David Beckham and Public Health

Yesterday, a story about alcohol got a fair bit of attention – David Beckham (and his manager Simon Fuller) are to promote a new whisky made by Diageo (when it’s actually launched later in the year).

Alcohol Concern were so agitated they put out a press release, and other groups like ‘It’s the drink talking’ complained about it on Twitter.

Initially, I was at a loss as to why this was an issue of concern – celebrity endorses alcoholic drink is hardly news (just look on http://www.thedrinksbusiness.com/).  My tweets on the issue were even favourited by Mark Baird from Diageo, though many people reading this won’t consider that an endorsement worth having.

But then John Holmes pointed out that this is about the association between alcohol and social and sporting success.  That sort of objection would make sense, as it’s against the ASA code.

So why was I initially annoyed?  Well, the actual objections I saw didn’t talk about sport or social success: they actually referred to David Beckham being healthy and appealing to children.

I don’t have the relevant marketing data, but the idea of David Beckham being used to market alcohol to children seems unlikely, given that he was at the height of his powers more than ten years ago – as the Diageo press release observes, he won the Champions’ League in 1999 and was runner-up for the FIFA player of the year award in 1999 and 2001.  Most ‘children’ won’t have any real memories of those seasons.

As for health promotion, this gets to the heart of the objection: there’s a belief that you can’t be healthy and drink, or that promotion of alcohol is necessarily incompatible with health objectives – which trump all else.

This is where the campaigners are on difficult ground.  Regardless of the ‘sick quitter’ hypothesis, it’s not generally felt that low levels of alcohol consumption make much difference to an individual’s health one way or the other (though they might have noticeable effects at a population level).

I’m also not convinced that David Beckham’s going to be fronting some campaign that promotes specifically high levels of alcohol consumption that would be incompatible with ‘a healthy lifestyle’, to use an awful phrase.  It’s more likely that the campaign will play on the sorts of themes his others have gone for in recent years: the impression of style, fashion and sophistication.

Of course we can argue about whether any campaign that makes alcohol seem sophisticated and respectable is a good thing, and whether the industry is sincerely promoting moderate consumption.

And that’s where the debate should be.  The objections aren’t to David Beckham promoting alcohol; they’re to alcohol being promoted.

This is why I was frustrated.  There’s nothing wrong with Alcohol Concern and other organisations objecting to alcohol advertising, particularly as alcohol is ‘no ordinary commodity’, and therefore needs special regulation.  My objection is that there’s nothing specifically wrong with David Beckham promoting alcohol.  I struggle to see even how he’s associated with sporting success at the moment.  He’ll be shown drinking the whisky a year after retiring, and more than 15 years after winning the Champions’ League; no-one watching is going to be thinking he’ll be up the next day winning the World Cup.

The point is that we should be having the argument that actually matters: should alcohol advertising be allowed, and if so, with what restrictions?  Then we can clearly ‘think to some purpose’ about the actual issue in hand.  Let’s not get distracted into thinking this is about whether David Beckham should be advertising whisky.  Knee-jerk responses just aren’t helpful in having a sensible debate.

Flirting with diversity and being open-minded

As an (occasional) academic, it’s good to be reminded that, amongst the pressures to have a clear argument that distinguishes my work from other people’s, I am able to change my mind and think again about certain issues.  On Wednesday, talking to the fascinating Rob Hazell from Flirt café bar in Bournemouth, I started to think afresh about alcohol and the night-time economy in Bournemouth.

When asked about my PhD, I’ve sometimes described it as an attempt to rehabilitate ‘binge’ drinking.

That’s not quite true, but one of the key arguments is that the ‘night-time high street’ is hugely varied, particularly when you focus on different people out drinking think about their own and others’ behaviour.

The idea of a monolithic ‘binge’ drinking culture is attractive to certain parts of the media, because it allows them to run stories that paint people’s behaviour as some sort of crisis.

However, it’s not just the media that paint this picture; academics do it too.  The work of lots of them identifies a ‘culture of intoxication’ and places this in the context of a liberalisation of alcohol regulation in the UK, and the dominance of a few big companies who, in some of the more extreme versions of this interpretation, are seen as having ‘seduced’ young people into drinking excessively.

My argument has always been that people are much more intelligent than this, and are able to create their own meanings for different practices and people within this apparently ‘homogenised’ landscape of night-time drinking.

The ‘industry’ certainly knows there’s a desire for (perceived) variety and diversity – but some academics have been quick to describe this as only the illusion of heterogeneity.

In my PhD, I argued that actually the apparently superficial distinctions within this homogeneity are crucial for understanding alcohol use in Britain – whatever your perspective or aim.  If you want to change their behaviour, it’s no good dismissing (young) drinkers as a homogeneous group, because they won’t all respond to the same messages.  (Of course, the interpretation that sees young drinkers largely as pawns in a corporately-controlled world doesn’t think there’s any point in talking to those possessed by false consciousness.)

Because of the way ideas like ‘diversity’ and ‘balance’ and a ‘mixed’ night-time economy have been used, I’ve been very sceptical of them.  Bev Skeggs has a great concept of the ‘cosmopolitan limit’ – a lot of categories, or types of ‘diversity’ are considered desirable, but some categories (or types of people) are excluded from this.  I found this very clearly in my research, where ‘chavs’ were excluded from a specific venue that was lauded for having a ‘mix’ of ‘different’ customers.

Similarly, when local officials talk about encouraging a better ‘mix’ or ‘balance’ of venue types, they’re often really looking for a different drinking style to dominate – ‘balance’ doesn’t mean a range of venues, it means moderation and balance in one’s approach to drinking.  Something completely at odds with what might be called ‘binge’ drinking (but I would call the ‘carnivalesque’.)

That is, the idea of ‘diversity’ can be exclusionary.

So when venues trumpet the ‘diversity’ of their clientele, I’m naturally suspicious of who might be excluded from that group.

