Category Archives: Poverty

Eric Carlin: Young people, alcohol and (the troubling concept of) ‘resilience’

BSA Alcohol Study Group Blog

I’m delighted to have the opportunity to present in Cardiff some thoughts about young people and alcohol drawn from my PhD research which is exploring the usefulness of theories of ‘social exclusion’ and ‘resilience’ to describe contemporary youth transition experiences in Pilton, a disadvantaged neighbourhood of Edinburgh.

My fieldwork was conducted between July 2012 and March 2013 and I am currently analysing findings and writing up.  I recruited young people (aged between 16 and 23) and people who work with them from youth centres and colleges and advertising in the local community newsletter. I also held two focus groups with local mothers.

The theoretical context has been strongly influenced by the sociology of Norbert Elias, who believed that human beings are engaged in a ‘civilising process’. He argued that we should study the constantly changing figurations that  individuals, families and others in society engage in with each other. I therefore…

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Glasgow Pride? Yes, but for some LGBT people, get a grip on your drinking behaviours!

I went to my first ever  Glasgow LGBT Pride event on Saturday, rather proud and excited that this city,  for so long riven by sectarianism and daily violence, had changed so much while I was away that it could – safely – host such an event.  I’ve written before about my ambivalence towards this city. Many LGBT people, like myself, had been driven away from the city in our youth, in large part to escape the prejudice and fear that growing up there, or in my case, in one of its feeder towns, Coatbridge, caused us. Nonetheless, I have always remained proud of my West Coast, working-class heritage, which in many ways has helped to define me as much as my sexuality has.

I took my partner along and was explaining to him on the way to Glasgow Green what an enormous shift had taken place in a very short period of time. So far, so good.

When I got to Glasgow Green I was surprised that there was a tent selling alcohol which was cordoned off from the rest of the festival. This meant that, rather than as I had experienced at festivals elsewhere, there weren’t families and groups having picnics, including wine, watching the free concert.  The few people who were drinking outside the cordon were being stopped and warned by the police, a result of a local bye-law to try to prevent alcohol-related disorder. This meant that those who were drinking alcohol legally were fenced uncomfortably, like pigs in a pen. “How ridiculous”, I said to my partner. Surely at an event like this, people could be allowed to celebrate, to let their hair down for one day in the year, to celebrate the huge achievements our community has made. Isn’t it insulting to them to assume that they need to be policed to ensure they behave? How wrong I now realise I was.

In my professional capacity, now working on alcohol policy, I have myself been accused on TV very recently of being a public health kill-joy who wants to restrict the rights of the sensible majority because of the behaviours of a small minority, policing people’s health behaviours with regulations that interfere with their individual choices in an unwarranted fashion. Of course, that’s not the case. However, alcohol is a regulated commodity and a drug and people will differ on what is appropriate. We must all be open to changing our positions based on the evidence that is available to us.

The connection between alcohol and violence has been well-documented by many researchers. They often differ on the causality of the relationship but there is consensus that where violent behaviours occur, alcohol is often somewhere around. In my current PhD research, many young people have described to me how, rather than places of festivity, alcohol often turns their parties into violent occasions. One young man expressed it thus:

“Ye get people that just go out, get full ae drink and just, somebody’ll look at them, somebody’ll just look at ye and that’ll be it. “What are ye looking at?””

Easy for me as a middle-aged man to think that that only happens at young people’s parties. However, at various times in Glasgow on Saturday (and not late at night – I’d made my exit long before that), I saw drunken women fighting with each other, men and women throwing up in the streets, women falling down. Finally, to top it all off, I was personally whacked in the face by a six foot six man’s shoulder as he flew towards me, having been punched in the face and knocked off his feet in an argument he was having with another man in a city centre gay pub. I didn’t know them. Just wrong place, wrong time.

Loic Wacquant’s research in French banlieues and US ‘ghettos’ unearthed experiences of what he calls an “extraordinary prevalence of physical danger and…acute sense of insecurity” (Wacquant 2008,p.54). He contextualises the daily experience of young people in these areas within what he calls “violence ‘from above’” (2008, p. 24). His thesis is that poor urban young people are constantly abused by the impacts of macro—level socio-economic change including, mass unemployment, relegation to decaying neighbourhoods and a heightened stigmatisation in their daily lives. Violent responses to this, though often self-destructive for individuals and communities, are easily comprehensible. 

