Transform submission to the DoH alcohol policy consultation

Transform have made a submission to the latest DoH consultation on Alcohol policy, a section of which is copied below. The complete submission is available here (pdf). The submission includes some broader political discussion points:

• The negative influence of the alcohol industry on implementation of public health based regulation.
  
  
• The Government’s historic failure to stand up to industry pressure, or undertake the potentially unpopular regulatory measures required
  
  
• The anomalous status of alcohol policy, relative to a) tobacco policy and b) illegal drug policy

It includes an endorsement of the Alcohol Concern submission regarding answers to the specific questions posed as well as some additional recommendations on alcohol pricing and drink driving limits (neither covered in the consultation document), advertising/marketing controls, and product labeling.

• Government relations with a profit-making drug industry

The alcohol industry has fought tighter regulation at every juncture, with current and previous Governments evidently all too willing to prioritise industry interests over the concerns of the Royal Colleges of Medicine, The British Medical Association, numerous public health bodies and independent NGO’s, not to mention the overwhelming weight of published scientific research and epidemiological evidence. The current failing state of alcohol controls are a shameful testimony of the systematic failure of government to stand up to vested interests in the alcohol industry and their substantive lobbying resources, combined with an inability to demonstrate principled leadership and pursue public health policies that might incur short term political costs.

As with the tobacco industry, the alcohol industry is solely profit-motivated and therefore public health issues become a concern only when they threaten to impact on the bottom line. The industry will always to strive to concede as little market control to regulators as possible by deploying a now familiar menu of faux outrage and populist posturing (the nanny state against ‘a man’s right to have a drink in the pub’ etc.), dubious science (creating the false impression there is a genuine debate or controversy over issues like the efficacy of price and advertising controls), and token gestures (such as ending branding of child sport replica kits, setting up www.drinkaware.co.uk etc.). These efforts have been startlingly effective at distracting from, or delaying any meaningful regulatory legislation and have successfully kept what regulation has been passed at a voluntary level, meaning it can largely be ignored or sidelined to the point of being almost completely ineffectual.

The alcohol industry as a whole will never willingly accept any policies involving increased or stricter regulation that leads to a substantial decrease in consumption - as this will obviously lead to a consequent decrease in profits. Yet this is exactly what is required if issues of binge drinking and problem drinking in particular are to be addressed. It is important to remember that problematic and binge drinking constitute a significant proportion of alcohol industry profits; they are, quite simply, hugely profitable market sectors. Going on past experience - which demonstrates much of the industry not only avoiding the issue but actively encouraging unhealthy (but profitable) drinking behaviours - we have no reason to believe the alcohol industry when they claim to be serious about reducing such problems. Transform recommend that in the future they are kept at arms length in all development of public health policy and that some form of independent scrutiny of industry lobbying is established (and made public). The time for voluntary regulation of alcohol marketing has passed – it was a doomed experiment that has transparently failed on all fronts. The industry has held the balance of power in the policy-making equation for far too long, with systematic policy failures and disastrous public health outcomes there for all to see. It is time the brief was taken away from those that profit from maximising consumption and is returned to the public health experts whose goal is to minimise harm.

• Alcohol and tobacco policy

Some comparisons between alcohol and tobacco policy are appropriate here. Whilst there are obviously differences in how each should be approached, in many key respects research from around the world illustrates that the basic regulatory principles and public health approaches that underlie them are remarkably similar – for example regards price controls, controls on marketing and promotion, controls on availability, and controls on where and when they may be consumed. Yet developments in alcohol policy seem to be lagging at least 10 to 15 years behind progress on tobacco regulation. Whilst tobacco policy is delivering dramatic improvements in public health outcomes, the situation with alcohol is deteriorating.

The reasons for this disparity are hard to fathom, after all, tobacco industry lobbying was arguably no less ferocious or well funded 10 or 15 years ago than today’s alcohol lobbying and PR machine. We can only assume that it is an issue of political fear, and that a failure of leadership is primarily to blame. These fears appear to be two fold; firstly the negative public reaction to increased prices and other regulatory market restrictions, and secondly concerns about potential negative consequences for the alcohol industry itself, which, we are informed in the consultation document’s second paragraph, turns over £40 billion a year, whilst creating only £20 billion in health and social harms. Maybe from a certain perspective this constitutes a reasonable piece of political maths, but from any ethical or public health analysis – it is entirely unacceptable.

