Category Archives: alcohol policy

Action on Sugar: Learning from Tobacco

In many ways, tobacco control has set the agenda for controls in other areas, such as (most notably) alcohol. We can see this by simply comparing recent calls for action on sugar in food with existing curbs on tobacco use, taking out the ones that are not comparable or might seem a step too far (at least for now, warns the IEA and DP). Here are the types of policy instruments for tobacco and I have put an asterisk next to the latest recommendations on food.

I. Regulation (through legislation or voluntary agreements)

  1. Bans or restrictions on advertising and promotion (e.g. to disassociate the product with physical activity).*
  2. Sales to children.
  3. Smoking and eating in public places (second-hand smoke).
  4. Modify and regulate ingredients, such as the levels of tar in cigarettes and the levels of sugar, salt and fat in food.*
  5. Customs enforcement on smuggling and counterfeit products.

II. Finance

  1. Taxation and other levies to discourage consumption of certain products.*
  2. Spending on directed health services, including cessation services.
  3. The reform of economic incentives, including agricultural incentives and tax expenditures on arts and sports sponsorship by companies.*
  4. Litigation against companies (more a US than UK practice).

III. Capacity building

  1. Funding for community development programs and organisations to combat use.

IV. Education

  1. Health warning labels on packaging.*
  2. Health education campaigns.*

V. Learning and information tools

  1. Legislative hearings* and executive reports (US) and reports by the Chief Medical Officer (UK).
  2. Funding scientific research on the harms of products.*

Donley Studlar and I tried to do something more extensive on tobacco alcohol in these tables – tobacco alcohol table 25.7.13 – before taking them out in the last cut of our forthcoming article (draft here Cairney Studlar Public health in the UK March 26 2014). See also: http://blogs.lse.ac.uk/politicsandpolicy/for-those-who-seek-to-strengthen-alcohol-regulation-the-experience-of-tobacco-control-shows-that-comprehensive-policy-change-is-neither-quick-nor-inevitable/

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Filed under alcohol policy, Public health, public policy, tobacco policy, UK politics and policy

Everything would be shite in an independent Scotland

FT story supermarkets 9.12.13

Adversarial politics is annoying, and people are bastards, but there is something particularly stupid about a debate that produces people gloating about how shite things would be in an independent Scotland. We might normally expect some critical analysis about stories coming from vested interests, but not if there is a line to maintain. Today’s example comes from the Daily Mail (which specialises in bile and breasts) and Financial Times (which, today, is held up as a provider of the truth carved in stone): supermarket prices will go up in an independent Scotland. Fuel and production costs will push up food costs (kept artificially low, and spread across the UK, by supermarkets just now) and Scottish Government public health policy will keep or push up the cost of tobacco and alcohol. So what might a more critical analysis of this news produce?

  1. In almost any other case, the story would be about multinational companies protecting their profits at the expense of the consumer. As with energy prices, this would normally feed into the debate about the cost of living. Yet, in this case, one side of the independence debate is forming a coalition of convenience with those companies.
  2. We should not necessarily see the food/ booze & fags argument as separate. The supermarkets have form here, signalling to the consumer that they don’t like restrictions on their trade because they would otherwise make decent profits on cigarettes and alcohol (Sainsbury has even produced a leaflet blaming the Scottish Government for a restriction in sales), and prepared to fight the Scottish Government to protect it. In this case, we should not be surprised that some of it spills over to the independence debate.
  3. Prices differ in different parts of the country anyway. It is felt particularly in rural stores which effectively keep price differences by offering only a selected range of (more expensive) products in smaller stores. Your shopping will likely be more expensive in the smaller store in Montrose than in the megasupermarket in Dundee.
  4. There is a big difference between some senior staff in supermarkets giving non-quoted scoops in the papers, or named people giving vague comments, and named chief executives actually speaking out in public with substance and subjecting these arguments to critical analysis.

Of course, this is grist to the mill for people who claim that the Yes campaign is ridiculously positive, with no room for anything going wrong. But it usually ends up with people appearing to gloat that everything would be that bit shiter in an independent Scotland.

