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This is an uncorrected AI transcript for guidance purposes only

Alice Wiseman: I kind of feel like I’m on a call with people who are real experts in this space. So, obviously I have a very particular interest in alcohol harm. and being from the northeast and being a director of public health across two local authorities in the northeast, it is right that I have that concern at a population level. Half of our population are drinking in a way that’s harmful to themselves. but at the same time, I don’t have the sort of background academic expertise that you have with many people on the call. shall I go for it and say what I was going to say,…

Alice Wiseman: Andy, and then we can All right.

Andy Mohan: Sorry. Yes.

Andy Mohan: I’m just loading the presentation now.

Alice Wiseman: Brilliant. I mean, I was going to start with the kind of background for Gates Head and for Newcastle. and as I say, I’ve been director of public health in Gates Head since 2016, and I just took on the joint role across the two in 2024. you’ve probably heard this already, but we know that alcohol It’s 91% more affordable than it was in 1987, available for as little as 13 p per unit in the Northeast.  And that was based on a balance survey of 2018. So there will be some changes in that. But we also know it’s way too available with over 8 and a half thousand premises just in the northeast alone. we are one of the areas that has the highest regional outlet densities across the whole country and that’s based on home office data.

Alice Wiseman: We know that it’s available 24/7, 365 days a year and in locations such as petrol stations and believe it or not soft play areas. it’s too heavily promoted. we’ve heard about that and we know that alcohol marketing does influence children. so we know that some research that was done that an awareness of alcohol brands demonstrated that children aged 10 before they leave primary school are able to identify various alcohol brands. It’s largely unregulated and especially online.

Alice Wiseman: And I have to say, I met with a mom of a 31y old who died just before Christmas in Gates Head and he’d managed to buy four liters of vodka on four separate occasions and have it delivered to the house with absolutely no safeguards in place. so there’s a whole issue that we’ve got around the online system, sponsorship of high-profile events. football is the most recent thing for us in the northeast at the moment with our success at the weekend. and we know also the alcohol industry has access to the heart of government. we saw this in February last year where there was a health select committee and the only people who were invited to speak at the first evidence gathering session were funded by the industry. And next slide please.

01:25:00

Alice Wiseman: So in terms of where we are in the northeast, just so you can give get an example and where we are specifically in Gates Head, we have the highest rate of alcohol specific deaths of any English region which is 25.7 compared to 15.9 per 100,000. So significantly higher. there were just under 700 alcohol specific deaths in the northeast in 2023 and that was an increase on the previous year where there was 576. So 100 people died in addition to the previous year in 2023 an increase of In Gates Heads that was just at around 60 deaths compared to only 43 in 2022.

Alice Wiseman: So this is an issue that we’re facing that’s getting worse over time. We know that there’s over 1 million related hospital admissions. Our rates have overtaken Scotland. and we know that the average age of deaths for somebody with alcohol specific mortality was of 57, but we also know that there’s significantly younger age groups affected where and when you look at the average age of death for all causes in the area that I work in, it’s se 78. So a real significant problem. increase in liver disease. You all know that and worse and we know locally by co-orbidities affected by health inequalities. so we know that half a million people are unable to work because of poor health that results from alcohol, tobacco and unhealthy food costing the UK economy 31 billion a year. so really if we’re focusing on the wealth and prosperity of the country, this is an issue that we can’t continue to neglect any longer.

Alice Wiseman: And next slide please. In terms of the breakdown of costs for Gates said we can see that it’s got a huge impact on community safety cohesion general being in the burough. We’ve got a really significant impact on our health services and hearing all the time about the pressures that we’ve got in our beloved NHS. again we can’t fail to address this as an issue if we’re going to resolve that problem. we’ve got a real issue again from an economic perspective in terms of presentersism, absenteeism and unemployment and per capita cost it’s around £541 in Gates Head per person compared to around 485 in England. And next slide please. So this is what we want and I’m sure that everybody on the call today will agree.

Alice Wiseman: We want a society where alcohol is less desirable and recognized as harmful. we do think that there’s an opportunity for alcohol advoc advocacy to be strengthened and particularly thinking about how we work more closely with tobacco and obesity colleagues and focus on reducing the impact of unhealthy commodities. we know that we need to focus on reducing harm in our most vulnerable groups and the alcohol paradox where we see greatest levels of harm in our most disadvantaged communities even when they are not consuming alcohol to the same extent as more affluent communities. We have got a positive emerging downward trend in conception in consumption amongst young people.

Alice Wiseman: So, how do we maintain that momentum moving forwards? Because we know that the age groups that are drinking in the most harmful way are kind of the 45 to 55 the age group that I myself sit in. we want a place where big alcohol in is an industry is excluded from policym in the same way that it is for tobacco. I just don’t find it acceptable that they are brought to the table to provide advice on prevention of harm when we know that the vast majority of their profits are based on, continuing and creating that harm. And we want a world where sobriety or low-risk consump consumption of social norms. So, not saying that we’re ever expecting it to become, sort of alcohol-f free, but at the same time, that place where social norms are completely changed. Next slide, please.

Alice Wiseman: So if I’m talking about this, I want us to think about we’re learning from history, and I think we’ve got some great progress that we’ve made on smoking that gives us an opportunity to think about what happened there and what can we learn from it. next slide, please. so this just gives you a kind of at the start of the framework of 1962 when the Royal College of Physicians wrote their first report around the linking tobacco and cancer.  And there’s a really interesting BBC interview in the archives where they talk to people on the streets during that time and people are saying we don’t want them to take our cigarettes away. That’s something that we enjoy doing. When you watch it, it reminds me exactly where we are with alcohol now. But over the years we have made progress in terms of reducing smoking prevalence. But alongside those things we’ve taken action on advertising, marketing, labeling.

01:30:00

Alice Wiseman: I’ll move on to the next slide so you can see up to date to date just onto the next slide where we were looking at focusing on point of sale displays rises in age and alongside all of this we’ve seen increases in prices and more recently of over the last few months obviously we’ve got a real ambition around a smoke-free generation. Next slide please.  So legislative measures work. We’ve seen it with tobacco. this is a cancer research UK slide which I have borrowed for the purpose of this. But you can see all of those interventions have contributed to that decline in smoking prevalence for both men and for women. Next slide, please. And the most important thing for me here is it’s contributed to a decline in smoking prevalence for our children and young people.

Alice Wiseman: So action on the adult world has changed the world that our children and young people grow up in. And I think that that’s really important to note because often what we find is industry talking to us around we need to educate young people. And we’ve seen some of the work that Mark Pedigrew’s done, sorry, around exposing the alcohol industry influence in our education systems, which is seeking to normalize the use of  action on the adult world rather than education for children and young people is the most effective way of having that impact and reducing the harm that’s caused. Next slide please.

Alice Wiseman: So I know you all know this again but common industry tactics we know and we see an awful lot around lobbying and political party donations not just for alcohol we’ve seen it for gambling for all sorts of things manufacturing doubt and shifting the blame doing their own research and presenting that as factual and grant was highlighting some examples of that when I joined the call there. aggressive marketing and advertising and I do think marketing and advertising has an impact on the things that we do. I don’t believe that people would spend billions of pounds marketing and advertising if it didn’t influence the choices and the decisions that we make. self-regulation. So promoting that self-regulation which again we know has absolutely no direct impact on anything and we’ve seen that with the public health responsibility deal which have very little impact.

Alice Wiseman: But also things like community alcohol partnerships which are funded by industry and actually often seek to distract local areas from sort of having the conversations and taking the action in the spaces that are more impactful that issue of corporate social responsibility. So being able to see that they’re funding things like drinkware. look we’re being responsible. we’re trying to tackle the harm with you. We’re part of the solution.  that focus on personal responsibility, actually trying to say that it’s okay for people to drink responsibly, to gamble responsibly, and I just thinking about taking that back to the individual distracts us again from the things that we need to do at a population level. to suggest that treatment services aren’t absolutely essential for those people who require that support.

Alice Wiseman: But actually what we need to do is to challenge the narrative of personal responsibility because that also challenges the stigma associated with people who are drinking in a way that is harmful. and I think that that is certainly locally in some research that we’ve done recently, one of the biggest barriers to accessing for treatment services is the fact that people feel really ashamed and stigmatized.  And I’ve already highlighted the industry sponsored education and awareness programs which Mark has written about. And actually one of the things that really stood out to me when I was learning from that work was that they were teaching 11 year olds not to drink on an empty stomach. As opposed to teaching 11 year olds that actually drinking is harmful for their growing and adolescent brain. We were saying you’re going to drink so just make sure you don’t do it on an empty stomach. It just seems Yeah. crazy.

01:35:00

Alice Wiseman: Next slide, please. So, how have we done the work around tobacco across the northeast of England? So, taking this back to a local DPH perspective, we’ve been really fortunate that we’ve got had our regional tobacco office in the northeast since 2005, almost 20 years I think. massively based on international evidence provides that comprehensive tobacco control program which looks to encourage smokers to quit and prevent youth uptake but to also look at how we can protect people from tobacco related harm. It’s jointly funded by 12 local authorities across the northeast. We’ve always funded it and also now the northeastern and north integrated care board.

