Friday, 21 June 2013

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. 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).

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Wednesday, 19 June 2013

The IndyRef and the Scottish Parliament

I have done a 3-minute podcast on this topic and it can be found here -

or go here:

I hope to make it a bit more exciting soon, but this will have to do just now.

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If you want to spoil the magic and just read the 'script', here it is:

A debate on constitutional change provides the main (or only) opportunity to discuss its constitution. A constitution can be a written document with bells and whistles or just an acknowledged set of relationships between governing organisations and “the people”.

Yet, we have not seen the same debate around independence as we did around devolution.

Remember all the hopes associated with the push for devolution:

·         In general, a new form of politics to get away from all that was wrong with Westminster

·         A new and more proportional electoral system

·         A new relationship between the government, the parliament and the people

·         A move away from top-down government policymaking

·         A rejection of adversarial and excessively partisan politics

·         An effective unicameral system

·         A chance for a wide range of (previously excluded) groups and individuals to have a routine say in policy

·         A chance for MSPs to spend quality time in their constituencies rather than sitting around being whipped in Parliament

·         A chance to redress ridiculous imbalances in representation, particularly for women

A lot of these aims proved to be unrealistic, but at least we talked about ideals rather than just getting bogged down in petty disputes.

In fact, now is the only time in which we can properly reassess devolution and ask ourselves if we want to simply keep and build on existing arrangements or seek to change them. Obvious examples include:

·         Should we keep the mixed member electoral system rather than STV?

·         Are we content with only one-third of MSPs being women?

The less visible question is:

·         What do we do about the Scottish Parliament?

·         The problem is that there is not a ‘power sharing’ relationship between government and parliament

·         The government makes policy and the parliament examines it

·         It does not have the resources to examine it well

·         There are too few MSPs and too few staff

·         So, the Parliament examines *some* policy, to some extent, and has to ignore most of it

·         This happened under all forms of government so far: coalition majority, single party minority, single party majority

·         So, if we simply add more powers or full powers onto the current system, its ability to scrutinise government will be much more limited

·         Now is the only time to discuss what we want to do about that

·         Whatever you think about independence debate, it may be the only event that allows us to re-examine the role of the Scottish Parliament and do something about it

Tuesday, 18 June 2013

Testing, testing, podcast on independence

This is a 10-minute podcast on Scottish independence - What Does it Mean and What Are The Big Questions? - recorded on my Ipad. The production values are fairly low and, on two occasions, it seems to flicker a bit (much like in those horror or sci-fi films where things go a little bit, spookily, wrong). I also get a text which distracts me a bit. Then I sound like I am getting bored and more sarcastic from 8 minutes (any of my former students will be used to that). Other than that, it is OK, as long as you like the Andy Murray style monotone (although our accents are very, very different).

You can also get it here:

The book is out in August and it won't really be £25 -

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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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