Análisis de contexto, designio común, empresa criminal conjunta,

There has been substantial analysis of public policy by political scientists, with some developing general models of the process and others highlighting the complexities and difficulties. In an ideal world the policy process forms a cycle of problem identification, policy development, policy implementation, and evaluation (see Bridgman and Davis 2000). This is assumed to be conducted in a rational and sequential manner. However, policy making is rarely straightforward and certainly not in relation to alcohol (Babor et al 2003, 229). The previous chapter demonstrated that the historical institutionalist approach has been increasingly used to comparatively assess areas of public policy. Scholars such as King (1992), Hacker (1998), and Dunlavy (1992) have comparatively assessed the different policy approaches taken by countries that were otherwise similar. Historical institutionalist scholars have also identified how domestic institutions, including political institutions and policy legacies, mediate the influence of actors and ideas on the evolution of different areas of public policy.

Outside of developments in public policy analysis developed by historical institutionalists, the work of political science scholars such as Kingdon (1984), Schrad (2005) and Lowi (1964, 1969, 1972, 1986, 1987) are of relevance when considering the alcohol control policy process. Kingdon’s influential work on the development of public policy included the thesis that significant change was rare and tended to occur when the three process streams

(problems, policies and politics) converged, opening a policy window (Kingdon 1984). A study by Greenfield et al confirmed that Kingdon’s thesis could explain United States alcohol control policy development (Greenfield et al 2004, 630). A model to understand the modern alcohol policy process was developed by Schrad (2005). Schrad’s triadic model assumed three important players – public health, government revenue, industry – with benefits to public health through tighter alcohol controls coming at the expense of state revenue or industry profits, therefore representing a zero sum game. Schrad argued that a responsible government would choose a benefit distribution weighted in favour of public health, with reduced consideration for private profit and state revenue (Schrad 2005, 197-219).

The work of Theodore Lowi is particularly relevant for the study of alcohol control policy. Lowi argued that public policies develop their own political structure and therefore influence politics (Lowi 1964, 689; 1987). He identified two approaches to understanding social regulation, mainstream and radical. In the mainstream approach actors avoid taking any moral stand on the regulated conduct, only concerning themselves with consequences. The radical approach defined the conduct morally and to be regulated because it was bad in itself, seeking to eradicate rather than modify it (Lowi 1987). Lowi found that regulatory policies in particular produced politics based on conflict that tended to favour the interests that were best organised (Lowi 1972, 304-5; 1986). Lowi argued that in the 19th century the language of public policy was heavily laden with morality. While the problems were complex, the solutions were simple. If problems today seem more complex, Lowi argued it is more to do with the way that they are defined (Lowi 1986, 132). From around 1935 he identified a decline in personal responsibility and dependency no longer required a calculation of whether the person was “deserving” and became the responsibility of government (Lowi 1986, 126-7). This transformation from private to public responsibility moved the ethical debate from

blame to no fault. The modern liberal government was obliged to respond to any negative consequence and became a giant magnet, with no limit to responsibility (Lowi 1986, 137). Kingdon and Lowi highlighted that policy making is likely to be far from simple and change could be rare and hard fought.

Studies conducted into alcohol policy have confirmed that stability and stagnation are more common than change. Greenfield et al’s interviews with policy actors in the United States found that there were considerable difficulties in achieving legislative change. Greenfield et al argued that there was often a policy stalemate due to the divergent views of the industry

and public health activists, and that change had tended to be limited and only observable over the long-term. Change advocates need a long time horizon and to keep “plugging away” to get change (Greenfield et al 2004, 643). Pennock and Kerr also found that United States policy changes occurred slowly and were more modest than advocates had sought (Pennock and Kerr 2005, 393). Greenaway argued that policy change was driven by experts and bureaucrats, especially in the modern era with extensive state capacities (Greenaway 1998, 916).

Many alcohol controls are unpopular. Policies that impact on “normal” drinkers tend to not be very attractive to governments (Plant, Single and Stockwell 1997, 263). They are

reluctant to risk political pain through aggressive alcohol control measures and will therefore often choose less effective interventions such as education (Chisholm et al 2006, 563;

Crombie et al 2007, 497). There is inherent tension between regulations and individual freedom. Indeed, much alcohol policy has been informed by the key tenets of classic liberalism that preserving autonomy was important in public policy because it allowed individuals to pursue their own ends. This tradition influenced alcohol policy through what Cook referred to as the harm principle, leaving the individual free to make their own choices as long as others are not harmed (Cook 2007, 140). This provides dilemmas for

governments. If liberty is paramount, then government should get out of the way and let individuals make drinking decisions. But if public health is the main concern, different principles are required. Using government authority to restrict choice in the name of public safety is contentious because it taps into disagreements about what is in the public interest (Cook 2007, 133-47). All developed countries are also committed to reducing market barriers, but international trade agreements treat alcohol like any other commodity (Edwards and Holder 2000, 621; Babor 2002, 72).

