It has taken over three years of delay tactics and a government deadline to drag the Portman Group into recommending its members include information about low-risk limits on their products. While no-one could deny this is half a step in the right direction, let’s not kid ourselves that this means we’ll soon have a nation of well-informed drinkers.
We know around one in four drinkers where Balance operates - in North East England - are consuming more than 14 units a week, and yet almost 90% of them class themselves as light or moderate drinkers. Nationally, only one in three adults spontaneously link alcohol with increased cancer risk. And recent research in the BMJ highlighted only one in five women attending breast clinics and screening appointments knew that alcohol is a risk factor for breast cancer.
Clearly more awareness is needed regarding the risks of consuming alcohol and how to minimise those risks. Mass media campaigns can raise awareness of both the harms alcohol can cause and the drinking levels below which consumers should remain in order to keep their risks low.
There are valuable lessons to learn from the campaign to reduce the harm caused by tobacco, which decades ago learned the importance of disseminating an understanding of the harmful nature of the product – not only as an encouragement for individuals to change their behaviour, but as an essential foundation for campaigning designed to reduce consumption at the population level.
There is evidence that mass media campaigns can generate tobacco quit attempts. Evidence on the efficacy of alcohol campaigns is sadly lacking – but we cannot draw from this that they do not work. As it stands, we haven’t seen enough well-resourced campaigns which have been sustained over a significant period of time. Additionally, campaigns are up against a well-resourced alcohol industry spending hundreds of millions of pounds on their own marketing efforts. I would argue evaluating mass media campaigns based only on whether they are immediately resulting in individual behaviour change is setting them up to fail and that doing so frames the issue too narrowly.
Professor Mark Petticrew and his team at the London School of Hygiene and Tropical Medicine argue that “Advertising aims to influence not just consumption, but also to influence awareness, attitudes and social norms; this is because it is a system-level intervention with multiple objectives.” In other words, we cannot understand the impact of health campaigns by looking at individual drinking levels alone, but must also track people’s awareness of harm and how that affects their attitudes to alcohol policy.
In the North East, Balance has run three integrated mass media campaigns to raise awareness that alcohol can cause cancer since 2013. We intend these campaigns not only to challenge individuals to change their drinking habits but, as the researchers at LSHTM suggest, to influence awareness, attitudes and social norms. They are also a small step towards countering the millions spent on alcohol advertising.
By sustaining and regularly evaluating these campaigns, we are building awareness of the links between alcohol and cancer. Awareness levels in the North East are generally higher than those found in the rest of the country. We also see that those with greater levels of awareness are more likely to support a range of evidence-based policy change, such as restrictions on alcohol marketing. That, for us, makes these campaigns a success, even though we cannot definitively say they are changing individual behaviour.
That said, people who understand their personal risk of cancer are more likely to take time off drinking. One in five people claim to have cut their drinking due to our February campaign on breast cancer. We have consistently seen the highest regional rate of sign-ups for Dry January® and we’re the only region in England which has shown small reductions in hospital admissions in recent years.
However, we cannot change attitudes alone. The rest of the country must follow suit. To do this will require major resources. In the past, public bodies have at times turned to the alcohol industry for funding, or even relied on them to deliver campaigns. But the alcohol industry cannot be trusted to run alcohol campaigns; evidence suggests not only that their campaigns don’t work but may actually result in improving the industry’s reputation – which you could argue is their true intention. Instead, Government must provide the necessary funding.
One thing is for sure: with our teenagers being bombarded with alcohol adverts at bus stops, at the cinema, on social media and on TV; with a high density of alcohol outlets in poorer areas; and with industry profits reliant on people drinking at heavy levels, the Government must act to properly fund health campaigns, and take these out of the hands of the alcohol industry.
The policies laid out in the Alcohol Charter represent realistic, powerful ways to reduce the harm caused by alcohol. Help make them happen.