Alice Wiseman: and I’ll talk a little bit more about our alcohol equivalent in a moment, but you can see from the slide there that this isn’t about taking a single approach. This is about making sure that the Northeast has that voice and that advocacy at a national level. but also that we have the opportunity to think about, some of our mass media campaigns. If you want to move on to the next slide, and this is where I was thinking when I joined the call with Grants.  I think I probably need to rewatch Grant’s presentation because I think what we found in the Northeast is that by raising awareness of the harm, we’ve supported people not only to access stop smoking services, but we’ve also built public support. So alongside these campaigns that we do and actually we use a lot of led work. So a couple of these are people who experienced a cancer journey as a result of smoking talking about the facts that they found it so hard to quit.

Alice Wiseman: And the lady on the right hand side Sue was talks about she took three attempts to quit despite having multiple cancer experiences and I think that bit around taking it back to the individuals. but it builds that public support for the measures that we need at a national level. So when it came to the smoking ban in 2008 I appreciate that’s a long time ago now. the northeast had the loudest voice.  we provided the most returns nationally on what was needed because we had already built that work around public support. Next slide please. So in terms of learning from the lessons I think from tobacco and these are just my views there probably other things on the call. We need to recognize the problem is to be addressed and work on it together.

Alice Wiseman: And I’m talking about this from a local level, but also a regional level and a national level because there’s things I can’t do locally that I need national and regional to do. Making sure that we’ve got that comprehensive multistrand and long-term approach and it is about, sticking with it and holding the faith.  So there was some work that was published I think yesterday, it was on radio 4 yesterday anyway that was talking about smoking prevalence across the country and saying the northeast has had seen the greatest declines and there are some areas of the country where smoking prevalence is possibly creeping back up again and I know we probably had the highest rates of smoking to start with.

Alice Wiseman: So there’s an element of that, but actually the reason I think that we’ve got that is because we have that comprehensive approach across all of the northeast working with all of our colleagues to try and ensure that that is delivered and also like I say holding the faith when things have been difficult. So evidence-based jointly owned actions and we need to look at monitoring working at scale I’ve mentioned that already because some things only need to be done once. if we could increase the price of alcohols through minimum unit price and taxation, we would only have to do it once. we think key messages and making sure that they’re communicated by many voices. So, I’ve talked earlier on about the fact that we’ve used local people to communicate those messages alongside some of our amazing clinicians that are working kind of at the front line dealing with the consequences of the harm caused. And then that visible and enthusiastic leadership at every opportunity, which is difficult.

Alice Wiseman: I think we’re winning there with tobacco, but sometimes when I talk about alcohol locally, I have people rolling their eyes or, having a little snigger because we’re not quite in the same place there. And sometimes it becomes hard to do that. But actually, I always think back to the public health colleagues in 1962 must have felt exactly the same. And so I feel it’s our duty to continue to do that as much as we can. Next slide, please.  So communication strategy and again it’s around efforts to ensure that we’ve got that ongoing media presence making sure that people are informed making sure that we are building that public support because it is public support that shifts the politicians. they’re not going to do anything that they think is going to cost them votes and I understand they’ve got that challenge and that balance and reach that we don’t have.

Alice Wiseman: but building that public support means that you’ve often got them with you and sometimes they can come to it a bit later because individuals every politician I’ve ever spoken to gets it and I’m haven’t spoken to lots of senior politicians but at a local level definitely they all get it but there is also that fear around and voting so local champions including political leaders and actually from the smoking work we’ve had great leadership so Mary Foy MP was a local council portfolio lead for health when I first started in Gates Head and she led all of the local Gates Head work and when she became an MP for Durham, she’s continue to lead it and chair various committees that’s made a real difference. and having that broader understanding around the commercial determinance of health talked about awareness and support for change so that the public are with us and focus primarily on adults and this is again a difficult thing at a local level.

01:40:00

Alice Wiseman: People are often saying, we want to do more work in schools. We just need to talk to children about, the harms and it’ll change what they do. I don’t know about you, but when I was a teenager, I was probably completely the opposite to that, and the evidence doesn’t sit there at all.  But some of the challenges we’ve got is that while we’ve got industry getting in there and trying to do stuff in schools, again, distracting from the real things that we need to do, trying to be responsible. and sometimes we feel like we’ve got to counter that by providing the education where we wouldn’t normally, but we’re trying to, make sure that industry aren’t there, in instead of us.  And then just accepting that it is complex and it takes ages but like I say I hope it won’t take as long as it’s taken for tobacco from 1962 to now and still more to go. but equally we have to kind of stick with it. So next slide please.

Alice Wiseman: and again the point that was made, I think it was by Sheila before around trying to pick those things that we know we’ve got a potential appetite for at the moment, because we can’t necessarily do everything. And sometimes as much as you don’t want to, you have to compromise on those things that are acceptable. And I think COVID 19 was a really interesting natural experiment. We would never have got the ethics to do it and understandably so. because actually what we saw was harm from alcohol rising during the pandemic when our entree sales were predominantly closed. People were buying cheap supermarket alcohol and drinking to excess at home and we saw it skyrocket. We know that the industry uses the hospitality sector as a way of pushing back at us.

Alice Wiseman: So actually the conversation and also we know that entrade they tend to make more money from food now than they do from alcohol. They tend to sell above what we would have ever had as a minimum unit price. And there are safeguards on trade in that if a pub locally in Gates Head is to is selling to somebody who’s intoxicated then we can seek to review their license and withdraw their license from them. so there are measures in place to help us tackle the entree.  So is there a conversation around focusing on the off trade as something that might be politically more acceptable? we know that the number of offlicicens has increased significantly over the last 30 years. we know that 90% of beer was sold in pubs whereas we’ve seen a real significant shift like I say in that drinking up to 80% following the pandemic.

Alice Wiseman: And we also know from our local because we do annual perception surveys in all of our local authorities as part of our balance program is that 95% of northeast residents feel that there are either enough or too many places selling alcohol. So we already have northeast public support and over half of our residents agree that offrade sales should be limited between 10 and 10. so we know that there’s public support there and as I’ve already spoken about the very tragic place that isn’t not an isolated incident of a dialer drink service and the impact of harm that causes. Next slide please. So I’ve already covered quite a bit of this. we know that the harm is being driven by treat strong offrade alcohol.

Alice Wiseman: there’s data on the slide there that you can see in terms of the average cost of laga on trade is £4.70 and off trade it’s 1.51. we heard, we’ve had adverts, articles where they’re highlighting that the attack on supermarket chiefs for selling booze at 1980s prices. and we know that this is a real shift and this is one of the reasons that we’re seeing this increase in the level and palm.

Alice Wiseman: So again linked to that if we’re thinking about reversing some of that then it is about reinstatement of the duty escalator minimum unit price wouldn’t impact on price in the tra on trade it might actually shift people to drinking on trade have a positive impact if we’re wanting to think of it that way but also learning from Scotland in terms of the ban on multi buy offers and alcohol promotions and I always remember a researcher talking to me about some research they did where they said this is a few years ago

01:45:00

Alice Wiseman: where you could buy three bottles of wine for 1010. And when the ban on multibby offers was in introduced, they just reduced the price to £3.33 per bottle. But actually what they found were people were buying the bottle they wanted rather than the three bottles they thought they had to buy to get the deal. So even that sort of shift would be helpful. Next slide, please. So obviously you’re on the call, I think probably because you get the importance of prevention.  Next slide, please. So, we know the evidence of what works. So, I mean, if it was down to all of us, we know that we would be able to shift some of those things. So, I think that we need to continue to talk about a comprehensive evidence-based multi- strand approach. Again, like I say, learning from tobacco. We’ve got the World Health Organization evidence evaluation from 2016, which looks at those population interventions.

Alice Wiseman: they’re effective and as pointed out earlier cost effective in terms of at the moment we are subsidizing alcohol harm. the real importance I guess of cross-system working both locally like I say regionally and then nationally that voice is so much stronger when we all work together on it. I think there needs to be that focus on upwards opportunity for us to work together on advocacy and legislation around price promotion place and again using people who’ve got lived experience in this space is really powerful and try starting to shift the perceptions of individuals. so locally we do quite a bit of work around aware awareness raising.

Alice Wiseman: So, for example, in the Northeast about five or six years ago, it was only one in 10 people understood that there was a link between alcohol and cancer. And so, we’ve been doing work to make sure that we are promoting and ensuring that people do understand that there’s a link between alcohol and cancer. And we’re now crushing up to about 30 35%. So, still a long way to go when we know that one in 10 breast cancers, for example, is caused by alcohol next slide please. I think I’m getting to the end. So, building on what we talked about earlier on in terms of our fresh approach, we have a very similar approach across the northeast in terms of action on alcohol harm. we have a lot of support for local engagement. So again, there are things that we can do better across a larger footprint that we can’t do at a local level. And some of that is coming together and sharing practice.

Alice Wiseman: at the moment we’re looking at the work that Sheffield’s done, for example, on banning, advertising and, what can we learn from that and we use some of that work locally? But balance helps us to do that. Where’s the evidence? What’s working elsewhere, both locally, regionally, but also internationally and helps to almost navigate some of that for us as local DPH, you often don’t have time to do that.  advocacy for evidence-based policies. again, Sue and Als from Fresh and Balance doing an amazing job of speaking at a national level, getting the voice of the Northeast there. we’ve got the communications I’ve spoken about making sure that we’re challenging that alcohol industry locally. So, we’ve had North Cumbria sessions with our integrated care board colleagues around commercial determinance of health that Mark and May came and spoke at.

