Welcome to The Church of Public Health, spiritual home to the New Puritan

A while ago I wrote a piece entitled “The new Puritans” in which I drew parallels between the assault on the pleasures of the ordinary man and the dour, stolid faith of the Puritans:

Just as did the Long Parliament, today's New Puritans propose to use the power and authority of the state to control pleasures of which they disapprove.

The smoking ban, calls for restrictions of alcohol, the attacks on video games, films and magazines for portraying terrible and lustful images, and a terrible contradiction in our attitude towards and treatment of children. These are the signs that these New Puritans are winning the battle – and it all seems so reasonable, doesn’t it?

And the driver for this new puritan ethic is the cost to society – smoking we’re told “costs the NHS” billions, complex costing are prepared demonstrating just how much our boozing is destroying the economy and now we are regaled with the terrible costs of eating the wrong sort of food:

Professor Dame Sally Davies, the chief medical officer for England, said parents had to be made aware of the "hidden risks" of poor diet for their children. "Fatty liver disease is becoming a very common chronic liver disorder in Western countries and causes serious ill-health. In addition, many cases of fatty liver disease are linked to being obese. We all need to be aware that fat is not only stored on our body surface, but in and around our internal organs too."

Welcome my friends to the Church of Public Health, the high priests of which have only your interests at heart in their quest to reduce the risks of modern living – cigarette smoke, alcohol, transfats, sugar, salt and Ronald McDonald. To understand the core articles of this church’s faith we can turn to its scriptures – lovingly provided for us by the Faculty of Public Health:

Public health is about improving and protecting the health of groups of people (or 'populations') rather than treating individual patients. It is concerned with 'the bigger picture'. Public health professionals must take action to promote healthy lifestyles, prevent disease, protect and improve general health and healthcare services for their local 'population' – which could be a rural community, an entire city or even the global population.

And the Faculty’s Manifesto includes:

A minimum price per unit of 50p for alcohol
No “junk-food” advertising in pre-watershed television
A ban on smoking in cars with children
Compulsory front-of-packet labelling for all prepared foods
Banning transfats
Presumed consent for organ donation

These proposals are supported by some of the dodgiest arguments (but remember this is a Church so acceptance of the argument is a matter of faith in the expert not in the revelation of truth). Over recent years the Church of Public Health has captured our National Health Service to the point where clinical investment choices are being directed not by proper processes of diagnosis and appraisal but by the Church’s obsessions – smoking, drinking and diet.

And the guardians of truth – our media – do not question or challenge the statements of the Church of Public Health and its priests. They appear regularly on the radio and television, in the pages of the newspapers and in a host of specialist magazines and what they say, their supposed evidence, is never challenged. If these priests say alcohol consumption is rising (when it’s not) no interviewer ever questions that statement. When the acolytes of the Church say that smoking costs the NHS billions, no-one points out how much smokers save by dying early or how much revenue they contribute to the exchequer. And when the discussion turns to excess weight, no broadcaster ever asks why we don’t talk more of personal responsibility rather than blame an advertising clown all the time.

I do not think that I will succeed – I feel as a lone voice in the wilderness. But I have had enough of this Church’s mission – a mission that has wholly corrupted the idea of public health, which treats us as recalcitrant children unable to make our own decisions about our own health. So I shall over the coming weeks look in turn at all the tenets of the Public Health – the New Puritan – faith, at smoking, at drinking, at diet and at our attitude to children and young people. Hopefully, this small heresy of mine will get some readers, will turn a few folk away from the New Puritans and will encourage others to question the lies of Priests of the Church of Public Health.

....

Plain packaging won't affect tobacco use or the numbers taking up smoking

****

The Department of Health under its supposedly Conservative minister, Andrew Lansley, is proposing to require cigarettes to be sold in plain packages and probably for displays of cigarettes to be outlawed. The purpose of this we’re told is:

"The evidence is clear that packaging helps to recruit smokers, so it makes sense to consider having less attractive packaging. It's wrong that children are being attracted to smoke by glitzy designs on packets.

"We would prefer it if people did not smoke and adults will still be able to buy cigarettes, but children should be protected from the start.

"The levels of poor health and deaths from smoking are still far too high, and the cost to the NHS and the economy is vast. That money could be used to educate our children and treat cancer," Mr Lansley said.

Now I’m not sure quite what all this is about or, indeed, whether the so-called evidence actually exists – I certainly couldn’t find it. However, unlike the doctors and bureaucrats crawling over the airwaves frothing with excitement about these proposals, I do know a thing or two about marketing and branding (having been Account Planning Director of a leading direct marketing agency and having spent six years writing management implications pieces in the Journals of Consumer Marketing and Product & Brand Management).

Firstly, brands do not act to recruit customers to a given product – we choose to buy the product and then we select the brand. Nobody starts buying bread because they saw a Warburton’s ad – they buy bread because, well, they want bread! What the brand provides is a heuristic – a short cut, if you will – allowing the consumer to make a choice quickly and confidently. What we do know is that it is the search for a benefit that makes consumers choose to buy a product rather than the shininess of the brand presentation.  Or is you prefer: we buy bread because we want to eat it not because the advert featured a brass band playing chunks from the New World Symphony!

