aspect; something approaching a 'pure' intoxication; conversely an ability not to feel intoxicated; perhaps the frisson of doing something illicit, or frowned upon, or dangerous.

Few people will find the final of these thrills as important as Wakeman's participants, one of whom decided that there wasn't much of a buzz in highs that were legal, and so decided to snort them off his dashboard while driving (though he waited till he was stopped at traffic lights - safety first, kids!).  However, as I've said before, there can be something of a frisson in smoking, knowing that it might kill you.  This could be particularly powerful when combined with the sense of invincibility of youth that means you don't really believe it'll kill you.

This idea of cigarettes as attractive in part because they're dangerous would, I'd suggest, only be strengthened by the view that they are the 'real' thing, in contrast to bowdlerised e-cigs.  Of course, if e-cigs are a nicotine replacement therapy, as the UK Government seems to think, then this is precisely the view that must be taken.  According to this view, and following Ingrid Walker's presentation at Under Control[2], the medicine (e-cigs) is likely to be presented as involving choice and health, compared to the destruction and failure of the tobacco.  (We're going back to Sarah Wollaston's strange claim that tobacco only brings bad breath, disease and death.)

I'd suggest that this perspective - whereby e-cigs are simply there to wean people off smoking - is one that governments can feel comfortable with.  This gives a reason for having an intoxicant on the market - it's there to divert people from another.  However, if we're serious about getting people to move away from tobacco, I'd suggest this dynamic of real/fake isn't helpful.  To some extent, OK-cigs know this, and that's (paradoxically) why they've gone out of their way to mimic traditional cigarettes: they want people to feel that their product is somehow real.

But my point would be that the mimicry can only go so far.  I think it would be more powerful to be able to say:

"Here's something - not a cigarette - that does the same thing, but better.  It gives a high, but without so much danger - and also with more choice of what the device looks like and what the vapour tastes like.  There's much more choice, and less danger."

OK, you lose some of the James Dean frisson, but you can present e-cigs as positive and something worth doing in their own right, rather than a healthy, diet, responsible version of smoking.  You'd also cut down the dangers of re-normalising smoking or offering a gateway to cigarettes.  It is clear that this is in the minds of some people who are currently selling e-cigs, with the shop in Camden quoted in this article sounding like it's trying to carve out a particular niche for the market.

This approach would also have positives in terms of resolving the Wetherspoon's issue.  At the moment, regulating indoor 'vaping' is difficult.  If device manufacturers stepped away from conventional mouldings (maybe branching out into something like these) then that would make it easier.  Perhaps there could be special categories for different types of e-cigs: if you wanted to go down the medicine route, fine, you could make the device look like a traditional cigarette; if you wanted to market it as a new nicotine product, then you have to deliberately move away from mimicry.  Of course, there'd be difficulties in setting down guidelines like this clearly, but there'd be some merit - and it does happen in the field of BB guns, which can't look too much like 'real' guns.

Of course the reason the Government wouldn't feel comfortable with this is that it would be licensing something that could be labelled a new intoxicant.  Although I can't go into it here, I see a general reluctance to countenance the pleasure of intoxication in itself by government, and in this case there's also the additional factor that the drug (nicotine itself, not found in tobacco) cannot be dressed up as 'natural'.  However, in the context of 'legal highs', which governments around the world have struggled to regulate for, there's the possibility that these sorts of debates will be forced to move to new ground.  E-cigarettes are a much easier target than Benzo Fury or the latest NPC, but it's hard not to see the inconsistency in the situation.

Caffeinated drinks offer an interesting comparison.  Coffee or tea might be constructed as 'natural', but Red Bull and Relentless are not.  They are presented in the 'hit' or 'kick' formula that's familiar from the alcohol industry's response to rave culture.  I have heard youth workers and those involved in drug treatment express concern that these could be the next major issue for the substance misuse sector.[3]  And yet they are legal.

