Tackling alcohol, challenging the norm

September 28, 2018 in ADPH Updates, President's Blog, Publications by admin

I remember arriving in the UK as a Junior Doctor to work in the NHS in the mid-90s. The nurses were my new friends, and I used to join them at 9pm post shift for a crawl down the Derby Mile.

The bigger the group, the more the rounds to be gotten through before the 11pm closing hour bell rang. Then curry and Cobra at the end. Not something I had known before, but seemingly commonplace and well, normal.

I jumped into my new social scene with gusto, before long exceeding any recommended unit count, and rapidly putting on weight. A trip back home allowed for a welcome detox and sensible reflection and resolve.

Drinking too much. So easily done when it’s so normal.

The normalisation of harmful heavy drinking

Around that time, there seemed to be an explosion of new product development, new marketing approaches, new ‘normal’ ways of drinking – I remember the bursting onto the stage of alcopops, the surge of stag and hen dos, the creative, free-flowing Happy Hour promotions …

Licensed premises have exploded in numbers since 2005/6 – in my borough, there was a 41% increase. Schools and even hairdressers joined the corner stores and 24 hour pubs.

Since 1970 the amount of alcohol consumed per person has risen by 50% in the UK. Over that period alcohol has become relatively cheaper and more readily available. Alcohol is aggressively and expertly marketed and drinking has become a normal feature of everyday life.

Alcohol can play a positive social and economic role – and the large majority of people enjoy alcohol without harm. However, excessive alcohol use can have a harmful effect on individuals, their families and our community. The number of alcohol-related admissions to hospitals in England has risen yet again, with middle-aged drinkers most likely to be admitted, according to new Public Health England figures. We know we need to do something.

Navigating new approaches to population health

We know that public health issues such as these are too complex for a business as usual approach. We do need to challenge our own thinking and innovate – while developing, and keeping an eye on, the evidence of what works.

Partnering with Drinkaware could be just such a shift. However major changes in approach need careful consideration – a precautionary approach. The Alcohol Leadership Board should have been a place to talk this through with experienced and knowledgeable people.  The ADPH was therefore disappointed at PHE’s independent decision to collaborate with Drinkaware which has led us to a place where we, as a public health system in the broadest sense, have been, in effect, arguing publicly. And sadly, it is likely that this will lead to further confusion for the public around the actual messages about alcohol harm.

The key point is that alcohol is produced for profit. The more that is sold, the greater the profit. The industry spends billions creating new markets, promoting its product and lobbying for favourable business conditions. It spends some on corporate social responsibility (CSR).

A critical review in the latest (Sept) edition of WHO’s Public Health Panorama: Alcohol industry actions to reduce harmful drinking in Europe: public health or public relations? concluded that CSR activities conducted by the alcohol industry in the WHO European Region ‘are unlikely to contribute to WHO targets but may have a public-relations advantage for the alcohol industry’.

And we can all now quote the evidence review produced by PHE (2016) which demonstrated that education campaigns on their own, and particularly those with industry involvement, will not reduce alcohol harm.

These are some of the reasons why the public health community has a healthy scepticism of all things alcohol industry. As we noted in last week’s BriePH (the regular briefing for Directors of Public Health), ADPH has a clear Ethical Collaboration and Sponsorship Policy which sets out that the ADPH ‘will not work with, or accept donations from, organisations whose activities, policies, aims or objectives contradict or are inconsistent with its own’ – this includes partnerships with organisations involved in tobacco or alcohol manufacture. We regard Drinkaware as being too close to the alcohol industry. ADPH remains a member of the Alcohol Leadership Board. But we believe partnering with Drinkaware as they currently stand is unethical.

Missing the value DsPH can bring

I’m sure many of us can tell our own stories of how ‘normalised’ high risk drinking is in our communities and boroughs.

Directors of Public Health recognise that nationally developed social marketing campaigns such as the ‘One You’ have their part to play – and many have adapted these locally. Linking the One You brand with the Drinkaware campaign – without DsPH having any input – may adversely affect these local efforts. And declaring the campaign is ‘where the people are’ forgets that DsPH work closely with elected members and local residents. To some of us, it’s unhelpful and galling.

There is much work to do to reduce the harm. Minimum Unit Pricing, Health as a 5th Licensing Objective, adequate funding of treatment and recovery services and a levy on alcohol driven business to support the cost to councils and police of keeping safe and clean town centres are all part of that. The ADPH is committed to working with, challenging and supporting partners in the public health system – including PHE – to make sure we unite behind efforts known to have impact.