The science and politics of costing alcohol harm
It was a typically astute, and largely uncritical, commentary on an article by Klaus Makela in Nordic Studies on Alcohol and Drugs, the gist of which is that attempts to aggregate in hard cash the cost of alcohol harms to society are worthless. At least in scientific terms.
Politically, of course, they’re gold dust. If the Government Alcohol Strategy can declare, for instance, that “alcohol-related harm is now estimated to cost society £21 billion annually” (p3) it acts as a permission to do all kinds of things to bring that cost down.
Put a figure on it and those other ways of measuring it, alcohol-related disease and death, crime and disorder and a multitude of less tangible impacts, become secondary, lost beneath that all-encompassing invoice. Not to mention any benefits that drinking might bring society.
There are other advantages to politicians. If you have a costing there is the promise that you might be able to measure the effect, the savings made, as a result of your policies. It’s also handy for grabbing headlines and being seen to be doing something about a problem. Journalists like simple numbers, too.
So with all that going for them, perhaps it doesn’t matter that societal costs are nonsense. Their political power is certainly appreciated by the public health lobby.
One of the odd things that always struck me about the Sheffield modelling study, on which claims for the potential efficacy of minimum unit pricing is almost exclusively based, is the compulsive costing of everything, and it attracts particular attention from Makela.
To take the most staggering example, Makela points out you can’t calculate the cost to society of people with alcohol problems becoming unemployed because someone else comes off the dole and takes the job. There’s a heavy loss to the individual but no loss to society.
Yet in the Sheffield modelling no less than 75% of society’s gain from a 40p minimum price comes from a fictitious reduction in unemployment.
Perhaps minimum pricing will work. Perhaps there is an ethical case for it. But spurious cost savings aren’t going to convince me.
It’s terrible, really, that such a serious subject attracts such bad science. At the root of the problem is the competition for attention, for resources. Makela compares it to an escalating “armaments race” in which different lobbies fight to come up with the biggest stats.
“Nowadays people know the price of everything and the value of nothing,” as Oscar Wilde wrote in The Picture of Dorian Gray, and another point that Makela makes is that by attaching price tags to everything researchers are disguising unspoken value judgements.
Yet it’s not that we need to reduce everything to numbers, but rather bring those values to the fore. Hard evidence has its part to play, but we can’t repress the value-driven political aspect without it returning as pseudo-science. Instead, Makela argues, we should be open about it.
“The allocation of resources is then the outcome of a combination of a rational public debate and political activism, and this is precisely how things should be. Value judgements should not be hidden behind a curtain of opaque calculations.”
As I’ve argued elsewhere, it’s not a matter of keeping science untainted by politics but of embracing the politics and getting them right.