I am disappointed by what I experienced this week in Glasgow. Is it possible that the Glasgow experiences of social disadvantage, combined with continuing prejudice against LGBT people from establishment figures, including a not-long-departed-in-disgrace Cardinal, influences some of them, instead of celebrating their diversity in a festival of celebration, to ape the worst behaviours of macho, boorish, prejudiced, drunken (mainly) men?

I wasn’t feeling very proud of the LGBT community in Glasgow on Saturday evening. I was proud though of the very considerate and kind bar staff who gave me ice to put on my cheek. Proud also that working-class people in places like Glasgow are standing up for equality. Proud that many people had dressed up and had fun.

I’m very grateful to so many LGBT activists who give so much  time and effort to celebrate our community and to champion equal rights in marriage, employment, immigration and a host of other areas.

To the others, in local parlance, I’d say, “Get a grip!” We can discuss appropriate health behaviours but violence? Really?

 I missed Heather Small who closed the Pride festival on the Green. The words of her song “Proud” may be a little trite but still pertinent:

“What have you done today to make you feel proud?
It’s never too late to try
What have you done today to make you feel proud?
You could be so many people
If you make that break for freedom
What have you done today to make you feel proud?”

Wacquant, L. (2008) Urban Outcasts. Cambridge: Polity Press.

 

Risk and Responsibility

In “World at Risk” (2009), Ulrich Beck asserts that we now live in a Risk Society where the old institutions of industrial society – family, community, social class – have been undermined by the process of global modernisation and where individuals have to learn to navigate society for themselves. Beck does not suggest that we face a world of “unprecedented dangers”; rather that we live in conditions of “manufactured, self-inflicted insecurity.”

Beck’s thesis can provide a backdrop for many current ethical and moral debates. These include discussions about what should be the role of the state in public health interventions and where individuals should be left alone to make their own decisions, based on their individual assessment of risk and with a moral sense of responsibility. This ‘individualism’ conflicts markedly with Elias’ assertion in “What is Sociology?” (1970) that we are interdependent: the term individual can only be understood as referring to interdependent people in the singular, society referring to interdependent people in the plural.

How we organise our social and economic systems relies on the dynamic interweavings in which we engage. The limitations of our linguistic and conceptual abilities lead us into and trap us in dualistic debates about rights versus responsibilities that neglect human complexities and dynamism and how more powerful groups exert power over weaker groups. Thus, for example, poor people rather than globalisation are blamed for their ‘cultures of worklessness’ and the duty of individuals to “drink responsibly” is emphasised over corporations’ responsibility to promote their goods in an ethical fashion.

In 1970, Elias discussed what he saw as the fetishisation of the hydrogen bomb and argued that people projected their fears and blame onto it and the scientists who created it rather than taking responsibility for their own complicity in the reciprocal hostilities which led to its creation. Contemporary discussions about issues such as child abuse follow the same tangent; rather than considering how we have encouraged the development of a culture where sexualised imagery, whether or not involving children themselves, is displayed to them, we lament the discovery that ‘much-loved’ entertainers have been monstrous sexual predators. The individualistic culture responsibilises those monstrous individuals and the ‘victims’, i.e. those who suffer the most demonstrable harm at an individual level are deemed to be unfortunate. We convince ourselves that society has changed, that such abuse is terrible but exceptional.

As individuals and as a society, we carry on as before in our “manufactured, self-inflicted insecurity”.

Alcohol Assertions – Consume with Caution

I attended a conference today. In among some very interesting and perceptive discussions about how important parents could be in supporting young people around alcohol issues and what they needed in turn to enable them to carry out this role, there were some inaccurate or misleading assertions and selective uses of statistics. There were several fairly self-congratulatory statements about the alcohol problem getting significantly better when in fact, as a population, we are drinking vastly more than we did 20-30 years ago and levels of alcohol-related harm, though they may not be at their peak, are still a huge cause for concern. I know that the statistics in relation to alcohol use will always be debated but alcohol industry retailers do not help clarify the position by maintaining their secrecy around sales figures.

Among today’s assertions, this one:

There are fewer young people drinking than ever before.

This was based on the annual schools survey in England and Wales, exclusively self-reported, which doesn’t in fact track back to “forever”. Nonetheless, the positive impression is given when in fact,  the welcome recent reductions in young people’s use have come after a period of sustained year on year increases. As well as this, even though fewer young people may be drinking now than in the recent past, the drinkers are consuming vastly greater quantities than in the past.