So I was pleasantly surprised on Wednesday afternoon, when Rob Hazell won me over.  He talked about the diversity of Flirt’s clientele, and how the bar is considered a safe space for a whole range of people within the town.  Now, it might not have absolutely every type of person in the town, but it does have a variety, and actually I believed it was more than a business to Rob and co-founder Peter.  The place had evolved from genuine values and vision.

Now contrast this with 60 Million Postcards.  I had chosen these two venues to talk to, because they were picked out as examples of good practice in a 2012 report called ‘Bournemouth by Night’ produced by Feria Urbanism for Bournemouth Council.

The manager from 60 Million told me that he wasn’t allowed to participate in an interview that might lead to a publication, and that I should get in touch with head office.  To be fair, I only sent them an email a few days ago, but I haven’t had a reply – whereas Rob was keen, prompt and communicative when he realised he might be late for our time slot.

As you can tell from my description of some of the academic work on the night-time economy, I’m not terribly fond of the interpretation that emphasises the corporate ownership behind the options available to young people – because these analyses tend to suggest people are cultural dupes.

However, I started to think again about this in another moment of open-mindedness in December, when I saw Rob Hollands (the external examiner for my PhD, incidentally, though he wasn’t effusive about it!) at the Drinking Dilemmas conference run by the BSA Alcohol Study Group.  I’m not hugely keen on Rob’s vision of the ideal night-time economy, and it is just that: a personal preference.  He was talking favourably about squats and free raves, or alternatively a (formerly) working-class pub in Newcastle near his house, which has philosophy nights and such, and counts amongst its clientele social workers, teachers, academics and so on.

Personally, I find these venues and nights out cringeworthy; I’m perfectly happy in my Palmer’s or even Marston’s pub that hasn’t been gentrified (sadly, most of the Hall and Wodehouse ones around me seem to be being gentrified), and for someone reason I find ‘philosophy in the pub’ or ‘café scientifique’ nights somehow a bit awkward and embarrassing.  I don’t generally like the idea of cultural expertise, or connoisseurship, or intellectualism in that sense – and I enjoy getting drunk*, and have a suspicion that a lot of this is artifice hiding the fact that other people like that too.

However, on this occasion, I genuinely thought again about Rob’s vision of the ideal night-time economy.  The key point that made me think again was the issue with corporate ownership: although the night-time economy is seen as being good for local prosperity, most of the money spent in these venues will leave the area, and not be spent in other local businesses.  Head office won’t be in the local area, and the managers will often be brought in from a central pool, rather than being local residents, and so on.

When I looked at the Mitchells and Butlers website, to get the details for how to contact head office to see if I could talk to the manager at 60 Million, I saw the huge range (and variety) of venue brands they own.  As well as Toby and Crown Carveries, O’Neill’s and All Bar One (to name just a few) they also run the Castle brand of pubs, described as ‘pubs with true individuality’, and the ‘Village Pub and Kitchen’ chain – ‘a small group of pubs with an independent […er…] spirit’.  That is, they’re aiming to attract precisely those people who try to distinguish themselves from the ‘mainstream’ of the night-time economy (arguably symbolised by venues such as O’Neill’s and All Bar One).

Somehow, this form of ownership feeds perfectly into my discomfort with the idea of ‘diversity’ and ‘difference’: it’s really just another way to distinguish people from one another.  And that’s not what Flirt and Rob mean by diversity.  Maybe ownership does have something to do with it after all.

*I wrote a specific section in my PhD on how my background might affect my views on the subject.  P.153 here.

The limits of a local alcohol policy

So, another day, another event, another blog post.  This time, I don’t feel like a voyeur, because I actually plucked up the courage and got the opportunity to ask a question.

On Tuesday, I attended a Westminster Social Policy Forum event on alcohol policy.  It raised a huge number of issues for me, but I’m going to try to focus on just a couple here.  My main concern underlying the whole event, though, was simply the question of ‘what’s the point of this?’  As I understand it, these events should provide a forum (as in the organiser’s name) for policymakers to hear the arguments of both industry and public health.  I’ve written before about how this binary isn’t helpful – and I wouldn’t suggest that someone like Chris Snowdon, who presented what might be seen as an industry-friendly position, is really ‘the industry’.  However, there is something in the binary, because it was drawn on by a number of speakers, who obviously felt they were being cast in a certain role.

At the same time, the reality was one of a divided retail sector at least, as Paul Kelly from ASDA sought to pin the blame for alcohol harm on (a) convenience stores (who facilitate street drinking, selling more strong beer/cider than large supermarkets) and (b) the on-trade, which he feels has been let off in debates around binge drinking (!!!).  I know that journalists were rubbing their hands (or rather, frantically scribbling away) at his comments – and you can see why when you look at the sheer number of stories in the sector papers about ASDA’s current woes.

Chris has (oh so flatteringly) described me as ‘the lukewarm water between fire and ice’ on alcohol policy, and I’ve written before about how ‘the industry’ has a legitimate role in alcohol policymaking, so I’d like to think I’m not known for being on a particular ‘side’ of the debate.  However, my question on this occasion, and the issue that has been preoccupying me since, is sceptical of the statements from the industry.

Eric Appleby from Alcohol Concern made a plea for localism to mean genuinely local decision-making.  He noted that local areas had a good deal of choice, in whether or not to introduce EMROs and Late Night Levies, and so forth, but the industry was able to draw on national resources and influence to reduce the chances of these being accepted.

However, this idea of localism ran through the conference.  Speaker after speaker rose to say how they too believed solutions should be local, and sought to present this as being the consensus of everyone involved: that alcohol issues can only be dealt with locally.

My problem with this is that there simply isn’t this consensus, and saying doesn’t make it so – though if there had been one at this event it might have seemed like it to a policymaker.

It’s hard to argue against the argument that we need solutions that are tailored to local need and circumstances, and as a commissioner of local services I know the value of that principle, but it’s important to get behind the claim to understand what it means.

