Dr. Matthew Lesch, University of York.
The adoption of the Public Health (Alcohol) Act in 2018 marked the first time the Irish government has legislated alcohol as a matter of public health. The legislation is underpinned by four main pillars: (1) minimum unit pricing; (2) the structural separation of alcohol from other products in shops; (3) new restrictions on alcohol advertising and marketing, particularly as relating to children; and (4) new requirements for labelling.
In a recent study published in Addiction, Professor Jim McCambridge and I explore the role of public health advocates in securing the passage of this landmark legislation. Drawing primarily on interviews with key advocates, experts, and public officials, our research identifies three mutually reinforcing tactics that were key to the success of advocates in Ireland in getting the legislation passed.
First, advocates created a broad based advocacy coalition, led by Alcohol Action Ireland and the Alcohol Health Alliance Ireland. The coalition included 62 organisations based in Ireland, representing physicians, public health experts, charities, youth organisations, among others. The coalition’s impressive breadth meant that there was a range of voices unified by an overarching concern: tackling alcohol-related health harms.
Second, advocates made a concerted effort to focus on the content of the policy problem, rather than examining the particular measures included in the legislation. Rather than debating whether minimum unit pricing or structural separation were the best means for reducing alcohol-related harm, advocates focused their messaging on the cost of inaction. Throughout their public health campaign, for example, Alcohol Action Ireland reminded policymakers of the loss of life due to alcohol-related harms. Liver specialists and psychiatrists drew from their experiences to help the public and politicians better visualize the damage caused by alcohol.
Finally, advocates possessed a keen understanding of how the political system worked in Ireland. Many coalition members had previous experience in politics and public health campaigns, and as a result, advocates knew which levers to pull and when. Using records from Ireland’s lobbying registry, advocates showed the public the magnitude of the alcohol industry’s lobbying campaign, turning the industry’s traditional advantage into a political liability. Advocates were sensitive to the local nature of Irish politics. To put pressure on individual legislators, the coalition engaged with local media, local activists, and travelled across the country to build public support for the legislation in communities throughout Ireland.
Ireland’s experience is potentially instructive for public health campaigners in other contexts. First, to be successful advocates need to focus on building strong and broad-based alliances. Coalition-building can significantly strengthen advocates’ credibility in the eyes of policymakers and the public. Second, issue-framing and message discipline are essential to securing public support. Focusing on the health harms associated with alcohol can make the issue much more relatable to the general public. Finally, medical professionals might be the key secret weapon for public health advocates. Doctors and nurses see the enormous toll that alcohol takes on patients, families and communities. As the current COVID-19 crisis reminds us, these professionals are also trusted by the public. Medical professionals are thus uniquely equipped to explain why a public health approach to alcohol is so necessary.
For more information, please see Lesch and McCambridge (2021) “Coordination, framing and innovation: the political sophistication of public health advocates in Ireland.” Addiction. doi:10.1111/add.15404
Dr. Frank Houghton, Limerick Institute of Technology, founder member of ACORN, summarises his new study for ACORN.
Ireland’s Public Health (Alcohol) Act of 2018 represents a welcome addition to the ongoing struggle to contain Ireland’s problematic relationship with alcohol. However, crucial deficits in this legislation continue to limit its full potential. Most obviously, these include the lack of any indication of a date of commencement for the introduction of a minimum unit price (MUP) for alcohol, and a similar absence in relation to the mandatory introduction of alcohol warnings on such beverages.
Concerns also exist around ‘intoxigenic’ (ie drunkenness inducing) environments in Ireland, given the pervasiveness of alcohol advertising. This issue is particularly important in relation to children and youths. The Act will restrict alcohol advertising at sporting venues and local authority parks, as well as in taxis, trains or buses, or at events targeted at children. These developments are positive. However, a number of other elements in this legislation are inadequate and appear rather perfunctory. For example, although there is now an exclusion zone on alcohol advertising around schools, crèches, and local authority playgrounds, under current legislation this zone is a meagre 200m. This exclusion zone obviously needs to be extended to at least 400m, and ideally to at least 500m.
The current legislation also involves exemptions to this exclusion zone for licensed premises and alcohol manufacturers and wholesalers. However, these exemptions are both inappropriate and unnecessary and serve only to perpetuate the pervasiveness of alcohol in Irish streetscapes. Finally, although the current list of premises with advertising exclusion zones is an important start, it is equally clear that many more locations should equally be afforded such protected zones. Obvious examples include health, medical and social care work facilities, as well both civic (eg.libraries & community centres) and entertainment venues routinely visited by children (eg. cinemas, theatres, zoos, wildlife parks, and swimming pools).
For more information see Houghton & McInerney (2020) The Public Health (Alcohol) Act: Spatial issues and glaring gaps. Irish Geography. 53(2). DOI: 10.2014/igj.v53i2.1423 The Public Health (Alcohol) Act: spatial issues and glaring gaps. – Drugs and Alcohol