If we take the long view, we can see that alcohol consumption in the UK was very high at the beginning of the twentieth century and then dipped significantly mid-century. Our current, albeit improving, situation is still markedly closer to those early twentieth century figures than to the mid-century position. Now, as then and in line with other health-related issues, the harm caused to poor and socially-disadvantaged communities is disproportionate. It is inexcusable and misleading to present only positive short-term improvements and ignore the sustained and serious increases in alcohol-related harms that have crept up and overwhelmed contemporary society.

Across Europe, alcohol is the world’s number one risk factor for ill health and premature death among the 25-59 year old age group and Europe is the heaviest drinking region in the world. The UK government (2012) estimates that in a community of 100,000 people, each year:

  • 2,000 people will be admitted to hospital with an alcohol-related condition;
  • 1,000 people will be a victim of alcohol-related violent crime;
  • Over 400 11-15 year olds will be drinking weekly;
  • Over 13,000 people will binge-drink;
  • Over 21,500 people will be regularly drinking above the lower-risk levels;
  • Over 3,000 will be showing some signs of alcohol dependence; and
  • Over 500 will be moderately or severely dependent on alcohol.

In Scotland, the alarming rise from the early 1990s has now stabilised but alcohol-related harm continues to be at historically high levels with alcohol-related deaths more than doubling since the 1980s and alcohol-related hospital discharges more than quadrupling since the early 1980s. There were over 40,000 hospital discharges in 2007 and alcohol related mortality has more than doubled in the last 15 years. In addition, Scotland has one of the fastest growing rates of liver disease and cirrhosis in the world. The Scottish government (2009) estimates that alcohol misuse costs Scotland £2.25 billion every year.

A couple of today’s speakers usefully drew attention to the impact that easy availability of alcohol has on people’s behaviours. In support of this, WHO (2011) has argued that,

Of all alcohol policy measures, the evidence is strongest for the impact of alcohol prices as an incentive to reduce heavy drinking occasions and regular harmful drinking. The health gains are greatest for heavier drinkers and there are also considerable gains in the well-being of people exposed to the heavy drinking of others.

The BMA has identified minimum price per unit as the most effective of all available price-related policy options for reducing alcohol-related harm. Yet the alcohol industry has consistently tried to block statutory regulation which would impact on sales of the cheapest, most harmful products. Indeed, the Scotch Whisky Association is currently engaged in legal action to try to block the Scottish Government’s planned introduction of Minimum Unit pricing. One of the industry’s speakers today said that he “believed that it wouldn’t work”. This flies in the face of real-life evidence from Canada of the impact of the introduction of Minimum Unit Pricing there (Stockwell et al., 2012).

We need public health focussed interventions in the markets, permitted by national and international law and to my mind, required by laws of social justice, to change our drinking cultures and behaviours.

Instead of this, the overwhelming theme today was the need for more education and information campaigns. As a champion myself for many years of alcohol education and its continuing supporter, I also know that education on its own is not going to achieve very much. We should always interrogate claims that are made about interventions that are deemed to be effective, even where there do appear to be signs of positive impacts. For example, the most notorious high-level failure in drugs and alcohol education was DARE, a high profile multi-million pound programme that was delivered across the USA for decades with no significant impact. Even with Life Skills training, Gorman et al (2007, p.585) have argued that:

far from supporting the evaluators’ claims concerning the rigour of the findings and their generalisability and public health significance, the results are very fragile, of little practical significance and quite possibly analysis-dependent.

This is not to say that Life Skills training should not be promoted – indeed I would strongly argue the contrary case. We must not, however, overclaim for it. Stothard and Ashton (2000) argue that there is insufficient consistency in the findings to be confident that implementing Life Skills will cut legal or illegal drug use, only that it can do and has done, most consistently in relation to smoking.

Regarding information campaigns, the BMA (Hastings & Angus, 2009) has argued that:

while alcohol industry- sponsored marketing seems like a good idea, its public health value is questionable, and given its stakeholder marketing agenda, the effects are likely to be counterproductive. Such activity also focuses attention on individual rather than population level solutions, and can delay more effective statutory measures.

The BMA also argues that messages such as:

We promote responsible drinking and find innovative ways to challenge the national drinking culture and tackle alcohol misuse

reinforce the idea of ‘safe limits’ rather than relative risks and the impression is erroneously given that problems only arise when the product is used in specific ways , for which it is not intended.

Today’s conference facilitator called for more accurate representation of drinking behaviours in the media, arguing that we should celebrate  the fact that the numbers who do drink are (according to him) falling quite sharply. I’m sorry but I think it’s a bit premature to be thinking about cracking open the (non-alcoholic) bubbly!