This baffling situation begs the question of how bad the public health crisis with alcohol misuse must become before it is taken anything like as seriously as tobacco?

Gordon Brown demonstrates safe, sensible and social drug use

Related blog posts:

Transform submission to the DoH consultation on the future of tobacco control
related themes are tackled

The fault lines in current drug policy
comparing approaches to alcohol and illegal drugs

Another alcohol strategy: fine words, but spineless
commentary on the June 2005 alcohol strategy this latest consultation is a follow up to

Why pulling alcohol ads from kids replica kits is nowhere near enough
a rant about the cynical alcohol industry

Government complicity in the alcohol marketing scandal
the industry couldn't have got away with it for so long without a bit of help

Supercasinos, drugs, and alcohol prohibtion: more than a whiff of ministerial hypocrisy
our leaders just haven't figured out how to be consistent when regulating 'vice'

Transform submission to the DoH consultation on tobacco control

Transform's have made a submission to the Department of Health's consultation on the future of tobacco control. The complete pdf of Transform's submission is available here, the introduction and one of the discussion points, on the wider implications of tobacco control policy, are copied below.

Introduction

Transform welcomes this consultation as timely, thorough and thoughtful, and hope that it will allow us to build on the recent achievements made in tobacco policy with more appropriate targeted regulation based around evidence of effectiveness on key public health indicators.

• Following a dialogue with Action on Tobacco and Health (ASH) Transform fully endorse ASH’s detailed submission (1) to this consultation and its answers to the individual questions posed.
  
  
• Transform also fully endorse the World Health Organisation’s framework convention on tobacco control (2) signed by the UK in 2003

In addition to this endorsement of the ASH submission we include some additional comments on overlooked elements of issues relating to tobacco harm reduction that are relevant to Question 17 (3) in the consultation document.

Transform would also like to present some additional discussion points not directly addressed in the consultation document regarding:

• Possibilities for a more radical restructuring of tobacco market regulation
  
  
• Discrepancies between alcohol and tobacco policy development
  
  
• The wider issues raised around drug policy and how to regulate drugs

The wider issues raised around drug policy and how to regulate drugs

All drugs, whether currently legal or illegal, need to be subject to the optimum level of regulation such that harms, both to individual users and the wider community are minimised and wellbeing maximised. Better regulation of tobacco is now delivering positive public health benefits, and as we argue above, it is hoped, and indeed seems likely, that these lessons will soon be translated into more effective regulation of alcohol markets.

However, it is hard to ignore the fact that such regulatory interventions, on price, packaging, availability, ingredients/strength, marketing etc, and the positive outcomes they can demonstrably deliver are entirely beyond the reach of government when it comes to drugs covered by the Misuse of Drugs Act. Responsibility for control of illegal drug markets was abdicated to criminal networks and unregulated street dealers when they were subject to absolute prohibitions against their production, supply and use, enforced with criminal law.

The distinction between legal and illegal drugs is not based on any rational evaluation of harms, but rather is a quirk of our political and cultural histories over the last 200 years. Indeed a recent Lancet paper (4) ranked alcohol and tobacco as more harmful than many illegal drugs.

The disjuncture between how we approach legal and illegal drugs is entirely illogical, and the case for all drugs to be regulated within a single regulatory framework, by a single regulatory agency, using a consistent set of evidence-based public health principles/tools seems overwhelming. Why are alcohol and tobacco the primary concern of the DoH, whereas over 200 illicit drugs are covered by the Home Office? It is a quite bizarre and untenable situation. Even the Advisory Council on the Misuse of Drugs, the body of experts appointed to advise Government on drugs issues recently argued that:

"As their actions are similar and their harmfulness to individuals and society is no less that that of other psychoactive drugs, tobacco and alcohol should be explicitly included in the terms of reference of the Advisory Council on the Misuse of Drugs (5)"

Transform argues that the sorts of questions being asked about appropriate levels of legal regulation and state intervention in the tobacco and alcohol consultations are precisely those we should be asking for currently illegal drugs. The current anomalous legislative framework however, completely denies us this opportunity and there is a striking and depressing contrast between the public health pragmatism of these DoH documents and the shallow politically-driven criminal justice posturing that characterised last year’s disgraceful drug strategy consultation (6). The DoH should unambiguously assert that drug policy is primarily a public health issue and is should therefore be the primary responsibility of the DoH and relevant public health authorities.

