Monday, 24 February 2020

How to handle 'good news' in 'public health'

Here's a little curiosity, a short comment piece by some of the alcohol researchers at Sheffield called The Problem with Good News.

They take a rather unusual and self-interested view of the UK's decline in alcohol consumption, seeing it as a problem for 'public health policy actors', such as activist-academics. Why is it a problem? Because it's more difficult to persuade politicians to make draconian laws when the problem is manifestly not getting worse.

Following steady increases across previous decades, per capita adult alcohol consumption declined in the UK by 18% between 2004 and 2016. Several other high-income countries saw similar trends, signalling a potential reduction in the burden of harm from one of the key determinants of global ill health.

However, for much of the same time-period, public health actors in the countries affected argued that their governments’ alcohol policies were orientated toward commercial interests, were not in line with the best available evidence, and required strengthening to reduce alcohol-related harm.

This apparent mismatch between improving consumption trends and criticism of government action raises questions about whether public health actors’ calls for stronger intervention were misplaced and, more generally, how these actors should respond when the prevalence of addictive behaviours declines. 

It is not clear that 'addictive behaviours' have declined just because overall consumption has declined and there is no reason to view the decline in alcohol consumption as 'good news' (as the article's title suggests) given that alcohol-related harms have not declined.

Moreover, the decline in alcohol consumption in the UK did not coincide with a decline in alcohol-attributable harm. Instead, alcohol-attributable hospitalisations and deaths increased. This is striking, given that many argue that population-level consumption and harm trends typically move in the same direction over time.

'Striking' is one way of putting it. Another way of putting it is that it undermines the cornerstone of their entire ideology and the political demands that flow from it.

So, what to do? The answer, surely, is to stop fretting about per capita consumption and focus on the minority of people who have a drinking problem.

By the end of the article, the authors appear to be stumbling towards that conclusion.

Remedial policies are not diminished in the their importance by this revised focus of attention, but should target instead the demographic groups that continue to exhibit the most risky behaviours or which experience sustained high levels of harm.

Blimey, a bit of common sense. Will it last?

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