There are all sorts of other issues involved in this debate, which I don't have time to discuss here.  Most notably: first, the involvement of 'big tobacco', which I think could actually potentially be a positive thing (imagine if those interests were shifted to selling something less harmful); and second, the nature of addiction and free choice within a market.  However, I'm happy to leave this post with this question: why shouldn't e-cigarettes operate a little like energy drinks, carving out a market niche distinct from their traditional (natural) forebears?  There's plenty of possible challenges to this position - perhaps most powerfully something thinking about addiction - but I'd suggest it's an interesting alternative starting point for thinking about the issue, rather than seeing e-cigs as re-packaged nicotine inhalers.

[1]Alasdair Forsyth has made the interesting point that this approach might be in breach of a code or law, as the e-cigs don't actually produce any smoke...

[2]I should say that I might be mis-representing this as I'm getting it second-hand - I couldn't go as I felt I ought to think of the day-job and go to presentations (which were themselves fascinating) about methadone maintenance and safe injecting rooms.

[3]I think this is somewhat overstating the case, with there still being plenty of heroin use across the country, not to mention ketamine and mephedrone.

Public health realpolitik

I've written two posts recently about the role of the industry in alcohol and tobacco policy.  The principle behind these was that, following a particular model of how policymaking could or should be done, there's a role for both industries - so long as it's at the right stage of the process: defining what's a problem about tobacco or alcohol, and what sort of government actions are legitimate.  There's less of a role for the industry (if any) in assessing the validity of research evidence.

I started to think about this issue again recently when the Daily Express, amongst others, ran a story noting that the risk of cancer increased with the consumption of just two drinks in a year.  Some responded to this idea by suggesting that the public health lobby was in danger of becoming a 'lunatic fringe', and comparing it to the temperance movement.

This critique is based on the idea that such a small level of risk is largely irrelevant to people who don't live their lives as risk minimisers.  There's also the additional concern around 'crying wolf' that I've noted before with reference to 'binge' drinking social marketing: if you tell people a couple of drinks a year (or even a month) is seriously bad for you, then they might not listen when you're telling them that more than 21 units a week is genuinely risky (if that's a more important message to get across).

There are some fundamental arguments here about the nature of alcohol and the role of public health professionals and researchers.  One of the key distinctions between smoking and drinking in terms of public health ambitions and tactics, apart from the issue of passive smoking, is that there is generally considered to be a 'safe' limit of alcohol consumption.  Indeed, sometimes certain amounts of alcohol are understood to be beneficial.  This impression is only strengthened by 'responsible' or 'sensible' consumption levels, which then offer a concept on which to hang a narrative that constructs your own drinking as unproblematic.*

The presentation of this sort of finding that two beers a year might harm your health could be seen as attempt to change this impression.  If just two beers a year can increase risk levels, then the message seems to be that there's no safe level of consumption.  This is certainly what Stephen McGowan thought on Twitter, and to some extent it seems to be the motivation of Ian Gilmore in commenting on the findings that drinking even within the government guidelines can be risky and has links with cancer.

There are genuine arguments here about how best to communicate public health messages.  However, I'm not sure that this is actually based on calculations about how to best to engage people or change their approach to alcohol.  It seems more sensible to view it in the context of the arguments about the appropriate role of the alcohol industry in policymaking and the assessment of evidence.

Taking this perspective, the whole approach of both 'sides' in the debate (public health and the industry) is somewhat dispiriting.  On the one hand the industry steps in to rubbish research findings, when what it's really saying is that regulation of the industry doesn't fit the principles of maintaining the free market and personal responsibility that the government is often keen on in other contexts.  On the other, public health lobbyists are driven to stress that any form of alcohol consumption is problematic, in order to compete with the attempts of the industry to downplay the link between consumption and health harm.

Neither of these positions is helpful for an open, clear debate.  I can get particularly frustrated with a public health position because I think there's real opportunities for great work in this area.  With the move to local authorities there could be steps to improve wellbeing by integrating work with transport networks to encourage walking and cycling, with schools to encourage healthy eating, and with adult and community services to look at fostering the sort of social capital that we know improves health in the long term.  There's the opportunity to take a broader view of people's health, and really consider the wellbeing element as well as health as the absence of sickness.

However, the sort of risk minimisation approach symbolised by the 'two beers' story and all the talk of 'avoidable deaths' is too narrow.  Risk is unavoidable, and all lives end in death.  This isn't just about a critique of the Longer Lives project; I want to suggest that a grown-up debate about wellbeing would accept that sometimes drinking at a 'risky' level could still be beneficial for someone's wellbeing - particularly later in life.  (And this is in addition to the point I've made before about how rationalism needn't be a universal aspiration.)

