It isn’t the drinkers we should worry about but the warped folk who hate drinking

Today the government published its Public HealthFramework setting out the purpose and objectives of this part of health spending. I don’t propose to spend a great deal of time boring you to death with what it contains. Suffice it to say that the devil will be in how the details are interpreted by the public health practitioners on the ground (we can expect still more of the ill-informed campaigns about booze, fags and burgers).

Nevertheless, here’s a flavour:

The whole system will be refocused around achieving positive health outcomes for the population and reducing inequalities in health, rather than focused on process targets, and will not be used to performance manage local areas. This Public Health Outcomes Framework sets the context for the system, from local to national level. The framework will set out the broad range of opportunities to improve and protect health across the life course and to reduce inequalities in health that still persist.

Now that’s clear, I’d like to talk about the “public health problem” that is drinking. And to ask – notwithstanding the liberal argument that it’s none of the government’s business – what the best strategy is to reducing the overall harm caused by alcohol. Currently the medical and public health professions argue for draconian measures:

Effective, evidenced-based public health measures do not include nudging people into healthy behaviours or getting NHS staff to lecture patients on healthy lifestyles. They include measures such as raising taxes on cigarettes, alcohol, fatty foods, and sugary drinks, reducing junk food and drink advertising to children, and restricting hours on sale of alcoholic drinks. 

Yet, as the government acknowledge, such an approach hasn’t worked in Finland:

“We are working in a very, very cynical environment at the moment where nobody believes we can do anything on alcohol consumption unless we price it out of the market. Finland would suggest that doesn’t work.”

So, instead of looking at these aggressive fiscal and regulatory measures, we should perhaps consider whether liberalisation might work. There is some evidence that society’s attitude to drinking is an important factor in its impact:

We, as a culture, set the rules. When they're broken it's not solely the fault of a drink or even five. It's the underlying message accompanying the way that we drink. That's something I believe we can change by recognizing drinking as a meaningful activity and by addressing problem drinking, which involves a more complete assessment, with culturally relevant programs and not with fruitless pleas to "drink less."

When the last Labour government liberalised licensing regulations (in 2003), there was an outcry from the grumpier tabloids. We were told that “24-hour drinking” would result in chaos as crime rose, disease spread and hospitals filled up with fighting drunken youth. So what’s the truth of this liberalisation?

Using the original method of conversion to units for comparability with earlier years, in 2006, men drank an average of 14.9 units a week (equivalent to about seven and a half pints of beer), around 2.3 units less than they were drinking in 1998. Average weekly consumption among women increased from 6.5 units in 1998 to 7.6 units in 2002 but had decreased to 6.3 units in 2006

OK, so I won’t (unlike too many public health people) make a causal link here but, since the liberalisation of alcohol licensing, consumption has fallen steadily and continues to fall. Far from the changes resulting in an epidemic of binge-drinking, we have seen an increase in more responsible, moderate attitudes to drinking. And the biggest fall (according to the ONS and NHS) in consumption has been among 18-24 year old men.

It seems that greater awareness of the risks associated with drinking and a society that sees drinking in moderation as a good, sociable thing to do, results in alcohol becoming less of a problem. Yet we still hear – almost without cease – how alcohol is a scourge. Here’s an American take – but it could be the UK:

The CDC tells us that binge drinking is a "bigger problem than previously thought," suggesting that it can (and often does) result in risky behavior, leading to violence, suicide, spread of sexually transmitted diseases, unwanted pregnancy, car crashes, and alcohol dependence. They also insinuate that binge drinking causes crime. By their measure, binge drinkers rack up over 223 billion dollars annually.

Yet most drinkers – including plenty who binge – don’t do any of these things. They don’t start fights, spread disease, kill themselves, get the girlfriend pregnant or wind up in hospital. They go home, go to bed and get up the following day to continue their otherwise normal lives. The liberalisation of licensing was a boon to these folk.

It meant they didn’t get tempted to buy three drinks at ten to eleven and drink them before getting turfed out at twenty past. It allowed them to finish their conversations, savour the last part of the wine or maybe a whisky and then make their way home with the gentle buzz of a good night.

The people who want us to be monitored, questioned, lectured, nagged – “denormalised” to use the chosen term – are those who want to spoil the pleasure of a drink for the outside chance of there being one or two fewer chronic alcoholics. It won’t work, it will spoil people’s pleasure and it is an act of bitter prejudice against something that has been part of human culture since we first stepped out from the African forests millions of years ago.

It isn’t the drinkers we should worry about but the warped folk who hate drinking – they are the ones who should be stopped. Banned maybe?

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