In a month in which the Government’s health quango, Public Health England, issued new guidelines suggesting the public should avoid drinking alcohol on consecutive days, and a group of MPs proposed reducing drink-drive limits, a new book Culture Wars and Moral Panic – the story of alcohol and society challenges the influence of the anti-alcohol lobby. In the following extract, author Paul Chase, a director of CPL Training and commentator on licensing law and alcohol policy, explores the government’s use of alcohol statistics in developing policy.
By the early 1970’s a small group of addiction specialists began to focus on what could be done at the policy level to reduce alcohol addiction and alcohol-related health harms. ‘Prevention is Better than Cure’ appears to have been their maxim, particularly since a ‘cure’ for a disease that no-one could quite pin down and define seemed stubbornly beyond reach. These addiction specialists rediscovered a piece of half-forgotten research by a French mathematician named Sully Lederman. His research in wartime Paris purported to demonstrate a causal relationship between a decline in the city’s alcohol consumption and a fall in deaths from liver cirrhosis.
The implication - that reducing consumption per head of population would produce measurable benefits in terms of alcohol-related health harms - was given further credence following the publication, in 1973, of fresh research by a team of scientists led by Kettil Bruun. This research came to be known as ‘the Purple Book’, apparently for no better reason than the colour of the publication’s cover. A young British doctor, Griffiths Edwards, who had previously worked pro bono with meths drinkers in the 1960s, was a key figure in getting this theory accepted by the WHO and was the lead-author of a book published in 1994 called Alcohol Policy and the Public Good. This publication expanded on Bruun’s earlier research. The third publication that built on the Lederman hypothesis was Alcohol, No Ordinary Commodity – Research and Public Policy, published in 2003. The lead-author was Thomas Babor, and this text has since become the WHO’s bible on alcohol policy and the basis of the public health lobby’s demands worldwide
The approach developed by these post-Lederman researchers goes by a number of different names: the ‘whole-population approach’; the ‘total consumption model’; the ‘single distribution model’ - all refer to the same thing, a relatively simple concept: the total amount of alcohol consumed by a population determines the level of alcohol problems that population will suffer. Ergo, the way to tackle these problems is not at the level of the individual sufferer, but by whole-population policy measures designed to reduce per capita consumption.
These policy measures flow down in a hierarchy: first, affordability - making alcohol more expensive by the use of taxation; second, availability – licensing policies that reduce licensing hours or limit the growth in numbers of licensed premises of all kinds; third, controls on advertising and marketing; fourth - measures that will tackle drink-driving – lowering the limit; fifth - better treatment services; and last of all - alcohol education of the type favoured by the alcohol industry, and concerning which public health activists are uniformly sceptical.
The belief is that the benefits of policy measures which suppress and reduce alcohol consumption per head across the whole population will be distributed across the piste in terms of reducing alcohol-related harms of all kinds – illnesses, accidents, lost productivity, domestic violence – all will be reduced. But, in particular, alcohol-related health-harms will reduce significantly and quickly if whole population consumption levels can be made to fall.
In the UK this approach was championed by epidemiologist Geoffrey Rose (Rose 1985) who persuaded the UK Government that the way to tackle the drinking problems that arose from excessive alcohol consumption by a minority of heavy drinkers was to restrict consumption across the whole population. Rose’s strategy recognised that the pattern of drinking was unevenly distributed - with very heavy drinkers and very light drinkers at either end of the spectrum – but the majority of moderate drinkers in the middle. The basic idea was that instead of concentrating on a few very heavy drinkers we should try to shift the consumption level of the entire population in the direction of more moderate consumption and as a result the number of people drinking to excess would fall as well.
The fallacy of the argument lies in the assumption that everyone’s drinking could be shifted in a more or less uniform way. In fact it is perfectly possible to reduce average consumption across the whole population whilst excessive drinkers actually go in the opposite direction and increase their drinking. In a number of countries, particularly the UK and Australia, evidence is emerging of a decoupling of the alleged relationship between population levels of consumption and levels of harm. Alcohol consumption has fallen in both countries whilst alcohol-related harms, particularly in the UK, continue to rise.
The alcohol industry has, of course, rejected the whole-population approach. Turkeys don’t vote for Christmas. As far as the industry is concerned there is a clear understanding that alcohol is an intoxicant that is vulnerable to abuse, but the industry argues that efforts to tackle alcohol-related harms need to be targeted at problem drinkers whose troubled drinking is symptomatic of wider social and psychological issues, and, in some cases, mental health issues too. The whole-population approach, according to this narrative, posits the proposition that ‘we all need to drink less’, when in fact those who drink too much need to drink less. Millions of people get enormous pleasure from making a controlled use of alcohol and the troubled drinking of the few shouldn’t be used to justify restrictions on the drinking choices of the many, who don’t have a troubled relationship with alcohol.
From Culture Wars and Moral Panic
Available on Amazon: http://www.amazon.co.uk/dp/1906643318
Signed copies available directly from CPL Training: contact Holly.Carr@cpltraining.co.uk or call 0151 650 6910