The reason the public health lobby can't bring itself to do this, I'd suggest, is that it sees itself as locked into some kind of dialectical confrontation with the alcohol industry.  It's taking the view of a hardened haggler in a market: start with a ridiculously low offer, and you'll end up with something reasonable and acceptable, because the seller will start with a price far higher than the item's worth.

I'd suggest that this kind of adversarial approach does nobody any favours.  Public health gets branded as a 'lunatic fringe', and the industry gets labelled as misrepresenting, distorting and undermining research evidence.  Drinkers probably simply get on with their lives none the wiser either way.

My soft spot for corporatism wants me to suggest that this would be the solution, getting everyone together to discuss the issues.  But actually this is a little naive.  I forget that this approach brought down both Tory and Labour governments in the 1970s.  To some extent you could see corporatism, with its views of opposing factions, as cementing this adversarial approach.

But, in that case, how else can we approach policymaking?  How can we ensure that stakeholders take a grown-up approach?  That fundamentally requires a certain level of trust from both sides that the other will be sensible too.  It requires the different players to understand their roles, and stick to them.  Public health won't want to stop (excessively) highlighting the health harms alcohol can cause while the industry keeps its current tack, as that would mean the overall balance of the message to the public on alcohol would be (in their eyes) too positive.

The only way to encourage this that I can see is to have a strong government that is clear about the different roles of the various stakeholders in the policy-making process.  I can't see that being the government we have now.

*This is particularly the case when 'binge' drinking is largely defined in terms of an attitude towards to alcohol (drinking to get drunk), and so those who deny this motivation are able to construct an idea of 'responsibility' that isn't exactly what the public health lobby, at least, would like to see.

Tobacco funding think tanks

A week ago, The Observer reported that the Adam Smith Institute and the Institute for Economic Affairs both accepted funding from 'Big Tobacco'.  Most people, I would have thought, would find this unsurprising.  I certainly did, but more importantly I don't find it particularly shocking or outrageous.

 

I'm slightly concerned about writing this post, as it could be read as support for the tobacco industry, and some might see it as naive at best in seeing them as having a legitimate role in society.  I want to make it clear that this isn't what I'm suggesting (or even discussing).  I think it's fair to say that the industry has not always accepted responsibility where it might, and I'm of the opinion that if tobacco were discovered today I wouldn't want it to be legal.  However, we are currently living in a country where tobacco is legal and it is important to analyse how people understand policymaking in relation to this issue.  I want to suggest that a black and white, good and evil framework for understanding the issues is unhelpful, and may serve to fuel people's opposition to public health aims.

 

As a starting point, it's worth noting that the fundamental basis for the industry funding of think tanks being a news story worthy of attention is that there is some concern about transparency: perhaps the ASI and IEA were being secretive about who gives them money, which potentially contradicts WHO guidelines.

 

I'd certainly want this information to be openly available, for reasons I'll discuss later, but this wasn't actually the tone of the article and people's responses to it.  According to ASH Chief Exec, accepting tobacco funding 'completely undermines' one's position on related policies.  David Nutt remarked in mock-shock on Twitter 'And they're influencing govt policy?'  Neither of these objections is based on the apparent secrecy; they're attacking the more fundamental (rather than procedural) point that the tobacco industry shouldn't influence government policy, however indirectly.

 

Setting aside the issue of transparency (which admittedly is genuinely serious and raises fundamental questions about the role of business in policymaking), there are two reasons why I'm not perturbed - or at least, don't think this funding is illegitimate or shocking.

 

First, I've got a bit of a soft spot for corporatist, stakeholder government/decision-making, which probably influences how I start to think about the issue.  This is probably in part a romanticising of beer and sandwiches and life before Thatcherism - and it's certainly a romanticising of the role the tobacco industry has played in policy debates over the years.