It means that national solutions, or those at a broader level, are unavailable.  But at the same time, we know that national policy shapes behaviour.

Crucially, this rules out serious price controls.  Bournemouth (and more recently other areas including Newcastle) have talked about – or even tried – local price controls, but they are fraught with danger around competition law and the voluntary nature of such arrangements raises the spectre of not-so-tacit collusion.

Ruling out MUP by talking about local solutions might be seen as convenient for the industry, but this isn’t just about the old MUP debate.  It could also be argued to be about education – one of industry representatives’ favourite causes.  There have been campaigns for effective PSHE to be embedded into the national curriculum – and the opportunity to do anything constructive in this vein at a local level is continuously eroding as more and more schools opt out of local authority control by becoming academies, meaning that a local authority can commission an education programme and then a huge proportion of schools can decline to take them up on it.

Even what Eric Appleby was envisaging could be local decisions – the introduction of an EMRO, for example – depend on national legal/regulatory frameworks.

Henry Ashworth, replying to my question (or rather, in classic conference style, comment), explained that he wasn’t saying there should be no national action, just that local action should come to the fore and be tailored to local circumstances.  That’s slightly missing the point though.  To illustrate how we need ‘localism’, he presented a map showing areas of the country coloured by the density of alcohol-related health harm.  But this doesn’t illustrate anything in itself.  We know that a considerable element of that variation is explained by independent factors such as deprivation, urban/rural settings, ethnic mix of local areas, and so on.  In fact, the variation isn’t so surprising when you take these things into account, and we can see national – even international – patterns in alcohol-related harm.  We know that alcohol consumption and behaviour are affected by factors not circumscribed by local authority or regional boundaries.

Localism, therefore, as I unwisely said to a journalist from The Grocer, feels a bit like a convenient argument, a cop-out when we should be having a serious debate about to genuinely get to grips with the issues that surround alcohol.

Henry Ashworth and the others on the panel know exactly what they’re doing with this narrative, and for the first time in a long time, I felt angered by ‘the industry’ in the way they were presenting themselves.  Miles Beale (as well as Mark Baird) again peddled the bizarre idea that statistical modelling isn’t ‘evidence’, when in fact he’d make use of these techniques all the time – in terms of judging brand recognition, making sales predictions and even, as he did in his own presentation, in presenting alcohol consumption figures.  And I felt Paul Kelly was being disingenuous throughout, with his comments about convenience stores and the on-trade, and his claim that Diageo would recoup any additional profits resulting from MUP.  It was all about conscious, contrived presentation – but dressed up as honest, constructive debate.

Next to them, Daniel Kleinberg from the Public Health division of the Scottish Government seemed a paragon of openness and neutrality, not criticising the SWA for taking legal action and (at least) delaying the introduction of MUP in Scotland – he said that he saw the delay as the result of court procedures, which might be unfortunate, but the challenge itself was a necessary, or at least reasonable, part of the process.  How I’d like to see that sort of helpful engagement from both ‘sides’ of this issue – and what a great reminder that Public Health officials can be constructive without being adversarial too.

Co-design and shared values

Apology in advance: more links available later – I’m posting this via my phone.

A few weeks ago I wrote a blog post about an event in Southampton I had attended.  I felt a bit like a voyeur, or whistleblower – someone writing an exposé.  This feeling was amplified by the fact that I hadn’t asked any questions or raised my issues during the actual event.  I wasn’t confident or quick enough to get my questions/comments taken in the main session, and unfortunately I wasn’t able to stay for food (and drinks?) after the event, to discuss them in person with the presenters and other attendees.  I did feel a bit guilty, therefore, as if I was going behind their backs by writing the post.

The guilt was, of course, lessened by the fact that this blog hasn’t exactly got an audience of millions.

Nevertheless, I’m feeling a bit of the same sort of guilt today as I write about another event I attended.  I’m not criticising so much this time, though, so perhaps it’s a bit better.

I went to an ESRC-funded seminar at the University of Bristol today, which was looking at urban spaces and ‘neuroarchitecture’ – that is, how neuroscience can inform planning, design and architecture.  There was a range of speakers from various backgrounds, and lots of interesting ideas flying about.

Here, I want to concentrate on just one, which relates to my concerns about nudging.
Dan Lockton gave a really interesting presentation about ‘co-designing’ public space.  In this formulation, design can be not about directing people to do what designers or planners want – they’re actually there to help people (potentially) using these spaces achieve what they want to.

This conception appears to get over some of my fears about nudging – that it’s just the same old exercise of power using a different means.  To accept it as an approach, we do have to set aside the issue that humans don’t have fixed preferences, and actions aren’t aimed at single objectives or problems.  I know lots of people – whether you call yourself a conservative, libertarian, economist or something else entirely – won’t feel they can legitimately set aside this point and accept stated preferences.  However, there is something in this point, as we have to do this for any policy issue: whether explicitly, tacitly, or unknowingly, balance up competing perspectives, objectives and preferences.

So, setting those concerns aside for a moment (and I know that dismissing them like that is a bit flippant), the idea of co-design suggests that people are involved in discussions about what the ‘aims’ of the development are.  And they should also be involved in the continual review and evaluation of any design – as Dan observed, you can see the ‘purpose’ of a system as being the effect it produces, so if that isn’t what you want, then you need to redesign.

If we see design effects at the individual level as this form of facilitation of individual objectives, then nudging doesn’t seem so bad; it’s making it easier for people to do what they really want to do.

(Writing that makes me want to take back the previous paragraph – I do really struggle with this idea of what people ‘really’ want to do.  Anyway, I said I’m setting that aside to raise a separate issue.)

