The booze battle - The Irish Times - Sat, Jul 28, 2012:
We know that Ireland has a drink problem, but how to tackle it has become a fight between politicians, lobby groups and the alcohol industry. How will we wean ourselves off the drink, asksPATRICK FREYNE
FIRST THE GOOD NEWS. The awareness campaigns have worked. We are now very aware of our drinking. We are also aware of a whole range of drinks products readily and cheaply available on the supermarket shelves – and, as a nation, we continue to drink them, fully aware of it.
Eighty-five per cent of us believe we drink too much, according to an Ipsos MRBI poll this month for the Health Research Board. Seventy-eight per cent believe the Government has a responsibility to address the issue, and 58 per cent believe it isn’t doing enough.
This follows decades of mixed-up thinking, in which successive governments bemoaned our drinking culture on the one hand while taking the tax revenue and liberalising the industry on the other. In this environment, soft rhetoric about education and awareness was the easy option. But policymakers have concluded more recently that the Irish will moderate their drinking only once price, availability and marketing are curbed.
Minister for State for Primary Care Róisín Shortall is pushing proposals based on February’s report from the National Substance Misuse Strategy Steering Group. These firmly target issues of price and marketing and will, if passed by the Cabinet, form the basis of a new public-health Bill and the fulcrum of a raft of new alcohol policies.
The statistics have always been stark. The Irish recently came top of the Eurobarometer for heavy drinking. Twenty-eight per cent of Irish drinkers binge-drank and 56 per cent overall drank harmfully, according to a Slán survey of 2007. And Ireland’s per capita alcohol consumption was 11.3 litres per adult, compared with an OECD average of 9.1 litres, according to OECD Health Data 2011. This behaviour is not without consequences. The health, crime and child-welfare ramifications of this national pastime cost an estimated €3.7 billion a year.
“While drink has always been part of Irish culture, the data suggests that the amount of drink we’re taking increased rapidly up to a peak of about 10 years ago,” says Dr Joe Barry, professor of population-health medicine at Trinity College Dublin and a member of the National Substance Misuse Strategy Steering Group. “We passed out countries like France that formerly consumed more than us. As we became wealthy we could afford drink, and when we could afford it we drank more.”
James Doorley, assistant director of the National Youth Council of Ireland, explains how the context has changed for young people. “In the past 10 years or so we’ve seen prices come down, we’ve seen much more advertising targeting young people and much more availability. Twenty years ago if a young person wanted to get access to alcohol it was at a local off-licence or pub. It wasn’t everywhere. Now there’s a lot more alcohol available and it’s much cheaper.
“The youth workers that we are engaged with are saying that things have changed. Twenty years ago people were drinking under the age of 18 but they were drinking wine and beer. Now it’s spirits, and they’re drinking more and younger. They’re also turning up with serious liver problems at a younger age.”
It has been convenient for politicians to assume that liberalisation of the market could be balanced out by education and awareness programmes. But public-health experts say education, on its own, is one of the least effective ways of addressing the issue.
“The uncomfortable truth is that advertising is also a form of education, and some of the best brains of that industry are working on drinks ads,” says Barry. “They’re educating people to drink. Expecting state education schemes to compete with that is unrealistic. The effect is completely asymmetrical.”
The reality, says Barry, is that when you increase availability and reduce price, Irish people drink more. So those concerned with formulating policy around alcohol favour the World Health Board framework, which, among other things, targets pricing, availability and marketing. The World Health Organisation guidelines are echoed in the steering-group recommendations advocated by Róisín Shortall. These follow in the policy footsteps of another hard-drinking nation.
“Scotland is leading the way in many respects,” she says. “They’re currently facing a challenge on the basis of EU competition law over minimum pricing and have gathered a very substantial body of evidence, some very significant research done by Sheffield University, making a case on the European level that the negative health impact outweighs competition concerns. I’d be keen that we wouldn’t just leave it up to Scotland to fight this battle alone and should row in to support them.”
The headline issues in Shortall’s proposals include a minimum price for alcohol, a 9pm watershed for drinks advertising and the phasing out of alcohol sponsorship of sporting and cultural events. The latter point is contentious for some of her colleagues, most notably Minister for Sport Leo Varadkar and Minister for Agriculture and Food Simon Coveney. This has led to some procrastination.
“My understanding was that it would go to the Cabinet last week, but I understand that the decision has been taken to refer the memo and the plan to the Cabinet Committee on Social Policy,” says Shortall.
On sport sponsorship in particular, she says: “The recommendation of the steering group was to ban sponsorship by 2016. I think that’s a bit too ambitious given the levels of debt in some of the sporting organisations, and it’s certainly not my intention to damage sport in any way. But I think the vast majority of people accept at this stage that we need to break the link between sport and alcohol. And the issue is not whether we do it or not, it’s about when and how we do it.”
