The alcohol policy debate was back in the spotlight earlier this month, with the publication of a paper in The Lancet warning of thousands of avoidable alcohol-related deaths if stronger action is not taken by the UK government. Ben Cooper, whose management briefing this month examines the various groups campaigning for tighter alcohol legislation, asks whether the debate needs to be so acrimonious.

Late-February saw the publication in the UK medical journal, The Lancet, of a paper by three senior doctors warning of thousands of avoidable alcohol-related deaths unless firmer action is taken. 

Advocating a GBP0.50 (US$0.80) per unit minimum price and concerned that the government is being too soft on the industry with its Responsibility Deal announced last year, the paper’s authors, led by long-time campaigner Professor Sir Ian Gilmore, warned that between 160,000 and 250,000 people could die in England and Wales from alcohol-related causes, such as cancers and road accidents, over the coming 20 years without stronger government action.

The Department of Health defended current government policy, saying: "The Government has wasted no time in taking tough action to tackle problem drinking, including plans to stop supermarkets selling below-cost alcohol and working to introduce a tougher licensing regime." 

The Wine and Spirit Trade Association (WSTA) also countered by saying the authors ignored the fact that UK alcohol taxes and prices are among the highest in Europe, and highlighted that France, a country with relatively low alcohol prices, had seen liver-related deaths fall.

The Portman Group, meanwhile, pointed to the fall in alcohol-related deaths in the UK last year and the industry’s funding of education campaigns. Creating “doomsday scenarios” was “not in anyone's best interests, least of all the responsible majority of people who enjoy alcohol in moderation as part of a healthy lifestyle”, said Portman Group chief executive David Poley.

So, the paper provided another exposition of the cut and thrust of the polarised alcohol policy debate. We have been here before, and we will certainly be here again.

Medical academics such as Professor Gilmore form a key element in what is often described as the “anti-alcohol lobby”. This is a rather unhelpful term as it suggests that those pushing for tighter controls represent a homogenous group, when in fact they comprise a spectrum of opinion.

Also, while extremist campaigners once would have certainly been ‘anti-alcohol’, railing against the devil’s brew itself, nowadays they would more accurately be characterised as ‘anti-alcohol industry’. The focus of alcohol campaigners in general tends to be on the marketing activities and pricing policies of alcohol companies.

Within the spectrum, ‘neo-prohibitionists’ represent only a minority. Some suggest it is an influential minority, but looking at the actual policy developments in recent years, there would appear to be little evidence that the extremists are gaining much traction with lawmakers.

The majority of non-industry participants in the debate cannot be characterised in this way. It is comprised of academics, medical professional groups, public health organisations, campaigners, think-tanks and alcohol charities which by and large set out to be transparent about their objectives and take an evidence-based approach to studying the problems.

This is not to say that they cannot be challenged when their campaigning rhetoric goes beyond what the evidence tells them. After all, the industry’s opponents play the ‘evidence-based’ card frequently when critiquing industry assertions.

Industry is also concerned at the close relationship campaigners enjoy with some public health agencies. Campaigners would argue that this influence is more than offset by the lobbying power of the drinks business, and would undoubtedly hold up the Responsibility Deal in the UK as an example of industry’s influence over government.

So if neo-prohibitionism only describes a minority of alcohol campaigners, how is it that it is so prominent? There are a number of possible explanations. It could be because they represent a particularly vocal lobby. It could also be that within membership organisations like the Global Alcohol Policy Alliance (GAPA) and Eurocare, which deliberately welcome a broad range of opinion, the more extreme views sometimes dominate over more moderate ones. 

On the other hand, campaigners would argue that industry over-eggs the ‘neo-prohibitionist’ tag in order to marginalise as wide a range of stakeholders as possible in the debate.

Deciding who is ‘extreme’ and who is objective and rational is, of course, a judgment call, and also comes down to the ubiquitous issue of scientific evidence. 

In private, industry representatives may accept that a significant proportion of the so-called ‘anti-alcohol’ lobby have a case, even if they disagree with their solutions, and are far from being tub-thumping puritans.

The responsible and strategically logical option, therefore, is to engage with the reasonable majority – however large it may be – in meaningful discussion and possibly collaboration. But, in this regard, industry does face a problem. What undoubtedly unites alcohol campaigners of all hues is their distrust of industry and their scepticism about industry social responsibility action.

It is probably one of the things which helps keep the disparate memberships of organisations such as GAPA and Eurocare together. Indeed, one facet of the non-industry side of the debate is its capacity for networking.

So, the bottom line here is that most campaigners are very wary about debating, let alone cooperating, with industry on this matter. They argue that the corporate interests on joint initiatives always come to dominate over the NGOs by dint of their larger resources. The fact that campaigners see the Responsibility Deal as pandering to industry interests also speaks volumes.

But multi-stakeholder initiatives have proved effective in other sectors in dealing with harmful social and environmental impacts of commercial activities, such as working conditions in supply chains. The EU’s Alcohol and Health Forum is a rare example of inter-stakeholder discussion on alcohol and appears to have been welcomed by both sides.

Whether more such cooperation can be initiated remains to be seen. While only a minority of non-industry stakeholders are neo-prohibitionists and abstainers, the majority still by and large regard the alcohol industry very much as public health advocates traditionally regarded the tobacco industry, in spite of the fact that many of these people are social drinkers and some may even recognise some positive aspects to moderate drinking. Looking at that another way, they are customers.

The preceding part of this management briefing can be viewed here.