public health fiddles, alcohol harm inequality widens
had that thing where you’re really looking forward to something and
then when it gets here you wonder what you were getting so excited
long-promised research paper Understanding the Alcohol
Harm Paradox, penned by what reads like a list of the most
influential names in alcohol academia, has finally been published –
and it raises far more questions than it answers. Not least, why they
have to admit that I was delighted when I heard Alcohol Research UK had
initiated this work, obsessed as I am by the observation that while the
most disadvantaged sections of the population drink no more than
better-off folk, they are far more likely to suffer
alcohol-related illness and far more likely to die of it.
the elephant in the room as far as alcohol policy is concerned, so
it’s good that it’s finally getting some attention, although I’ve
been worrying about calling it the ‘alcohol
close correlation between poverty and poor health is long established
and, far from being a paradox, is obvious to anyone. Alcohol-related
harm is one aspect of a complex tangle of problems at the root of which
is the difficult objective
circumstances many people struggle against.
authors of Understanding the Alcohol Harm Paradox complain that “the
precise pathways and mechanisms through which SES (socioeconomic status)
and alcohol-related harm are associated remain unclear” because of a
lack of research, something I stupidly thought the authors were going to
they merely confirm once again, though in quite a lot of detail, what we
already know, and suggest, as far as I can make out, a total of two
policy recommendations: minimum unit pricing and the inclusion of public
health objectives in licensing decisions.
Nothing to see here, then.
more revealing, if rather disturbing, is another new Alcohol Research
UK-sponsored report, this time by Alcohol Concern. A
Measure of Change is a survey among local authorities and NHS
clinical commissioning groups (CCGs) about the impact on alcohol
services of measures contained in the Health & Social Care Act,
especially the devolution of public health responsibilities to local
councils and CCGs.
shows that in the last two years not only has the number of local
authorities reducing spend on alcohol services trebled from 7% to 21% of
the total, but that among councils designated as having ‘high’
levels of alcohol harm 50% have made cuts, and over the next three years
62% expect to cut services still further.
most CCGs don’t see alcohol services as their responsibility at all,
despite drink being increasingly explicitly
blamed for the crisis in the NHS.)
with high levels of alcohol problems are, of course, pretty much the
same areas that suffer the greatest deprivation. And, shockingly,
Alcohol Concerns points out these authorities actually get less
government money per capita than wealthier areas to spend on public
instance, my old manor Waltham Forest is ranked the 15th most
deprived area in the country and receives £42 per head for public
health. Yet across London in Kensington and Chelsea, ranked 103, they
get £130 per head, more than three times as much.
there’s part of the paradox solved. Places that need most help are
getting less money, and they’re cutting alcohol services as a result,
even while recognising the importance of addressing drink problems.
is a suspicion, too, one that Alcohol Concern almost dare not
contemplate, that frontline services are losing out to a growth in the
fluffier but cheaper ‘whole population’ solutions that the
organisation itself has promoted so vigorously.
the report notes, “whilst a greater population focus is welcome, it
should not be at the expense of acute and entrenched problems”.
as councils, especially poorer councils, come under increasing pressure
to find cuts from somewhere we should not be surprised that they turn to
the services that support stigmatised sections of the community, such as
those with drink problems.
if this results in a deepening of the so-called alcohol harm paradox, we
shouldn’t need too much more academic research to find out why.