In the second part of February's just-drinks management briefing, Ben Cooper continues his detailed look at the alcohol debate, returning from the other side of the Atlantic to look at the state of play in the UK.

Persistently high levels of alcohol-related harm have ensured that alcohol policy has been a hotly-debated subject in the UK for many years. In recent years, the debate has focused particularly on pricing, advertising and underage drinking. 

The industry has had to face concerted campaigning on these issues and others, notably from academics, medical professionals and medical professional associations.

Academics and medical professional organisations 

The British Medical Association (BMA) has been a supporter of tighter alcohol regulation since it produced its first report on the subject of alcohol and young people in 1986. It supports minimum pricing and also advocates lowering the drink-drive limit, health warning labels, tighter controls on promotional activities in the on- and off-trade and banning all alcohol marketing communications.  

A 2009 BMA report into underage drinking, entitled Under the Influence: The damaging effect of alcohol marketing on young people, received a considerable amount of media coverage.

One of the authors of that report was Gerard Hastings, professor of social marketing at Stirling University. Professor Hastings is one of a number of high-profile academics who have engaged vigorously in the alcohol debate in recent years.

In addition to being a co-author of that report, Professor Hastings published another paper in the British Medical Journal early in 2010, entitled The Failure of self regulation of UK alcohol advertising. He writes frequently and speaks at alcohol policy conferences, as does Dr Peter Anderson.

A former general practitioner and alcohol and tobacco adviser to the World Health Organization (WHO), Dr Anderson has specialised in researching alcohol harms and now works as a consultant on projects financed by the European Commission, the WHO and other governmental organisations worldwide. 

Some in the industry feel the strong opinions the likes of Anderson, Hastings and others hold on key alcohol policy issues compromises their objectivity and raises a measure of doubt about the arguments and evidence they put forward. They are sometimes portrayed almost as 'rent-a-quote' critics of the alcohol industry, and certainly industry prefers to treat them as advocates rather than objective observers. Nevertheless, the involvement of well-qualified experts who have both a specialised knowledge of alcohol policy and a zealous commitment to the issue is a factor industry advocates cannot ignore.

Professor Sir Ian Gilmore, former president of the Royal College of Physicians (RCP), has been another frequent contributor to the alcohol policy debate in the UK. 

In 2007, Professor Gilmore founded the UK Alcohol Health Alliance (UK AHA) on a policy platform calling for dedicated funding for alcohol treatment and prevention strategies; increased taxation on alcohol; a ban on alcohol advertising before 9pm and in cinemas apart from 18-rated films; promotional material to carry information on health-related harm; and lowering the drink-drive limit from 80mg to 50mg of alcohol per 100ml of blood.

Professor Gilmore's status in the medical profession affords him considerable respect in media and political circles. Like Hastings, he is frequently quoted in newspapers and interviewed by broadcasters.

UK AHA retains strong links with RCP which houses the AHA secretariat and acts as a press office for the Alliance on a pro bono basis. The AHA does not have its own website, so all communications come from RCP which arguably gives its communications added authority.

In its recent response to government plans to ban below-cost selling of alcohol, UK AHA welcomed the move as "a step in the right direction" but said the price had been set too low. That announcement referred to research published in 2008 by Professor Petra Meier at the University of Sheffield's School of Health and Related Research into the impact of pricing and promotion on alcohol consumption. Professor Meier is another academic who has spoken at conferences and in the media on alcohol policy.

The Institute of Alcohol Studies (IAS) 

Another prominent organisation in the UK alcohol policy debate is the Institute of Alcohol Studies (IAS). With roots in the temperance movement, IAS is viewed by some as an advocacy organisation with an 'anti-alcohol' agenda.

These reservations may arguably be fuelled by the fact that its director, Dr Adrian Bonner, is a member of the Salvation Army and a teetotaller. However, Dr Bonner says his decision not to drink owes more to his scientific research than his religious affiliation and says in "no way could we be linked to neo-prohibitionists or anything at all in that area".

However, IAS openly admits its historical links with the temperance movement. It was founded as an educational charity by the Alliance House Foundation (AHF), formerly the UK Temperance Alliance, and remains a subsidiary company of AHF. But IAS spokesperson Katherine Brown states that it "is a separate organisation and its legal/charitable status is based upon the aim of promoting scientific understanding and effective prevention of alcohol related harm". Brown adds that IAS "seeks to promote evidence-based policies for reducing alcohol harm".

Brown also states that IAS "is not a temperance-based organisation and does not have a view on whether individuals should drink or not drink". She says there is no requirement for IAS staff to abstain from drinking alcohol. Indeed she points out that a number of the staff are social drinkers.

While IAS is open about its past history, its scientific objectivity can only be judged by examining its research. The primary means of assessing research is through peer review. Brown says that, while more generalised publications on alcohol that it produces may not be peer reviewed, the major studies it undertakes are. IAS lists seven external scientific advisors on its website, including Petra Meier and Gerard Hastings.

Alcohol Concern and Alcohol Focus

Alcohol Concern is a charity which campaigns on alcohol policy issues and runs training programmes and other projects, and publishes information related to alcohol harm reduction and treating alcohol dependence. It is part-funded by the Department of Health, though this funding is being substantially cut for the current year.

The fact that it has another major area of activity and slender resources may explain why Alcohol Concern is not the most vociferous campaigning voice that industry has to face. Moreover, while it has campaigned for minimum pricing and a pre-watershed advertising ban, some of its campaigning resources are directed to lobbying for increased funding for direct practical interventions in the health and social care arenas.

Alcohol Concern's multi-faceted mission may help to explain why it is viewed as a more pragmatic rather than ideological organisation. Alcohol Concern works in England and Wales. The organisation's counterpart in Scotland is Alcohol Focus.

Public health bodies

As already discussed, what medical professionals say concerning alcohol policy can be uncomfortable for the industry. The same can be true for statutory public health bodies.

The Department of Health (DH) will reflect and defend government thinking on alcohol, which, since last year's election, campaigners suggest has taken a distinctly industry-friendly turn. Campaigners have been critical of the setting-up of the Department of Health's Responsibility Deal Alcohol Network which it believes gives industry too much influence over policy.

However, interventions from statutory health bodies often play a part in the debate and can evoke a critical reaction from industry.

Last year, the National Institute for Clinical Excellence (NICE) issued guidance on alcohol including recommendations for minimum pricing and tighter advertising controls which elicited a critical response from industry advocates. It also joined other medical experts in calling for a lowering of the UK's drink-drive limit from 80mg of alcohol per 100ml of blood to 50mg/100ml to bring it in line with most European countries.

The industry's response to the NICE guidelines may seem similar to how it responds to pro-regulation campaigners but the degree to which industry challenges official public health bodies is a delicate judgment. Organisations such as NICE do not just claim to be acting in the public interest, they are mandated so to do. If industry advocates are going to suggest they are misguided - in spite of the expertise, information and research resources at their disposal - they have to be very sure of their ground.

To read part I of this management briefing, click here.

For part III, click here.