However, design – especially of public space – isn’t at the individual level.  To perhaps overstate my case: no building is private, in the sense of its effects being confined to a single individual.  This issue of power and control was raised by a couple of participants – notably Sam Kingsley.  The fact is that although it’s possible to imagine a community all agreeing on the desire to use less energy, other objectives aren’t so clear cut, but we need prior agreement on the values underpinning the design aim.

In a way, this is a pretty basic insight, that isn’t specific to the issue of co-design, and just raises the broader issues that always surround discussions of democracy and community engagement.

However, there is a fundamental point that questions the very model that initially made Dan’s version of co-design seem more acceptable to me.  Dan’s argument runs that design helps people achieve what they actually want to do.  But although the summing up by Joe Painter proclaimed ‘the death and cremation of the rational actor model in social science’, this is in fact precisely that: a continuing model of rational, individual actors.  The space or design is not in fact individual, it is necessarily social, as are the actions of individuals in their genesis and effects.
That is, we simply can’t conceive of co-design (of public space, at least – but certainly any architecture) in terms of individual preferences and actions.

To be fair to Dan, it wasn’t him who proclaimed the death of the rational actor – and there are two key saving graces of co-design that mean it still works for me as the best (or more accurately ‘most acceptable’) formulation of nudging I’ve heard yet.

First, if we think of the ‘people’ (in Dan’s phrase of co-design helping people achieve what they really want) as a collective, then it makes complete sense – but the problem is that this then makes the whole idea less straightforward, and takes us back to the need to agree collectively on aims and values.

Second, as Dan explained in response to Sam Kingsley’s comment, it’s not as if he’s suggesting co-design is perfect, and you’d still need to have checks, balances and evaluation; the thing is, it privileges the values and perspective of the designer less than the alternatives, so it’s at worst a good start.  And there’s nothing wrong with that.  Let’s just hope it’s more like co-production than the parody I stumbled across browsing Twitter on the train back from the seminar.

A new kind of drunkenness and the future of Public Health?

On Wednesday afternoon I was at an event at Southampton University – ‘Big Alcohol, Big Tobacco, Big Influence.  New vectors for global diseases’.  The event was very much targeted at public health academics and professionals, thinking about how best to tackle the challenges seen ahead.  You can (at the time I’m writing) watch the whole thing here: http://livestre.am/4NDpa (the event actually starts about 8mins 40sec into the video)

I’ve got two real themes I’m going to take up here.

One is (again) about the idea of a change in drinking habits in the UK in the past 25 years, prompted by Nick Sheron’s presentation.  I should admit an interest here: I am very much of the generation that was brought up in this apparently ‘new’ culture – it was as I finished my undergraduate degree that alcohol consumption in the UK began to decline; no mere coincidence.

The other theme is based on Gerard Hastings’ presentation, which made me wonder about what the discipline of public health is for (again).

There were some pretty big names there.  Don Nutbeam, Vice Chancellor of the university, has considerable experience of working in government as a public health advisor, and opened the event.  The chair was Sir Ian Gilmore, and the speakers were Linda Bauld, Geof Rayner, Nick Sheron and Gerard Hastings.  (Links to their work are on the event page.)

There was lots of (healthy) food for thought. The most useful section for me was Nick Sheron outlining some well-analysed stats relating to alcohol health harm.  Given that my working time is basically split between commissioning substance misuse treatment services and thinking about alcohol policy from an academic perspective, there was lots to chew over (to continue the clunky food metaphor).

Nick’s point was that much more than overall average alcohol consumption, we have to think about affordability and patterns of consumption within that, as overall figures don’t necessarily predict harm levels that well.  For this reason, relatively recent increases in spirits and strong beer consumption are worth thinking about.

However, I’m still sceptical about the idea of a ‘new’ kind of drinking or drunkenness – that’s just what Henry Fielding said about gin.  And the marketing might be different, but that’s not necessarily the primary cause of the change in drinking behaviour: the marketers are responding to a potential market.

It’s interesting that Nick accepted the Parker/Brain/Measham view of the 1990s change in drinking habits as being about the ‘industry’ being panicked by ‘rave culture’, and putting all its efforts into tempting young people (back?) into pubs by presenting alcohol as a psychoactive substance.  This doesn’t quite fit with his claim that there was no binge drinking when he was at university in the 1970s – or at least no spirits drinking.  If that was the case, why would the drinks industry suddenly be in crisis in the 1990s?  Surely young people not drinking much would be nothing new?  Certainly the trend data don’t seem to suggest a major decline in consumption in these years.

Sticking my neck out with some speculation, which I can do as this is a blog not an academic article, I’d suggest that actually rather than a crisis for the industry this was a great opportunity.  You can read commentators from the 1930s, 1940s or the 1950s worrying about young people not going to pubs any more – they go to the cinema, or coffee bars, or dances.

At the same time, however, plenty of young people were going to pubs and getting drunk (or ‘buggering off with the bloody port-wine’, as one young woman put it).  And, to be a bit cavalier and take fiction from a few years later as a source: ‘Can’t tek the drink, that’s what’s the matter wi’ yo’ young ‘uns.’

What’s different in the 1990s and since is the affordability of alcohol.  This isn’t, as Nick Sheron came close to suggesting a couple of times, a measure of the ‘real’ price of alcohol.  It also relates to how much money we’ve got to spend on alcohol.  And thinking of Nick’s point about his university drinking, students have more to spend, and alcohol is, relative to other consumer items, cheaper than it used to be – particular for spirits.

The spirits marketing from the 1970s and 1980s Nick displayed was appealing to middle-aged drinkers because they were the ones with the money to spend.  By the 1990s, young people had some of that too, due to a period of ‘extended adolescence’, as Rob Hollands puts it.

It’s not that deliberate drinking to drunkenness is new; it’s that it’s more prevalent, and public.

And the way to deal with this is partly to address marketing, but also to take broader measures to address affordability and availability of alcohol.

Of course, like much of the rest of the afternoon, all this sidesteps the crucial debates about liberty and competing policy priorities.  Do we want to reduce ‘binge’ drinking?  Why?