But Varadkar does not sound as if he’s willing to move on the issue. “Anything done must be workable, proportionate and evidence-based,” he says. “It’s clear that cheap alcohol is a big problem, and a minimum price makes sense if it does not violate EU competition law. A ban on sports sponsorship is not proportionate or workable or evidence-based. Sport is international, and the images will be on TV anyway . . . A unilateral ban would achieve nothing, but millions would be lost to sporting organisations and clubs, undermining their work and harming health.”
Fiona Ryan, chief executive of Alcohol Action Ireland, is unsurprised by the delay. She lists all the working groups, Oireachtas committees and liquor-licensing commissions that have been established since 1990 (11 committees and 15 reports in total).
“I managed to have a baby in the middle of one of them, came back from maternity leave and it was still going on,” she says. “The fact is there’s a vested economic interest and its primary goal is to maintain profits. Meanwhile the public-health goal is to reduce alcohol consumption in order to reduce alcohol-related harm. There is no middle ground.”
Many in the industry itself are troubled by Shortall’s proposals because they aim to reduce overall consumption. “They prefer to say, ‘No, we really need to target the problem drinkers,’ ” says Joe Barry. “The difficulty in Ireland is that we have a lot of problem drinkers. Most adults drink over what’s recommended. The industry says ‘drink sensibly’, but when you ask someone if they drink sensibly, unless they’re an outrageous alcoholic, they usually think that they already do – ‘I can take my six pints!’ ”
It’s arguably part of a wider ideological change. Individual choice, value for money and self-regulation have been rallying cries for the modern consumer and truisms of modern governance. The notion that our free, unfettered individual choices together amount to something rational and sane is appealing, and hard to shake. But in this instance the rational and sane approach seems to be regulate the product more strongly.
“It’s not rocket science,” say Fiona Ryan. “We know that if you want to reduce alcohol harm you’ve got to reduce consumption, and if you want to reduce consumption you’ve got to tackle pricing, availability and marketing. We know this from the World Health Organisation and from all the data available. It’s not a moral position. It’s a scientific one.
“In Ireland, up until now we’ve implemented policies that do the reverse of the WHO recommendations. In the same year that they recommended we tackle pricing, we cut excise duty by 20 per cent. We’ve increased availability by 161 per cent during the boom period. When they said to tackle the marketing of alcohol, we put alcohol on the same shelves as bread and milk in a supermarket. We treated it as a grocery, not a licensed product. And this is in a country where the fallout from alcohol abuse costs €3.7 billion a year. You need to have a black sense of humour in this job.”
Tried and tested: What we've done in past attempts to cut our consumption
Abstaining
There’s a long legacy of abstinence in Ireland from Fr Mathew’s 19th-century temperance movement to the 125,000 contemporary members of the Pioneer Total Abstinence Association. One in five of Irish adults does not drink (although the numbers are dropping). Today, abstinence is seen as a lifestyle choice or a response to an addiction. The Pioneers, however, like other temperance movements, have a wider social vision, with members abstaining for the good of society.
“The aim of the association is the promotion of moderation primarily in the use of alcohol but also moderation in all of God’s gifts in every aspect of life,” says Padraig Brady, chief executive of the Pioneers. “The pioneers themselves go one step further, and because alcohol is a gift from God and good if used wisely, they take the step and decide to abstain from that for the greater good.”
Fiona Ryan of Alcohol Action Ireland isn’t sure abstinence is hugely relevant to contemporary policy approaches. “The Pioneers are coming from a spiritual and moral perspective and we’re coming from a health, economic and scientific perspective. Their approach is about individual choice while ours is about population-wide initiatives to affect overall levels of consumption. If you have a high level of abstention in a population it’s going to bring down your overall levels of drink consumption, but it’s very much an individual choice and it’s stemming from a particular religious cultural legacy.”
Nonetheless, Brady notes an uptake of interest from people who want to take up a short-term pledge in recent years. “The short-term pledge has always been there. People would give up for the Holy Souls or Advent or Lent, but now it could be any month of the year. There seems to be more of a demand for it at the moment.”
Drinking like a European
In 2005, as minister for justice, Michael McDowell, acting on recommendations from the Commission on Liquor Licensing, proposed licences for European-style cafe-bars. “The idea was to stop people binge-drinking,” says McDowell. “The report advocated the creation of a cafe-bar society where people would have food with their drink and wouldn’t stand in the pub lorrying in pints.”
