The British Medical Association have published a position statement about how it wants to tackle some public health issues including alcohol misuse.
The paper is critical of the government’s strategy of engagement with industry through the Public Health Responsibility Deal and their press release says:
In March 2011, Dr Nathanson and others withdrew from participating in the alcohol network, saying that pledges were not specific and the process had prioritised the views of industry.
Dr Nathanson says she is not convinced that the networks have delivered any tangible public health benefits. The food responsibility deal network has come up with putting calorie counts on signs at some fast-food restaurants, but this is not universal and it has taken years to get that far, she says.
Meanwhile, the statement also argues that health inequalities will widen if only education and nudging is used.
The BMA are calling for a number of policies to be introduced in relation to alcohol:
- Introduce minimum pricing
- Improve labelling to show alcohol content and daily guidelines
- Compulsory levy on industry to fund independent research
- Increase and ring-fence funding for specialist treatment services
- Increase and rationalise tax to ensure it is proportional to alcoholic content
- Cut licensing hours
- Ensure that licensing legislation is strictly enforced.
As you’ll see there’s a focus on environmental prevention – price and licensing controls – but there doesn’t appear to be very much faith in developmental prevention – the sorts of programmes that the recent Cochrane review suggests are “effective and could be considered as policy and practice options.”
This isn’t that surprising given the previous statements that the BMA have made about alcohol prevention. In 2008 they wrote:
In the UK, mass media campaigns, public service messages and school-based educational programmes are used as key alcohol control measures. While these may be effective at increasing knowledge and modifying attitudes, they have limited effect on drinking behaviour in the long term. It is essential that the disproportionate focus upon, and funding of, such measures is redressed.
I think it is worth contrasting that view to the position taken by the American Academy of Pediatrics which in 2010 released a policy statement calling for their members to support a range of activities these include:
- Serve as a resource and support for school and other community-based alcohol use prevention programs.
- Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.
Or indeed to the US National Academy of Sciences who in 2009 argued:
“Several decades of research have shown that the promise and potential lifetime benefits of preventing mental, emotional, and behavioral (MEB) disorders are greatest by focusing on young people and that early interventions can be effective in delaying or preventing the onset of such disorders.”
I hope that the BMA can one day be persuaded that investing in evidence based prevention programmes can add to a broad public health policy, and that prevention and early intervention is as important as specialist treatment services.