And here I come onto what I found the most interesting aspect of the whole event: Gerard Hastings’ presentation.

In a way, he was simply following Don Nutbeam’s injunction in his opening speech to ‘stand up for what we think is right’.  I strongly encourage you to watch it (starting at about 1hr 54mins).

His presentation was a self-conscious call to arms, to stir people to struggle for a particular vision of a better world.  I liked this presentation because it was openly, self-consciously political.  There was no dissimulation.

I agree with lots of his points – and even where I don’t, I think public policy should openly debate them.  Should we be aiming for constant economy growth, and if so why?  Is private industry the best way to allocate particular resources, and if so why?  Should marketing (especially to children) be seen as just a part of everyday life?  Should we be doing more to address climate change?

These are all important questions, and Gerard helpfully framed these, openly, as questions about what we think it is to be human.  They are necessarily political and moral questions.  And as such, the discussion of evidence-based policy that framed much of the afternoon seemed a little sideswiped.

I didn’t get the chance to ask some of the questions I had in mind, nor to raise them over food and drink afterwards, as I had to rush back to Dorchester.  However, I wanted to ask why this call to arms was something for public health professionals specifically, and whether the approach recommended would actually be helpful in pragmatic political terms.

We’ve just seen a report come out from the Health Select Committee that argues that PHE (and really the Department of Health more generally) should be more vocal in presenting the Public Health case.

Of course, people like Chris Snowdon disagree (for reasons I can’t entirely understand, despite a lengthy Twitter exchange).  However, I see this as a perfectly reasonable part of policymaking as a balance of competing interests and perspectives: we have to balance one set of (likely) consequences against another, and decide whether the action is worth it (even if the decision is implicit rather than consciously calculated).

I can therefore see why Geof Rayner referred to ‘our side’, but I don’t know that I’m really on any ‘side’ in that sense.  I certainly can’t square my practices, preferences and beliefs with that kind of a public health viewpoint.*

Compromise doesn’t have to imply conflict – in fact, it could imply quite the opposite.

However, what a sensible compromise does need is for all the relevant positions to be stated clearly, and there’s a role for all sorts of stakeholders and views in this – though their opinions perhaps shouldn’t be given equal weight.

This is very much in line with the description of actual policymaking given by Don Nutbeam at the beginning of the event – though the reality is of course not so ordered and open as a textbook flowchart.

My vision of Public Health is that, just like ‘industry’ stakeholders, it should be a voice round the table to be weighed up.  This weighing up depends on values and structures of thought (as I’ve written about what I call neoliberalism); you need some critieria.

And this is where Gerard Hastings’ presentation is relevant: it does make sense to have some debate about these values and structures of thought (by which I mean what we see as possible and even imaginable).

However, that’s a much broader debate, and not something that people should do as public health professionals, but rather simply as citizens.  It’s not about public health; it’s about having a strong democratic culture.

But it’s also important in terms of practical politics.  Hastings was clear that he wanted people to think seriously about genuinely shocking problems around the world – and the crucial next step was for people to actually do something about them.

But what exactly we do is up for debate.  And personally, I think that transforming public health agendas to fight business full stop would be unhelpful.  The key contribution of public health as a discipline is to put an evidence-based view about what policies would maximise public health.

It might be that that a communist society could be healthier than our (arguably) neoliberal environment today.**  However, you’d still need public health stakeholders around the table, making the case for that particular perspective – since there would continue to be other priorities and interests: providing people with more material goods, for example.

Therefore, it’s not a cop-out to argue that public health has to be something narrower and more specific than ‘good’ things (meant in the sense of ‘the good’).  In fact, it’s essential.

And more than this, I’d suggest that the more public health professionals talk in frothing terms about industry, the more likely they are to be ignored.  This is not to say that the dominant structures of thought should simply be accepted; but if someone really cares about public health, they should be thinking of an answer to the question Yvette Cooper asked Don Nutbeam when he was a civil servant working on health policy: “What can I buy?”

To persist in a metaphor he would no doubt find awkward – and revealing – I wasn’t sure what I could ‘buy’ from Gerard Hastings, or today’s event.

*I’d had some Walkers crisps on the train to the event, and later in the evening had a pint of Cornish Coaster - manufactured by a company owned by Coors.

**I mean something very specific by neoliberal, as discussed in detail here: http://csp.sagepub.com/content/early/2014/01/20/0261018313514804.abstract

Government of the people, by PHE, for PHE?

What is Public Health?  And what are Public Health directorates in local authorities for?

These are questions that have been behind a few posts on this blog (here’s one, two, three, for example).

These questions occurred to me again today by the coincidence of a discussion at work and seeing a post on the Dick Puddlecote blog (via a Chris Snowdon tweet).  Both were prompted (in part) by this week’s Health Select Committee report on Public Health England (PHE), which I acknowledged in my previous post I should probably be writing about.*

A key point in the Select Committee report is that PHE should “campaign on behalf of those public health objectives and policies which it believes can improve the nation’s health”.  This is a point Dick Puddlecote puts in bold as something shocking.

The odd bit is how what is effectively part of government could be a campaigning organisation.

Dick Puddlecote sees this as particularly frustrating because PHE is at odds with public opinion on issues like standardised packaging.

These are two separate issues, really: (i) whether the fact that government (or in fact, just one government department) is at odds with public opinion is an issue, and (ii) whether the idea of a ‘campaigning’ department makes any sense.

On the first point, without wanting to sound too much like Robespierre, representative democracy doesn’t imply that issues should be determined by the popular will.  The reason I couldn’t do what Owen Jones does, for example, is that I have no idea about the details of many policy issues.  I find it hard enough coming to a view on substance use policy – something I know a bit about – let alone something like social security, which I should be well-informed about, but don’t have any expertise in.  There’s also a neat point that (academic) policy commentators expect more coherence from politicians than they manage themselves.  Quite possibly true of me – it’s much easier to criticise than offer definite solutions.  (Look how I wimp out in the conclusion of this article.)