Secondly, packaging serves two purposes – identification and appeals to impulse. In the first instance we put our product into easily identified packaging as part of that heuristic, as a quick means of identifying our particular version of a given product. And, where purchase is often impulse driven, we use packaging to make the product stand out from other similar products. So yes packaging can assist purchase – but only where it isn’t a considered purchase. Sadly for Mr Lansley and his pals, tobacco isn’t an impulse purchase – we have to make a choice to buy and ask someone for the product. We can’t just grab 20 Regal from the countline display! Thus the only impact of plain packaging will be to increase confusion and error (they all look the same) and slow down the purchase process by making selection by the shop assistant more difficult.

And thirdly, smokers are going to buy tobacco. Put it in plain packets or wrap it in shiny gold tissue paper, it doesn’t make a difference – the smoker will go to the counter and ask for the product she wants. And the smoker will still ask for a brand – Benson & hedges, Marlboro’ or whatever – as that is the heuristic, the short cut allowing the person serving to meet that customers requirements. What will change – which suits big tobacco fine – is that levels of switching between brands will reduce. In fact the same effect that banning advertising had on consumption (and why it was the media and advertising industry that opposed the ban far more vigorously than did the tobacco manufacturers).

My main concerns in all this – leaving aside the issue of personal rights – is that, if the aims are twofold: first to increase rates of smoking cessation and second to reduce rates of smoking adoption, then we are barking up the wrong tree. By way of illustration, between 2003 and 2005 all forms of tobacco advertising in the UK were banned. If the arguments for a ban were correct – less tobacco use and fewer tobacco users – we would have expected the rate of tobacco consumption to accelerate. However, the ban (like the smoking ban in public spaces) had no discernible impact on the long-standing decline in use.  In fact, as this chart shows the reduction has slowed almost to a stop – the ban did not do what its advocates claimed.

 And we should remember that tobacco consumption figures get more and more inaccurate with each passing year and with every duty increase.

In 2004, it was widely accepted that around 25 per cent of all cigarettes and as much as 75 per cent of hand-rolling tobacco consumed in the UK were non-UK duty paid. Independent retailers put the cost to them of this trade at £1.2 billion per annum in sales. In 1999, a study showed that smuggling cost the Treasury £2.5 billion in lost revenue. 

That is pretty much a guess and today's situation has got worse and the tobacco business is become less and less legal, less protected and more dangerous. And plain packaging make counterfeiting more likely, smuggling easier and, coupled with ever more draconian controls on normal retail sales, will result in yet more of the trade shifting from supermarket and corner shop to white van and sixth floor council flat. Where of course, the sale jostles for position with stolen goods, counterfeits and illegal drugs!



....

Anyone know how to make moonshine? Thoughts on the economics of minimum booze prices.

****

Today the Prime Minister came out in support of a proposal to introduce a 50p per unit minimum price for alcohol within Greater Manchester. Now, leaving aside the absence of any border control in this conurbation and the obvious fact that driving from Bolton to a supermarket in Bacup isn’t exactly a great trip, we should maybe consider the economic impact of minimum pricing.

The core argument – and we have to start somewhere – is that a relatively low minimum price will only impact off-sales since pub and restaurant sales are typically over £1 per unit. Here’s one study’s conclusions:

Only alcohol sold for home consumption would see an increase in prices, and reduction in sales would generally spare pubs and restaurants. While consuming more units of alcohol than other groups, higher income and high managerial groups would be less affected by this pricing policy.

However, this isn’t the view held everywhere. The Centre for Economics and Business Research (in a study funded by a brewer) criticised the theoretical basis for the argument and the evidence. Most importantly, while the evidence shows (not surprisingly) a relationship between price and consumption this is weakest for the heaviest drinkers.

However, when overall alcohol consumption levels and prices are taken into account, heavier drinkers are less responsive to price changes than moderate drinkers. The University of Sheffield study estimates that hazardous and harmful drinkers have a
price elasticity of -0.21 across all alcohol products – this implies that a 10 per cent increase in price would only lead to a 2.1 per cent reduction in consumption amongst heavier drinkers.

However, we still see a “positive” impact from minimum pricing albeit a small one. However, this is a pretty blunt implement that, in effect, targets the poor (note the findings from the first study cited). More importantly, minimum pricing has an impact on supply – there is an incentive for the producers of alcohol sold currently at below 50p per unit to increase their supply so as to take advantage of the excess profits implied by the minimum price. With higher profits the producers (and their retail agents) can afford to invest more in promotion.

The most likely outcome of this surplus reducing investment is promotion targeted at drinkers currently buying alcohol at higher prices – either in pubs or for home consumption. The impact of this would be negative for the pub trade and counter to the expectations of those promoting minimum pricing. And we have not yet considered moonshine!

All-in-all it seems unlikely that minimum pricing will address the core issue of the ‘problem drinker’. And we have to set this against falling consumption and fewer alcohol-related emergency admissions. Whatever we’re doing at present, its working and, rather than penalising people for only being able to afford cheap booze, maybe we should focus our efforts on the relatively small number of problem drinkers.