Each country has a unique culture and history that have informed their experience with alcohol, determined the type and severity of alcohol related problems, and therefore driven alcohol policies (Babor and Winstanley 2008, 725). Schrad argued that alcohol policies that existed prior to modern science are remarkably similar to those in the modern era. Many modern policies exhibit similarities to policies implemented two hundred and in some cases two thousand years ago (Schrad 2007, 438). Historical factors offer powerful explanation for policy trajectories and divergence between countries. Taxing spirits at a higher rate can only be explained by historical convention, principles of fairness and efficiency support uniform

tax (Cook 2007, 177). Bruun et al identified the importance of historical experience and political composition for determining the most appropriate alcohol control policies in a country (Bruun et al 1975, 83). The WHO also acknowledged that there is no policy mix that can be simply taken from one country and transplanted to another (WHO 2004b, 76).

In certain countries at certain times alcohol control has been a major political issue. Yet at other times, alcohol has been remarkable for the absence of debate (Edwards et al 1994, 1). Because of the unique dynamics in alcohol control policies across time and place, Schrad argued that there is tremendous potential for studying them in a comparative perspective (Schrad 2005, 218). There have been numerous attempts at establishing quantitative indices of comparative alcohol control systems. Anderson and Baumberg used a numerical scale to compare the strictness of alcohol policies across Europe (Anderson and Baumberg 2006, 19). The Alcohol Policy Index also rates countries on their comparative policies. Quantitative comparison of alcohol controls led Ritter to question whether this represents “science or silliness” (Ritter 2007, 617). Researchers have made varied claims about whether alcohol control is displaying convergence or divergence. Babor et al argued that during the late 20th century there was convergence of policies in the European Union (Babor et al 2003, 226). Yet there remained huge variations in alcohol taxation despite attempts to harmonise them (Babor et al 2003, 235). Crombie et al reviewed 12 developed countries, arguing that policies displayed heterogeneity despite some similarities in approach (Crombie et al 2007, 498).

Alcohol policy responsibility is often shared between national and local governments. Room argued that national governments are best placed to coordinate alcohol taxes and to

coordinate research (Room et al 2002, 224). Local level policy can have advantages, because people are more personally involved with alcohol related problems and therefore have a motivation to put in place the right policies (Holder 2001, 6). In the United Kingdom responsibility for liquor licensing is at the local level with limited national oversight (Babor et al 2003, 255). Babor et al considered that approaches using law enforcement and

availability controls were not well suited to the local level (Babor et al 2003, 254). State alcohol regulation occurs in federations, and policy responsibility is shared between national and state governments or delegated to the state level (Babor et al 2003, 252). In the United States and Canada, most decisions are made at the sub national level, and there are as many alcohol policies as there are states or provinces (WHO 2004b, 11). This is also the case in Australia.

It has been argued that globalisation of the alcohol trade requires a global approach to regulation (Room et al 2002, 227). The organisation identified to take this forward was the WHO, a division of the United Nations, with its strong history of activity with regard to alcohol (Babor et al 2003, 241; Room 2006, 589). WHO resolutions have urged member states to give attention to the prevention of alcohol related harm and promote strategies to reduce the consequences of the harmful use of alcohol (WHO 2006, 8). However, Room argued that the high prevalence of social harm and law and order issues from alcohol means that much of the impact lies beyond the remit of the WHO (Room 2006, 589). This provides an argument for extending beyond the WHO to include the World Bank, World Trade

Organisation, International Monetary Fund and regional organizations like ASEAN (WHO 2006, 11; Babor et al 2003, 241). There have been calls for global leadership since Bruun and his colleagues raised the possibility in the 1970s (Bruun et al 1975, 88; Jernigan et al 2000, 492-6). But international treaty making is an extremely slow process and an agreement on alcohol may be harder to achieve than for tobacco. The message on tobacco is clear and unambiguous (any smoking is a threat to health), whereas the alcohol message is more complicated (Room 2006, 588).

3.5 Conclusion

This chapter has demonstrated that a huge proportion of the global adult population consumes alcoholic beverages. Alcohol is a contributing factor in a large number of diseases, injuries and accidents that make it one of the leading risk factors for death and injury. Dangerous consumption also has impacts on the drinker’s family and wider society. It isn’t just alcoholics or long-term heavy drinkers that suffer the negative consequences of alcohol. Skog (1999) identified a “preventive paradox”, because a majority of problems are

experienced by lighter drinkers because of their greater number and the impact of irregular intoxication. A complicating factor is the demonstrated positive impact on coronary heart disease from light to moderate alcohol consumption. The prevalence of heart disease in developed societies means that drinkers experience better health outcomes than abstainers.

