Public Health England and alcohol (2)

Alcohol Policy UK recently sent out their email discussing Public Health England’s just released 2014-2017 marketing strategy outlining plans for campaign related activity around alcohol and other lifestyle behaviours.

However PHE says its plans for alcohol-related communications are limited for a number of reasons. Namely, budget limitations and recognition of the limited evidence base for alcohol campaigns in changing behaviour, alongside the awaited revisions to the Chief Medical Officer (CMO) drinking guidelines. The strategy says the CMO’s review will “involve appropriate consultation and so is unlikely to report before the end of the year” and this has been awaiting revision since first being announced in March 2012 (so over 2 years and counting).

Under the alcohol chapter, 7.4 Making it easier for adults to drink at lower-risk levels, PHE says it has developed an evidence-based model for which:

‘alcohol is reported as low priority in the model, due principally to the paucity of evidence (nationally and internationally) of success in marketing-based interventions around alcohol. Given the low prioritisation we could not support a recommendation to develop a significant national campaign in 2014. This is further argument for taking a test-learn-refine approach.’

If there is paucity of evidence then surely new research needs to be funded to look at marketing-based interventions around alcohol rather than using that logic as a reason to side-step it as a strategy?

The strategy identifies a number of possible areas for ‘social marketing’ based activity including binge drinking and preventing early age drinking. However it states since industry-derived funding (via Drinkaware) will continue around young people and resume shortly around young adults, we recommend focusing PHE’s funds on increasing and higher risk drinking in middle-aged and/or older adults.’

So we’ll let the industry lead the way shall we?  No conflict of interest there then!!

The strategy says most increasing and high-risk drinkers underestimate their level of risk and are happy with their consumption levels. This is in contrast to other areas such as diet where target populations ‘readily accept that they need to change and are keen to eat more healthily and be more active.’ The strategy also says that PHE and a small number of other organisations have made attempts to change at-risk drinkers’ beliefs and behaviours regarding alcohol.

So although they state that high-risk drinkers underestimate their risk because they are happy with their consumption level there is no current role for public health!!!

However it says:

‘while the evidence is patchy, the emerging picture is that attempts to change attitudes generally fail (although possibly because no one has ever spent enough to impact on the counterweight of industry spend); however, providing people with tools to assess and record their drinking has had some success in reducing consumption. While people repeatedly tell us that they have no intention to change how they drink, it seems they do change in response to price, availability and strength, but also to identification and brief advice.’

So because we can’t compete on funding we just won’t try then is that it?

They outline 2 regional pilots to be implemented:

1. A participative abstinence event – so building on the success of Dry January and Dryathalon (and indeed to repeat or enlarge temporary abstinence outside of January).
2. Promoting irregular drinking – This project will start with research into people who already drink within guidelines, to understand the strategies they currently deploy to drink at lower risk levels. From this phase, we will develop articulations of strategies for maintaining low consumption and, via an experimental methodology, assess the ability of increasing and higher risk drinkers to adopt and follow the strategies. For example, daily drinking is a key contributor to increased risk, so it is possible that promoting a simple approach such as never drinking two days in a row would have a positive impact.

I’m not saying that these are not good pilot strategies but they are regional and I feel are tinkering around the edges of the problem we have in this country with alcohol.   They are not targeting the right people with the right questions.

I feel like a school teacher going through a piece of work with a red pen here but my frustration is almost uncontainable.  I didn’t know how to post this and respond eloquently without losing myself (and you) hence my bold thoughts after each statement which feels a bit clunky.

So to summarise: the industry gets to keep doing what they are doing for the next 3 years completely unchecked and with no national PHE initiatives to counter the problem?  Genius PHE genius …….

46 days to go


8 thoughts on “Public Health England and alcohol (2)

  1. So agree Lucy, and I know this us my pet bang on, but what about education at primary, junior and senior schools, get them BEFORE they start or a least have a problem. We don’t seem to be changing attitudes at the root just fire fighting when it gets out of hand later. I know both are needed but we have a culture to change and that takes time and education. Well that’s my thoughts 🙂

    1. Hey Catlady I agree too and it is taught in secondary schools already although there are so many competing subjects to be covered in collapsed curriculum PHSE days that I’m not sure how much air time it gets. I would argue that it is also a role modelling issue in that if the parents role model healthy attitudes and approaches to drinking the children learn it at home also. Although school and education are important the biggest teacher children have is their parents 🙂

  2. Lucy, I’ve read and re-read your post and I am frustrated and confused. I can’t help but wonder if this is how education and advertising restrictions regarding cigarettes got started? I believe the alcohol problem in the US and UK (and world-wide I’m sure) is much more greater than we know, because we can’t find honest answers. High-risk drinkers who are “happy” with their consumption levels? Sorry I’m rambling here, it’s so hard to understand why this lightweight attempt at research and prevention is acceptable. Sigh…xx

    1. Hey lori – you are not the only one who was confused! I hope my writing of the blog post hasn’t added to your confusion but the PHE statements are contradictory and misleading imo. It just doesn’t stand up to any level of critical analysis which is shocking for an organisation as big and central to public health as they are. Unfortunately it doesn’t make me sigh it makes me want to scream!! xx

  3. Thanks for the post, Lucy. I work in Public Health in the US and our attempts at curtailing the problem are equally paltry. I got a good laugh at the idea of promoting irregular drinking, “promoting a ‘simple’ approach such as never drinking two days in a row.” Seriously?! Wow. That shows a COMPLETE lack if understanding of the issue, both how it begins and then progresses. The financial aspect of alcohol marketers vs government interventions sounds just like the big tobacco fight, and yet (US) public health strives toward prevention and cessation. Is there just a lack of understanding about the severity of problems caused by our drinking cultures? Is it the shame that comes with being an “addict” that is keeping this epidemic from getting its share of the public health pie? I completely agree with both you and Catlady that it starts in the home with parents modeling healthy behaviors with alcohol and then should be reinforced at school. More than that though we need to dig into why kids and adults start drinking, find the tipping point between social drinker to problem drinker to alcoholic, and research evidence-based interventions. And that is done through trial and error. And that takes money.

    1. Hi Amy So great to have a US public health perspective! 🙂 I agree the drinks industry has learned from big tobacco and for me it isn’t a lack of understanding it is corporate capture. The lobbying and funding gravy train from the industry is too big for the Govt to ignore and so a blind eye is turned to the damage it causes and there is always expensive rehab if one of their own develops a problem. Cynical maybe but money and profit trumps health and equality of treatment services. A great deal of research has been done between smoking cannabis at a young age and the pruning of the neural network that happens at that time in adolescents and how it pretty much locks in the addiction but the same has not been done with drinking. I’d be interested in that as I think many of us started drinking at this young age and I wonder if the same neural network pruning also happens around booze. But as you say that takes time and money which is not being prioritised for this issue. I so look forward to more discussions with you!! 🙂

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