 

However, it does have a sound basis simply because most policy issues have multiple implications and almost infinite possible perspectives, as I've suggested before here and here.  All policy-making is something of a compromise, so it's probably helpful to listen to a range of perspectives and points.  The tobacco industry will obviously defend itself, but then you'd also listen to a public health perspective, or someone with a more critical view of the role of corporations and profit in society.

 

Now, this might seem in contradiction of the WHO guidance on tobacco and policymaking, but actually what those guidelines talk about is partnership between government and industry, and voluntary codes of regulation.  They don't suggest banning the industry expressing its views as much as actually participating in the drafting of policy.

 

The second reason I'm not so shocked is that I think I take a slightly different approach to people's motivations.

 

The tobacco industry, like the alcohol industry, will use liberal (or libertarian) arguments to claim that individual consumers' choices should be respected and it's simply supplying a legal product in a regulated market.  On the other hand, some public health campaigners would characterise big tobacco as 'evil', self-interested and calculating - or even say that 'evil' isn't a strong enough word.

 

I'm interested here in analysing these ideas of free market liberalism presented by the industry.  I would emphasise at this point that worldviews and ideology aren't neutral, consistent, coherent, objective or independent and impartial.  My worldview is likely to say something about my background and my current activities (though it won't entirely explain them or be consistent with them).  This is partly because I might try to do things that are consistent with some set of values I consider to be important to me.  However, it's also because a worldview is in some senses a rationalisation of where we find ourselves, to help ensure some kind of psychological coherence.*

 

That people who work for tobacco firms have free market views isn't just a front; it's likely to be both cause and effect of their working for these firms.  It would be hard to work for an industry if you didn't, at some level, believe in some principles that make the tasks you undertake legitimate, even if this is some warped notion of the 'invisible hand' and the magic of the market that sees individuals' selfishness as part of a functioning mechanism that delivers positive outcomes for all.

 

The think tanks the Observer article mentions have mission statements that fit perfectly with such an outlook on political economy:

 

            The IEA is the UK's original free-market think-tank, founded in 1955. Our   mission is to improve understanding of the fundamental institutions of a free           society by analysing and expounding the role of markets in solving economic     and social problems.

            The Adam Smith Institute ... works to promote libertarian and free market    ideas ... the Institute is today at the forefront of making the case for free   markets and a free society in the United Kingdom.

I might be being generous, but I would suggest that those working for these think tanks 'genuinely' believe in these principles, rather than seeing themselves as some kind of Trojan Horse or entryists changing the nature of political debate to benefit their sectional interests.  Their acceptance of tobacco money should not be seen as some kind of Faustian pact, because this is not how they would see it.  Rather, it should be understood as the coming together of two similarly-minded actors in the policy debate.

 

It is not simply because they're taking tobacco money that the IEA and ASI are against increased regulation of the tobacco industry; the tobacco industry supports these particular think tanks because they are against industry regulation to begin with.  The same arguments apply to Labour and the unions, for example.

 

This is not a one-way causal relationship, as I've already suggested, and as such this is the point where the importance of transparency comes in.  Worldviews are not neutral, objective or impartial; they are particular perspectives, which owe something to the position and experiences of their adherents.  It's not unimportant that free market ideology in this context benefits big tobacco, and so if the argument is coming from this perspective, that might mean something different than if the claim is coming from a public health expert.  If organisations aren't clear about the sources of their funding it makes it more difficult to assess their perspective.

 

However, this is quite a different thing to considering the view irrelevant or illegitimate.  The public health perspective is equally as partial when it claims that smoking 'brings nothing but bad breath disease & death'.  The questions are about balancing freedom, profit, health, pleasure - and at a societal level, not as an individual, personal decision.

 

We don't get any closer to a resolution of the issue by framing the debate as a battle of good and evil.  Instead we should debate openly the principles that should underlie tobacco policy, the perceived problems and benefits of smoking and the industry according to these principles, and then assess proposals as potential solutions to these.  We're not helped in this if we see think tanks as amoral puppets of an amoral tobacco industry.

 

*I'm not saying that we ever achieve this kind of coherence - and crucially, it's not entirely conscious or calculating, just like worldviews themselves.  (Otherwise we wouldn't need analysis; people would just tell us what they think and that would be that.)  This is a common way of looking at how people understand and negotiate the world across the social sciences, not just in psychology.  The idea of habitus outlined by Bourdieu and others is one example.

