Busting alcohol policy myths
This year is a particularly significant one for alcohol policy in New Zealand. Amendments to the 20-year-old Sale of Liquor Act are currently at select committee stage, and the Law Commission is conducting its comprehensive alcohol law review. Acceptance is high that alcohol-related harms are significant, and there’s a high level of media interest in proposals to mitigate those harms.
So there’s a lot being said about alcohol policy right now, and Mythbusters are here to help with a special edition that separates the straight talking from the fast talking.
As with any complex health and social issue, the debate relating to effective alcohol policy has been characterised by the frequent brandishing of half-truths, scare mongering and, at times, deliberate misinformation At stake, after all, are the profits of an industry worth tens of millions of dollars annually. The discourse on alcohol policy also taps into deeply rooted philosophical beliefs regarding individual freedoms and the extent to which they may be curbed by government intervention.
We think it timely to draw attention to some of the often heard myths around alcohol policy. We have identified several spurious claims commonly made by those opposed to making alcohol more expensive and less available. These claims have been grouped under six common ‘myths’, which Mythbusters here refutes.
1. Myth: Alcohol consumption is a matter of individual responsibility.
Blame for our binge drinking culture is more often directed towards the irresponsibility of users than the producers and marketers. The constant refrain from the industry is that, if people took more personal responsibility for themselves, the harms associated with their product would be mitigated. Industry is supposedly only there to help responsible people enjoy themselves and fulfil their chosen lifestyles. Those who call for increased prices and tighter restrictions on availability have even been labelled ‘health Nazis’.
This claim overlooks important factors about alcohol itself and the environment in which it is consumed, both of which can have a strong influence on individual decision making.
Firstly, alcohol is an addictive substance. Addiction and dependency seriously impair the ability to make rational decisions. Secondly,consumers find themselves in an environment in which several millions of dollars are spent on alcohol marketing. The messages are very clever and subtle, come via a variety of media and draw on the best marketing science available. They exploit human needs, which are most intensely expressed in youth. These include the need for inclusion as part of the ‘in crowd’ and the need to feel grown up. Marketing tactics used by the alcohol industry appear very similar to those formerly used by the tobacco industry. There is now strong evidence that alcohol marketing promotes a culture of drinking and has a reinforcing effect on young people’s drinking.
Another important aspect to keep in mind is that harmful alcohol use is rarely an individual problem. Rather, it impacts on family, friends, neighbours, work colleagues and, ultimately,society as a whole. Alcohol is a contributory factor in a wide range of social problems including crime, violence, family breakdown, child abuse and child neglect. The concept of ‘passive drinking’ to capture the damage done to the innocent when people drink too much is useful in this regard. Focusing on individual responsibility for a problem with far-reaching consequences across society is short-sighted and ignores the obligations governments have to protect the most vulnerable.
Far from being health fascists, those who advocate for greater restrictions on alcohol availability and increased prices are champions for those whose lives are blighted by alcoholfuelled disorder, violence and abuse.
2. Myth: We should not penalise the entire community for the drinking behaviour of a problematical minority. Alcohol policy should focus on the minority groups that are most at risk, such as youth and binge drinkers.
This is a common myth actively pushed by industry and with some notable success. When the Chief Medical Officerin England called for a minimum unit price for alcohol, the proposal was instantly dismissed by Prime Minister Gordon Brown, who said, “We don’t want the responsible, sensible majority of moderate drinkers to have to pay more or suffer because of the excesses of a small minority.”
Contrary to the widely held misperception, alcohol harms are not confined to the heaviest drinkers in a population but are much more widespread. For example, recent research from Finland found that the majority of problems occurred in 90 percent of the population consuming moderately, compared to the 10 percent of the population drinking heavily. In addition, the purported cost to moderate drinkers of measures such as raising the price of alcohol has been greatly exaggerated. Recent modelling in the UK has shown that setting a minimum price of 50 pence per unit would likely increase the average weekly spend on alcohol of moderate drinkers by only 23 pence per week, but would decrease the consumption by underage and heavy drinkers by 7.3 percent and 10.3 percent, respectively.
Overwhelming, evidence demonstrates that efforts to reduce the burden of harm from alcohol need to reach the majority of drinkers and not just the high-risk groups. The World Health Organization (WHO) says populationbased policies can have a protective effect on vulnerable populations and reduce the overall level of alcohol problems. It has recognised the need for both population-based strategies and interventions and those targeting particular groups. A WHO-sponsored review of 32 alcohol strategies found the most effective alcohol policies included restricting availability and raising price, drink-driving laws and brief interventions for hazardous and harmful drinkers. By contrast, the least effective policies included education in schools, public service announcements and voluntary regulation by industry. It concluded that, if the less effective measures are used, they should form part of a comprehensive, population-based strategy.
