Policy for the people? Alcohol Change UK national conference 2019

Post originally published on the Alcohol Policy UK blog.

19 June 2019 was a significant day for the UK alcohol field. Not only did it mark Alcohol Change UK’s first national conference, at which keynote speaker Jonathan Ashworth MP announced the Labour Party’s commitment to make alcohol labelling mandatory, but also the release of early data indicating ‘encouraging signs’ of a decline in alcohol consumption following Scotland’s landmark minimum unit pricing (MUP) policy.

In many ways the timing couldn’t have been more fitting. While strong arguments for the role of key population level measures such as minimum pricing, availability and marketing have been repeatedly made, policy-makers for England have shied away from evidence-led approaches. Instead, alcohol policy has favoured cleverly framed but flawed arguments for alternative approaches of self-regulation and ‘local partnerships’, and ideas of ‘personal responsibility’.

This is not to say that individuals – or interventions targeting individual behaviour – don’t have a crucial role to play. No one would disagree we all have ‘personal responsibility’ for our behaviours, but it is simply not possible to reduce alcohol harms sustainably without looking at the environments in which they take place. As many cognitive psychologists might point out, we are less consciously in control of our decision-making than we would like to believe.

Demonstrating this at the conference, Professor Dame Theresa Marteau, director of the Behaviour and Health Research Unit at the University of Cambridge, presented on how the ‘choice architecture’ around us – such as product placement or serving sizes – has significant effects on a number of health behaviours. Marteau therefore called for the prioritisation of policy changes to create environments in which individual behaviour change – or interventions targeting it – would be more fruitful.

However, Marteau’s concluding remarks and subsequent discussion hit on a key point – will further scientific evidence demonstrating the role of environmental change win over the hearts and minds of the public and policy-makers? Further, where does this leave us in terms of exploring the multitude of individual experiences in a society in which alcohol is culturally embedded?

Indeed, the conference, through a rich and diverse range of presentations and workshops, highlighted the existence of an apparent ‘conflict’ between reducing alcohol problems via seemingly impersonal population policy levers, ‘versus’ recognising the role and experiences of individuals and their drinking in discussions about how to achieve change.

Witnessing or experiencing alcohol’s harmful impact first-hand is surely why many people feel strongly committed to reducing alcohol harms. So why is support for tougher alcohol control measures still not widely endorsed amongst the general public? Is it a lack of understanding, or perhaps cynicism, towards population measures and their potential effectiveness? Is it because cries of ‘nanny statism’ have been effective in making an enemy of policies that can be framed as impingement on our freedoms or as undermining ‘personal responsibility’? Or could it be that we don’t want to lose touch of the personal value these issues hold for us; population approaches simply feel too impersonal?

Such questions may be important in framing future debates about alcohol change and potential tensions between stakeholders working towards the same end goal. In a powerful keynote talk, MP Jonathan Ashworth interwove his own personal connection to the subject with a pledge to bolder policy action, including a commitment to mandatory labelling on alcohol products – a current hot topic amidst claims of the persistent failure of self-regulation.

Notably, Ashworth has been widely applauded – even by his political opponents – for speaking candidly about his experiences of his father’s alcohol problems. His openness has led to other MPs speaking out about their experiences and resulted in government investment in projects to help children of alcohol-dependent parents. Speaking at the conference, Ashworth captured the audience with a heartfelt account in which he described the phone call he received informing him of his father’s death – a call which came just months after his father had missed his wedding. The family friend told him his father hadn’t gone due to the shame and fear of embarrassing his son due to his alcohol problem. By openly recounting this story, Ashworth reminded us of why policy change, including an end to the slashing of treatment services, is fundamentally important on a human level.

In her presentation, Alison Douglas, Chief Executive of Alcohol Focus Scotland, reflected on the Scottish government’s hard-fought journey to implementing minimum pricing. As well as facing the significant opposition mounted by the ‘Goliath’ of sections of the alcohol industry, Douglas highlighted the challenge of communicating minimum pricing given that people tend to ‘immediately think about their own drinking’ when alcohol policy is discussed. Pricing measures are effective in reducing consumption through small changes across groups of heavier drinkers, and therefore less likely to be noticeable at an individual level. However, on reflection, Douglas posed that Scotland’s approach may have been too focussed on population level policies, therefore ‘missing a trick’ by not working more closely with grassroots movements such as Soberistas or Club Soda.

The conference therefore highlighted a very real question for the future of the field – how do we most effectively engage and harness the wide range of perspectives on alcohol harm reduction? Lived experiences of alcohol use and problems hold tremendous power. As the final speaker, Africa Brooke, shared, our experiences of alcohol use and ‘recovery’ are fundamentally unique. People need to be able to explore and express their drinking and its motives without having labels imposed on them or their individual capacity to change undermined.

The possibility to share and hear the range of lived experiences is evidently being bolstered by social media and the growing number of grassroots alcohol-free and moderation movements. As a field we must embrace this, but also seek to understand the complex implications, including potential unintended consequences. ‘Sober movements’ are undoubtedly fostering a positive alternative culture, particularly for younger people among whom drinking and social norms around drunkenness have significantly declined. Moderation or harm reduction goals, though, are still arguably too often viewed sceptically, whilst ideas of alcohol problems are too often associated only with more severe problems of dependency. Developing understanding about the breadth and scope of alcohol use and problems – and the many routes to behaviour change or ‘recovery’ – is imperative to an inclusive and effective approach to large-scale alcohol change.

These issues, and many others touched on at the conference, remind us not to underestimate the breadth of the problem, despite areas of progress. Co-occurring alcohol and mental health problems, the deep-rooted stigma around alcohol problems, unreached groups of drinkers, and the need to address key drivers of inequality and poverty are all areas where significant progress is urgently required.

Despite many challenges facing the field, the first Alcohol Change UK conference captured a real sense of optimism and aspiration. Spanning the spheres of research, policy and practice, the event reminded us not only of the scale and complexity of the issue, but also of the human side to it, and the belief and enthusiasm of a range of people working together to achieve our shared goal. Alcohol Change UK is evidently committed to ensuring we can work together to share our experiences and ideas about how to best achieve this change.