Not Invented Here #2 - Alcohol

Not Invented Here Syndrome is a term used about institutions which reject practical solutions because they originated from outside the in-group.

This is the second in a series of articles about how pressure groups often oppose a practical solution to a problem if they did not devise it themselves. “Not Invented Here” syndrome is a well known issue that frequently arises from groups that are broadly anti-industry, or in some cases, are simply anti-capitalist.

Doctors have been advising people to have several days without alcohol each week for decades. It is sound advice because, as the British Liver Trust says, ‘it is simple and easy to understand, reduces the overall number of units that you drink each week, helps prevent alcohol dependency and importantly for liver health gives your liver a rest and a chance to rejuvenate.’ In 2011, Ian Gilmore, the chairman of the Alcohol Health Alliance, advised drinkers to have ‘two to three alcohol-free days a week’. In 2012, the House of Commons Science and Technology Committee said that ‘people should be advised to take at least two drink-free days a week’. In 2016, the Chief Medical Officer said that ‘a good way’ for people to reduce their alcohol consumption was to have ‘several drink-free days each week’. None of this was remotely controversial until the alcohol education charity DrinkAware partnered with Public Health England (PHE) in 2018 to launch the ‘Drink Free Days’ campaign. Aimed at drinkers aged between 40 and 64, it advertised on radio and digital platforms and provided an app to help people monitor their alcohol consumption.

You might think that public health groups would be delighted to see a well known charity put its time and money into encouraging drinkers to consume less alcohol. But you would be wrong. DrinkAware is funded by donations from alcohol producers and retailers, and this was enough to make the aforementioned Ian Gilmore resign as co-chair of PHE’s alcohol leadership board and write an article titled ‘Public Health England’s capture by the alcohol industry’. An open letter opposing any collaboration between PHE and Drinkaware was signed by 332 academics, some of whom threatened to stop working with PHE if it did not part ways with the charity.

To outsiders, the furore was baffling. As The Times pointed out in an editorial, ‘Drinkaware is not a front for the alcohol industry’ and the ‘campaigning message is both sensible and realistic’. It urged the head of PHE to ‘not allow academics’ purist objections to the drinks industry to override his responsibility to work with it to develop a pragmatic approach to public education’.

For the ‘purists’, the problem wasn’t so much that they hadn’t invented the idea of Drink Free Days - they had - but that it was being promoted by the wrong people. Their institutional preference was to have the drinks industry excluded from the policy-making process and they feared that collaboration between the government and any organisation linked to the industry would give the industry ‘legitimacy’.

A similar kerfuffle had taken place in 2012 when alcohol manufacturers promised to ‘remove’ a billion units of alcohol from the market by 2015 by giving consumers ‘a wider choice of lower strength products’. This was one of the central pledges of the government’s Alcohol Strategy and was part of a voluntary arrangement between industry and government known as the Responsibility Deal. Since there were 52 billion units of alcohol consumed in the UK at the time, this amounted to a pledge to cut the nation’s alcohol consumption by around two per cent. The logic was similar to that of the subsequent sugar tax and of food reformulation; that small changes to individuals can add up to make a significant difference to the population.

The pledge was met ahead of time. The Department of Health’s evaluation found that the number of units sold fell by 1.9 billion between 2011 and 2013, and attributed 1.3 billion of this to the industry launching new, lower-alcohol products and reducing the alcohol content of some of its existing products.

You might think that anti-alcohol groups would be in favour of less alcohol being consumed. But you would be wrong again. In 2009, two prominent public health academics had published a study with the self-explanatory title ‘Low alcohol alternatives: a promising strategy for reducing alcohol related harm’. When asked about the billion unit challenge in 2012, Ian Gilmore grudgingly admitted that it would produce ‘some benefit’ if the target were achieved, but by the time the evaluation was published in 2014 nearly every public health group had walked out of the Responsibility Deal in protest at the government’s refusal to proceed with their institutional preference of minimum pricing.

Instinctively opposed to anything that didn’t involve state coercion, public health campaigners refused to celebrate the billion unit target being achieved. Some of them refused to accept that it had been achieved at all. Three academics who had made their name doing theoretical modelling for minimum pricing complained that the data used in the evaluation were not good enough to draw any firm conclusions and that since the type of evidence that would satisfy them would never exist, the evaluation report should be withdrawn and never spoken of again. Several activist-academics argued, without a shred of evidence, that people had started drinking the new, lower-alcohol drinks in addition to their usual intake. Others griped that if the target had been achieved, it was only because the drinks companies made changes to their products that they were going to make anyway. Eight years later, a 3% fall in alcohol sales in Scotland following the introduction of minimum pricing was described in the British Medical Journal as “extremely encouraging”. In 2014, however, the same journal described a similar decline in sales in the UK as “a mere accident of the market”.

The Responsibility Deal ended in 2016 and the market has since moved towards drinks that are not just lower in alcohol, but totally alcohol-free. Even these products, which are literally soft drinks, have faced institutional resistance from the neo-temperance lobby. Alcohol Action Ireland, a state-funded pressure group, claims that the industry advertises brands such as Guinness 0.0 not because it wants people to buy them but because such advertisements act as ‘alibi marketing’ for the alcoholic versions. That is not their only objection. ‘Like alcohol itself,’ they say, ‘zero alcohol products are no ordinary product and seek to further normalise drinking at every single occasion in life. There is no end to the possibility of where industry will go with this or what other consequences might flow from it over time.’ They do not speculate about what these consequences will be, but complain that ‘there is no law preventing zero alcohol drinks being sold to under 18-year-olds’ (why should there be?) and claim that zero-alcohol drinks have ‘the potential to disrupt public health achievements as the potential risk of normalisation of alcohol use for young people could be developed.’

Last year, the World Health Organisation got involved. In a report that threw every conceivable objection at no- and low-alcohol drinks (NoLos), the WHO claimed that they ‘normalise a culture of alcohol consumption’ and could ‘serve as gateway products’. It fretted that ‘NoLos may be purchased at a broader range of retail outlets than typical alcoholic beverages, further normalising alcohol consumption’. Noting that many countries tax drinks according to their alcohol content, the WHO made the puzzling complaint that this meant that people ‘pay lower taxes for NoLos, resulting in cheaper products on the market, reducing the overall effectiveness of these taxes’. 

Although the WHO claimed that there is insufficient evidence to show that people who consume NoLos drink less alcohol, it simultaneously expressed concern that the products could exacerbate ‘health inequalities’ because one study found that ‘NoLos reduced overall ethanol consumption among more affluent households, and, as a result, they increased inequalities between income groups’. The WHO then argued that low alcohol drinks in Nigeria tend to be sweetened and that since women have a preference for sweetened drinks, there was a danger that Nigerian men will ‘buy them for women, encourage them to consume them above their limit, and engage in unsolicited sexual advances when intoxicated’. ‘Thus’, it concluded, ‘due to the marketing of NoLos to Nigerian women, the level of sexual violence and other alcohol-related problems may increase.’

It is a long list of charges to level against products that strike most people as being benign at worst, but the WHO had warmer words to say about NoLo drinks if people consume them as a result of state coercion. The ‘public health’ lobby’s institutional preference is for higher taxes and minimum pricing. Such pricing mechanisms ‘may incentivise producers to reduce the levels of alcohol by volume and may lead to more considerable reductions in alcohol consumption’, says the WHO. As usual in ‘public health’, an approach that is ineffective and harmful when done voluntarily magically becomes powerful and life-saving when it is forced on consumers.