story

The leaders of a UK organisation representing traditional pub and ale enthusiasts have decided to hold an investigation into the effects of minimum alcohol pricing.

The move comes in response to a motion passed at the Campaign for Real Ale (CAMRA) annual conference in Dundee last month calling for the organisation to back the “urgent introduction” of minimum pricing in England, after it was introduced in Scotland last year.

“The national executive are carrying out further investigation into the issue to determine the best way to deliver the decision taken by conference,” a CAMRA spokesperson said. “We are unlikely to have any different updates imminently.”

Alcohol has retailed for more than 50p ($0.66) per 10ml UK unit in Scotland since May last year. Supporters hope it will curtail the drinking of very heavy drinkers who gravitate towards cheap sources of alcohol. In England the price per unit starts at 16p.

The price of beer sold in pubs is unaffected by minimum pricing, typically being more than three times the 50p minimum price. Supporters within CAMRA argue minimum pricing may help counter the decline of British pubs by narrowing the price gap with supermarkets.

Others do not see it this way, saying on social media the pro-minimum price motion panders to “anti-alcohol” forces, threatening to cancel their CAMRA memberships. Some, however, wonder if an appreciation of untainted liberal economics is a necessary part of appreciating traditional beer.

Help may be at hand. An initial evaluation of the short-term economic impact of minimum pricing in Scotland is due later this year. And some insight into its effectiveness in achieving its goal of reducing harmful drinking is expected next year.

The conference also saw the arrival of a new CAMRA chairman, Nik Antona. ■

Why don’t we fix the amount of alcohol which can be legally sold and issue tradable permits to sell it, like we do with pollution?

Such “cap and trade” systems helped create commercial incentives for reducing emissions, including greenhouse gases.

Democratically accountable regulators could be in charge of setting the level of the cap, raising or lowering the annual amount in response to its health costs.

Having a market for alcohol sales permits would mean they went to the highest bidders, able to make the best of their allocation.

This would create a powerful commercial incentive for companies to sell alcohol at higher prices, rather than simply sell the most by discounting.

In doing so it would incentivise those adding value to alcohol through taste or in the hospitality they offer around it.

This would, arguably, be good news for niche alcohol players with unique product offerings rather than bulk producers.

The renewable energy market is now worth around $1trn, in partly thanks to cap and trade together with other regulation. 

Regulation by its nature prevents certain business practices, but it can also create commercial opportunities.

A form of market regulation which helped align environmental and business goals might do the same for health. ■

This week BBC Radio 4’s In Our Time told the story of the Temperance movement in Britain which is said to have really got going in 1832 in Preston. It provides fascinating insight into where we find ourselves now, where we have moved forward and where the debate has become frozen in time. You can listen yourself here.

What struck me was that we are not so much reliving this history, but that the knotty issues raised by retailing addictive psychoactives were never resolved. While we might scoff at our ancestors, we have not come much further. What we see now on the internet are, perhaps, are echoes of the arguments made in temperance halls and colourful lantern slides.

One notable quote from the programme came from Bishop of Peterborough in 1872. Looking it up verbatim in Hansard it was, “…it would be better that England should be free than that England should be compulsorily sober.” He went on, however, “I would distinctly prefer freedom to sobriety, because with freedom we might in the end attain sobriety.”

The bill he was opposing with this speech to the House of Lords was one to allow local parishes to stop the issue of alcohol licences. This might well have been a blunt and ineffective instrument. I don’t know. But what is clear is that the bishop’s argument brushed aside positive freedoms we typically value on a par with the freedom to do business.

This is a fateful oversimplification of the conception of freedom, which has the dire consequence of polarising the discussion from there on. I outline this more fully in the opening chapter of Alcohol for Nerds, drawing on the work of intellectual historian Professor Quentin Skinner who created a detailed genealogy of freedoms, plural.

But, in essence, 150-years on it is still not accurate to portray those who seek to regulate alcohol sales more as being “against freedom” and those in favour of fewer regulations as being “for freedom”. It ignores the fact that restrictions help curb the freedom-reducing effects of things like inebriation, violence, dependence, illness and disability.

As the BBC programme makes clear the Temperance movement was largely led by and for the benefit of working people looking to improve their lives, by avoiding the many perils of Victorian life. It was also part of a wider struggle to find a political voice. This is a struggle for freedom, not against it, although it can impinge on some commercial freedoms.

The UK has not found a satisfactory democratic solution to this day. Elected representatives have long abdicated responsibility for regulating alcohol marketing and advertising, handing it to the alcohol industry itself, despite the direct conflict of interest. The results are predictably poor, with government ministers unable to introduce something simple as guideline labelling.