Alice Wiseman: making sure that people really understand the harm that’s caused by industry. and then also, of course, research data. making sure that we’ve got that evidence base and we grow that evidence base locally. and also have that public opinion. So, I can go to my local elected members and go, we’ve got a lot of support locally to do this, and it just gives people that assurance. So, I think this is nearly my final slide. So, key advocacy opportunities.  I’m sure you’ve talked about this already. price is absolutely critical. Evidence from Scotland is showing us that it’s working. we’re hoping that there’s some interest from the Treasury because actually the impact of the duty cuts and freezes over the last decade have not only meant that we’ve seen an increase in harm, but we’ve also seen a reduction in the money that would have been coming into government to support the public services that are able to respond to the harm.

Alice Wiseman: have talked about availability, but actually I think licensing laws need to be really revisited health as a licensing objective, again in Scotland, but actually also making sure that we can do that at the population level because often you’re looking at a license application unless you can tie it directly to the harm at that particular point in time. You have to wait until you’ve got a retrospective bit.  So being able to look populationwike, we could look at cumulative impact for example for off trade as well as thinking about the kind of nighttime economy which has been easier. labeling and campaigns with the the public have the right And like I say that we do think that awareness changes, behavior, but also it changes the way people view the harm that’s caused and obviously continue to lobby with national and local government. this is the final slide, I promise.

01:50:00

Alice Wiseman: So yeah, we’ve got practical examples, local prioritization of alcohol within the local authority and wider system. So people signing up to, sort of codes of conduct and agreements about how we will work or the fact that we won’t work with industry, the fact that we will look at, sort of the evidence-based measures, making sure that we are thinking about protecting vulnerable groups from harm.  Lots of people who are in our recovery communities have talked about the fact that it’s incredibly triggering to see many of these adverts and some around Christmas and what have you maximizing opportunities through licensing so we’ve developed a matrix where you can put in the postcode for a new license and it pops up with all the harm that’s caused in that area not just from the health perspective obviously because it’s not a licensing objective but also from the crime and disorder and protecting children and some of those other things that we have the opportunity

Alice Wiseman: to feed in with you making sure that we are feeding in around economic regeneration because actually diversification of that kind of economy of leisure services if you have been shown to be impactful in terms of we know that lots of people avoid the nighttime economy because they’re frightened which stops them from going to the theater or stops them from going to the cinema in the evening. but then also making sure that we are focusing on that kind of early intervention and prevention with people who have got already drinking in a way that’s harmful to themselves particularly focusing again in primary care and with our alcohol care teams in the NHS. So I shall stop there if that’s okay.

Andy Mohan: Thank you so much, That was very really interesting. lots of information provided there. and then I know we have some comments coming in. I suppose maybe I’ll just kick things off by asking around the media campaigns because I know with Grant’s presentation, we’re talking about I suppose the effectiveness of mass media campaigns and it was really interesting seeing the different campaigns that you have going on locally. and I was just wondering if I suppose that the effect of that has been measured or captured in any way.

Andy Mohan: Yes, of course. Yeah.

Alice Wiseman: So, all of our campaigns are evaluated and have shown an impact in terms of people considering cutting down. So, I’m not suggesting that that’s going to solve the world on its own at all. but raising public awareness of the homes because I think when people hear alcohol because of the way industries got into our heads people think of people who are lying in a gutter or people who are addicted to alcohol whereas like I said at the start half of our population who are drinking in a way that’s harmful to themselves and the vast majority of people do not understand the link between alcohol and cancer so I think in the same way that we had to build that understanding with tobacco and how harmful it was

Alice Wiseman: and to get that public support that’s kind of the aim that we’re having throughout this and I think that the only way that we’ve been able to do the mass media work has been to do it by collaboration across local authorities because we couldn’t afford to do it as individual local authorities expensive it would be even better if they did it nationally because I’m sure that would be even more effective at a national level and again using local people so there’s a woman a lady called Karen Slater who is from Newcastle who speaks really passionately.

Andy Mohan: Mhm.

Alice Wiseman: She’s written about her own journey through addiction. She actually came with us to parliament earlier in the year to talk to MPs about it as well. But she talks about the impact that advertising has on sort of triggering a relapse for her during her recovery journey. so making sure that you’ve got those local voices I think is also really important. we learned from COVID with the vaccine program. The best people to talk to, people who were reticent to get the vaccine were local people in the local community that had the same, life experiences as them. Not seen as preachy, but seen as,…

01:55:00

Alice Wiseman: kind of helpful. So I do feel there is a place for it. But I will watch Grant’s presentation back as well.

Andy Mohan: No, that’s good.

Andy Mohan: So is there anyone in the audience who would like to ask Alice a question? If you could please raise your hand or you could pop it in the chat. I suppose while people are considering Alice as well I note Alistister’s comment around health as a licensing objective I do a lot of work on alcohol licensing in Scotland and I guess Alistister’s point that we’re not necessarily convinced that even though we have the health as a licensing objective that it really works in reality.

Andy Mohan: I don’t know if you wanted to just comment on that a little.

Alice Wiseman: No, I mean it’s been interesting,…

Alice Wiseman: hasn’t it? Because we’ve looked at some of this when we’ve been trying to lobby for it. And I guess there’s something about building that public support for the wider measures that are needed and this being one of them. So on its own, absolutely. But at the same time, we’ve seen harm increase as we’ve seen availability increase.  So, if we’re going to reverse that or at least freeze it, then there needs to be something that we can do to reduce the availability of it. I do think that we could focus differently. I think the licensing act is not fit for purpose as it is.

Alice Wiseman: So I had a conversation with licensing colleagues the other day and even with health as a licensing objective that like I say there’s limited impact that we can have because you’ve always got to look kind of retrospectively is that individual premise going to cause particular harm in that place. it’s much easier to look back and say they have caused harm because they’ve had so many antisocial behaviors or they’ve sold to children and then we can revoke the license  So there is something about the current licensing act as it is not fit for purpose. But I think I always make representations where I can. There are times as a director of public health where I’m sat alone making those representations because health is not a licensing objective that often means you’re not listened to because if the police are not sat alongside you when you’re saying there’s antisocial behavior issues or children’s services are not sat alongside you when you’re saying I’m worried about harm to children. Then you kind of lose the argument.

Alice Wiseman: Whereas if I could go in and talk about health, then we would have a different position. And just to slightly extend this, but there was one situation we had where there was a licensing gates head they wanted to open from 8 in the morning instead of 10:00.

Andy Mohan: Yeah.

Alice Wiseman: So it probably felt like, why the stable doors already been opened and the horses bolted. Weather Spoons just down the street selling from 8:00 in the morning. And the reason the local place wanted to do it was because they wanted to compete with Weather Spoons.  But it just felt not right. And so we pro provided all this evidence to the local licensing committee around extensions on the hours leading to increased levels of The harm that we saw in the area was around 7:00 in the evening. So by opening it two hours earlier, we were saying actually you bring that harm forward by two hours. It’s really tenuous.

Alice Wiseman: And we did win that locally…

Alice Wiseman: because the elected members that were sat around the table didn’t want children and young people to be exposed to that harm on their way from school after school clubs. But it always feels a bit tenuous and you always feel like you’re kind of David and Goliath in terms of the fight.

Andy Mohan: Yeah, definitely.

Andy Mohan: Okay, so Peter, would you like to come in with your question?

Peter Rice: Okay, and yeah, thanks that was really great, hearing it all pulled together and I think what you’re just saying there about the practical examples of that off license and Gates head I think maybe answer my question because I think what I was thinking about when you’re talking about home delivery systems is that they’re up and running have been for years and it’s very difficult to pull it back once it’s happening.  So really what I was going to ask you is what systems you can picture that would prevent that happening. so that there would be an opportunity to stop things before they started if you like.

Peter Rice: so you partly I think answered that what you’re saying about needing the law to be revised but in your ideal world what would that process actually look like so that we weren’t shutting the stable door after the horse was over the  rest.

Alice Wiseman: Yeah. I mean,… I guess there’s a couple of things. if I was thinking in advance it would be not only that the license was granted in the place where the premise was that was deliver doing the delivery but that it was actually taken consideration around the geographical area that it could deliver to because I think that that’s part of the problem. I mean at the moment you can pay an extra five quid for a bottle of wine and get the co-op to deliver for you. So I mean we are in a bit of a sort of stuck place with that. I’ll just use a slight link to a different piece of work that we did in Gates So in 2015 we banned any new hot food takeaway planning applications. so in areas where there was more than 10% childhood obesity, there was no new hot food takeaway planning applications. we have had not one new hot food takeaway since 2015. Now everybody said that’s not really going to do anything and it’s closing the stable door after the horse has bolted etc etc.

Alice Wiseman: 

02:00:00

Alice Wiseman: However, what we have seen because we’ve had some change of use. So, we have seen a reduction in hot food takeaways. and what we have seen because there was some recent research that was just published before Christmas is in our most disadvantaged communities that had the highest prevalence of hot food takeaways, we’ve seen a reduction in childhood obesity when you compare Gates Head to an area of the Northeast that didn’t have the same policy.  I think it was Lancaster University that did that research, but if I could share it or you could Google it. So, it’s that sort of thing that I think that we need to hold the faith with, because actually there is a demonstrable impact of closing the stable door after the horse has walled, albeit small. And I think that learning from the tobacco, it is about those small steps, but it does take local politicians to be really brave because they have been lobbyed multiple times about it.