Plain packaging versus minimum pricing

This is a new thing for me: an attempt to write a genuinely short blog post.  (We'll see how that goes...)

Andrew Brown over at Mentor has written a blog post about a YouGov survey looking at various attitudes people have at the moment, which includes some stats on plain (in fact most likely standardised) packaging for tobacco and minimum unit pricing (MUP) for alcohol.

Andrew wonders whether this is to do with the messages around the values behind Public Health, or that tobacco control messages have been around for longer, or simply that people think plain - sorry, standardised - packaging doesn't have a (direct) cost to them, the consumer, where MUP would.

So many thoughts occurred to me that I thought rather than leaving a comment or trying to condense things into a tweet or two, I'd do my usual and expand this out into a rambling post.  I would stress that these are just some thoughts, and I'd love comments or feedback via comments below or Twitter.

My immediate thought was: have they controlled for whether people are smokers/drinkers?  We're obviously going to care more about a policy that directly affects us, so that's quite important.  I can't see any evidence that they have, and this brings us onto a couple of wider points about cultural attitudes.

First, more people in the UK drink than smoke - pretty much the same proportions of men smoked at all as drank at twice the recommended limits in 2011.  That means (and reflects the fact) that drinking is more commonplace than smoking, which is reflected in (and the result of) wider aspects of society.  There's something about the place of alcohol in society and British history that is telling, and this is reflected in literature, for example. I can immediately think of plenty examples of drinking and literature (my personal favourites being Alan Sillitoe and Thomas Hardy), where the only example of smoking taking a prominent role in literature that occurs to me straightaway is Tolkein.  More substantively, we have pubs but we don't really have smoking clubs (at least, not in the aftermath of the ban).

Second, there's an idea of 'safe' drinking, which is crucial.  Despite in my view it being a mistaken and unhelpful position to take, it's not uncommon to hear it voiced that, for example, smoking 'brings nothing but bad breath disease & death'.*  The common argument in favour of the smoking ban over the years is that there is no safe level of (second-hand) smoke.  Contrast this with the impression (sometimes challenged) given by the 'recommended' limits that there is a 'safe' level of drinking.

Drinking, therefore, is not seen as an unequivocal vice.  There is an elusive practice called 'responsible drinking'.  This might be, as Andrew suggests, because anti-tobacco lobbying has been around for longer, but it's also about the importance of alcohol in our culture even before this.  Nights out, venues, 'keying' of time, have long centred on alcohol, and never really on tobacco.  Alcohol is associated with good times and bad.  Weddings and funerals would be (almost) unthinkable without alcohol for many in Britain; the same couldn't be said for tobacco and many social situations.

This takes on crucial importance when we think about how the measures described - plain packaging and MUP - are universal.

I've written previously about how MUP is understood (or at least portrayed) by the Coalition - or more specifically Cameron - as a targeted measure.  James Morris has persuasively argued that the logic of MUP is based on a population model of public health, but equally the debate continues as to who the measure will affect and how hard.

The point here is that these aren't 'Booze ASBOs' or sobriety orders, which target those who are seen to have transgressed.  Under MUP everyone who buys alcohol would do so in a regulated market (and everyone who smokes would have to smoke cigarettes bought in plan packets - though perhaps the market for cigarette cases would boom?).  That is, whether or not there would necessarily be a material effect on all drinkers, which is still debatable, the starting position is that alcohol is by definition problematic.  This isn't an easy fit with ideas of 'responsible drinking'.

In my research, I found that even amongst those going out drinking on a Friday night on the night-time high street, who might be classed as 'binge' drinkers, there was an amazing tendency and ability to distinguish oneself from those 'other' drinkers who were the real issue.  People might drink a lot but they're not about to start a fight.  They might end up drunk, but they'd never drink to get drunk; they drink for the taste and the drunkenness is just an almost irrelevant byproduct.  And so on.

I've argued before that attempts to govern by concepts ('responsible', 'moderate', 'binge', 'excessive') is difficult, because people have a tendency to want to justify their own behaviour to themselves and others, whether consciously or not.  Give them an idea of responsible drinking, and a particular model of irresponsible drinking, and most people won't see themselves in the irresponsible camp.  (And conversely, for those that do, this is often seen as amusing and precisely what's being aimed for: trangression of norms established by perceived authorities such as governments.)

