Disabling the public interest: alcohol strategies and policies for England

In March 2004, two important documents on alcohol policy were published by the British government. One is an Alcohol Harm Reduction Strategy for England (UK Cabinet Office 2004). This document has received more attention, but is arguably of less import. As we shall see, what it offers is a recipe for ineffectiveness at the national level. The second document, the kind which only a lawyer could love, is entitled Draft Guidance issued under Section 182 of the Licensing Act 2003 (UK Ministry of Culture, Media it should be noted that I was a member of that report's working group). The Strategy's proposals for how to respond to a bad and worsening situation can best be described as bathetic. If one takes the listing at the back of Alcohol—No Ordinary Commodity (Babor et al. 2003), for instance, where preventive measures are ranked roughly on the evidence of their effectiveness, there is an almost total correspondence between the measures proposed in the Strategy's recommendations and the measures which are ranked in the listing as ‘ineffective’. They are all there in the Strategy: school education, voluntary advertising codes, even a half-hearted discussion of alternative entertainment for youth. Conversely, the Strategy eschews almost all the strategies ranked as ‘effective’. For those from the effective end of the list which it does advocate—for instance, brief interventions in primary health care—no new resources are provided, and the problem of actually getting health workers to conduct brief interventions (Roche again the Strategy chooses a measure for which there is no evidence of effectiveness. The Strategy mentions that the United Kingdom's blood alcohol limit of 0.08% is among the highest in Europe, but does not broach the idea of reducing the limit to 0.05% to match most of the rest of Europe, nor other effective measures such as intensive random breath-testing. Again, the Strategy steers away from any measure with a reasonable track-record of effectiveness. The Strategy acknowledges that ‘there is a clear association between price, availability and consumption’ (p. 23). However, it eschews any proposals either on excise taxes or on controls of availability, with the explanation that ‘our analysis showed that the drivers of consumption are much more complex than merely price and availability’. While this statement is true (although no back-up analysis for it is offered), it is irrelevant: that the aetiology of emphysema is more complicated than just cigarette smoking is not an argument against doing something about the smoking. The Strategy also mentions ‘evidence which suggested that using price as a key lever risked major unintended side-effects’. No such evidence is given, but presumably potential rises in cross-channel purchases and smuggling are what is meant. A discussion of these issues would have been a good opportunity to raise the issue of whether the United Kingdom should attempt to change EU rules on alcohol in the Single Market which undercut public health. Indeed, an indication of the parochial quality of the Strategy is that the European Union (EU) is mentioned only once (in connection with seeking permission from the EU to require warning labels on alcoholic beverage containers; p. 33). After implying that price and availability policies would be unpopular, the Strategy offers its capping argument for looking away from price and availability: ‘measures to control price and availability are already built into the system’ (p. 23). The idea the Strategy can thus ignore a whole arena of action because it is ‘already built into the system’ is a breathtaking contradiction with the Strategy's general thrust, which points out how fragmented alcohol issues are between government departments, with ‘no clear focus for policymaking’ (p. 82). A document cannot be accepted seriously as taking ‘a strategic approach to addressing alcohol issues’ (p. 82) if it rules out of consideration some of the most effective available strategies. Having offered its arguments for steering away from price and availability, the Strategy continues: ‘So we believe that a more effective strategy would be to provide the industry with further opportunities to work in partnership with the government to reduce alcohol-related harm’ (p. 23). No evidence is offered of why this would be ‘a more effective strategy’; again, the evaluation research literature would not support the belief. My reading of the sentence is that it must have been written with a wink, essentially as a statement that ‘our political masters decided that the Strategy's approach would be to work with the alcohol beverage industry, and vetoed recommendations on matters like price and availability which would upset the industry’. This reading of the sentence is supported by the most ludicrous item in the Strategy—the model of actors and responsibilities for reducing harms from drinking (pp. 24–25). Three sets of actors are named. The first are ‘individuals and families’, who are responsible through ‘their own choices about what they and those for whom they are responsible drink, where and how’, including being responsible for actions while intoxicated. The third actor is ‘government’, which is responsible for informing consumers, ‘supporting those who suffer adverse consequences’, protecting others from the drinker, ‘ensuring a fair balance between the interests of all stakeholders’ and ‘providing the right strategic framework’. Also mentioned is ‘protecting against harms caused by the supply of alcohol where appropriate, and for regulating to the minimum necessary to achieve this’. (One can guess which qualifiers in this sentence were insisted upon by industry interests.) Between the individual and family and the government is another actor, the ‘Alcoholic drinks industry’, which is