Alice Wiseman: so with alcohol, that’s where I think we should be going. I mean, I’d love it if we didn’t have delivery available. I don’t think the safeguards are sufficient delivering to someone’s door, both from an age perspective and also from a sort of risk of serving to somebody who’s intoxicated. Once you’ve turned up at the door, you’re not going to not give them the drink, If you think they’re drunk because you run the risk of, violence what have you. So, I mean, ideally, we wouldn’t have it at all.  And that’s why I’m saying I wonder if we focus on the off trade because it might be more acceptable to the public and therefore might get us over the line with some of the politicians.

Andy Mohan: Yeah, thank you for that, Peter. Sheila, would you like to go ahead with your question?

Sheila Gilheany: Hi Alison, I’m really really interested in that and just the whole question of a public health approach to licensing. I mean in Ireland public health isn’t given as a reason for licensing. Although there is a new piece of legislation that says that if you open or you seek a new license you have to inform the HSSE about that.  But I don’t think there’s ever been any action taken, by the HSSE in relation to that.

Sheila Gilheany: I’m coming back to the idea of I suppose density of outlets as maybe a particular way in which this might be approached and I was just wondering if I was interested there with the linking of the hot food outlets with particular issues that are in place but have you done anything in relation to alcohol and density of outlets there in Ireland we have an amazingly big outlet density.

Sheila Gilheany: It’s, 3/4 of the population live within 300 meters of an alcohol outlet. So, it’s very dense.

Alice Wiseman: Yeah. So in Newcastle,…

Alice Wiseman: predating me, so I can’t claim any of the credit for it, there was work done on cumulative impact zones, but again that work was done on trade because it’s much more It’s much easier to see the harm.  So Newcastle City Center is a cumulative impact zone in terms of not able to open new premises or if they do they have to pay significantly more for their licensing so that they then have to sort of contribute to the cleanup and actually many of the premises in the city have signed up to a minimum unit price so the problem for me in terms of density is I think the current licensing act means that we focus on the things where we can see it whereas for me the harm that

Alice Wiseman: is really increasing in our population is that bit that’s less visible in the home and I’m not aware of anybody being able to do anything around cumitive impact generally around density unless it’s got a really big nighttime economy…

Sheila Gilheany: Thank you very much.

Alice Wiseman: where I say it’s easy to show the whole yeah so I could check back but we haven’t in Gates Head or Newcastle I’m not aware of Okay.

Andy Mohan: Thank and I see we have a question from Mark Petru in the chat. so he’s asked, “What are the evidence gaps that need filled to support your work? I.e.  What can academics and researchers do to support you that they are not currently doing

Alice Wiseman: Not currently doing that’s a tricky one because I use all of the research.  I mean, Mark’s one of the people that I quote all the time in everything that I do. So, and think I guess, the being able to demonstrate things like I don’t know if I’m allowed to say it because I’m scared I’ll be taken to court, so I’ll not use names.  But when Mark did some analysis around a school-based education program that was focused on alcohol, the ability to be able to do that and publish it meant that we could then share it without fear of litigation because I think that there’s always that issue locally that if you take it on individually and we have had emails where we’ve been told that we shouldn’t be saying certain things from industry sources.

02:05:00

Alice Wiseman: So that ability to be able to say to schools here’s the evidence that shows that that is ineffective sort of that is helpful I think the research it’s how we bring the public with us because we know what works don’t we know the things that we need to do but it’s how we bring the public with us so there is something about how do we build that public support for this how do we build the public understanding around the commercial determinance of health how do we do that work so that we can bring them with us? I guess it goes back to some of the framing stuff that I think Grant talked a bit about when I joined the call as well.

Alice Wiseman: there’s probably loads more I could think of afterwards, but at the moment, and I do use all the research, absolutely, like I say, in the license objection that I put in when they were looking to extend that, it was academic research that we used to demonstrate that by increasing your hours of opening by an hour, it would increase your harm and similarly with the hot food takeaway work, we demonstrated that if people were more likely to experience greater levels of harm if

Alice Wiseman: I think it was Cambridge Uni had done some research around, if they hopefully take away on their way home from work, they’re significantly more likely to. and then the other bit that I would say is around inequalities. because we often, focus on work, but actually how do we make sure that we, address for the alcohol paradox where the harm’s greater in almost disadvantaged communities. and I know that no and low is contentious so I’m interested to see the outcome of my big concern with that is it makes the industry look like they’re being responsible. It allows them to be part of the solution and I think the impacts at a population level and certainly with our most disadvantaged communities will be limited because it’s not a cheaper product.

Alice Wiseman: so there is something about being clear what if we are going to look at something like that the impact that it has not just sort of at the population level but on inequalities as well you’ve probably got loads of other things that I should have said Mark so apologies I mean I guess the other thing I’m thinking now you’ve said that is around sort of children and…

Andy Mohan: Yeah, definitely. Yeah.

Mark Petticrew: Thanks very much. the reason for asking was exactly that just continually trying to think about what’s actually useful to do and your presentation and grants beforehand were quite useful in terms of thinking what I mean there’s lots of things one could do but yeah what’s actually  All

Alice Wiseman: exposure to and that bit  around children being able to identify alcohol brands. There’s a bit of that already been done, but it’s kind of always useful to be able to use it because then when you’re talking to local politicians, they get the whole thing and local people, they get the whole protection of children from harm, So, actually, if we use that almost as a bit of a focus, but the way we protect children from harm isn’t through education. It’s through changing the adult world.

Andy Mohan: I think maybe at this point in time, Grant, I might just invite you. Don’t know if you had any kind of thoughts reflecting on Alice’s presentation in relation to what you’ve presented.

Andy Mohan: Hopefully, I’m not putting you on the spot there, Grant.

Grant Ennis: No, I really liked your last comment,…

Grant Ennis: I was typing it down just now that Let me see. I didn’t get a chance to finish it, but you were saying that the way that we improve things for children is not through children’s educ education, but through changing the adult world. I think that’s a great way of framing the material environment, the adult world. I think we can be using that a lot more.  I think on the power of media to make sure that we’re framing the work that we’re doing and getting the word out there and building political support for what we do. Also labels, also education. I think we’re all in agreement on the value of it to get the word out.

02:10:00

Grant Ennis: I think where I just tried to make very clear the more we place the locus of responsibility or change on individuals be the label reader be the child or the person in the video clip the less we build support for political change and that’s very tricky and that gets an area of public health that we don’t discuss enough. It’s used to be called critical discourse analysis. it’s where is responsibility in a given sentence, in an image, in a video clip. And the personal story narrative rather than the societal story narrative is a very important distinction. Both can use a video clip.

Grant Ennis: both can be using a meme or an op-ed, but one builds support for policy and one removes support for policy and that’s a very difficult and fine line to walk. and I think we all are working on it together. Industry is definitely pushing for one direction and I think the more we can do to push in the more success we’ll have in saving lives. another thing I just wanted to say, nice to finally meet you, Alice.

Alice Wiseman: You too. I’ve read your book.

Andy Mohan: I guess for me kind of maybe just reflecting on…

Andy Mohan: what you just said Grant as well as Alice. so we have one of our spotlight sessions by Mary Martin Madden around alcohol brief interventions and actually alcohol brief interventions 2.0 door. really the kind of key point is that alcohol brief interventions the way that they stand at the moment are just no longer fit for purpose because they really focus on the individual and the individual’s ability to self-regulate the drinking without acknowledging all of these wider influences on drinking behavior.

Andy Mohan: And so if anybody has time please do go take a look at that spotlight session because it’s really interesting concept and I know recently public health Scotland they just provided a review of the Scottish alcohol brief intervention program and essentially the bottom line is also the same is that ABIS while I think in the past in

Andy Mohan: in I guess 20 plus years ago were really seen as a tool that could be used by GPS and other healthcare practitioners that actually do see a lot of population again over the recent I would say decade or so the number of ABIS being done or has been declining and so I think it’s really interesting I think that idea of the individual  ual and the individual responsibility, considering, the huge attempts by the alcohol industry to really influence drinking at a level that’s not really conscious to a lot of us. So, yep, I just wanted to in introduce that point as well. does anyone have any questions?

Andy Mohan: So, I’m just seeing that a few people are put posting up some links to resources in the chat as well. so, I believe Phil we will be collecting those resources and sharing as well for attendees. Yes, Phil,…

Andy Mohan: would you like to come back in now?

Phil Cain: I will put back in there.

Phil Cain: Thanks very much. We’re actually coming towards the end. I was just going to make a comment which I didn’t make at the end of Grant’s thing about the bot farmer. I have to say I’ve never actually seen them in physical reality but that was quite a shocking image.  But as somebody who’s at the sort of front lines of the information war, in online and on Twitter and so forth, a lot of it still does come from originate from, what we would consider old media that often that spawns a narrative and this kind of zone flooding that Grant I would say at the moment often around alcohol free drinks being the solution to all our ills.

Phil Cain: is something that I kind of deal with on a daily basis and this kind of zero sum game politically is kind of played out just in terms of the amount of space on a newspaper page or in these days on a website only got so much resources to go around and if you can fill it with something that doesn’t work that all to the good as far as the alcohol industry is concerned. 