Anyone know how to make moonshine?

....

Liberalisation works but that won't stop the New Puritans banning your pleasures

***

Some will have watched the programme on Channel 4 this evening pointing out the extent to which out drugs policies – all of them – are failing. I’ve long been equivocal about our approach to drugs but this has been on the basis of disagreeing with the tactics rather than questioning the strategy. This programme hasn’t yet changed my mind but I now doubt the efficacy of the draconian, ban everything, ‘bang ‘em up in jail’, catch the drug lords and take all the money strategy we now employ.

Many of you may well agree with me on this – but believe me the politicians (from every party) who use the term ‘soft on drugs’ as a cheap vote vacuum will be revving up the opposition to the politician who says ‘legalise it’ or ‘don’t ban it’. Even when the evidence of liberalisation’s success is there before them, politicians, egged on by a coalition of the ignorant and the scared, still don’t see it. As I pointed out a few days ago, we’re about to ‘put and end to the 24-hour drinking culture’ despite:

Alcohol consumption has fallen since the liberalisation of licensing laws – yes folks we’re drinking less

Alcohol-related emergency admissions to hospitals have also fallen since the liberalisation of licensing laws

Levels of violent crime – and especially alcohol-related violent crime – have fallen in the same period

Yes folks – liberalisation works. And draconian restrictions change nothing – despite the smoking ban and the endless scares about the habit nearly a third of 18-24 year olds admit to smoking (and if you ask me that’s an under-estimate). The number of smokers continues to decline (mostly because smokers die younger rather than because of people quitting) but not at any faster a rate than was the case before the ban. All the ban has done is closed a load of pubs and annoyed a lot of people – it isn’t saving many lives.

Yet people still don’t seem to be listening. Here’s Guido Fawkes reporting on Kit Malthouse (Tory Deputy Mayor of London and Chair of the Metropolitan Police Authority):

Behind the paywall at The Times, Deputy Mayor of London Kit Malthouse has been expounding on the ‘need’ for state intervention to combat alcohol consumption. The chief of the Met Police authority suggests twice daily alcohol testing for problem drinkers with “intensive monitoring and enforcement to ensure compliance”.

He gleefully explains what happens to those who dare breach a prohibition order in a similar scheme run in the backwoods of South Dakota: “The sanction is immediate and certain – straight into the cells, no argument, no court, no lawyers.”

It seems the new prohibitionists are everywhere despite every scrap of evidence suggesting that a more liberal approach is more effective (see above). And there’s more to come – fatty foods, soft drinks, driving, red meat and staying up late are all in the sights of the new puritans. As Mr Puddlecote will remind us – we told you so.

....

Let your kids eat red meat, fats and milk - it's good for them

The prohibitionists, vegetarians, vegans and food faddists are, as always, wrong.

It seems that under pressure from these stupid faddists we're half staving out children. let them eat cake if they want to!

"And parents really shouldn't feel too anxious about puddings - sponge and custard is a good dessert to offer, surprising as that may sound," says Jessica Williams, a paediatric dietitian.

Prohibitionist, puritan, anti-business...that's the UK Government for you

Our Government - egged on by leading prohibitionists like Sir Ian Gilmore and its own bigoted grass roots - has targeted the wine business for extra taxes. This is presumably because us middle class wine drinkers are an easier mark and of course we are ruining our children's futures by drinking wine in front of them.

So now the international wine producers are pulling out leading to lost jobs, closing businesses and missed opportunities. No surprise there then!

...

Smoking, drinking and the buying of pubs

Had a long discussion yesterday evening – fuelled by beer and whisky – with neighbours in the village about The Fleece, which is sadly lacking a tenant at present. Now this isn’t an idle conversation – the local pub is an important institution and some residents are seriously considering taking on the tenancy. The pubco are keen to talk with us and there are maybe a dozen or so villagers who might be up for the project.

The first community run pub was the Old Crown at Hesket Newmarket in Cumbria and there is a growing interest in such initiatives (to the point where politicians are clambering onto the bandwagon). Here in Cullingworth there’s a little more thinking to be done yet (probably with a little less drinking involved) and I guess that there are big differences between pubs and between communities.

However, none of these initiatives and the apparent government support changes the fundamental truth about the pub trade. Over the past ten years or so, the licensed trade has been subjected to the most comprehensive and deliberate attack from the agents of the state. It’s not just the smoking ban where Labour reneged on their 1997 election promise, nor the blaming of pubs for binge drinking - it is the indulgence of the new prohibitionists – men like Ian Gilmore (President of the Royal College of Physicians and militant prohibitionist) and pseudo-charities like Alcohol Concern – that is driving an anti-pleasure agenda.

And when I see Labour MPs getting all weepy over the demise of pubs, I want to scream at them – “It’s your fault, you stupid, opportunistic twit.” Putting up £4 million for community owned pubs is welcome but set against the billions the Labour government is taking in taxes from the business and the damage done by Labour’s smoking ban it is a drop in the ocean.

...