We have changed enormously since the days of the Temperance movement, as has the knowledge-base from which we work. But the balancing of different conceptions of freedom goes on. This is society struggling to decide what freedom is and how to deliver it. Long may it continue. ■

With a welcome spotlight being shone on rising inequality this week it is worth noting that alcohol makes it harder for poorer people to succeed in a game already heavily weighted against them.

This fact is not as widely acknowledged as it should be. A large charity told me to call elsewhere because it focuses on poverty not alcohol. Of course, specialism is necessary, but not when it means neglecting clear links. Luckily it seems they will not be ignored much longer.

On the radar
“One cause for concern is a rise in ‘deaths of despair’” said the IFS Deaton Review, launched in the UK this week, referring to deaths from suicide, drug and alcohol overdose and alcohol-related liver disease. They have overtaken deaths from heart disease in recent years (see chart).

Of course death is the most stark outcome. With luck, the review’s army of sociologists, demographers and epidemiologists will also shed light on a myriad more nuanced inequalities to which alcohol contributes. As the Alcohol Change UK campaign pointed out alcohol harms poorer people more in many other ways.

Poorer people tend to live with fewer healthcare facilities, more crime, more stress and higher levels of alcohol availability, so slipping more easily into heavy drinking. The middle classes have their difficulties, but generally nothing to compare with the perils faced by people struggling to get by.

A dicey game
The board game snakes and ladders, or chutes and ladders in the US, can help picture how circumstances alter our chances of success or mishap. Each player moves along the board and when landing on a ladder takes a big step up and when they land on a snake they slip a long way down.

But, crucially, we do not all play on the same board. Poorer people start further away from the giddy heights of their terrain. And, to reflect their less fortunate circumstances, they face more penalties and fewer bonuses, so fewer and shorter ladders, and more, longer snakes. Consequently a smaller percentage of poorer people make as much progress.

To make it more realistic we should test a skill to decide whether we necessarily slide down a snake or climb a ladder. Maybe we have to answer an exam question or, something silly like catch a ball in a cup, anything really to mimic a real life test. Adding this extra obstacle simply multiplies the extra difficulties faced by poorer people.

Now, finally, we can add another level of realism to the model, alcohol. Consuming alcohol impairs our skills, judgement and planning, so meaning we fall down even more snakes and can take advantage fewer lucky breaks. Adding alcohol to the equation tips the balance of an unfair game even further against poorer people.

At the same time advertising relentless associates alcohol with success and winning, deliberately obscuring the fact that it is far more likely to increase our chances of losing.

Clear, not less subtle
The “alcohol paradox”, the name often given to the way alcohol disproportionately harms poorer people is unhelpful, adding intrigue to something which is not mysterious. It is not paradoxical that poorer people are harmed more It is simply a testament to the combined effect of more challenging circumstances and substance blunting our abilities.

It is, of course, vital for the review unveiled this week to go beyond this simplistic model and to shed light on the details. But, as a starting point, the reason alcohol tends to compound inequality can be an unfortunate effect everyone can readily understand and find ways to avoid. With luck, more policies will emerge to make it easier. ■

The effort to control the covid-19 outbreak shows the public welcomes government action to protect life. Politicians might take note when formulating policies on alcohol, responsible for one in twenty deaths.

Billions of us have overnight willingly complied with often stringent laws curtailing our business and social lives, thanks to our clear understanding that doing so is saving millions of lives.

It seems reasonable to suggest that we would also gladly accept modest extra tax, advertising restrictions, and labelling and availability measures to cut millions of deaths, injury and suffering from alcohol consumption.

Far harsher restrictions are in place. Alcohol sales have been banned under lockdown laws in South Africa, Botswana, and parts of Thailand, Greenland and among a native group in Canada. The impact is uncertain.

Alcohol dependents will likely suffer the physical and mental health effects of withdrawal.Some have reportedly died as a result of “toddy” becoming hard to come by in India, largely by their own hand.

Providing support will be more challenging in coming months. Can Zoom support ever really replace a face-to-face meeting? Or might online even attract new people and offer more privacy?

Or will online help miss those who need it most? One former alcohol dependent said in a philcain.com discussion that being in covid-19 isolation with a stash of alcohol would have been her “happy place”.

Like it or not, we will find out some answers in the very near future. But our exceptional circumstances will also create exceptional statistics, full of “confounders”, making them incomparable with those before.

Road accidents in places where alcohol is suddenly off-limits, for example, are likely to drop sharply. But, then again, there is going to be hardly anyone on the road. So what will the numbers mean?

The first phase of the covid-19 outbreak has shown the public welcomes decisive government action to protect health and we will gladly accommodate them. 

As a species we are adaptable survivors. And we have now shown we welcome advice that helps us survive. We might also use this time to reflect and rethink our priorities and habits.

There is room for a glimmer of optimism we might make the best of this unusually bleak situation. ■