3. Myth: Raising prices has no effect on heavy or binge drinkers.
This myth is widely disseminated by certain sectors and frequently cited in media reports. Yet the evidence shows the opposite is true. Price increases and a set minimum price have a much greater effect on heavier than on lighter drinkers, with modest or only small extra financial cost to lighter drinkers.
When all other factors are equal, increased alcohol prices generally lead to decreased consumption and vice versa. At-risk groups such as youth and heavy drinkers are particularly sensitive when it comes to pricing. Recent research from Scotland, for example, found that overall consumption decreased following a tax increase that exceeded the cost of living, and heavier drinkers cut down the most. There is also good evidence to show that policies that increase alcohol prices delay the start of drinking, slow young people’s progression towards drinking large amounts and reduce the volume of alcohol consumed per occasion.
The relationship between alcohol price and consumption has been extensively evaluated and forms the basis for the WHO’s recommendation that raising price (along with restricting availability) is among the most effective measures to decrease harms from alcohol. On the basis of the overwhelming body of evidence to date, we are confident that higher prices will lead to a reduction in alcohol-related harms across society.
4. Myth: It is important to work with industry when formulating alcohol policy.
This is a call often made by the liquor industry and its allies. Variants include the much touted lines that ‘we are allin this together’ or ‘we need to involve all the stakeholders when formulating policy’. Unfortunately, this argument does not stand up against closer scrutiny.
The supposed commonality of interest between public health and the alcohol industry is difficult to reconcile with the direct correlation that exists between overall volume of consumption and levels of alcohol-related harm. Furthermore, the majority of alcohol consumed in New Zealand is done so in the context of excessive or harmful drinking. It is naïve to believe the industry would voluntarily support measures to reduce overall consumption when this would clearly undermine profits.
At the very heart of the matter is a fundamental conflict of interests between public health and pursuit of profits. Recognising this, a WHO Expert Committee has recommended that the global public health body continues its practice of no collaboration with the alcohol industry. Governments should take a similar stance when it comes to formulating policy.
However, engaging in a dialogue with industry on specific ways to reduce harm is an entirely different matter to collaborating on policy. It is reasonable (and necessary) to engage industry when it comes to matters such as working to provide safer drinking environments.
Alcohol producers are well organised and effective lobbyists for industry-friendly policies, both nationally and internationally. There are many parallels between their strategies and tactics and those of the tobacco industry. A major focus is to campaign against effective strategies and for ineffective strategies.
Another industry tactic is to instil doubt about non-industry research. A recent disclosure of hitherto unpublished documents provides a revealing insight into how the alcohol industry operates. It shows that industry holds grave concerns that alcohol will be viewed through a public health lens in the same way as tobacco and has invested in co-ordinated strategies to divert attention away from programmes it perceives will do the most damage to its interests. Among the measures it has opposed most strongly are tax increases, controls in advertising and sponsorship, health warnings and tough policing, especially on drink-driving. According to the lead author of this paper, “although [the alcohol industry] don’t want to be seen in the same way as big tobacco, they’re going down exactly the same path.”
5. Myth: Legislation can’t change our drinking culture.
While legislation alone won’t change our drinking culture, its role in shaping behaviour should not be dismissed outof hand. Our view is that legislation has a crucial role to play in influencing the drinking environment, which is currently oriented towards ease of access and excess. We also believe there are important parallels that can be drawn from the success of anti-smoking legislation, where a substantial culture change has occurred following the enactment of smokefree legislation. There has been a significant shift in attitudes towards smoking in public places since the smokefree legislation.
6. Myth: We should not interfere with the market by artificially setting minimum alcohol prices and restricting marketing.
Alcohol is no ordinary commodity. It is an addictive substance that can lead to long-term dependence. It isassociated with a range of acute and chronic health harms and has been classified by WHO as a Class 1 carcinogen, alongside asbestos, formaldehyde, mustard gas and plutonium-239. Were it to go before the New Zealand Government’s Expert Advisory Committee on Drugs, it would be classified as Class B (High Risk).
Alcohol’s association with crime and violence is well known. To argue it should be treated like any other commodity and then rely solely on market forces to determine supply and demand is therefore absurd.
Governments have a duty to protect and promote the public good. Setting minimum unit price levels and/or increasing excise tax are a very effective means of reducing alcohol-related harms. Marketing contributes to the uptake and spread of alcohol use and the consequent spread of harm. Regulation of marketing to mitigate these harms should be a core national response.