Update 1: by the end of the day, this (oh dear) might be the story instead

compare with the more sensible:

https://twitter.com/KevinJPringle/status/410135761728847872

Update 2: other coverage is available (I’ve just clicked on any ‘related content’ on my wordpress thing)

Update 3: one of the big bones of contention for supermarkets has been resolved, which is presumably enough for them to stop intervening in the #indyref http://www.bbc.co.uk/news/uk-scotland-scotland-business-25676222

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Filed under alcohol, alcohol policy, Public health, Scottish politics, tobacco policy

After the War on Tobacco, Is a War on Alcohol Brewing?*

The United Kingdom now has one of the most comprehensive tobacco control policies in the world, a far cry from its status two decades ago. Some influential public health voices have called for a similar campaign against alcohol consumption. But is the comparison appropriate? We identify the factors which were important in the relatively successful campaign for tobacco control, then analyse the obstacles and opportunities facing the movement for more stringent alcohol control. Alcohol policy today bears a striking resemblance to tobacco policy pre-1990s, when the UK started on its path to becoming a major regulatory state in the world. Can alcohol policy be changed in a similar way?

Paper here  Cairney Studlar 2014 WMHP Alcohol and Tobacco Policy UK

See also – https://paulcairney.wordpress.com/public-health/

See also: http://blogs.lse.ac.uk/impactofsocialsciences/2013/07/16/evidence-matters-tobacco-and-alcohol-comparison/

*We submitted the paper to a US journal, where this framing is more normal. The idea of a public health crusade is also in good currency in some libertarian circles.

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Filed under agenda setting, alcohol, alcohol policy, Evidence Based Policymaking (EBPM), Public health, tobacco, tobacco policy, UK politics and policy

Alcohol: the Harmful versus Healthy Debate

I predict a lot of debate and attention to the idea that alcohol consumption is healthy or harmful. A key strategy for public health groups and other advocates of further alcohol controls (such as a minimum unit price of alcohol) is to reframe the debate – by challenging the idea that alcohol can be healthy, in particular circumstances, if consumed in small amounts. A key strategy for the alcohol industry is to maintain that image so that they can argue that alcohol policy should be targeted at problem drinkers only. One is a public health argument calling for general policy measures that influence the drinking habits of the population (e.g. raise prices, ban promotion). The other is an individualised argument calling for specific measures that deal with particular people (e.g. provide NHS services for alcoholism; change police powers to deal with anti-social behaviour). So, the *way we understand the evidence* is key battle ground in the policy debate. That is why you will find public health groups so bothered by the fact that the industry takes such an important part in the production, dissemination and interpretation of the evidence within government and when communicating with the public (e.g. drinkaware.org is funded by the industry).

The obvious contrast, at least in the UK, is between alcohol and tobacco. In the latter, in the not-too-distant past, tobacco companies had similar amounts of joy in government and public circles: funding scientific research; arguing that the link between smoking (and then passive smoking) and ill health was not proven; and portraying the issue as one of individual choice based on their thoughts on the evidence and how they might way it up against their enjoyment of smoking. Key strides were made in tobacco control when the evidence on harm (from smoking and passive smoking) were ‘set in stone’ within government and stated unequivocally to the public. A good example is in health education before and after tobacco company influence. In the heyday of smoking (when men were men), the public health advice was overshadowed by tobacco advertising. It was also more likely to be harm reduction in nature – e.g. smoke pipes rather than cigarettes (not too long after companies introduced healthful (not really) filtertips and moved from high to low tar). Then, the health advice changed markedly to reflect a ‘no safe level’ message (as in the health advice suggesting that a move from high to low tar was like jumping from the 38th floor of a building rather than the 39th).

Now, in my day, as an undergraduate, we might try to interpret that sort of story in terms of early insights on Power by people like Bachrach and Baratz. Power is not simply about visible conflicts in which one group wins and another loses (such as in a policy debate in government). Rather, groups may exercise power to reinforce social attitudes (perhaps to make sure that the debate does not get that far). If the weight of public opinion is against government action, maybe governments will not intervene. In this case, if the vast majority of people think that moderate alcohol consumption is healthy (or not harmful), they may not support control measures that affect the whole population. In fact, it is a measure of public health group success that it even *occurs* to us to consider the issue. Still, a key part of the minimum-unit-price debate is that it punishes responsible drinkers as much as problem drinkers. This will not be such a powerful argument if the vast majority of the public begins to believe that we are *all* problem drinkers (well, apart from me – I don’t touch the stuff).

