A healthy attitude

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Alan Maryon Davis has spent his life in the public health arena. As Public Health England prepares to oversee drug and alcohol service provision, he talks to David Gilliver.

This April will see oversight of drug and alcohol services pass from the NTA to Public Health England, the advent of which, according to chief executive Duncan Selbie, is the ‘opportunity of a lifetime to make health and prevention everyone’s business’, (DDN, December 2012, page 11). As honorary professor of public health at King’s College London, does Alan Maryon Davis think that’s realistic, or hyperbole? ‘It’s good to see him being so optimistic,’ he says. ‘But it is a new beginning and I think, although it’s a mainly structural change, there are some opportunities there, so let’s think positively about it.’ 

As an ex-director of public health himself – for the London borough of Southwark – does he feel the worries that drug and alcohol services won’t be a priority for many of those directors, when it comes to dividing up the money, are justified? ‘Yes,’ he says. ‘I was chairing a seminar just the other day where there was great concern about how much would be left for drug and alcohol services after various other big bites are taken. People were concerned about the patchiness across the country, because while there may be some guidance coming from the centre, a lot of it is down to local determination now.’

Given that, how should services be making their case at local level? ‘The case has been made many times, but they should be basing their appeals on the health harms and longer-term costs of not dealing with problems, and there’s also, to some extent, the criminal justice impacts. The trouble is, of course, that you’ve got short-term budgetary concerns and these massive cuts in local government funding that are going to continue for the next few years – there’s not much light at the end of the tunnel.’

Despite the ‘very strong’ arguments, many councils are now making those big cuts, ‘not only to the directly-provided services, but also to their funding of voluntary services, which is going to have an impact on drugs and alcohol’, he continues. Alongside this is the huge NHS restructuring programme instigated by Andrew Lansley – ‘a very unfortunate, not to say potentially highly risky manoeuvre, the wrong policy at the wrong time,’ Maryon Davis states. ‘But it’s happening so there’s no point crying over spilt milk. The important thing now is to try to make best use of it, for the health of the people. I think moving public health into local government is a good idea, because it does link up with the wider determinants like housing, employment, education, social care and all of that.’

While he sees Public Health England as a potentially useful organisation, as a long-term public health practitioner he’s mystified by the decision to dismantle and merge the Health Protection Agency (HPA). ‘That was a great success, very highly regarded nationally and internationally, and now it will be absorbed into this new body, which of course won’t be a quango but a branch of the Department of Health. So all of these people are being pulled into the civil service to be part of this massive government department.’

Where the ‘glass is also potentially half full’, however, is that the Department of Health will be connected with what’s going on at local level and ‘the whole health protection machinery in a very direct way’, he says. ‘But the downside of course is that they’re civil servants, and it will be politically driven as well as based on the science.’

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Before making the move over to public health, Maryon Davis trained at St Thomas’s Hospital. ‘I was one of those nerdish kids that used to pore through encyclopaedias and books about human biology,’ he says. ‘I was interested originally in being a hospital doctor, a rheumatologist.’ That was before his ‘light-bulb moment’, however. ‘I was cycling along the Walworth Road and I saw a plaque on the wall of a local government building that said “the health of the people is the highest law” – a famous quote from Cicero, although I didn’t know at the time. I got interested in public health and the whole business of prevention, so I switched from clinical medicine to social medicine, as it was then called.’

After ten years at the Health Education Council he helped to set up the National Heart Forum and Heartbeat Wales, before going on to head up public health in Southwark. He’s also well known for his appearances on TV, Radio 4 and LBC, as well as the weekly doctor’s column he wrote for Woman magazine for 17 years and several books on health issues. 

These days he chairs a charity called Best Beginnings that works to reach underprivileged parents through social media – ‘obviously alcohol and drugs are very relevant to that,’ he says – and is a trustee of Alcohol Research UK, which gives out around £500,000 every year to fund research into reducing alcohol harm.

On that note, the government’s consultation on minimum pricing closes this week – despite opposition in the cabinet and threats of a legal challenge from the industry does he think we’ll see a minimum price implemented in England? ‘I think we will – there are ways around the EU rules and regulations, and I think a pressing public health benefit is an important aspect that might let us get round the legal objections. The Scots are pretty optimistic that they can see this through, and I think England and Wales will follow pretty quickly, with Northern Ireland interested too, but obviously there’s a big issue about the price.’ 

Would he be happy with the 45p the government seems to favour? ‘I think 50p’s more sensible, and a key issue is obviously to try to prevent cross-border differences. It would be kind of crazy to have Scotland at 50p and England and Wales at 45 – it just wouldn’t make sense. The objection that’s often been raised is that it would be penalising sensible drinkers who are less well off, but the difference between 45 and 50p would be pretty small in that respect.’

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According to the chief medical officer’s annual report, deaths from cirrhosis and chronic liver disease rose by 20 per cent among under-65s in England between 2000 and 2009, at the same time as they fell in 14 other EU countries (DDN, December 2012, page 4). Is part of the problem simply that there’s an ingrained drinking culture here that will be very hard to change, no matter what legislation is imposed, and the industry will always do its best to exploit that?

‘There certainly is a culture that will be hard to change, but people focus on the drinking culture among the young – there’s also a pretty big marketing exercise aimed at older, more staid people tippling quietly in front of the telly with a bottle of wine,’ he says.

‘At the moment the government proposes “working with” the Portman Group or advertising standards, all very loosely worded, all sort of cosy and not making any real impact. Although there’s some self-imposed regulation around TV advertising, that’s not great and there’s still ways to get through those loopholes, but there’s really nothing much at all around social media. That’s where the big growth area is in marketing – along with all the sponsorship and partnership stuff around music venues – pushing the brands, creating the image that alcohol makes you glamorous and sexy and successful and all the rest of it. We need to find ways of getting into that.’ 

Speaking of marketing, what did he make of the ‘responsibility deal’ with the industry? (DDN, April 2011, page 4). ‘Too slow, too soft, and they’re only negotiating with part of the industry, anyway – OK there are quite a few big players in there, but there are quite a few who aren’t in that negotiation. I don’t think it’s the right way to go about it.’ 

Does it help that the media can often misrepresent the issues, as happened to some extent with minimum pricing? ‘The difficulty is getting the balance in there, and getting the press to cover the boring facts,’ he says. ‘The journalists who do actually take an interest on the whole try to look at it as responsibly as they can – the problem then lies with the editors who decide what stories they’re going to give prominence to. It’s very hard to get them to change their tune because obviously they’re trying to sell papers and get the online hits. 

‘What the health lobby can try to do is get the stories out – from research, conferences and seminars, reports and reviews – which do provide the balance and the evidence to counter the other stuff. You just hope that it gets picked up.’  DDN

alcoholresearchuk.org

www.bestbeginnings.org.uk