Grant Ennis: I’m gonna talk today mainly about my book and the research behind it in how corporations use disinformation to undermine political will for a very effective public health and environmental policy. I am not an alcohol expert. I’m trying to build on the work of other experts that are here, but a lot of the ways that industry uses narratives are the same regardless of the public health issue.

Grant Ennis: And a lot of the underlying ideological or financial capture issues that exist between corporations, public health organizations, and research institutions are quite the same regardless of which industry or which health issue we’re talking about. I’m eager to answer any questions along the way as I’m presenting. we’ll leave it to Phil and Andy to see how we want to make that happen. if it should be on video questions or just from the comments, but I won’t be able to see your comments in the chat while I’m presenting because I have the full screen in front of me. so please beep me if you have a question or want to interrupt me. So I love this quote. Some of you may have heard you don’t know that gets you into trouble. It’s what for sure that just ain’t so. Many of that Mark Twain said this.

Grant Ennis: The best thing about this Mark Twain quote, I think, is actually that Mark Twain never said it. f further underscoring how great this quote is. I’m going to use it a couple of times in the presentation today. I think it’s important to start with this, especially given the level of capture globally the public health community has had forever. I mean on Mark, this is one of your and Nason and May’s papers here on the left. And then this is a screenshot of who Drinkaware was funding just a few years ago. I think the screenshot from 2020 or funded by. So you have these NOS’s that are ostensively working to the public benefit that are clearly captured by industry and it essentially Drinkaware is essentially an industry organization.

Grant Ennis: but that’s really kind of the tip of the iceberg for the direct capture that if you look at just across the board the universities around the world that are funded by the alcohol industry. I mean this is just a quick snapshot. it’s hard to find universities that aren’t find it funded by industry is more to the point.  So our entire research community not even looking at alcohol is tainted. We have all been influenced and surrounded by people that have been influenced by the alcohol industry. And a lot of the stuff that we take as axiom or that we take to just fundamentally be true has been largely shaped by industry without us even knowing it.

00:25:00

Grant Ennis: So, I think it’s really important to be willing to question the things that we see as sacred cows because we might actually be believing things that are harmful to the goals that we ostensibly seek to achieve. The United Nations similarly works very closely and has worked very closely for a very long time with alcohol industry and other industries. this then further shapes the way we globally think about alcohol. What we don’t talk about, what we don’t say, the things that are just not on the table. and then the way that each issue and the solutions to our issues are defined are being highly in influenced by industry. NOS’s all around us are being funded by alcohol industry.

Grant Ennis: again further shaping and surrounding us with industry narratives in places where we would least expect it. and to such an extent that I think we just don’t understand deeply enough the level to which we are captured. So we really need to go back and look at what we know for sure that just ain’t so. And I’m going to cover a lot of that today.  Some of it some people might be surprised by some people have heard it from me before if you’ve met me or heard some of my presentations read my book Dark PR but please feel free to challenge me along the way if you would like.

Grant Ennis: in terms of capture just to kind of recap, funding of course is one form of capture. and funding different actors through different layers of front groups is very commonly known.  There’s another kind of capture that I think is very important is the people and organizations and institutions that actually aren’t taking money from industry but because everybody else is we have adopted their ideas without being realizing I call it environmental capture. Sometimes this is called the creeping colonialization of ideas or cultural capture.

Grant Ennis: whatever you want to call it. It’s a big problem that I don’t think we recognize enough. We can be captured ideologically without ever ourselves having to have been funded or directly influenced by industry. the way around this of course in terms of the direct capture is to make sure we never take money from industry in any way. self-funded member-ledd organizations are best but this still doesn’t solve the problem of environmental capture.  I also want to start instead of looking at solutions to alcohol harm from an additive standpoint. I think we need to take a step back and realize that a lot of subtractive solutions would probably be more appropriate. It’s not that the system is broken that but that we’ve built it this way.

Grant Ennis: For example, rather than thinking of the nanny state being something that we would look to solve our problems and it’s like intruding on our lives, the nanny is actively killing us right now. The government is subsidizing alcohol. so a lot of the policies that we have in place are actually incentivizing ill health. so we could do a lot just by getting rid of the policies on the books that are actively harming us.  That’s not the case across the board for everything. in some cases taxes and other things for harmful industries would be good. But I think that when we take into account the polluter pays principle, we would recognize is that taxes in fact in some ways are just offsets to implicit subsidies. And they’re not really nannyate subsidies.

Grant Ennis: they’re more so offsets to an existing nanny state that is actively harming the public interest. Here’s another health issue that’s actively subsidized. This is Australian example.  So Australian according to a calculation I did with a colleague of mine or a friend of mine some years back we found that Australia subsidizes process ultrarocessed food manufacturers 5 billion per year. we looked at what they should have paid in taxes and then what they did paid in taxes after all of the deductions that they were given.

Grant Ennis: quite shocking to see these numbers and you could do similar kinds of calculations around in other countries if you have the data available of course if you look at fossil fuel subsidies for example the globally government subsidized fossil fuels 7 trillion per year.  So, a lot of these health issues could be addressed by removing these subsidies. And if you look, you see here is a diagram showing diabetes incidents over time and the price of sugar dramatically collapsing over time. When you subsidize goods like sugar or ultrarocessed foods or alcohol or fossil fuels or driving, you make them cheaper. You make all of these harmful products cheaper.

00:30:00

Grant Ennis: people use more of them and then you have more disease incidents or health harms. So again, we live on a nanny state planet and the nanny is killing us. I think it’s a very helpful way of framing a lot of these problems rather than thinking of them as something that we need additive solutions to. Then I wanted to quickly touch on what we know works for solving health problems.  We know that taxes on things that are harmful make people use less of them. Removing subsidies makes people use less of them. changing the proximity of things to us makes people use less of them. If we make things further away, for example, alcohol-free zones would be an example for alcohol or sometimes called dry zones. or we by modifying the temporality of our policies.

Grant Ennis: So making it illegal for people under 21 to drink alcohol or making it illegal to sell or buy alcohol on Sundays after five you name it. These policies really work. An industry works very hard to shift debates so that we don’t talk about these policies and they stay off the agenda. The way that they do that is by framing debates. they work to make sure that we just keep a focus and a dis discourse on other things because if we’re focused on other things, we’re not focused on what matters. Politics is zero sum. by having attention on one thing, you have less attention on other things.

Grant Ennis: And that’s something very difficult for a lot of people to keep in mind that political will is not something that allows us to do both to do things that are ineffective and to do things that are effective or to use narratives that are ineffective combined with those that are effective. And I’m going to talk a lot about that today. But the core of all of this is this kind of political will pie chart here.  this zero someum pie chart of political will. framing by industry helps to make sure that we have less attention on what really matters. you’re all kind of familiar with PR and framing, I’m sure. this is a pretty good example of it.

Grant Ennis: If you look and try and figure out the number of the parking spot, just take a second to look at this diagram and guess the number where the car is. What’s underneath the car? I’ll give you a couple seconds to play with this in your head. What if I frame the question a little differently, though? I think for everybody now looking at this, it’s a lot more  Small changes to the way we visualize diagrams, to the way we use words and present information lead to dramatically different levels of understanding and political support. here’s two different framing techniques for advertising a piece of property. Is it a small room? Is a cozy room?

Grant Ennis: more common ones are pro-life in discussions about abortion, minimum wage laws versus what industry likes to call the right to work laws, which is getting rid of minimum wages, health policy versus nanny state, etc. These are small differences in framing that make a really big difference. and then the way we get people to believe a given frame or not believe a different given frame is how many times they’ve heard it. it doesn’t really matter how accurate the frame the information is so much as the level of exposure. If we inundate a population with information, true or false, they’ll be more likely to believe it, which is quite terrifying.

Grant Ennis: and I should take a moment at least to explain the way this is now happening in the information age. bot farms are one of the most common ways that advertisers and malicious actors can spread and amplify framing. So, here’s an example of what a bot farm looks like.  So that’s a series of cell phones. I’ve got echo. Can somebody mute their Thank you very much.

00:35:00

Grant Ennis: Those bot farms are a series of cell phones that are all connected to central computers where the computers will manage thousands and thousands of Twitter or Blue Sky or Facebook accounts to retweet or amplify given narratives. I’m about to show you an interview with a former Bot Farm operator explaining…

Grant Ennis: how this works.

Grant Ennis’s Presentation: I’m a former tech employee,…

Grant Ennis’s Presentation: created and sustained a bot farm between 2015 and 2018. Give you guys some information because American bot farm operators are pretty rare. Most bot farms operate overseas. I don’t know if there’s anyone like me in the US that can tell you this stuff is all I’m saying. Typically way more secretive about this, but it’s gotten so bad I need to talk about it. So, what is a bot farm?  something that a company or an individual purchases. You get a set amount of bots that normal people go out and spread your message. Here’s the work that goes into that. as the operator have to create each individual fake person. I have to create a picture, a username, a real name. Then I have erate Has to be supportive of the message that the client is paying for. Positive opinion of the company or the individual. If anyone has ever tried to create content, that takes time and it also takes ideas. It’s not easy.