No credible calls have been made for an outright ban on tobacco, or for it to criminalised and brought within the Misuse of Drugs Act. Indeed, when the then Home Secretary, John Reid, was asked on the Jeremy Vine radio show (BBC Radio 2, 11.11.04) if he supported such a ban he replied:

“Prohibition doesn’t work, as the US found out many years ago.”

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[1] http://www.smokefreeaction.org.uk/news/ASH_DH_Consultation_tobacco_control_final.pdf

[2] http://www.who.int/features/2003/08/en/

[3] Do you support a harm reduction approach and if so can y9ou suggest how it should be developed and implemented.

[4] Development of a rational scale to assess the harm of drugs of potential misuse . The Lancet , Volume 369 , Issue 9566 , Pages 1047 - 1053 D . Nutt , L . King , W . Saulsbury , C . Blakemore.

[5] Pathways to Problems 2006 http://drugs.homeoffice.gov.uk/publication-search/acmd/pathways-to-problems/Pathwaystoproblems.pdf

[6] Discussed in more detail in the submissions from Transform: http://www.tdpf.org.uk/Policy_General_DrugStategyConsultationSubmission.htm and the Drugs and Health Alliance: http://drugshealthalliance.net/documents/consultation_submission.php

Loads of people taking drugs shock!

There are two main official UK drug use surveys each year, the British Crime Survey, and the Department of Health drug use school survey, now compiled together by the NHS Information Centre each year published today along with various other data from the DoH, the Home Office, Office for National Statistics, the Health Protection Agency and NTA. Notably (pay attention journalists) 'most of the data contained in the bulletin have been published previously', in fact the only unpublished figures are on drug-related admissions to hospital.

It is now a calendar fixture that each time these surveys are published the media will run 'loads of people taking drugs shock!' stories, demonstrating their goldfish-like ability to forget the 4 monthly repeated fact that, unbelievably, loads of people are in fact taking drugs. As regular as clockwork, this morning sees the Independent lead with one of its tabloid style front page headlines:

None of these facts are new or significantly different from last year, when loads of people were similarly taking drugs. The Home Office, with similar predictability will spin the prevalence figures as best they can, and try and show that drug use is actually falling, when it clearly isn't - especially when you look at the area that matters most - problematic use of heroin and cocaine which remains more or less stable at its historic Euro-league topping high.

The Sun front page has a similar theme:

As does the Daily Mail

If anything this tri-annual media ritual only serves to highlight, yet again, what stunningly poor value for money we are getting from our disastrous drug strategy and just how hollow all that political posturing about 'cracking down', 'getting tough', 'turning the corner' and 'zero tolerance' really is. But nothing it seems will prompt the Government to change course or give alternative approaches even fleeting consideration (even though many evidently think we should in private). Not the relentlessly bad news on drug use, misuse, drug related crime, or the spiralling catastrophes in Afghanistan or Colombia, nor the endless stream of authoritative high level reports spelling it all out in tedious detail. More of the same is all we are promised, with a bit of populist window dressing if you're lucky.

The DoH is quoted in the Independent parroting the usual line that:

"More people than ever before are getting into and staying in treatment, drug-related deaths are down and the level of drug-fuelled crime has fallen substantially."

Scratch beneath the surface and even these claims are either untrue or misleading. They dont measure drug related crime, drug deaths are not down, and even if treatment numbers are up no amount of throwing money at the problem or diddling the stats can hide the fact that treatment outcomes remain obstinately awful.

The Independent at least gives the Transform position a nod in its coverage :

Danny Kushlick, the head of policy at the drugs think-tank Transform, said the Government was burying its head in the sand by refusing to acknowledge that millions of people used drugs safely. "In order to maintain its position on prohibition, the Government has to show that all drug use is dangerous. Politicians find it very difficult to admit that 90 per cent of those who use drugs either have a boring or a fun time. Drug policy is overwhelmingly focused in a very skewed way on problem drug users. We should focus our attention more on managing use rather than mismanaging misuse.

"We need legal control and regulation of drug use. That is how we manage use of alcohol and we need the same for drugs."