See also: http://blogs.lse.ac.uk/politicsandpolicy/archives/34735

‘Alcohol’s evaporating health benefits’ http://linkis.com/www.bmj.com/content/kpLcG

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Why is there more tobacco control policy than alcohol control policy in the UK?

The obvious answer is that drinking is less bad for you than smoking. Or, if you are the optimistic sort, drinking is really, really, really, really, really good for you – mm, mm, delicious and nutritious. And it’s cool. And it’s sexy and it makes you sexy. Especially when you are pissed.

The non-obvious answer is that, although the same sort of public health evidence has been produced to suggest that: (a) both smoking and drinking are unhealthy; and, (b) both should be controlled using similar instruments – the alcohol-is-unhealthy evidence is less accepted in government and alcohol control policies are a harder sell (for now). Alcohol can still be advertised, there is less tax on booze and the alcohol industry has a regular say in the interpretation of the evidence (and what we should do about it).
The aim of this ICPP paper (link) is to explain the difference between policy choices in tobacco and alcohol. It says: here is what would have to happen for alcohol control to mimic tobacco control (I do the same in a comparison of tobacco controls in different countries here). We can break the policy process down into five key factors:
1.     Institutional change. Government departments, and other organisations focused on health policy, would take the main responsibility for alcohol control, largely replacing departments focused on finance, trade, industry, tourism and employment (and crime).
2.      Paying attention to, and ‘framing’ the problem. The government would no longer view alcohol primarily as a product with economic value, central to the ‘night time economy’.  It would be viewed primarily as a public health problem; a set of behaviours and outcomes to be challenged.  This happened with tobacco, but it is trickier in alcohol because the government may only be worried about aspects of alcohol consumption (such as the binge drinking and anti-social behaviour of certain individuals) rather than the broader notion of public health.
3.      The balance of power between participants.  The department of health would consult public health and medical groups at the expense of groups representing the alcohol industry. This is central to the type of evidence it gathers, the interpretation of the evidence, and the advice it receives.
4.      The socioeconomic context.  The economic benefit of alcohol consumption would fall (or, the tax revenue would become less important to the Treasury), the number of drinkers would fall and opposition to alcohol control would decline (although it already seems fairly low).
5.      The role of beliefs and knowledge.  The scientific evidence linking alcohol consumption to ill health would have to be accepted and ‘set in stone’ within government circles.  The most effective policies to reduce alcohol consumption would also be increasingly adopted and transferred across countries.
Change in these factors would be mutually reinforcing.  For example, an increased acceptance of the scientific evidence helps shift the way that governments ‘frame’ or understand the alcohol policy problem.  The framing of alcohol as a health problem allows health departments to take the policy lead.  Alcohol control and alcohol use go hand in hand: a decrease in drinking rates reduces the barriers to alcohol control; more alcohol control means fewer drinkers (or less drinking).
It is tempting to think that this sort of process is more likely under Labour and less likely under the Conservatives – and there is some evidence to back up this argument. However, the point of the paper is that these long term processes develop during the terms of both parties. Major policy change, of the level we have witnessed in tobacco (but not as much in alcohol), takes several decades. Indeed, you can be suitably impressed or depressed with my hunch that alcohol control is at least a decade (if not two or more) behind tobacco.

See also: http://paulcairney.blogspot.co.uk/2013/06/alcohol-harmful-versus-healthy-debate.html
Compare with: http://velvetgloveironfist.blogspot.co.uk/2013/07/the-real-reason-for-public-smoking-bans.html and http://dickpuddlecote.blogspot.co.uk/2013/07/an-lse-guide-on-how-to-denormalise.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed:+DickPuddlecote+(Dick+Puddlecote)

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