Report prepared by Leila Luheshi.
The consumption of alcohol has been ingrained in many societies for centuries. Historically there have been many attempts to control the consumption of alcohol and to mitigate its negative effects on individuals and societies, from temperance movements to prohibition. In March this year the UK government published their alcohol strategy, the most recent attempt to tackle binge drinking, alcohol related anti-social behaviour and the negative impact of alcohol consumption on health.
On 21 May 2012 a diverse group of students, academics and policy professionals assembled at Hughes Hall College Cambridge to hear three unique and provocative perspectives on the government’s alcohol strategy, and in particular the role that evidence has played in its development. The event was chaired by Professor Theresa Marteau, Director of the Behaviour and Health research Unit, and hosted by Cambridge Public Policy and the Hughes Hall Centre for Biomedical Science in Society.
The first speaker was Professor Mike Kelly, Director of the Public Health Excellence Centre at the National Institute for health and Clinical Excellence (NICE), who lead the development of the “Alcohol-use Disorders: Preventing harmful drinking” guidance published by NICE in 2010. Mike emphasised the scale of the negative effect that alcohol consumption has on society. He told us that 35% of A and E attendances are alcohol related and that alcohol was a contributory factor in ~500,000 crimes in 2005. More positively, he also set out how alcohol misuse is an unusually well studied public health challenge for which there is a robust evidence base that, again unusually, pointed overwhelmingly towards primary prevention as the best intervention to reduce misuse.
At the time of its publication, the most striking recommendation of the NICE report, establishing a minimum price per unit of alcohol, was rejected by the health secretary. However, the government has now, in their most recent alcohol strategy, adopted this recommendation along with many others from the report, a seeming victory for evidence-based policy making...
...Or was it? The second speaker, David Howarth, Reader in Private Law at the University of Cambridge, former Member of Parliament for Cambridge (2005-2010), presented an ingenious thought experiment through which to address this question. What if we strip away all knowledge of the evidence from the policy making process? What would we expect the decision on whether to set a minimum price per unit (MPPU) of alcohol to be? By interrogating the specifically political aspects of policy making in this way, David elegantly demonstrated to the audience how economic impact, ideological and moral considerations, and political expediency more often than not, overwhelm the contribution of evidence to the process. In the case of the MPPU, whilst it is clear from correspondence within government (highlighted in David’s talk) that the alcohol industry is broadly opposed to this policy, and that the more libertarian members of the coalition were likely to be opposed on ideological grounds, the policy has nonetheless been adopted. David concluded his talk with the question, “Did the politicians all change their minds, or was the evidence, after all, important?”
The last of the three speakers was Professor Jonathan Wolff, Professor of Philosophy at UCL. He first addressed the fundamental question of whether it was legitimate or desirable for a government to intervene in alcohol pricing given the emphasis the Treasury places on allowing markets to operate freely. He identified two potential justifications for intervention, the negative impact of the free market in alcohol on others through its effects on anti-social and criminal behaviour, and the paternalistic desire of some policymakers to ‘protect people from damaging themselves’.
Despite these apparently strong incentives, a population level change in attitudes to alcohol consumption is proving, said Jonathan, very difficult to achieve. Individuals do not seem to be responding to health education messages about the dangers of excessive drinking. By way of an explanation for this observation, he drew a parallel with smoking, where recent reductions in the prevalence did not stem from the knowledge that it was bad for smokers health, but was instead motivated by the loss of social acceptability that came with the understanding (partly promoted through the ban on smoking in public places) that passive smoking harmed others.
Trying to enforce behavioural change instead through the introduction of price controls, on alcohol may, on the basis of evidence from Scandinavia, also have little effect on levels of consumption. It may even, argues Jonathan, have a detrimental effect on overall population health if it diverts money from being spent on items such as healthier foods or essential utilities. Finally, Jonathan concluded by observing how alcohol policy is a good example of where societal expectations can overwhelm the impact of evidence on policy making, noting that on the basis of evidence alone alcohol consumption is far more harmful than ecstasy. A lively discussion ensued.
Banner image from Rich Bowen on Flickr
21 May 2012, 5:30pm
A Hughes Hall Centre for Biomedical Science in Society and Cambridge Public Policy Special Seminar