BMA Board of Science 2012, Reducing the affordability of alcohol, London.

Gorman, D.M., Conde, E., & Huber Jr., J.C. (2007). The creation of “evidence-based” drug prevention: a critique of the Strengthening Families Program Plus Life Skills Training evaluation. Drug and Alcohol Review, (26), 585–593.

Hastings, G. & Angus, K. (2009). Under the influence: The damaging effect of alcohol marketing on young people British Medical Association, London.

Home Office 2012, The Government’s Alcohol Strategy, London.

Scottish Government 2009, Changing Scotland’s Relationship with Alcohol: A Framework for Action, Edinburgh.

SHAAP 2007, Price, Policy and Public Health, Edinburgh.

Stockwell, T. et al. 2012, ‘Does minimum pricing reduce alcohol consumption? The experience of a Canadian province’, Addiction, vol. 107, issue 5.

Stothard, B., & Ashton. M. (2000). Education’s Uncertain Saviour. Drug and Alcohol Findings, (3).

University of Sheffield 2012, Model based appraisal of Alcohol Minimum Pricing and Off Licensed Trade Discount Bans in Scotland using the Sheffield Alcohol Policy Model v2 – Second Update, Sheffield.

World Health Organisation 2009, Global health risks, Geneva.

World Health Organisation Europe 2011, European Alcohol Action Plan 2012-2020: Implementing regional and global alcohol strategies, Geneva.

Protest

Earlier this month I went to an anti-poverty conference in North Edinburgh. It was great to see so many people from disadvantaged communities not giving up but, rather, challenging the status quo of ‘haves’ and ‘have nots’ which characterises our society.  

And I am inspired also by the protesters in St. Andrew’s Square, Edinburgh and across the UK and other countries who are bringing into mainstream discussion – at last! – the unacceptability of the increasing gap between rich and poor.

First among major UK politicians, Ed Miliband in his conference speech (which received fairly mixed reviews) raised this issue and he even linked it to the unrest that led to riots in England earlier this year. In government, however, New Labour advanced the neoliberal market agenda. Albeit that they introduced worthwhile schemes targeted at specific individuals and communities, they didn’t want to tinker with addressing structural economic inequalities. Indeed, politicians like Mandelson seemed to revel in encouraging greed and excess for people at the top. (And remember, I’m only talking here about our UK context; the situation becomes even more extreme when we consider the global situation.)

This week the High Pay Commission described the high salaries of UK executives as “corrosive” to the economy. Stating that the disparity between what top executives and average workers earn has been building for 30 years, it drew up a 12-point plan to stop “high pay creating inequalities last seen in the Victorian era”. Vince Cable, the Business Secretary, said he would be “looking seriously” at the proposals.

Let’s hope he does but I wouldn’t hold my breath.

Because the political establishment has presided over and even encouraged a situation where, for example, the pay of top executives at a number of FTSE companies had risen by more than 4,000% on average in the last 30 years.

In the companies’ defence, Richard Evans, president of PepsiCo in the UK and Irish Republic, told the BBC:

“If we want great people to come and work in the UK, given it’s a global talent pool, we’ve got to be prepared to pay the amount of money that those executives can get elsewhere in the world”.

To which I say, follow the St. Andrew’s Square protesters’ example. Don’t buy any of Pepsico UK’s brands. These include: Walker’s Crisps, Doritos, red Sky, Sunbites, Quaker Oats, Scott’s Porage Oats, Tropicana, Pepsi MAX, 7UP, Gatorade, Planet Lunch, Copella, SoBe V-Water. (I have to admit that it won’t be a big sacrifice for me not to purchase anything from this unhealthy list!)

Protest loudly. Lobby politicians. Don’t let David Cameron say that we’re ‘in it together’ while pay for directors of the UK’s top businesses has risen by 50% over the past year, to an average of around £2.7m.  If you’re working in the much maligned public sector, strike on 30th November.

And snap out of complacency.

To return to the North Edinburgh Poverty conference that I mentioned at the beginning of this blog, one of the things that most moved me was when an old woman, describing her experience in her ‘ice box’ flat, suggested to others, as a way of managing their fuel bills, that they follow her example and make up a flask of tea or coffee first thing in the morning so that they won’t have to boil the kettle more than once a day. I met a few days later with a friend and expressed my disgust at the unacceptability of such a situation. His response was that there was no ‘real reason’ for anyone to be worried about being able to afford to boil a kettle.

But they are.

And that’s ‘real’.