I’m also painfully aware that policy decisions should combine considerations of effectiveness and ideology (as well as politics).  But as I’ve said before, effectiveness can only be measured if we have an aim.  And no policy issue has just one aim.  So policy debates are about priorities as much as evidence.  And we know that in reality policy-making is a messy business, with horse-trading and competing agendas.

This highlights the importance of the second issue: should PHE be a lobbying organisation within government?

This isn’t exactly a new development.  PHE isn’t so much a new organisation as a rather odd agglomeration of preceding organisations that made sense, such as the Health Protection Agency (HPA) and the National [substance misuse] Treatment Agency (NTA) – and for the period from 2010 to when PHE was established, the NTA was clearly making the case within Whitehall for substance misuse.

But this isn’t a new or unusual development.  The NTA was a part of the Department of Health that had responsibility.  You don’t have to subscribe to some Weberian theory of bureaucratization** to see that this might be an everyday part of government.

Government is not a single impartial observer or decision-maker, sitting above the fray; it is a complex organisation, with various interests and ideologies operating within it.  (And here I don’t mean government as in the cabinet, so much as the machinery of government, of which PHE and local Public Health teams are a part.)

Thinking back to another policy issue I have had some knowledge and experience of, the same pattern can be seen in Higher Education.  When it came to budget time, the Department for Business, Innovation and Skills (BIS) and the HE sector had very similar hopes: for the science budget to be protected, and so forth, to help the HE sector.  Of course, the Treasury had different priorities – hence the bizarre student loans arrangement that really is just an accounting trick.

This doesn’t make BIS a quango or Trojan Horse (or sock puppet as Chris Snowdon would put it).

PHE might be finding its way, and honing what it can do best as a national organisation when much of its remit has been taken on by local authorities – but it certainly does have a remit, and if public health is a government funding stream (which it is), then there’s a need for some kind of body to represent that area of activity within central government – even if final responsibility is mostly devolved to local government.

It might be that some liberals think the new public health shouldn’t be a part of government, but that’s not the same thing as thinking that government shouldn’t be comprised of bodies representing different perspectives.  It’s quite right that the Health Committee should recommend PHE ‘campaign’ for a policy if it can be demonstrated to be beneficial to public health.  You might find that the Treasury, or BIS, or the Department for Culture, Media and Sport might disagree, but that’s how the decision has to be made: by all the potential interests putting their points of view across.

That’s how I see local public health teams making the most worthwhile contribution: by being a voice round the table as much as a direct commissioning or spending department, and informing planning, highways and transport and education, for example, to make them more conducive to healthy living.  Of course every time a decision is made in any of these areas it will be a compromise, and other interests might win, but that’s what a healthy debate is, if you’ll excuse the pun.

*I was going to write about older people and alcohol again, in light of the DrugScope report, but there’s not any real discussion points in that – apart from their suggestion that services for older people with substance misuse issues are at threat, which in my experience couldn’t be further from the truth.  I see that as the future of substance misuse services in Dorset, for better or worse.  At least it might be evidence-based, as we’ve just commissioned Alcohol Concern to conduct a project for us on that very topic.

**Dan Malleck has written brilliantly about bureaucratization within the field of alcohol policy.

Binge drinking as a 21st-century phenomenon

This week I know I should probably be writing about the Select Committee report on Public Health England, but sadly I haven't got time to craft something new and insightful (or even to read the report in full - though the section on MUP is interesting, and chimes with my feelings about the relative roles of industry and public health).

Instead, given that I've been thinking about the history of alcohol policy a lot lately, I thought I'd post an academc piece I wrote on a quiet afternoon at work 3 years ago, and so far haven't found a home for.  It's a bit short to be a proper social policy academic article, but I haven't had the time or inclination to work it up into something more significant.  If anyone has any comments or thoughts, I'd love to hear them.

“They’re buggering off with the bloody port-wine!”  Binge drinking as a 21^st-century phenomenon

The term ‘binge’ refers to a problematic form of drinking, rather than an attractive one, as Mass Observation noted in 1943 (p.342).  However, there is little clarity regarding what the term means in current discussions, beyond the general sense that it is new, and worrying.

The most striking discussions of binge drinking are in the media, both in newspapers and on TV.  Ladette to Lady and Booze Britain are prime examples on the TV, while headlines such as “Binge Britain’s Night of Shame” are common in newsprint.  In these discussions, ‘binge’ drinkers are generally understood to be young people who drink large quantities of alcohol in city centres before behaving in out of the ordinary ways considered unacceptable – perhaps anti-socially or even criminally.

The same picture emerges from an analysis of government approaches to alcohol policy.  ‘Binge’ drinking is a term that has been deliberately used by both the Labour and Coalition governments, and although quantity of alcohol consumed is often employed as a proxy, the key concern appears to be the altered state of norms that accompany such drinking, which is characterised by a particular approach: drinking to get drunk.

There has been a recently growing corpus of academic research on the topic of ‘binge’ drinking, which generally shares the focus on motivation in defining the phenomenon, stressing that this drinking to get drunk is a new development.  Quite what new features are of interest varies, but the contrast is drawn with a period – usually understood to have included the 20^th century prior to the 1980s – when ‘traditional’ drinking, a masculine, working-class culture centred on local community pubs, was the dominant form of public drinking (Gofton 1990).  In this environment, it is argued, intoxication was incidental to drinkers’ motivations, and drinking interactions formed part of a larger congery of social practices, including work, family, locality and other forms of leisure.  In these nostalgic academic accounts, the focus of research tends to be current young people’s drinking practices and their wider lives.  The historical comparison, though central to the argument that something is new and distinctive about ‘binge’ drinking, is often discussed only in passing, however.

