Advocating in the Public Health Interest Dr Evelyn Gillan Chief Executive Alcohol Focus Scotland

Multiple Streams Approach [Kingdon 1984,1995] Three independent streams of problems, policies and politics. Greatest policy change occurs when the three streams come together. A policy window is opened, a problem is recognised, a solution is available and the political climate is right.

Problems Stream What is the frame of the problem? The way problems are defined, the values and assumptions of those describing the problem are crucial to policy solutions [Bacchi 1999] Are there competing frames?

Competing Frames in Alcohol Policy Alcohol is normal. Problems arise when individuals misuse it. Solution - change the behaviour of the minority through education. [industry frame] Problem is not with the individual but with the product. Solution - make the environment less pro- alcohol and reduce per capita consumption. [public health frame]

Reframing the Alcohol Problem Re-frame the problem away from problem drinkers and policies with the weakest evidence base towards a whole population approach. Acceptance of the public health frame is necessary before people will support alcohol control measures and increased regulation. Methods – publicise research and use scientific experts; media and political advocacy.

Policy Stream Three decades of evidence and WHO review of effective alcohol policy. Findings - alcohol problems are preventable; the higher the average alcohol consumption the greater the harm; alcohol is a leading risk factor for death and disability; evidence of what works is available. [Bruun et al 1975; Edwards et al 1994; Babor et al 2003]

Politics Stream Is the political climate conducive to change? New SNP administration (2007) in the Scottish Parliament and one high profile Minister who made tackling Scotlands booze culture a personal political priority. Government officials who promoted an evidence- based approach to alcohol policy.

Alcohol Etc. (Scotland) Bill (1) Introduce minimum unit pricing Ban on quantity discounts in off sales Restrictions on location of drinks promotions in off sales Provision regarding sale of alcohol to under 21s Introduce social responsibility levy on licence holders.

Alcohol Etc. (Scotland) Bill (2) 10. The objective of minimum pricing is to protect and improve public health by reducing alcohol consumption. 26. The objective of restrictions on drinks promotions is to protect and improve public health by reducing alcohol consumption. The objective of conditions on the location of drinks promotions is to help emphasise that alcohol is not an ordinary commodity and to contribute to efforts to change Scotlands alcohol culture. Policy Memorandum Alcohol Etc. (Scotland) Bill

Challenges Promoting understanding of the evidence base. Seeing alcohol harm as a product problem not a people problem. Exposing the role of commercial vested interests in the policy process. Challenging the ubiquity and centrality of alcohol in our society.

Exposing Vested Interests Industry influencing presence in public policy process. Industry-funded research which seeks to cast doubt on the evidence base. Partnerships which focus on ineffective policies. Role of Big Alcohol in sustaining consumption and consequent problems.

Opposition to Alcohol Bill Big Alcohol producers and retailers publish industry- funded research (SAB Miller, ASDA); engage public affairs consultancies and undertake intensive lobbying of politicians. Opponents say minimum pricing will cost industry jobs; penalise moderate drinkers; is illegal; will impact on poorer households and put money into the pockets of retailers.

Problems, Policies and Politics All three came together leading to publication of Alcohol Bill but Activity in the politics stream ultimately worked against successful implementation. With the Scottish Parliamentary elections occurring in May 2011, party politics took precedence over the public health interest.

Advocacy Gains Acceptance that alcohol misuse is no longer a marginal issue and requires population measures – problem was successfully re-framed. Cross party recognition of the link between alcohol consumption, price and harm and some alcohol control measures introduced – policy solution partially accepted.

Advocacy Losses Minimum unit pricing removed from the Bill. Failure to successfully challenge some of the oppositions arguments – that the money raised would go to supermarkets and not the public purse and minimum pricing represented a tax on the poor.

Relevance for Alcohol Marketing Ban Problem - it may be necessary to re-frame the problem in order to build support for a ban. Policy – anticipate the arguments that the opposition will advance and have responses prepared. Politics – consider the likely political responses and identify political ambassadors.

Alcohol Marketing Ban The greatest danger for most of us is not that our aim is too high and we miss it, but that our aim is too low and we reach it. Michaelangelo