But McDowell’s plan was scuppered by the vintners’ lobby, which was “firing on all cylinders at the time. Pubs were still full. Their licences were very valuable and they didn’t want any further competition. None of them could envisage a situation where they would have to consider diversifying to get customers in.”
He got little support from his Dáil colleagues. “I was surprised by the vehemence of the response. Fianna Fáil had a very significant publicans’ lobby, and they had an informal deal with the publicans that they would nominate a publican spokesman to the Senate. And Bertie did the agnostic on it. He was neither in favour nor against it. I thought the opposition would try to embarrass me by voting for it, to divide the government and put pressure on me personally. But they let me off the hook by joining in and kicking me to death in public. It was all over in six months. I announced the cafe-bar idea on April 15th and the whole thing was effectively killed in November.”
Dr Joe Barry, professor of population-health medicine at Trinity College Dublin, says McDowell’s plan wouldn’t have worked anyway. “He was advocating new licences that were better, but he wasn’t doing anything about the problematic ones that were already there. I suspect that the cafe-bars would soon have been full of the foreigners and the superpubs would have been full of the Irish.”
McDowell observes how things moved on. “We were against superpubs at the time because we thought they were leading to uncontrolled drinking – enormous drinking barns with 500 or 600 people swilling drink. Now the problem is that people aren’t going to pubs at all and are drinking at home. It’s a moving target.”
Drinking Better
Drinkaware.ie, operated by the drinks industry’s not-for-profit Mature Enjoyment of Alcohol in Society group (Meas), aims to educate people about responsible drinking. Meas’s chief executive, Fionnuala Sheehan, speaks of “creating a brand for
drinkaware.ie. We need to be challenging in our voice and not to be judgmental. The development of the approach – the messaging – is evaluated on a regular basis, and we benchmark it on at least an annual basis as well.”
She stresses that over the past decade drink consumption has come down 20 per cent and that Ireland’s problematic relationship with drink predated the Celtic Tiger and the age of mass marketing. She also rejects the notion that if
drinkaware.iewere too successful it would conflict with the industry’s interests.
“We’re very clear that if underage drinking stopped it would be no problem as far as Meas is concerned. If people drink in a more moderate way that’s absolutely no problem as far as Meas is concerned.”
Others are sceptical. “I dont accept that the alcohol industry can be in charge of alcohol-awareness or -education programmes,” says Minister of State for Primary Care Róisín Shortall. “Their objective is to sell more alcohol or at least maintain the existing level of consumption.”
Indeed, the site’s messages about moderation are illustrated by jaunty bottles of beer and appealing pictures of pints. “Do you think beer shouldn't look nice?” asks Sheehan when this is mentioned. “This is about reaching the people who drink. The way we communicate is in keeping with that.
“Eighty-per-cent-plus of people drink in Ireland, and we’re starting where the consumer is. We are doing everything we can do to get across to them that when they drink they should do so in a moderate way, and we give them the strategies to do that. I know from the research that if we put up pukey green pints, we’d lose them.”
'You always have the sip-and-grin moment in beer commercials' How drinks advertising works
“Drinks budgets tend to be large, which is why advertising creatives like to work with them,” says Eoghan Nolan, executive creative director with Leo Burnett and Brand Artillery.
“You get the best directors, the best music, because the volume of revenue that can be gained by the drinks company is proportionate to the money they’re willing to spend getting it.”
But, he says, “I think within agencies now you will have people who aren’t happy to work on drinks brands, in the same way I recall people not being happy working on cigarette brands.”
When it comes to advertising alcohol there are a few generic tricks. “You always have the sip-and-grin moment in beer commercials. Guinness is seen as a contemplative drink, and there’s always a bit of hankering to add that in.
“Everything is researched to death, because 21- and 22-year-olds are a very tough audience – critical, visually literate.”
And, yes, the primary target is young. “You would often hear people say they hate a certain ad, and I’d say, ‘Are you an 18- to 24-year-old male? If not then it’s not aimed at you.’ You tend to make a drinks decision at that age and you tend to stick with it.”
Nolan says alcohol advertisements are already heavily policed by the Advertising Standards Authority, the drinks industry itself and the media organisations that carry them, and he is unsure if further curtailment is helpful.
“If I said it wouldn’t make any difference, that sounds like I don’t believe advertising works at all,” he says.
“Advertising does add cachet to a drink choice. Do I think that if advertising was cut, recruitment might slow into drinking and that it might help more lifestyle decisions to be better balanced? I think yes. But I don’t think it’s the only factor . . .
“And I’d worry that if we nanny ourselves on the issue where would it would stop? Do we not show Mad Men? Do we not show Sex in the City? Do we curtail anything we think glamorises alcohol?”
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