Grant Ennis’s Presentation: Finally, you need to program those bots based on activity. Bots respond to what you do. You think that you going around and liking things is invisible. It’s not. You’re leaving a footprint across the app. That footprint is tracked by people like me. So, based on what other people like or comment on, I program my bot to go and search for those people, find them, and then interact with them with my content that supports the message that I’ve created.  This programming also includes research to find the people that are the most susceptible to believing the message that you’re selling and targeting those people. This is just a scratch on the surface of what it takes to program one of these and people are buying hundreds of them. Now, here’s the interesting part. The software to run all those bots is not free and the time that it takes to create all the things that I just told you about also not free. All of this stuff costs money and it represents money when you see it.

Grant Ennis’s Presentation: If you’re seeing non-stop videos posted with a certain agenda,…

Grant Ennis’s Presentation: someone’s paying for that. So when you see a dump a ton of media that’s telling you all the same message, do not say, “Wow, what a thing happening right now.” Please instead say, “Wow, who’s trying to buy my opinion on this topic?

Grant Ennis: and that’s very important who’s paying discussion.

Grant Ennis: Many people think disinformation is an issue of what I call the viral theoretical model of disinformation where it’s like people spreading it. Sometimes I’ll call the idiot uncle model where it’s like our uncle that lives in a very rural area. It’s on the computer way too much and they just keep sharing, toxic misinformation. That’s really not what’s happening.

Grant Ennis: It’s really not what’s happening. You’re having millions and billions of euros and pounds and dollars spent to amplify disinformation. This downstream understanding of disinformation where we can just educate our way out of it by teaching people to be more resilient of disinformation won’t work because fundamentally what matters is the quantity of exposure. it’s not how smart the individual is that really matters.  it’s how much exposure they have to the message. and we need to be going upstream and ending this amplification of disinformation. And just quickly, this is really not an issue about convincing everybody. When I’m talking about these narratives today, we’re not talking about convincing the whole world of these sometimes rather ridiculous ideas.

Grant Ennis: you really only need to convince a small margin of a given population in order to sway a very large election be it a referendum or what you name it or to sway political support for a policy.  So if there’s an alcohol tax or minimum unit pricing or something, if you see on the screen in front of you, you’ve got all these elections and you can see very small margins and all of them were these elections have a lot of documented disinformation around them. So you got to wonder were they thrown by disinformation campaigns? It’s quite possible.

Grant Ennis: So I’m now going to talk about the framework the cross industry playbook as I’ve documented In my book I cover in dark PR I cover the automobile road crashes and the road industry the toxic food environment, diabetes, obese overweight and obesity and the sugar industry. and then the global warming and the fossil fuel industry and I demonstrate that they use the same playbook of nine devious frames and this playbook can be applied to any industry and issue. So I’m going to go over some of the issues I covered in my book and I’m also going to talk a little bit about the way the alcohol industry uses these narratives as well.

00:40:00

Grant Ennis: I’d love to know if you think that my adaptation of this to the alcohol industry and alcohol harm is accurate or if you think I should use a different example. So, if you have any thoughts on the way I present this information, I’d be glad to know it because I think many of you are alcohol experts are far more wellversed in this than me. So, the first is deniialism.  I think this is a very important frame of course but we spend way too much time on it. we know that industry denies that their pro products are harful. Of course tobacco industry famously did this but other industries do the same. Alcohol industry downplays cancer risk. When we talk about industry disinformation it tends to stop the year and that’s really too bad. this is really just scratching the surface of disinformation. We need to go much deeper.

Grant Ennis: Next is what I call post deniialism. Post-di on the Overton window on…

Grant Ennis: what we think is acceptable and what we think is true around us. so I’ll show an example from the fossil fuel industry in Australia which is quite striking.

Grant Ennis’s Presentation: This can provide endless possibilities.

Grant Ennis’s Presentation: It can create light and jobs, delivering $6 billion in wages for Australians. It produces steel and powers our homes as well as our economy,…

Grant Ennis’s Presentation: injecting $40 billion each year. And it can now reduce its emissions by up to 40%. It’s coal. Isn’t it amazing what this little black rock can do? Authorized G. Evans, CRA.

Grant Ennis: That’s the Australian Coal Association or…

Grant Ennis: something to that effect that sponsored that. this is the plastic

Grant Ennis’s Presentation: 

Grant Ennis’s Presentation: This can Presenting the possibilities of Plastics help save you from dents and broken bones. They help save Thin light plastics, fewer trucks, less gas. They help save you from being scrambled. They help food stay fresher. Brussels sprouts. Plastics can even help save toddlers from trouble.

Grant Ennis’s Presentation: And this vest helped save my dad’s life. Plastics make it possible.

Grant Ennis: So famously industry said Guinness is good for you.

Grant Ennis: Cigarettes will help you live longer and that sugar will help you lose weight. alcohol industry famously said that small amounts of red wine can make you live longer. they tobacco industry famously did this campaign under Edward Bernese called torches of freedom where they marketed cigarettes as something that were liberating for women. They paid for all these actresses to do fake protests and smoke cigarettes.

Grant Ennis: And they did, I don’t know if you all remember, but I remember this very strikingly that some years back the alcohol industry started trying to convince the feminist community that it was a liberatory act to drink alcohol while pregnant because there was no evidence to actually definitively say alcohol was harmful to the fetus. which is dramatically shameful that they were doing that. But they’re basically saying alcohol is part of women’s liberation. This is please correct me if anybody thinks I’ve got that a little bit wrong. This is me operating from memory. You all are the experts on this subject.

Grant Ennis: But across the board, we have a lot of documented cases of alcohol being framed as something beneficial either to society, to social justice or to health itself, which we now know pretty clearly is nonsense. the industry also likes to normalize debates. This framing of normalization is common across all issues with harmful industries.  So industry funds the fat acceptance movement for example. the automobile lobby has long called car crashes accidents to normalize them. We know that the fossil fuel industry has promoted the term climate change over global warming in order to normalize global warming and make it seem less scary.

00:45:00

Grant Ennis: and that all of these terms when they get message tested lead to less political support for meaningful policy interventions. this normalization framing really works to reduce political will. In the case of alcohol, you see this kind of normalization all the time.  There’s this quote here on the bottom by the distinguished Shayla who’s here on the call with us. noting how alcohol industry likes to normalize drinking pairing it with sports. you see this in research from Mark who’s also on the line with us today. and across the board industry tries to frame drinking and especially moderate drinking as normal as part of everyday life.

Grant Ennis: natural, historical, something humans have always done. because why would you regulate something that’s natural and normal? the remaining six frames are all in one way or another pseudo solution frames or false solutions. And so this is where we get into you can’t be doing both in terms of framing and political will.  The more people believe even slightly in false solutions, the less they support the really powerful stuff. You can’ We can’t be doing both. And I’ll explain that more in depth as we go along. I call the civil rumoring frame. This is an industry framing where they promote something that boomerangs back in some kind of harmful way.

Grant Ennis: so the more you make devices energy efficient for example the more people use them. So industry loves to promote energy efficiency in the case of global warming industry loves to promote exercise for weight loss. very famously and the more we get exposed to this kind of stuff like exercise in order to lose weight the less we focus on the food environment.  we get stuck on looking at the thing that doesn’t work rather than what does. and we know that the more exercise you do, the hungrier you get. so we don’t really see any gains from weight loss. We see other kinds of health gains. Exercise is great. It’s just not going to solve the overweight pandemic that we’re dealing with globally.

Grant Ennis: In the case of alcohol, I identified two things that I thought might be silver boomerangs. You all researchers in the audience that are specialists on this might have a wiser opinion than me. But one thing you see is this narrative that we should teach our kids to drink when they’re very young. I believe the evidence now shows that if you do that, you see more binge drinking later in life. So there’s this rebound when you teach kids to drink when they’re very young that they then end up drinking too much. Possibly also is this argument that you should hydrate while you’re drinking. But I also suspect that probably leads to people drinking more.

Grant Ennis: I’ll leave this one to the wisdom of the crowds if anybody wants to leave some good ideas in the comments. but this silver boomerang framing for alcohol, for diabetes, for road safety, for global warming, it’s pervasive. We see it all the time. The next frame in the stevia frame playbook is the magic frame. So, autonomous cars will save us from the road death. pandemic globally or carbon capture storage is going to solve us from global warming or that diabetes can sol be solved with genetic cures and genetics I really see as the magic frame for alcohol. This idea that alcohol abuse is an issue of genetics.

Grant Ennis: but we know in the case of diabetes for example that it’s not genetic. I talk about this at length in my book. This is a little bit touchy u in some sectors. U but you don’t have these kinds of skyrocketing rates of change being associated with genetic change. Humans are not fundamentally genetically different than they were 100 years ago. And yet our diabetes incidence rates are skyrocketing. but the same attribution that genetics is the cause of smoking, genetics is the cause of diabetes is used over and over again by industry So here you can see Drink IQ is a website funed by Dagio perhaps Mark you would know better than I. I think it just might be a DAI website. I’m not entirely sure.

00:50:00

Grant Ennis: but you see the industry promoting this idea that genetics and somehow we need a genetic cure for alcoholism and that’ll solve our issues with alcohol harm. This framing is very powerful treatment frame.  This is the idea that rather than end the subsidies for alcohol or regulate alcohol, we could just treat the harms of alcohol. we can just give people more medicine or invest money in health care you name it. Industry loves to shift health problems from prevention to the treatment of them.