So what's my answer to Andrew's question of why we tend to see MUP as unacceptable?  I think it's because MUP hints that, actually, for every single one of us, alcohol is no ordinary commodity, and, although that's its primary attraction, it's also something we don't really want to hear.

(And there we go, I didn't keep it short.) 

Addition, 17^th May 2013
Partly because it doesn’t so directly relate to the public’s perception of drinking versus smoking (though it’s crucial in the background) I’ve forgotten to mention here one of the key points that I’ll often bore people with.  Public Health often draw the key comparison between the two practices, citing how smoking has declined considerably over the past 40 years, and how alcohol policy and harm reduction should learn from anti-smoking campaigns (and sometimes other behavioural changes, such as seat belt use).  (I noticed this at the recent Alcohol and British Society conference, for example.)  The key difference is the idea of passive smoking.  The smoking ban was able to gain public support not as a paternalistic measure, but as a liberal one, in line with JS Mill’s harm principle: your smoking would not just harm yourself, but me too.  Despite this, it is still judged on whether it has lowered general smoking prevalence, and this is partly where the difficulty for the smoking-drinking analogy lies.  Passive drinking, despite the efforts of Liam Donaldson, hasn’t caught on as a concept.  Of course all these aspects of the culture are mutually reinforcing: this difference is partly what allows alcohol to have such a central role in British society, but it’s also that central role that makes us less likely to accept Donaldson’s point.  And so on. 

*I think we have to acknowledge the pleasures of intoxication and trangression, which includes the very thing that motivates Wollaston: smoking kills.  Smokers know this, and this is partly why it is transgressive and offers a devil-may-care allure.  If we ignore these points, then we can't possibly build an effective harm reduction strategy.

**Personally, I think that even the Sheffield work has neglected the fact that pricing policies aren't solely based on cost: if your £3.50 wine becomes £4.50, the £4.50 wine isn't going to stay at the same price; there's an incentive for there to be a differential.  Looking at how tobacco pricing strategies have coped with increased taxes, there's sure to be some complicated dynamics regarding the pricing strategies for the lower and higher ends of the market, but it's certainly hard to say that people currently consuming above the MUP floor won't be affected.

A Postliberal Public?

Despite it dating from 22nd April, as far as I can see, today has seen the Joseph Rowntree Foundation (JRF) publicising – and the media picking up on – a report they commissioned from NatCen based on the British Social Attitudes survey.

As you’ll see if you look at the Guardian and Telegraph links, the story the media have tended to run with is that Labour supporters especially – but the population generally – have shifted from societal explanations for poverty to those emphasising laziness in particular. That is, we’re much more likely to see poverty as an individual’s fault now, as opposed to in 1986 (with the highpoint of societal explanations over that period in the first half of the 1990s).

The survey offered for options for people to answer the question “Why do you think there are people who live in need?”

• ‘Inevitable in modern life’ (the most popular throughout);


• ‘Laziness’;


• ‘Injustice in society’; or simply


• ‘Unlucky’

I noted in a previous post that recently there’s been a lot of discussion of how postliberalism might be an appropriate way of characterising current political trends in the aftermath of the financial crisis.  Individual decision-making and market mechanisms are viewed with more suspicion than they used to be, according to Will Davies for example.

 

The findings of this JRF/NatCen report got me thinking again about these ideas.  Although I didn’t state it in the end in the blog post, one initial response I had to these suggestions of postliberalism was that the political elite remained neoliberal, but I could perhaps allow that the British public might be postliberal.*

 

This is the argument of David Goodhart with respect to immigration: his ‘political tribe of north London liberals’ has been divorced for some time from broader ‘public opinion’.  You’ll also find it in the work of Blue Labour, with Maurice Glasman arguing that ‘The lessons of New Labour are not to have a contemptuous attitude to the lived experiences of people but work within them to craft a common story of what went wrong and how things can be better’.  Or in Philip Blond’s Red Toryism, which argues that we have become a ‘bi-polar’ nation, divided between government and populus.

