Health report was far from definitive

Recent publication from AFS was well put together but flawed

• A definitive link between alcohol availability and harm was not established.

“A STATEMENT of the bleedin’ obvious” – that was a short and simple ‘tweet’ verdict following the publication of new research examining the connection between alcohol-related health harms and the number of licensed premises in Scottish communities.

Or, more accurately, it was a reaction to the newspaper headlines generated by the study, for example: “Areas with many pubs have triple the alcohol deaths” and “Extra off-sales mean early deaths for city residents”.
A classic case of the truth getting bundled aside for the sake of a great story.
In the first place, the academics sounded the warning that their categorisation of licensed premises meant that “outlet availability measures were a relatively crude way of measuring the actual availability of alcohol in a neighbourhood”.
Even more significantly, the report – looking at a “single point in time” – could not conclude that there was a causal link between the availability and alcohol-related harm.
In fact, there was a need for the “further analyses” required “to establish whether the links are causal”.
Let me be clear. This is a careful piece of work.
It was put together with a great degree of diligence by academics working for the highly-respected Centre for Research on Environment and Society (CRESH) at Glasgow and Edinburgh Universities.
Interestingly, it pointed to discrepancies between the researchers’ licensing statistics and those last published by the Scottish Government.
But I reckon that the report’s fundamental limitations ought to have appeared not on page ten but under its “key messages” on page two.
That’s the summary likely to be read by those who can’t be bothered to trawl through the next 16 pages – and the source of the apocalyptic headlines. If the authors couldn’t reach a conclusion on cause and effect – and more work requires to be done – that surely is a “key message”.
This research doesn’t sit in a vacuum. In fact, the connection between alcohol availability and health harms has long engaged the energies of researchers here and abroad.
For example, just before the publication of the CRESH report, a review of over 130 studies found “important limitations in current evidence” and concluded that availability research needed a “step change” in its approach.

The report could not conclude there was a causal link.

And if the overprovision/health harms dynamic is “the bleedin’ obvious”, someone ought to have told the National Institute for Health Research, which has provided the University of Cardiff with £416,000 of funding for a study seeking the answer to: “What is the impact of a change in the density of alcohol outlets on alcohol consumption and alcohol-related harms to health in the community?”.
Against that background it’s surprising that Alcohol Focus Scotland – which commissioned the CRESH study – reckons that it should inform licensing boards’ decisions despite its serious limitations.
Licence applicants seeking to overcome the hurdle of an overprovision policy are expected to advance robust and reliable evidence in support of their case – so it would be rather ironic if the policy itself had a shaky foundation.
In fact, any overprovision rulings based on research failing to find a “causal link” has to be on a fast-track to the appeal court.
There are broader concerns here.
Of course, the availability of alcohol must have at least some connection with health harms – in a way that has yet to be properly established – but calls for large supermarkets seeking a licence to provide anticipated alcohol sales data as a means of bolstering the “evidence base” looks a bit desperate.
I haven’t the remotest idea how that information would lead to better understanding of purchasing habits.
And it looks as if we’re being encouraged to take a hopelessly simplistic approach by tackling the provision of outlets as a magic bullet that will curb alcohol misuse, to the exclusion of major problems such as health inequalities and economic deprivation.