Grant Ennis: because the more you believe in the treatment being the solution, the less you support the policy change for prevention. and that’s pretty well documented. In the case of alcohol, you can see I mean this is just one of many examples of industry promoting healthcare infrastructure or funding hospitals or a lot of the time they fund health races like running races and…

Grant Ennis: stuff. I think you all have probably seen the alcohol industry doing this kind of thing. Oops. this is this CEO of Exxon Mobile talking about how global warming can be solved by treating it, by adapting to global warming rather than preventing it.

Grant Ennis’s Presentation: Not disputing that increasing CO2 emissions in the atmosphere is going to have an impact.

Grant Ennis’s Presentation: It’ll have a warming impact. how is what is very hard for anyone to predict and depending on how large it is then projects how dire the consequences are.  as we have looked at the most recent studies coming out in the IPCC reports which I’ve seen the drafts and I can’t say too much because they’re not out yet but when you predict things like sea level rise you get numbers all over the map. If you take what I would call a reasonable scientific approach to that we believe those consequences are manageable.

Grant Ennis’s Presentation: They do require us to begin to exert or spend more policy effort on adaptation. What do you want to do if we think the future has sea level rising 4 in 6 in? Where are the impacted areas and what do you want to do to adapt to that? And as human beings, as a species, that’s why we’re all still here.  We have spent our entire existence So, we will adapt to this changes to weather patterns that move crop production areas around. We’ll adapt to that. It’s an engineering problem and it has engineering solutions. And so, I don’t the fear factor that people want to throw out there to say we just have to stop this. I do not accept.

Grant Ennis’s Presentation: I do believe we have to be efficient and we have to manage it but we also need to look at the other side of the engineering solution…

Grant Ennis’s Presentation: which is how are we going to adapt to it and there are solutions it’s not a problem that we can’t solve

Grant Ennis: So, here’s some of the research on the way adaptation or…

Grant Ennis: treatment framing is found to either crowd out budget for prevention or to keep political will low for prevention. we know very well that the next frame is probably the toughest one and I think the Mark Twain quote that is not a Mark Twain quote is probably most apt for this section. We’ve been captured globally like the dogooder the public health community.

Grant Ennis: We are so surrounded by industry narratives, we don’t even realize where we’ve been adopting industry arguments, individualization, individualism, sometimes called informationism, victim blaming, idealism, agency, choice, responsibilization. This frame I call in my book victim blaming. but it’s much more than that.  It’s in the focus of responsibility on the individual and a lot of us don’t realize it but we continue to endorse public policy and public health interventions which are keeping the focus of responsibility on the individual but we don’t realize it and is why this is one section’s a little tough for a lot of people to get.

00:55:00

Grant Ennis: if anybody would like to get a copy of my book, I can email them a PDF for all the sources. Or if you’d like to discuss things about this with me, email me at grant.nisman.edu and I can provide more information. Bill also has my email if you just want to ask him for it. reminder, these things These things change human behavior. it’s a framework I came up with in my book.  But price, proximity, and temporality are the things that change the way humans behave at a population level and nothing else. And that’s a really strong argument to make. I’d be glad to be challenged on it, but I’m pretty convinced that this theoretical framework on how human behavior works is solid.

Grant Ennis: this is changing the material environment rather than the information environment which does not change human behavior such as education, persuasion campaigns, pledge drives, perform performative congruency acts, non-disclosure forms, labels, plane packaging, advertising bands. Some of these things can be very good when they don’t individualize things when they’re talking about issues at a population level.  So, education exposing people to the way politics works. Persuasion campaigns encouraging people to view public health issues from a public population lens. labels which explain public health issues from a public health perspective. Plain packaging and advertising bans are both very good in taking away industries’s ability to manipulate us.

Grant Ennis: But none of these things actually changes human behavior. And that’s important because when you look at the claims that many of our colleagues and friends and industry make about these interventions, when we make claims that these interventions change behavior, normally we’re not doing it from a position of strong evidence.  What we’re doing is we’re conflating knowledge, attitudes, behavioral intention, self-re purported behavior with observed behavior or worse with documented impact. And you can easily change knowledge, you can easily change attitudes, you can change behavioral intentions, you can even change self behav reported behavior.

Grant Ennis: even pie hack, you can cherrypick, you can leverage positive results bias, you can use varial complation, you conflate clinical significance with statistical significance and you can say you’ve got observed behavior or documented behavior to small amounts.  But when I think most people are aware you don’t actually see real changes in documented impact of any clinical significance from informationist interventions. And I think we need to be a lot more honest about that because the underlying narrative from industry is that we don’t need to change public policy. We don’t need to change public health policy in order to solve these health crisises.

Grant Ennis: All we need to do is shift the focus onto the individual and help them to make better choices. and this framing is constantly being financed and supported by industry efforts. in terms of alcohol control, in terms of all public health issues, anything that industry makes money off of, they boost this narrative. and I think as a public health community, we need to do a better job of recognizing this is a very devious f acknowledging that it doesn’t work to change behavior.

Grant Ennis: And I think we need to more deeply understand when we message test labels, we message test campaigns for behavior change,…

Grant Ennis’s Presentation: I’m not

Grant Ennis: what we are actually doing is message Testing against public policy because when you are promoting one frame, you are reducing support for another. So when you message test for individual responsibility, getting people to intend to change their behavior, you’re getting people to believe that it’s not public policy that needs to change, it’s individuals. And we need to do a much better job of recognizing that. and this is a framing technique that’s consistently used, as I said, already by all industries, and we know it undermines political action.

Grant Ennis: That’s why industry uses it. And the evidence for why this framing is so difficult and harmful is so consistent and old over the years. More and more studies showing that it’s harmful. And yet many of our colleagues continue to embrace it. And that’s understandable because we are so surrounded by industry influence that we don’t even realize it. here’s an example from feminism. The more women are told they need to lean in in order to seek to achieve women’s liberation, the less women will support public policy that would lead to them getting equal pay.

01:00:00

Grant Ennis: the more we place the less women place responsibility for women’s rights on the political system. very very scary.  So when we blame the victims of the food environment for the political system, when we individualize it, people are less supportive of policy change. when we say just lose weight, eat less today. when we say the solution to the overweight pandemic is better food labels, we are keeping the responsibility for the pandemic on the label reader.

Grant Ennis: the same for the carbon footprint, which I’m going to show some more content on in a moment. the same for the harmful drinker, the alcohol abuser. When we keep the focus of responsibility for alcohol harm on the individual by focusing on narratives in our debates like we need better labels, to help people be warned and make better choices.  We are undermining our efforts for policy change for things like minimum unit pricing, for alcohol tax, for dry zones, all of these other things. and we need those things. We need those policies in place and those are the policies that we should be focusing on. But industry loves it when we focus on what should be on the label instead.

Grant Ennis: Here’s some studies that show that food labels don’t lead to behavior change. We just don’t want labels message tested for individual responsibility, which by and large is what’s happening right now. Carbon labels also don’t work. I spent 20 minutes finding these studies, so I’m sure there’s even more out there, but it was pretty consistent when I was looking at the research on actual outcomes from labels on alcohol, but they didn’t end up changing behavior. You change knowledge, you change behavioral intentions, you change other stuff, but you don’t end up with any kind of actual outcomes from labels.

Grant Ennis: So, I’m not sure I don’t think we should continue to keep labels as something that we claim behavioral change for. We need to see labels as something that can lead to better support for more powerful policy action later, but we need to do two things differently. We need to stop saying that labels change behavior. and we need to stop making them the focus of all of our efforts at least as an outsider from the alcohol control community. my take is that they are pretty much the focus of our efforts to influence policy at this moment. So, here’s just a bunch of studies that I found very quickly that and…

Grant Ennis: that labels don’t change behavior. I’ll wrap up in two or…

Phil Cain: Hi. Hi.

Phil Cain: Maybe we can give it a couple more minutes and then we can move to questions because particularly this labeling thing I’m sure people want to ch on. Thank you.

Grant Ennis: three minutes. Thanks similarly with again Mark this is you and your colleagues doing great work alcohol. Am I still online? I heard a beep. Am I still here?

Grant Ennis: 

Andy Mohan: Yes.

Andy Mohan: So, you’re still online. That was just someone joining in. Okay.

Grant Ennis: Okay. …

Grant Ennis: so, pledges, I promise that I will drink less. These things don’t work. similar advertising bans are great because they deprive industry of an ability to manipulate us, but they don’t lead to behavior change. and the claims that they do are really quite harmful.  I’m going to skip some of the videos and carbon footprint stuff. this one is mass media campaigns. don’t change behavior. know all of these kinds of interventions could be good if they were focused on societal and public policy issues and stuff, but when you message test them for behavior change, they end up undermining our efforts.

01:05:00

Grant Ennis: this quote, usually if I had more time, I’d ask somebody in the audience to read it out. I love this tweet. I still think my favorite thing that’s ever happened to me on the internet is the time a guy said, “People change their minds when you show them facts such as labels.” And I said, “Actually, shutty though that studies show that’s not true and link two sources.” And he said, “Yeah, I still think it works.” I get that reaction quite a lot when I present this information. but if you dig and you look at the studies on informationist interventions, we consistently find zero population level material change in the public health issue we’re trying to solve. And then when you test levels of political spo support after exposure to these messages, we end up with much less support for meaningful policy change as a result of this kind of messaging. And we know very well we can’t be doing both. You can’t be doing individual framing and population framing.