 

This idea has particularly come to the fore with the ‘UKIP surge’ in the 2013 local elections.  Max Wind-Cowie, amongst others, has argued that UKIP is picking up votes from those who feel abandoned by the ‘excesses of both social and economic liberalism’ from both Labour and the Tories.  He advises that both parties could ‘grasp the post-liberal nettle’ and win these voters back, and still avoid some of the simply ‘illiberal’ policies that UKIP promotes.

 

In this sense, these arguments are consistent with what I’ve said before: neoliberalism is still alive and well in the corridors of power.

 

However, the other side of these arguments about a disconnect between voters and parties is that the public at large is ‘post-liberal’ – and this claim is certainly questionable.

 

As I’ve mentioned before, Thatcher sought to change the heart and soul of the nation, and in the discussion of her legacy – just weeks before her death – the consensus seemed to be that she had succeeded (‘she changed everything’, The Independent told us); the only question was whether this was a good or a bad thing.  Britain was now a Thatcherite nation.

 

To some extent, this tension is about the way we see UKIP and Thatcherism.  Max Wind-Cowie obviously sees UKIP as postliberal, but at the same time parallels are drawn between the ability of both Margaret Thatcher and Nigel Farage to win working-class votes with right-wing policies, and there’s certainly a strong case to be made that Thatcherism has more than a little neoliberalism in it.

 

I’d understand the recent evidence – UKIP voting and British Social Attitudes surveying – as pointing to the possibility that in fact the British public remain in some sense Thatcher’s children, and as such neoliberal.

 

On UKIP, Farage smokes, drinks and has an idea of a Little England centred around the pub (“every pub is a parliament”) – but his opposition to the smoking ban or minimum unit pricing (MUP) is an opposition not to neoliberalism, but paternalism.  His rationale for opposing the smoking ban, for example, is that it is ‘illiberal’.  This is exactly one of the words quoted from ‘Senior Conservatives and Liberal Democrats’ to explain the Cabinet wobble over MUP.

 

Immediately, this raises the suspicion that, despite its opposition to the free movement of labour, UKIP is more neoliberal than postliberal.

 

This impression is only strengthened when I think about how much of UKIP’s brand of euroscepticism rests on opposition to the Social Chapter and all those features that conversely led many within Labour to become pro-European, seeing the EU no longer as a ‘capitalist club’, but more as a brake on 1980s neoliberalism.  This is certainly how I grew up seeing the EU, and was shocked to find such euroscepticism amongst older Labour Party members.

 

Going back to the British Social Attitudes survey data, a key feature of neoliberalism understood in the way outlined in that previous post is the maintenance and expansion of marketised structures alongside a tendency to place responsibility for any undesirable outcomes on individual citizen-consumers.  That approach would imply seeing poverty as a result of individual failings rather than structural causes, in line with many respondents to the survey.

 

The prevalence of this worldview, represented by a falling number of people have seen poverty as caused by ‘injustice in society’, is at odds with an understanding that the public are somehow postliberal.  An awareness of how people are interdependent and the importance of solidarity (which are key themes of the work of all three) would surely mean that more people than currently would see poverty and general life chances as significantly determined by a lottery of birth and the structures of the world we live in, rather than reflecting underlying personal value or effort.**

 

And when I’ve read the work of people like Blond, Glasman and Goodhart I’ve got the impression that they do feel the public is fundamentally postliberal, as I’ve said.

 

But perhaps this is to look at things the wrong way.  What Blue Labour, Red Toryism, David Goodhart etc are saying is that the flaws of UK† society today are partly the result of politicians’ failures to see the importance of community and local relationships.  Certainly, living in a small town set in the Dorset countryside where I’ve found these elements more accessible has made me happier and more comfortable than living in E15 or E17, where I’d lived the two years prior to moving here.‡

 

Taking these approaches as recommendations for improving British political life, then, rather than descriptions of the wider polity, maybe there’s something in them.  And perhaps, if Jonathan Rutherford is to be believed and Blue Labour is seen as drawing on some kind of ‘English modernity’ like the New Left of people like EP Thompson and Raymond Williams, then such a political philosophy might tap into that ‘Little England’ theme of UKIP’s – and in a more positive way.  This is certainly what Blond and Glasman would like to see their parties doing.  They understand people as voting UKIP because there isn’t a mainstream party that seems to understand their concerns (even if they wouldn’t articulate them now in quite the postliberal language of the commentariat).