The conception that ‘binge’ drinking is a new phenomenon is questionable on two levels.  First, and most obviously, does it exist at all – and if so, what does it mean in practice?  The burgeoning body of academic research referred to above suggests that many young people – though certainly not all, even of those who drink in city centres at weekends – often understand themselves to be drinking to get drunk and many consider unusual behaviour to be a desirable feature of a night out – even something that should be actively sought out.  Although it remains the case, as it was in 1943, that drinkers tend not to describe their practices as a ‘binge’, this academic picture has notable similarities with that painted by government and the media – though also considerable complexities (Griffin et al. 2009; Haydock 2009; Hollands 2002).

The second problem with these academic accounts, however, is that they claim that such practices are new.  As I suggested, exactly what is considered new varies.  In Measham and Brain’s (2005) account, for example, ‘determined drunkenness’ (a deliberate, almost calculating attempt to get drunk) is the key feature of the ‘culture of intoxication’.  In Hall and Winlow’s (2006) account, it is the broader friendship groupings, which are now the necessary means to the end of going out, rather than the drinking being the means to the end of spending time with one’s friends and cementing these relationships as was apparently the case in ‘traditional’ drinking.

Much research – including these two prominent examples – notes the importance of the wider environment to the emergence of this ‘culture of intoxication’.  Most obviously, licensing laws have changed, but alongside this there have been changes in the design of venues, the drinks available (and their prices) and the marketing of these products.  The role of the 1980s/1990s ‘rave’ culture in prompting this approach from the alcohol industry is often noted.

That there have been changes in the regulatory and broader environment regarding alcohol in the UK is undeniable, and it is certainly plausible that certain of these factors will influence drinking behaviour.  The affordability of alcohol, the licensing laws and the design of venues may all be important factors in affecting drinking cultures – and indeed, as I have argued elsewhere, government might be well-advised to think more broadly about the policy options open to it.

Nevertheless, to address the broader point first, it is not at all clear that friendship groupings and their relationship to consumption of alcohol have changed fundamentally over the past 100 to 150 years.  To begin with, it is unclear when this apparent golden age of pub friendship should be placed.  By the 1930s there is no question that, in “Worktown” at least, many drinkers felt the age of community pubs had passed, and the number that had closed was certainly notable.

It has been suggested that the tax changes introduced with the First World War fundamentally altered the nature of pub drinking, changing the affordability of alcohol, along with the more restrictive licensing laws.  This suggests that, if anything, any heyday of the British pub and ‘traditional’ drinking would be prior to this period.  On the other hand, in the nineteenth and early twentieth centuries, at the time when the Victorian and Edwardian pubs described by Hayward and Hobbs (2007) were springing up, there was concern that the influx of labour into cities had destroyed traditional rural forms of community, and there was considerable movement of people in search of work within an economy constantly in flux.  The stable communities, dominated by and centred around a single large employer, of Nottingham with its Raleigh factory* and “Ashton” as described in Coal is Our Life (Dennis et al. 1969), were always the exception.  It is hard to believe in the face of the evidence that the majority of lives – particularly for those without security of income or residence, the working class – were at any point stable and predictable in the way that the vision of the ‘traditional’ pub seems to convey.

In terms of how these relationships compare to today’s, if all that is meant by the idea of community is the ‘congeries of interests’ and ‘social experiences’ described by EP Thompson (1968: 939), then it is hard to argue that these have disappeared.  As I have argued elsewhere (Haydock 2010), class distinctions and communities, cemented by cultural practices, are alive and well within the night-time economy (see also Hollands 2002), and indeed the work of Hall and Winlow themselves is filled with acknowledgements of the importance of class in determining people’s social options and the prevalence of cultural distinctions within the night-time economy.

However, the argument of change is deeper than this; it is about the instrumental nature of friendship within today’s economy.  Hall and Winlow argue that today’s young people know less about each other than their predecessors did, and interact primarily through signifiers of consumption rather than production, with long-term relationships through work no longer being commonplace.  Although, as I have suggested, there is an element of nostalgia to these claims – friendships in the past were deeper and today’s social interactions are a “theatrical simulation of traditional forms of communality” (Winlow and Hall 2006: 186) – my aim here is not claim whether one form of social interaction or friendship is better, or to be longed for; I simply wish to consider whether or not two such different forms can realistically be posited.  Fellow drinkers in the pub, whether in the 1930s or the 1880s, did not necessarily work for the same company or in the same trade.  The community that existed and can be understood in terms of class was cemented through shared situations and practices, rather than strictly shared occupations or workplaces themselves, and such shared backgrounds are common amongst groups of drinkers today.  Moreover, although debates abound regarding the changing nature of work and leisure time in industrial and advanced deindustrialised economies, a holistic view of relationships, friendships and class as expounded by EP Thompson or Pierre Bourdieu (1984), for example, acknowledges the importance of practices that can broadly be considered consumption throughout, at the very least, the nineteenth and twentieth centuries.

Of course, it could be argued that the nature of communities and the centrality of production relations meant that leisure in the pub was not so separated from work as it is today, in a ‘binge’ drinking culture where the aim is understood to be getting ‘annihilated’ (Griffin et al. 2009) – away from everyday relations and relationships, especially those related to work and family.  As Winlow and Hall (2009), following the pop song and the advertisement for the lager Carling, put it, drinkers are ‘living for the weekend’.  The paying of wages might be cited as one prime example of the way in which pub life was tied to work.  It cannot be denied that this practice at the very least has died out, more or less, but the apparently new opposition between drinking and work relates to the second, broader point of what is new regarding ‘binge’ drinking: drinkers’ motivations.  Do current ‘binge’ drinkers approach alcohol in a fundamentally different way to those from the past?

