As Scotland's 1st May 2018 Minimum Unit Pricing (MUP) implementation date fast approaches, debates on the role of pricing and other alcohol control policies is again receiving increased attention.
Writing in the Scotsman, Alcohol Focus Scotland's Chief Exec Alison Douglas says MUP’s 'positive impact on the nation’s health will be felt in a matter of months' and the 'life saving measure' is a ‘starting point for even more ambitious policies aimed at further tackling Scotland’s problematic relationship with alcohol'. The Scottish Government is shortly due to release a new national alcohol strategy to follow its former strategy and MESAS evaluation.
Whilst Wales are already following Scotland’s lead on MUP, Westminster has continued to take the position it will 'wait and see' what happens north of the border, notwithstanding the embarrassment of a David Cameron U-turn in 2013 and a recent Commons Committee taking place. Public Health England (PHE) have also highlighted the importance of pricing and affordability in its assessment of the evidence for alcohol policy measures.
Other groups such as the Institute of Alcohol Studies (IAS) though been long campaigning for pricing controls including MUP and taxation measures, recently producing a new report on alcohol affordability. It highlights supermarket beer is now almost 188% more affordable today than it was thirty years ago, and whilst the alcohol duty escalator temporarily halted the rising affordability of off trade prices, it has since been rising steeply again. Many see the rising gap between on and off trade prices as a key driver behind the continued decline in pub numbers, whilst he IAS say official data shows the overall affordability of alcohol has increased by 60% since 1987.
Industry influence?
The nature of alcohol policy decision making though may be regarded as a complex and often curious matter in which the main arguments are often narrowed down to simplistic diametrically opposed positions. The simplification of such complex issues though, arguably seen on both ‘sides’ to varying degrees, may often be a reflection of the intention to influence public opinion and in turn policy decisions.
A new systematic research review by Jim McCambridge and colleagues sought to assess alcohol industry involvement in policy making, concluding alcohol industry 'actors' are 'highly strategic, rhetorically sophisticated and well organised in influencing national policy‐making'. Whilst identifying a limited number of studies investigating the role of industry roles in influencing alcohol policy, the authors argue that industry activities are motivated by 'managing threats to commercial interests' and exhibit many similarities with tactics and strategies seen with tobacco industry efforts to influence policy.
Certainly most- but not all - in public health and academia may agree that the alcohol industry should not have a role in national policy making to address alcohol harms due to a fundamental conflict of interest. However, discrepancy may be more apparent when it comes to industry roles in the delivery of activities, some of which fundamentally rely on the industry, particularly when pledged under self-regulatory agreements. Drinkaware for instance, the alcohol industry funded education charity, has secured itself as the dominant player in the delivery of alcohol-related health messages to consumers, and has achieved some engagement with public health and other non-industry stakeholders. Whilst McCambridge has previously argued that Drinkaware 'serves only to legitimize corporate efforts to promote partnership as a means of averting evidence‐based alcohol policies', others appear to accept their role, particularly in the absence of Government led campaigns. Drinkaware also maintain they act as entirely independent from their funders.
Other alcohol policy areas are also subject to significant debate and scrutiny, particularly with regard to the question of self-regulation. Alcohol labelling is currently a hot topic with health groups dissatisfied over the history of reportedly failed pledges, most recently with the controversial responsibility deal. Whilst research is still yet to clearly identify to what extent alcohol health warnings or nutritional information can actually play in reducing alcohol harms, many feel that helping consumers to easily make informed choices is a basic right and should be required by law. Marketing is another area where there are certainly mixed feelings over the voluntary nature of codes and practices, with the Portman Group due to launch a consultation on a new self-regulatory code.
Other areas of contention may include the Government's endorsement of industry favoured 'partnership approaches' as a central plank of national alcohol policy, some of which have been described mainly as 'an alcohol industry corporate social responsibility measure which is intended to limit the reputational damage associated with alcohol-related ASB'. Again though, others appear to see the role of local activities and partnership approaches as valid given the need for co-ordinated activity between key partners such as police and licensed premises. Whilst the number of outcome evaluations of the various night times economy initiatives is still particularly limited, the current Government led 'Local Alcohol Action Areas' (LAAA) aims to 'tackle alcohol-related crime and health harms and create a more diverse night-time economy' and has promised the inclusion of monitoring and evaluation plans as a key component.
Health policy, typically considered to span prevention and treatment activities, is another area where calls have been made for a clear national strategy. Ongoing cuts to public health budgets have inevitably hit treatment services, potentially contributing to recent falls in the number of people receiving alcohol treatment. Prevention activities such as brief intervention (IBA) efforts are also likely to have been much reduced in most localities, though a new national CQUIN seeking to embed IBA across hospitals this year has potential to reach significant numbers of at-risk drinkers if implemented successfully.
A national strategy for England?
Whilst alcohol policy is undoubtedly not top of Westminster's policy priorities list, recognition of the impact of alcohol problems has increased significantly since the release of the first national strategy in 2004. However, with the absence of any over-arching national policy for England, and specifically any commitments on the areas of price, marketing and availability, health groups feel there is much more to be done. Whilst opponents of pricing measures may highlight positive signals including significant falls in drinking amongst younger generations, hospital admissions are yet to fall and the costs to society remain significant, if still not also regularly disputed. Attempts to persuade public and politicians alike over alcohol policy decisions are set to continue for some time, particularly as evidence emerges over the precise impact of MUP in Scotland in the coming years.
Comments