The discourse about alcohol and the role for governments has changed. In the late 19th century, the temperance discourse viewed alcohol as an evil product that must be eliminated,

with a high priority for government action (especially prohibition). As scientific research advanced, the idea that alcohol was an addictive product became dominant with drinkers divided into the “diseased” minority and healthy majority. As opposed to temperance, the disease discourse implored governments to leave the majority alone and focus on alcoholics. Since the 1970s the public health discourse has returned the focus to the population impacts of alcohol and increased government intervention.

Alcohol control policies have a very long history and vary enormously from one country to the next, even those with cultural and historic similarities. The range of policy tools is diverse and may target the entire population, particular groups in society, or individuals. These policy tools can be classified into broad categories of: taxation, availability controls, drink-driving countermeasures, advertising controls, education, and treatment. Regulatory systems in each country, while unique, implement a range of measures under these policy headings. Across the extensive history of alcohol policies in the developed world, the most effective policy tools have been demonstrated to be taxation, availability controls and drink- driving countermeasures. The least effective policy tools are education and information. The cases to be analysed in the following chapters (Australian and New Zealand alcohol control) will therefore not focus on information and education, but instead target the areas of both proven effectiveness and greater potential conflict.

Despite a significant amount of research into alcohol policy tools and their effectiveness, there has been little analysis of the process of alcohol policy making. The HI approach outlined in Chapter Two – with its focus on undertaking detail comparative and historical studies – has strong potential for explaining the ongoing divergence of alcohol control policies in two similar countries such as Australia and New Zealand. Although the findings of other scholars such as Kingdon have been applied to alcohol policy, the most applicable scholarship was that of Theodore Lowi. While not specific to alcohol policy, Lowi’s work demonstrated how policies would develop their own political structure, how social regulatory policies tended to be based on conflict, and how the modern government has become a magnet for problems.

Alcohol policy making is difficult. Many measures are unpopular and alcohol control policies that benefit public health can be inconsistent with fundamentals tenets of modern, liberal governments such as individual freedom and free trade. The capacity to introduce

new policy measures is also constrained by the history and culture of the society. Each country has a unique set of political institutions that impact on the capacity for certain policy measures to be implemented. Alcohol policy making is further complicated because

responsibility is often shared between different levels of authority (international, national, state/provincial, local), making integration and coordination difficult.

There has been little comparative research into alcohol systems, except at the meta-analysis or quantitative level. Quantitative analyses tend to be reductionist and do little to explain the complexities or context of alcohol control systems. No analysis has specifically set out to observe whether there are certain institutional arrangements or historical circumstances that might explain ongoing divergence or that inhibit or promote policy change. The conflict between the alcoholic beverage industry and the public health movement is real, but to argue that this conflict has been the major driver of alcohol policy is unproven and unlikely. The public health movement has taken aim at the alcohol industry, arguing that their

intransigence, greed and underhand tactics are the reason why alcohol control policies are weak and ineffective. In turn, the industry has argued that the public health movement seeks a return to prohibition and that their scientific veneer covers the same moral zeal as the temperance movement of one hundred years ago. Unfortunately, there has been little analysis of whether there are other factors at play.

The scholarly engagement with alcohol control has largely had a scientific focus. However, studies of alcohol control policy have tended to be written from a perspective that the policy tools with proven effectiveness across jurisdictions should be broadly adopted (with some consideration of cultural and historical circumstances). This has led to a somewhat naïve assumption that each country will be able to implement the most effective policies for their circumstances, and if they have not then it must be due to the influence of vested interests – especially the alcoholic beverages industry. What this assumption fails to do is understand the institutional, cultural, historical and political constraints that government’s face. The difficulties for governments in regulating alcohol are multi-faceted. They must achieve a balance between public health, individual freedom, free trade, government revenue, social order, and morality. There has also been little research into the drivers of stability and change in alcohol control policy, although the research available has generally identified the lack of change. Similarly, there has been little analysis of why alcohol control policy divergence remains across countries, especially when they are otherwise similar.

There are therefore great prospects for a comparative and historical study using the HI approach. Comparing across a long time period and using two similar cases will allow the best chance of identifying the relevant impacts on alcohol policy making. This chapter has also identified an important question – if the effects of alcohol on individuals and society are known, and if the effectiveness of available policy tools is also known, why do the

approaches to regulation vary so much? Perhaps the institutions that prevail in each country can explain this variation and the HI approach will provide useful insight to explain

Chapter 4 Alcohol policy in Australia