Lessons from lockdown for (anti-)alcohol policy
According to contemporary ‘public health’ ideology, harmful drinking is the result of ‘commercial determinants’, especially advertising, affordability and availability. If you clamp down on those then alcohol consumption will decline, and if alcohol consumption declines then harmful drinking will decline because – as the influential epidemiologist Geoffrey Rose put it…
“… from the average alcohol intake of a population one can predict precisely the number of heavy drinkers. It is therefore likely to follow that changes in average consumption will lead to corresponding changes in the prevalence of alcoholism and in alcohol-related health problems.”
The World Health Organization says that the three ‘best buys’ when it comes to reducing alcohol-related harm are raising prices with taxes and minimum pricing, banning or restricting alcohol advertising and restricting the availability of alcohol sales through tougher licensing laws. There is mounting evidence that minimum pricing does not work, but what about restricting advertising and availability?
The COVID-19 lockdowns provided an extreme test case. In March 2020, the number of licensed premises open in the UK fell by two-thirds and spending on alcohol advertising fell by half. According to ‘public health’ theory, we should have seen a sharp decline in consumption and an equally sharp decline in alcohol-related mortality.
In fact, as I show in the report, we saw a small decline in consumption and a large increase in the number of alcohol-related deaths. From this, we might conclude that harmful drinking is not driven by commercial factors or by a lack of regulation, but by personal circumstances, hardship and stress. One reason for the rise in alcohol-related deaths in 2020 is the sharp decline in face-to-face support for alcoholics and the lack of in-patient detox. This only serves to underline the point that helping the minority of problem drinkers is more effective than policies aimed at the whole population.
Tackling harmful drinking requires focusing on harmful drinkers rather than on the whole population. We need to get away from the simplistic and peculiar theories of ‘public health’ academics and focus on what works. Moving away from the whole population approach and targeting support at those who need it would not only be of greater benefit to those who are vulnerable. It would also benefit the majority of drinkers who do not drink at harmful levels but who nonetheless incur the costs of high taxes and unnecessary regulations.