assigned responsibilities for giving accurate information and warning about consequences of drinking, for ‘supplying its products in a way which minimizes harm’ and for working with national agencies and local partners. So much for civil society. No other intermediate actor is mentioned in the chart, whether professions, institutions, voluntary associations or—notably—local governments. There is simply the individual drinker or family, the government and the alcoholic beverage industry. It is a telling and indeed a rather totalitarian picture, and an utterly inadequate representation of reality in a complex society such as the United Kingdom. As noted, in the same month another major British alcohol policy document was released, the Draft Guidance issued under Section 182 of the Licensing Act 2003 (UK Ministry of Culture, Media & Sport 2004). This document was also the result of a long process of consideration. In May 2001, the Home Office published its proposals on alcohol licensing ‘reform’ (UK Home Office 2001), the culmination of a review and consultation process dating back to 1998. A notable feature was a provision to eliminate any national closing hours for pubs and nightclubs. After an intervening election, legislation based on the proposals was finally passed in 2003. The Draft Guidance, which must be passed by Parliament, begins the process of actually implementing the new legislation. After the election, responsibility for alcohol licensing matters was transferred to the Ministry of Culture, Media and Sport. This transfer, which of course further fragmented government responsibility for alcohol matters, has tended to provide the industry with a more reliable governmental ally (alcohol licensing falls under the ‘tourism’ section of the ministry's portfolio). A 2002 speech by the Culture Secretary to an alcohol trade group, for instance, essentially promised that the reforms would increase alcohol sales: ‘the reforms would be good for the economy, opening the way to new and more diverse markets, providing new investment opportunities and creating new employment’ (UK Ministry of Culture, Media & Sport 2002). A major change in the new licensing law is the abolition of the centuries-old system of ‘licensing justices’ and their replacement by a licensing committee drawn from the local elected council. This can be seen as a positive change in terms of governance and accountability, making the licensing authorities responsible to the community which elects them. However, this is precisely what has greatly worried alcohol industry interests, which fear that such local authorities may be less co-optable: ‘They have a vested interest in the people that vote for them’, a board member of the Restaurant Association complained (Restaurant industry speaks out . . . 2002). As troubles with drinking in the core city area have increased, a number of British municipal governments have become activist in their licensing policies, and some have been looking to charge the trade for the extra policing, street-cleaning and late-night transport that later closing hours would require (BISL hits out . . . 2002). The trade became worried that the shift in structure might mean a more restrictive rather than a weakened licence regime, including in some places a reduction rather than an increase in opening hours. The task for industry interests, thus, has been to lobby the central government to impose severe constraints on what actions local licensing boards can take, in the form of ‘guidance’ from the central government on how the boards can act. The March 23 document gives evidence of the trade's very considerable success in this effort. From the perspective of an outsider, the result is astonishing. The instructions on what may and may not be carried out are, after at local who have presumably been elected to their as people of and It is to such an taking to the of the which in its as if at As for the the is to the of any local of the document is on the of the of the licensing which are to ‘the of and public the of public and the of from harm’ (p. is no for the licensing to a the which is merely it must be For may not be which to the health of rather than their (p. public is with the of the people using the and not with the public with is with in other (p. licensing authorities are to look no further than the of the in question in terms of which might result in on the to cannot to the of once they are the of the licence and or (p. to public caused by the of once they are the control of the licence . . . cannot be . . . the of the these are matters for responsibility of under the (p. from in the street the cannot be into by in a of (p. licensing authorities may not impose which the of as to the of should be to . . . It will be the responsibility of the licence as an and not the licensing to that at the are and and licensing authorities must that they not their powers and (p. are to be essentially as an which must be from or (p. or even in terms of a of (p. This applies even to issued to or of even ‘a deal of time may (p. the are will be important for investment and that no new are the actually (p. While licensing authorities are to policies to which the of new in a may only be into a new licence or change in an one is being it cannot be into even in a review of an licence (p. policies be as a for an licence are received about problems with those (p. licensing authorities should not with the of the The of by the licensing is no a consideration. the for another or or This is not a for the licensing . . . is a for and the (p. 23). problems from a or licence is The for advertising that an has been is to one on the (p. only and but also are to be from consideration for which would have been the for the licence was first and which were by of the of a licence (p. It is that the on whether a is thus not to be be to of the licensing committee (p. This that political is as an of decisions on a not be on the of any political which would a approach to the This may be for from their own (p. and the is in For instance, on of it in general that and be to alcohol at any time which they to The document in the British government that and early closing are ‘a key of and of are to This in the of the research literature (Babor et al. 2003, and . . 