In the weeks since Public Health England (PHE) announced its partnership with Drinkaware for the 'drink free days' campaign, it has faced widespread criticism. The extent of the concern may have taken some, including PHE, by surprise. However, the fact it has raised the profile of debates about industry-Government partnerships may be seen by critics as an important repercussion.
An open letter expressing concern about the partnership has now been released, calling on UK public health scientists to sign and support its calls for PHE to “work with your Alcohol Leadership Board to formulate and publish guidelines for engagement with the alcohol industry and its associated organisations”. The letter argues the decision has led to significant “reputational risk to PHE’s status as a provider of impartial, evidence-based advice” and its authors are “alarmed by public statements from PHE” in response to concerns raised.
Earlier this month, Drinkaware, the alcohol industry funded education charity, jointly launched the 'drink free days campaign' in partnership with PHE, aimed at encouraging middle-aged drinkers to take more days off from drinking as a way of reducing their health risks. However, the decision led Prof Ian Gilmore to quit his role in as a PHE advisor, writing in a letter to the Times that the decision marked "a major shift in PHE policy in its willingness to share a public platform with the alcohol industry".
At the time of the campaign launch, PHE Chief Exec Duncan Selbie defended the partnership in a blog stating that Drinkaware are "partly funded by the alcohol industry but factually they are governed independently and we will be fiercely vigilant on this." However, this did little to diminish the criticism.
In a Twitter thread and blog post Colin Angus (Sheffield University) set out why he felt it was less than credible to describe Drinkaware as independent of the alcohol industry. Even if not directly at the bidding of its funders, he argued that the potential withdrawal of funding resulted in potential for a 'strong indirect influence', which was precisely why conflict of interest statements were so important in academia.
BMJ and Lancet editorials set out further concerns. In the Lancet, Mark Petticrew (London School of Hygiene and Tropical Medicine) and colleagues argue the alcohol industry should be treated as the tobacco industry now is – and that despite general recognition of nefarious tobacco industry efforts to influence policy in the past, "alcohol producers seek to portray themselves differently—with some success". Petticrew claims Drinkaware's "approach is consistent with the alcohol industry's corporate social responsibility activities, which typically focus on pathological drinking patterns while avoiding or misrepresenting evidence on measures known to work, including pricing, marketing, and availability controls" – a claim that has been previously argued by other public health researchers.
The Lancet editorial identified also concerns about the online self-assessment tool used as part of the campaign which "seems to endorse heavy drinking", stating:
'For example, a 30-year-old man who drinks 7 units a day, every day - over three times the current guidelines for low-risk drinking - receives the advice: “If you continue drinking at this level and do not exceed the daily guidelines then you are drinking in a way that is unlikely to harm your health. Drinking consistently within these limits is called ‘lower risk’ rather than ‘safe’ because drinking alcohol is never completely safe”. This Drinkaware advice also refers to “daily” guidelines. The current guidelines are, however, weekly guidelines: “To keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.'
In defence of the partnership
PHE Director of Health Improvement John Newton, and Paul Cosford, Medical Director at PHE published a response in The Lancet, which set out the 'opportunities and risks' of working with the industry. It also acknowledged that the examples raised by Petticrew and colleagues showed "the wider Drinkaware website needs a full audit, which we are discussing with Drinkaware”, as reported in the Guardian.
Newton and Cosford argue that PHE "understand very well the potential dangers of engagement with industries, such as the alcohol industry, that profit from the sale of harmful products", but that in PHE's primary duty to protect and improve health, in this case it "is best served in this case by working with Drinkaware on their campaign". They also made the case that PHE must “deal with the world as we find it, not as we would like it to be”, which meant making pragmatic compromises where they felt it was in the wider public interest. "Many charities receive such [industry derived] funds," and further, "no workable code of conduct could be drafted to exclude partnerships with charities on the basis of the nature of their donors". Finally, they asserted that "the campaign has been well received by the public and will be rigorously assessed."
Where next?
PHE is evidently now committed to this campaign, and it may mark a longer-term change in strategic direction regarding their work with the alcohol industry. However, any such developments would surely need to await the outcome of independent evaluation of the campaign. PHE’s own evidence review states that public education campaigns of this kind are among the least effective forms of intervention to reduce harm, so the results of the evaluation will presumably need to be significant to justify further collaboration.
It remains to be seen how this will play out in terms of PHE’s reputation among the public health community. Increasingly, and unlike their earlier decision to come down in favour of e-cigarettes where opinions were divided, PHE looks to be at odds with the many public health stakeholders in the field. Perhaps the senior leadership at PHE see this as an opportunity to prove their critics wrong, as they feel they did on vaping. Only time will tell how this bodes for both organisations.
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