 

However, it’s one thing to say ‘this is what I would like to see politicians talk about’; it’s another to say ‘this is what will win you elections’.  Postliberalism at the moment, I’d suggest, remains more of a political recommendation than a characterisation of the electorate.  There might be elements within UKIP’s agenda that this approach could tap into, as Max Wind-Cowie suggests, but it’s hard to see postliberalism as an electoral panacea for either Labour or the Conservatives, or to think that it will instantly resonate with the electorate now.

 

Of course, with Thatcherism in mind, I would argue that it’s possible for particular discourses and policies to in themselves change the weather, so that you make your own luck, but this can take time and power.

 

At the moment, I’d suggest that David Cameron expresses it pretty well: we’re all Thatcherites now, but then again maybe we’re not.  Certainly the effects of that individualistic (even neoliberal) worldview can still be felt – and not just in the corridors of power.  Politicians maybe aren’t so distant from the rest of us as the postliberals might have us believe.

 

*Although if they’d never been neoliberal, or even liberal, it’s hard to see how they would be postliberal rather than simply communitarian.
** To some extent the particular decline in the societal explanation amongst Labour supporters might have more to do with tribal loyalty than a particular worldview: wanting to believe that the party has done as much as it can, so any residual poverty will be the fault of the individual rather than the government.  However, in terms of effects, this still amounts to a neoliberal view that at least up to 2010 was remaining pretty resilient.
†In ‘A Note on Language’ at the beginning of his book The British Dream, Goodhart explains: ‘I generally use the word Britain when I really mean the United Kingdom.’  How to wind up someone with (some) Ulster heritage…
‡Though I should point out, in liberal fashion, that living here wouldn’t suit everyone, and some people would probably feel more comfortable and welcomed than others.

MUP in Scotland

As you’ll realise if you’ve been able to see anything in the news today apart from the (reliably predicted) UKIP surge in the local elections, the challenge to MUP in Scotland brought by the Scottish Whisky Association and others has been rejected by Lord Doherty.

Plenty has been written about this already by other people (just check the Twitter feed of Stephen McGowan).  What I wanted to do at this point is think through how this relates to what I said the other day about industry involvement in the policy-making process.

Fundamentally, thinking back to my view of the appropriate role of the industry, this ‘petition’ was an attempt to shut the stable door after the horse has bolted.  I understand the motivation – to mitigate any effects, avoid setting a precedent, and take a symbolic stand against regulation – but the judgement basically makes precisely this point: all the evidence and arguments have already been discussed, and the decision has been reached on the basis of a perfectly reasonable process.

The whole debate is structured around whether the action is reasonable and proportionate to the problem.  Notably, the idea of there being a ‘problem’ of ‘excessive consumption of alcohol’ is taken as given.  (There would certainly be some mileage in a detailed analysis of how class is understood in this judgement.)

For the industry – and in fact for England in general – this is a great opportunity.  Although the two countries are not identical, this offers that rare opportunity in policy-making: a pilot project with the opportunity for simultaneous comparison.  We can have a look at how MUP works in Scotland, with the English as a (rather unscientific) control group.  Of course, the Canadian case already offers comparisons between different areas with different systems, but if we’re honest a comparison closer to home will always have more impact.  There will of course be complications, such as the economic recovery potentially advancing at different rates, and the fact that we start with somewhat different longer-term trends in consumption, but the comparison should still be instructive.

But this doesn’t mean that the industry should be preparing all the ways to rubbish the evidence from the Scottish case.  First, some research suggests that regulation might benefit both public health and the industry.  Second – and to my mind more importantly – if England did wait and see before implementing MUP (as seems likely even if this isn’t for scientific reasons), the lull would give the industry the opportunity to set aside their attempts to rubbish the evidence on public health, and instead develop and communicate all those arguments that they have thus far strikingly failed to do.

So here’s to a genuinely informed, intelligent, rounded debate…