2002). opening in for instance, in in and in The work was more the but this a change in shift to the new work at et al. 2002). One to the problem of the pubs at the same it would might be closing licensing authorities should also not to closing by for closing . . . In the this would only to the of and . . . with a of . . . and would not be necessary to the licensing The general should be to support later opening that for a (p. 82). I found for a the of the document ‘licensing authorities should not closing for (p. this would a key of the 2003 (p. are licensing authorities to reduce opening hours in the to the new licensing regime, even in the case of with permission to for hours. the even more ‘a licensing is from . . . which would have the of opening hours to more hours than the (p. the other any idea of the public responsibilities as a of public to be ‘there is no . . . to for the . . . for a public has no trade on a the licence is entitled to the (p. The end result of the Guidance, if it into will be a the new local licensing authorities will be with and but will be almost to the licensing to the or of of the alcohol in their for local to have to alcohol licensing is also not For instance, the in that there was local the licensing system was In such the for in some local control alcohol has been through their and In for instance, have good of which essentially impose controls on hours and of through the system & The UK Guidance that the local process is also in local control of alcohol In it the argument that local authorities should provide control and licensing will be to and (p. it is to how is to However, the of the has arguments that the local powers in England cannot work as a for licensing powers 2003). A for the Prime Minister's Office of the of a measure by the government in to local gives support to this that ‘the local authorities the of about by of the is about the for and drinking in ‘the of public that has in This a market that has been by the central constraints on local is by authorities to have the of and to have given to because of the number of people in one area and by in the (UK Ministry of Culture, Media & Sport 2001, As the report on the there is a problem in British and with alcohol and the & et al. 2003). The powers of local governments have been they cannot provide a The Guidance on the new Licensing to that licensing cannot provide a and there is in the Strategy which is likely to have much in reducing these The which is of a central government which is to be with respect to alcohol and which effort to any by local government to effective alcohol This is a which England has to at the end of of efforts on the Strategy and on the Licensing The one feature of the is that the because this gives some to the that there has been the government the is I itself is a very and is to alcohol industry In recent some have of the The supply of to was to have between and A member of noted ‘a rather change in the The most of the while the of drinking are . . . I have there are now more people than who in the in a 2002). Media have also to drinking among a on Home Office proposals to by it just the and suggested that the Home Secretary was by the of the Home 2002). Alcohol industry interests are in and in the government. The is the at with of and industry interests to have as an on this government as they on the governments which In March for instance, the government that it was on its dating from to reduce the blood–alcohol limit for from 0.08% to the general level of the European Union, to this the with the which is by the drinks industry and reducing the The Department of on research by the A of noted that ‘the with that of the alcohol industry but is by local the the British Medical the the for the of the and the for (UK of 2002). The of the of a noted that by the of the drinks 2002). The also general of the Blair government. has a to problems in individual to the in pubs and on the street to be seen as a of and the are individual and from or a law for the to on the for and This from the Prime with but up again in the Strategy as a of to be by the and (p. in the is thus in terms of steering away from the and in which the trouble as more to than any government . . . It that it has been to to the more than any of its It would be to of a more of than the of the Blair government on alcohol the end of the Strategy, under the ‘ensuring the is there is an attempt to the are to the industry to its to by best that in the should be voluntary . . . the next if industry actions are not to an in reducing will the case for including legislation. However, in the light of the it is to much to this There was a not long was of on alcohol It is to the new Strategy with the report on Alcohol in in the final of the government, by the The report was but published in in the of the Act the Strategy, the review noted the of alcohol issues UK government departments, by the for the for for However, the of the not much further than The review on the literature a of alcohol consumption to of in the and not the It proposed that ‘the should a positive on the in consumption and on the reduction of alcohol-related (p. It the of alcohol taxes as an of alcohol with the at a minimum being level with changes in the price licensing should not be further it should be and in respect to under drinking its ‘the on drinking and should be and legislation (p. A the review still a than the document for a British strategy on alcohol.