Tuesday 24 November 2015

Final thoughts on the Licensing Act

November 2005

November 2015. Plus ca change.

I've written a post for the IEA lifestyle blog about what happened after England and Wales relaxed their licensing laws ten years ago to the day. Go read that if you haven't already read Drinking, Fast and Slow.

I have one final observation to make, which is that the story of the last decade has posed a problem for the orthodoxies of the temperance/public health lobby. At the centre of their belief system is the Whole Population Approach (or Total Consumption Model) which says that reducing overall alcohol consumption invariably reduces alcohol-related health and social problems, even though those problems are caused by heavy and binge drinkers rather than the population as a whole. The theory, which was popularised by Geoffrey Rose, holds that the whole population changes its behaviour in tandem, so if moderate drinkers reduce their consumption, so will heavy consumers.

Because they are not targeting heavy consumers specifically, this means that any method of reducing per capita alcohol consumption should be effective. The three pillars of the 'public health' approach to alcohol are therefore remarkably similar to those of gospel temperance - ban advertising, restrict availability and increase price.

The fact that the increased availability that came with the Licensing Act coincided with a 20 per cent decline in alcohol consumption is therefore an inconvenient piece of information. Largely as a result of the British experience and other inconsistencies, even the WHO now accepts that the evidence linking availability to consumption is mixed.

Faced with this paradox, the pretend public health lobby could do what they often do and produce some black-is-white research claiming that all sorts of health and social problems related to alcohol are getting worse - indeed, the Institute of Alcohol Studies recently had a bash at doing this - but it would break their golden rule to admit that alcohol-related problems can increase while per capita consumption declines.

More suited to their hypothesis is the fact that alcohol-related violence and drink driving have declined while per capita consumption has declined. But it is clear that both of these trends began when alcohol consumption was rising between 1995 and 2004. Awkward.

Equally awkward is the effect of price. Alcohol became more affordable between 2004 and 2009 but then became less affordable as a result of falling real incomes and the alcohol duty escalator. And yet alcohol consumption fell at roughly the same rate in both periods. Temperance dogma says it should have risen and then fallen.

And then there are health outcomes. Alcohol-related hospital admissions have continued to rise, albeit at a slower pace than prior to 2005. Incidence of liver cirrhosis is still rising. They could claim that these increases are the result of the Licensing Act, but, again, they would have to explain why the fall in per capita consumption hasn't led to a decline in admissions.

Finally, there is alcohol-related mortality which has neither risen nor fallen since 2005. According to the Total Consumption Model, the kind of sharp decline in consumption seen in Britain in the last decade should have reduced mortality. Talk of a 'lag effect' is starting to sound a little desperate now that a decade has passed since consumption peaked. As Holmes et al. showed in 2012, the time lag between consumption falling and health outcomes improving is not supposed to take this long; much of it should be immediate.

In short, 'public health' dogma dictates that the Licensing Act should have led to more alcohol being consumed, more alcohol-related deaths and more alcohol-related crime. In fact, it has been associated with less alcohol being consumed, fewer alcohol-related crimes and the same number of alcohol-related deaths.

Time for a rethink?

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