Public health and public policy: the alcohol controversy

Six organisations concerned with health have withdrawn their support from the Government’s attempt to broker a “responsibility deal” on alcohol and public health between what might be broadly characterised as “the industry” and “the health lobbies”. The latter have complained that the Government is kowtowing to the former and allowing them to dictate health policy. Profit before health is the claim, with an undercurrent that the Government’s close association with business generally is leading them to distorted and partial conclusions. You can read more detail from the BBC here.

I won’t pursue the issue of motivation since I have no direct knowledge of the players, and I’m not sure how useful it is to try and infer the inner workings of the minds of other people from indirect evidence such as their political or financial sympathies. But in any case, there are more fundamental matters at stake here. To enumerate the most obvious:

  • efficacy: what is most likely to work, if by working we mean bearing down on the ill-health which everyone agrees flows from excessive alcohol consumption along with its toll in personal suffering and costs to the public purse?
  • individual responsibility: to what extent should the weaknesses of some members of society be moderated at the expense of others who do not display those weaknesses?
  • liberty: should we limit personal choice even when some choices are clearly to the detriment of the choosers?
  • collateral damage: what is our collective responsibility for the collateral damage alcohol does to those not even involved in its consumption – for example domestic violence or street violence?
  • ethics: should we tolerate the making of profits from the vulnerabilities of some members of society?

It is pretty obvious that none of these questions can be answered with a definitive yes or no. In some cases the evidence is too uncertain, and in others even when evidence is unassailable, the ethical issues are far from clear. To that extent I think the health lobbies are not responding with much discrimination. They are mistaking certainty of end with certainty about means. Because the medical charities see in stark relief the damage that alcohol does, and know just how much the health interventions cost, they are rushing to conclusions about what to do. This would be mistaken even if there were no dispute about efficacy: but there is a lot of dispute.

However, efficacy is just one of the issues I’ve rehearsed in my list. Most of the others have to do with values, not outcomes. The real problem with the Government’s approach is that it is bringing the wrong combatants to the table. The problem of alcohol in our society is nothing to do with the sellers or manufacturers of the stuff. That may seem an odd thing to say, but I believe it’s true. The social problem is the excruciating conflict between alcohol as a social good which many people enjoy, and alcohol as a social evil that some people are unable, for whatever reason, to control. We need to make decisions as a society about how we want to trade these issues off. The issue of profit is entirely secondary, and only serves to cloud the matter. I have not heard many people say with outrage that profits made by the Château Lafite-Rothschild are immoral – more that some people are prepared to pay crazy sums for fine wines, but that’s their look-out. Profits from alco-pops – oh, well that’s different. It’s not different, and to say that it is is merely to expose one’s snobbery.

Far from discussing the issues with those with a clear vested interest (and that’s not to say the interest is immoral) we should be discussing it with, on the one hand, those of us (all of us, of course) who pay the financial and other costs of alcohol as social evil, and, on the other, those of us (also the vast majority) who enjoy drinking and want to drink alcohol as social good. Once we’ve got that balance right, we can then explain to the producers and sellers of alcohol what restrictions we wish to impose on them. Their opinions about the matter aren’t important.

We are adults. We should be capable, and be encouraged to be capable, of balancing one thing against another. If we want cheap alcohol so we can consume it at reasonable cost and with responsibility, we must also accept that we’ll probably need to pay higher taxes because that liberal approach will cost the health service more, and society more. On the other hand, if we want low taxes, and low demand in the health service, we may have to accept paying much higher prices for alcohol if that can be shown to be an efficacious policy. If we want to prize liberty, we must also accept consequences. If we want to prize outcomes, we may need to accept the infantilising consequences of the “nanny state”. What none of us can have is a free society in which we are shielded from all bad outcomes, or a society that is concerned primarily to protect us but which also sets us free. And finally, everything has to be paid for. The libertarians who want low alcohol taxes and no restrictions cannot also have low social costs, either in taxes generally or in harmful consequences. But they are right to draw attention to the primacy of choice. That applies to all of us, regardless of political or indeed any other kind of allegiance.

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2 thoughts on “Public health and public policy: the alcohol controversy

  1. Of course the extra revenue from sin taxes vastly exceeds the additional cost to the health services. Smokers and drinkers already accept that higher tax argument. However, the government is in danger of killing the golden goose – already has on tobacco really since around a third of tobacco used in the UK is non-UK duty paid. This will come with drink as well.

    Couldn’t resist the gentle dig at libertarians though could you 🙂

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