Monday, 17 June 2013

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.

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  1. This is a really useful comparison that could be made also between tobacco and illicit drugs, or even with fizzy drinks and full fat ready-made meals! A review of alcohol policy back to 1979 and comparison of party responses in each of these areas is likely to tell us something about their attitudes to public health generally. Then there's the public tolerance of alcohol-associated behaviours (not all positive and not all negative) as against what we feel about tobacco - and (other) drugs.

    1. Yes, we had grand plans to compare tobacco, alcohol and obesity, plus I have clung on to the idea of returning to HIV and drugs - but we settled for this paper just now. Rob Baggott already does a lot of these comparisons too -

    2. I enjoyed this piece very much. I think there is another dimension to the current sympathetic framing of alcohol: industry marketing. We are all familiar with the marketing (communications, product design, pricing and distribution) aimed at the public to encourage consumption. But this effort, and equivalent activities targeting stakeholders and policy makers, is also designed to maintain social norms that encourage alcohol consumption. So a beer brand’s sponsorship of a music festival or sporting event will get fans drinking more, but it will also reinforce the idea that alcohol is bedded into our culture, is attractive and life affirming. The sponsor buys innocence by association.

  2. I am currently researching the differences between alcohol, tobacco, and obesity regulation in the US. To your knowledge, are there any particular countries that would be interesting to examine in terms of obesity?

  3. No, but it would be worth getting in touch with Professor Donley Studlar. He has just moved to Strathclyde.