Grant Ennis: you undermine yours political support for population framing. Frameworks institute sometimes also calls this splitting the frame. I cause call it multiffactorialism that I’m going to talk about really quickly as I wrap up in a moment. last two frames knotted web framing sometimes called complexity. So you have industry saying that alcohol problems are complex.  Mark Mark Patty Crew who’s on the line has done some really great writing on this as well as some of his Natalie Savona if I’m remembering the name right great great work this is Drinkawa again this is Dio and all the other alcohol industry actors saying alcohol harm is complex so circular so knotted so weblike that it’s impossible to take action on.

Grant Ennis: we know that framing undermines strong political action. Road safety Climate change is complex according to Chevron. here’s Exxon Climate change is final frame before I wrap up because we’re running low on time  Multiffactorialism is this idea for diabetes, genetics, lifestyle and exercise are the necessary combination of solutions to solve the problem. in alcohol maybe it’s alcohol harm is the result of a complex multiffactorial interaction between genes, lifestyle, and policy or something. It’s this idea that it’s not one thing. the source of the problem is really multiffactorial.

Grant Ennis: goes back to the tobacco industry from the 70s. This is the Roper proposal or sometimes called the Panzer memo. we know that industry uses multiffactorialism under a lot of different names in order to polit undermine political will for action. Here’s Coca-Cola saying obesity is multiffactorial. industry always does this. and we know that multiffactorialism, it’s treated as if it’s axiom in a lot of public health communities, but multiffactorialism there’s nothing special about it. it’s treated as if it was a virtue. but’s not. it distracts us and it undermines our ability to take meaningful action on the material le levers of health. I’m gonna wrap up here.

Grant Ennis: I know we’ve got a lot of discussion to Go to the last slide. Over to you, Phil.

Phil Cain: H I’ll press the right button this time. yeah, we’ve got about 10 minutes left in this half of the session, but I’m sure some of these themes will cross over into the second session with Ellis who I gather has just joined us. So, yeah, I think what I should probably do is ask somebody, maybe Peter, if you’re, available, to jump on and sort of bat for bat for labeling,…

Phil Cain: and some of the benefits I think you mentioned in the chat. If you just jump on the

Peter Rice: Yeah. Yeah.

Peter Rice: I mean, thanks, Yeah. I don’t disagree with anything that Grant said about labeling and I agree with the other points that people have made that and Grant made that labeling, can be a way to build commitment for other things.  But my point was that I think it certainly is labeling issue can be a useful way to kind of open the box on why do we not have labeling why do we have nutritional information on yogurt in Europe and we don’t have it on beer we have nutritional information on free beer but not on alcoholic beer and that’s simply due to lobbying and stuff.

01:10:00

Peter Rice: So I think it can be a useful way to open that box. But if I could actually take the opportunity to ask R a very specific thing about the silver bullet framing and the reason I ask that is you went through minimum price in Scotland and a very kind of common thing from people who didn’t like the idea was to say this is not a silver bullet. Right now, the advocates never said it was a silver bullet, but when you’re in debate, how do you actually handle that? So, I’m never quite sure what a straw man argument is, if that’s a straw man argument, but I don’t know, if I’m clear what I’m getting at, how do you kind of handle that going, this isn’t a simple issue to it ties up with your complexity point, so specifically if someone,…

Peter Rice: said to you, Grant, taxation isn’t a silver bullet.  How do you actually handle that in the here and now of the debate and discussion? Yeah.

Grant Ennis: Yeah.

Grant Ennis: I mean, they are man strawmaning you, aren’t they? they’re really trying to put you in a position that you weren’t making the case for. Especially because the minimum union pricing is the levels tebly high in taxation is not set so terribly high that you couldn’t buy a drink. I think in a conversation like that you’d have to pivot. I take it back a moment to subsidies and implicit incentives.

Grant Ennis: So if you calculated the cost of alcohol harm to society and then you looked at how much alcohol tax would recoup of that, you were still subsidizing alcohol. So it try and try and change the framing and get away from them. when you look at the way we’re supposed to deal with these kinds of more heated debates, you never want to repeat the framing of the opponent party. So, don’t even say, ” I’m saying it’s a silver bullet.” Don’t mention it. Just go with what you want. We’re subsidizing an alcoholic environment at the moment.

Peter Rice: Hang on. Yeah.

Grant Ennis: I mean, that’s probably not very good framing. Maybe skip the alcoholic bit, but you get the idea. stick with what you want. And then with labels, I think thank you for your comments, Peter, and totally agree as well.

Grant Ennis: I just want to repeat the important thing is to not message test for behavior change.

Phil Cain: Thanks very much, Grant. I think also Eric Carlin came in with a point, a former person. maybe you’d be able to just make your two penith

Eric Carlin: Yeah, formerly SHA with Peter as well. You’re hearing from Sha twice as well. Grant, that was a brilliant brilliant presentation. I guess I don’t end up agreeing with you and everything in all of your conclusions though. So I don’t think that necessarily people who are supporting labeling are arguing that labeling is more important than anything else. when we were looking at labeling at WHO Europe, very much we were approaching it in terms of finding out what does the evidence tell us about kind of what impact it can have rather than saying that we thought it would bring about behavior change and certainly I’ve put in the chat it does raise awareness. it rais giving people information is a consumer right?

Eric Carlin: You should actually know what’s in a product that you’re consuming that might do you Whether or not having that information diverts attention away from support for other policies, that’s where I lost you a bit in terms of your argument. I think that raising awareness of har the harms in a product for individuals, surely that would contribute to improving support for effective policies. the other thing I would say is where I get confused a bit with the discussion as well is that it’s a bit that with the silver bullet thing that Peter was talking about. I think that we’re clear that we have to have a range of policies working together and different policies will work better in different places at different times.

Eric Carlin: So when we were writing the framework for alcohol in Europe which I was the lead author on we basically had six priority areas. The first three very clearly related to the best buys you that you’re covering in your book. action on price availability and marketing but then we also had labeling health services support and that means actually supporting treatment. So actually it’s not an argument against treatment and for prevention and not treatment. but also community action and actually kind of recognizing the community is coming together over all of these areas

01:15:00

Eric Carlin: of raise public support and raise public awareness of what’s actually going to affect the structural change that shifts us away from all this individual responsibility stuff. So, I think what I’m saying overall is I agree with you with the whole gist most of what you said, but I don’t necessarily agree with all of your conclusions. it’s great to be challenged though.

Phil Cain: So, we’re coming right to the end. Maybe there’s time for one more point or one more question. If you can hit the raise hand button and maybe we can pick you up that way. anybody’s got something. Don’t know whether Sheila has mentioned a few points in the comments,…

Phil Cain: but Perfect.

Sheila Gilheany: No just to say firstly Grant an enormously entertaining useful presentation.

Sheila Gilheany: Thank you indeed. Just in relation to labeling to me it’s part and parcel of an overall package that’s needed.  We know that pricing is actually the thing that is probably most helpful in terms of reducing alcohol consumption. but there is evidence that we show that when people are exposed to warning labels, say about cancer, they’re more likely to support introduction of pricing measures as a thing that’s there.  And I think it probably is one of our problems is that as small NOS’s and as everybody working in this field, there are many different things we could be working on at any one time. And I know that for us that’s a massive challenge because we’re simultaneously We’re trying to get excess duties increased and also we’re trying to make sure that labeling, happens.

Sheila Gilheany: And clearly there’s an industry that benefits enormously by there being these multiple things going on at any one time. But I just put a thing in there because I did find it interesting. I was reading Heineken labeled as their number one business risk was regulation and the three regulations that they specifically drew attention to included labeling of their products. So they certainly are concerned about labeling as a thing.  And I like Peter’s comment very much because it allows you to say why don’t we have labels why is this industry being allowed to get away blue murder literally on the labeling things.

Sheila Gilheany: So I think there is something there and I suppose maybe the lesson that I have to try and absorb is where’s our best buy at any one particular time and sometimes that can be from a political point of view we might just have an opening on something and we should take that and I’m never 100% sure that I’m ever doing anything correct in this…

Sheila Gilheany: because politics isn’t physics unfortunately and it’s just a bit tricky to know what is sometimes the best and…

Phil Cain: Yep. Thank you.

Sheila Gilheany: the right thing to do. So I did find your talk really really interesting and I’ll have to look back at it again too for other stuff. Thank you.

Phil Cain: Thank you very much, Sheila. I know we’ve got one more time for one more quick point before we move on to the second session. it’s Alistister McGillchrist, I think, is masquerading as Jean Leech, but

Alastair Macgilchrist: Hi Phil. it was kind of linked to Sheila’s point really, Grant. I quite like your zero sum argument, but it does constrain you a bit. I mean, here in Scotland, SHAP has probably moved its focus in the past 5 to 10 years to include treatment policies.  And that’s partly I guess in response to pressure to do something for those already affected despite knowing that so much of what we do should be focused on what works the prevention. So do you think we’re doing the wrong thing paying attention to treatment? we have more stuff because we spend a lot of our time getting down rabbit holes about treatment.

Grant Ennis: I think it’s going to be something to watch. we can’t not do treatment. We have to do treatment. But it should really be the government doing it and then over time does our portfolio for treatment start as 10% and now is it 95 and then when does it become 100%. It’s a very scary slippery slope and it’s tough to watch how it changes our political prioritization.