Monday, 19 February 2018

Another neo-temperance flop

Remember the great 'public health' initiative of removing high strength beer and cider from shops in Suffolk? These are the 'cheap' drinks that are supposedly targeted by minimum pricing (this is a shameless lie). Minimum pricing is going to effectively remove these drinks from sale - why buy them when you can get the same number of units from vodka for the same price? - but outlets in Ipswich removed them from sale back in 2012.

How did this 'Reduce the Strength' (RtS) scheme go? Well, it must have gone well because the Local Government Association has a briefing document telling councils that they should do likewise:

Suffolk – perhaps more than any other area – has led the way with tackling the consumption of high-strength, cheap alcohol... The campaign has proved incredibly successful. Ninety out of 138 off-licence premises have signed up, including big chains like Tesco, Sainsbury’s and Morrisons.

Note that the scheme is 'incredibly successful' because it had a large take-up, not because it reduced alcohol consumption or alcohol-related problems. It has been claimed that the number of street drinkers declined in Ipswich, but it seems more likely that these people (most, if not all, of whom are homeless) moved away rather than that they suddenly sobered up.

(As a brief digression, what are the chances of Scotland's homeless moving to England en masse in even greater numbers once minimum pricing is in place? Will anybody be studying this as part of the SNP's rinky dink evaluation?)

Since Ipswich councillors were primarily interested in shooing away street drinkers, they may consider the policy to be a success, but from a 'public health' perspective, the aim was to reduce alcohol consumption. Even if reducing overall consumption wasn't the explicit aim, consumption should decline if the number of the street drinkers and heavy drinkers declines because these people consume a non-trivial proportion of the booze sold. Aren't we told that 4 per cent of the population consume a third of all alcohol?

So did that happen? A new study published last week suggests that it did not. The authors got hold of sales data from the East of England Co-op which got rid of all its cheap high strength beer and cider (>7.5% ABV) from its 53 Suffolk branches in September 2012. Its Norfolk and Essex branches followed suit in September 2013.

The authors describe the roll out in Suffolk as Wave 1 (W1) and the roll out in Norfolk and Essex as Wave 2 (W2). Superstrength booze prior to removal made up 6.5% and 3.6% of total alcohol units sold in W1 and W2 respectively.

Let's see what happened when these drinks were removed...

Our analysis indicates that the impact of RtS on units of alcohol sold for beer/lager and cider was not significant in the two waves. More specifically, following RtS implementation, W1 stores experienced a non-significant increase (3.7%, 95% confidence intervals (CI): −11.2 to 21.0, P = 0.647) whereas W2 stores experienced a non-significant decrease (−6.8%, 95% CI: −20.5 to 9.4, P = 0.390).


The researchers missed a trick by not using Norfolk and Essex as the control group when W1 went into effect, but the results are interesting nonetheless. There was no significant change in the number of units sold and so far as the Co-op is concerned, unit sales went up in one area and down in the other.* As the authors say:

...the changes observed in the two waves were not consistent and so the overall findings showed no intervention attributable impact.

Although the results were non-significant in both places, the Suffolk experience is of most interest because it was there that the Reduce the Strength initiative extended to the most shops, and because Suffolk branches of the Co-op were selling more high strength products before the quasi-ban came into effect (6.5% of alcohol unit sales). It should therefore have seen the biggest decline in sales.

As the authors note, the RtS scheme did not make it impossible for people to buy high strength products in Suffolk. Not all retailers signed up. But the fact that alcohol sales rose in the Suffolk branches does not immediately suggest much switching to other shops. It seems that people in the area did not cut down their alcohol consumption, although some of them must have switched to different drinks.

This evidence goes against neo-temperance beliefs. The 'public health' lobby claims that some people drink too much because high strength booze is being sold at pocket money prices. The drinks taken off the shelves in Suffolk offer the cheapest units of alcohol money can buy in Britain. High strength beer and cider were still available in outlets like the Co-op after the RtS scheme began, but they were more expensive varieties, such as craft beer and scrumpy cider. Good, healthy, bourgeois rocket fuel, in other words.

The logic - and computer models - behind minimum pricing suggest that overall alcohol consumption should have declined as a result of high strength drinks becoming much more expensive, but that doesn't seem to have happened. The authors don't even seem to be very surprised by this. They've seen it all before. Under the heading 'What is already known about this topic', the authors write:

Evaluation of the Scottish Alcohol Act 2010 showed that banning alcohol multi-buy promotions did not reduce alcohol purchasing at the household level, and the introduction of the Alcohol Act was not associated with any changes in off-trade beer sales. 

I'd almost forgotten about the ban on multi-buys. Remember when that was an urgent 'public health' policy that was costing lives for every day politicians delayed? All water under the bridge now. It didn't work, but nobody's going to repeal it. Failure goes with the territory.

In 'public health', the only response to failure is to do more of the same but more vigorously. The authors of the study pounce on the fact that the RtS scheme was 'voluntary', as if it had been the retailers who had come up with the policy when it was actually the brainchild of Ipswich Borough Council, the Police, Suffolk County Council and the NHS. They conclude with a call for coercive, but unspecified, policies to do what this microcosm of minimum pricing couldn't...

Our findings suggest that voluntary RtS initiatives, have little or no impact on reducing alcohol availability and purchase amongst a broader population of customers. The research literature suggests that more effective regulatory public health interventions will be required to achieve substantial population health benefits in reducing alcohol consumption and alcohol-related harms.

Next time will be different, eh?

* Statistical significance is used in this instance to see whether the sales outcomes in Co-op shops reflects the change in sales cross the county.  

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