The historical work on drinking cultures in Britain is perhaps surprisingly thin, when considering the nineteenth and twentieth centuries.  Brian Harrison’s (1971) landmark study, despite its broad title – Drink and the Victorians – analysed the Temperance movement specifically, while more recently John Greenaway (2003) has analysed political discussions of alcohol since 1830, and James Nicholls (2009) has looked at broader public discourses surrounding alcohol and drunkenness.  There is much less material considering how those who were actually engaged in the apparently problematic drinking thought of alcohol and themselves.  There are excellent historical sources, of a variety of types, that refer to alcohol consumption, but these have not been synthesised, and there is no identifiable single source.  As with issues of the carnival and carnivalesque more broadly, it is difficult to access accounts from drinkers themselves rather than observers (see Easton et al. 1988; Stallybrass and White 1986).

However, this material from observers is valuable.  Although government states that one of the key features of ‘binge’ drinking is that those involved drink to get drunk, such drinking is also defined by its consequences; not only health damage, but more notably behaviour.  This behaviour is understood to be out-of-control, violent, irrational and dangerous to both the drinker and others.  This sort of behaviour, and the idea that alcohol offers ‘time out’ from normal everyday requirements, is not confined to twenty-first century Britain (see, for example, MacAndrew and Edgerton 1970).  A cursory read of The Pub and the People will reveal that such ‘breakdown’, festival or carnivalesque behaviour was certainly not unknown to “Worktowners”.  If the concerns with ‘binge’ drinking are sex, violence, irrationality, public disorder and incapability due to alcohol, Christmas Eve in the late 1930s before World War II can illustrate these as well as any Saturday night in a city centre in 2011.

Therefore, I strongly challenge the assumption that ‘binge’ drinking is a new phenomenon.  While the economy may be organised along different lines from the late-nineteenth or early-twentieth centuries, and the design of pubs, licensing laws and alcohol advertising may all have changed, it is highly questionable that young people’s approach to alcohol is fundamentally altered, or that their formation of friendships is conducted on a different basis.  Further, more detailed research would be required to assess nineteenth- and twentieth-century drinking cultures in more detail, but at first sight at least it seems that the appreciation of ‘fuddled joy’ (Smith 1983) of drinking alcohol and the temporary ‘breakdown’ (Mass Observation 1943) offered by weekend nights out in the pub, accompanied by music and hot fast food, with the possibility of sex, are not new.

*I'm referring here to Alan Sillitoe's brilliant novel Saturday Night, Sunday Morning, from which Rob Hollands' Friday Night, Saturday Night takes its name (I assume!).

Here are some fun sections from The Pub and the People - I assume I'm not in breach of copyright by posting them, but let me know if so.  Do go and buy the book - it's not expensive and it's entertaining and informative: http://www.faber.co.uk/catalog/the-pub-and-the-people/9780571250950

 

 

  

 

"In a litter of broken glass and bottles, a woman sits by herself, being noisily sick" made me think of these two famous photos (though neither of them features a women actually being sick)

References

Bourdieu, P., 1984. Distinction: A Social Critique of the Judgement of Taste. Nice, R., Trans. London: Routledge.

Dennis, N., Henriques, F., and Slaughter, C., 1969. Coal is our Life: An analysis of a Yorkshire mining community. London: Tavistock.

Easton, S., Howkins, A., Laing, S., Merricks, L., and Walker, H., 1988. Disorder and Discipline: Popular Culture from 1550 to the Present. Aldershot: Temple Smith.

Gofton, L., 1990. On the Town; Drink and the 'New Lawlessness'. Youth and Policy, 29, 33-39.

Greenaway, J., 2003. Drink and British Politics since 1830: AStudy in Policy-Making. Basingstoke: Palgrave.

Griffin, C., Bengry-Howell, A., Hackley, C., Mistral, W., and Szmigin, I., 2009. 'Every Time I Do It I Annihilate Myself': Loss of (Self-)Consciousness and Loss of Memory in Young People's Drinking Narratives. Sociology, 43 (3), 457-476.

Harrison, B., 1971. Drink and the Victorians: The Temperance Question in England, 1815-1872. London: Faber and Faber.

Haydock, W., 2009. Gender, Class and 'Binge' Drinking: An ethnography of drinkers in Bournemouth's night-time economy.  Thesis (PhD). Bournemouth University, Poole.

Haydock, W., 2010. "Everything is different": Drinking and Distinction in Bournemouth. In: Wellard, I., and Weed, M. eds. Wellbeing, Health and Leisure. Eastbourne: Leisure Studies Association, 67-84.

Hayward, K., and Hobbs, D., 2007. Beyond the binge in "booze Britain": market-led liminalization and the spectacle of binge drinking. The British Journal of Sociology, 58 (3), 437-456.

Hollands, R., 2002. Divisions in the Dark: Youth Cultures, Transitions and Segemented Consumption Spaces in the Night-Time Economy. Journal of Youth Studies, 5 (2), 153-171.

MacAndrew, C., and Edgerton, R. B., 1970. Drunken Comportment: A Social Explanation. London: Thomas Nelson and Sons.

Mass Observation. 1943. The Pub and the People: A Worktown Study. London: Faber and Faber.

Measham, F., and Brain, K., 2005. "Binge" drinking, British alcohol policy and the new culture of intoxication. Crime, Media, Culture, 1 (3), 262-283.

Nicholls, J., 2009. The Politics of Alcohol: a History of the Drink Question in England. Manchester: Manchester University Press.

Smith, M. A., 1983. Social usages of the public drinking house: changing aspects of class and leisure. The British Journal of Sociology, XXXIV (3), 367-385.

Stallybrass, P., and White, A., 1986. The Politics and Poetics of Transgression. Ithaca, NY: Cornell University Press.

Thompson, E. P., 1968. The Making of the English Working Class. Harmondsworth: Penguin.

Winlow, S., and Hall, S., 2006. Violent Night: Urban Leisure and Contemporary Culture. Oxford: Berg.

Winlow, S., and Hall, S., 2009. Living for the weekend: Youth identities in northeast England. Ethnography, 10 (1), 91-113.