INTRODUCTION
In September 2001 the French minister for Health Bernard Kouchner presented
a new alcohol action plan. The starting point of the plan is that only
a reduction in the total consumption of alcohol is a realistic target if
alcohol-related problems should be minimised. To many observers it comes
as a surprise that among all countries France adopts a policy line that
has been usually associated with the temperance traditions of the Nordic
countries. Even there, its sustainability has been cast into doubt (Sulkunen,
Sutton, Tigerstedt and Warpenius 2000). From the public health perspective
it has been argued that a more targeted approach, focusing directly on
drinking occasions and related harms is more efficient. On sociological
grounds it has been argued that the public acceptability of controlling
availability has become weak in neoliberal societies.
The recent French policy document is not unique. It reflects and redefines
a long public health tradition in the alcohol policy arena. The Epidemiological
Model, as we prefer to call it, originated in France in the 1950s in the
work of the epidemiologist and demographer Sully Ledermann. It has repeatedly
surfaced as the policy argument in alcohol control efforts that seem to
come in cycles of about 12 to 15 years, and then to disappear for a while,
as if in a permanent state of war where no victories are final - just outcomes
of waves of battle now in favour of the public health army, and next in
favour of contradicting interests.
The recent policy paper continues the legislation pressed through the
parliament in 1989-1991 by Claude Evin, then minister for Health. The so-called
Loi Evin, the Evin Law, marked the most radical restrictive reform in alcohol
and tobacco policy in Europe in the second half of the twentieth century,
aiming at a quasi-total prohibition of advertisement and sponsoring, and
introducing serious cuts in the availability of these products especially
for the young. Also the Evin Law was based on the total consumption argument,
although its focus was on the representation of alcohol and tobacco in
the media, while the recent policy paper is more strongly oriented to drinking
contexts.
In this article we analyse the persistent survival of the Epidemiological
Model in French alcohol policy from a sociological perspective, analysing
the ideological and structural basis of the argument that it is the total
consumption of alcohol that must be reduced, and that measures directed
specifically to cut back only problem drinking are not efficient or acceptable.
Our conclusion is that in circumstances where alcohol consumption is considerable,
modern public health institutions find the epidemiological approach more
legitimate than selective controls because of its universalism. The epidemiological
model is persistent and convincing especially to many experts, and will
remain so, although the social preconditions for its implementation - especially
the central power of the nation state - may be questionable. Although the
control of the total consumption level through availability restrictions
may be an impossibility, both in terms of the acceptability of the "discourse"
and in terms of the practices and institutions of state regulations, this
is still the view on consumption risks that modern contractual and technocratic
social thinking finds most palatable.
HARM REDUCTION AND THE DEMISE OF WELFARE STATISM
The total consumption model has been criticised from the public health
point of view as being inefficient and misguided in its lack of focus directly
on what justifies public regulation of private consumption in the first
place: its harmful consequences. J?rgen Rehm, among others, represents
a view that is often presented as a challenge and a critique of the total
consumption or availability approach (Rehm, 1999). It is often tagged as
the "harm reduction" alternative to availability control, implying that
the most proficient method of preventing shark attacks might not be to
drain the ocean, as Rehm's title suggests. The arguments can be summarised
in five points. 1) The J-curve is reality, and it has favourable outcomes
at population levels, which contradict the "less is better slogan" at least
under some specifiable conditions; 2) risk functions are less steep for
most (acute) problems than required for the skewed distribution argument
to hold - instead of annual consumption the target should be drinking occasions;
3) historical variations of consumption levels are not systematically related
to availability policy, and when they are the causal direction cannot be
proven (control might get tighter as a consequence of lowered consumption
rather than vice versa); 4) a threshold probably exists beyond which availability
control measures become irrelevant; 5) public acceptance of traditional
availability controls has become insufficient, both from the point of view
of free market interests and of modern individualist consumers. Rehm points
out how, for example, dramatically increased availability in Ontario between
1975 and 1991 was associated with a reduction of both consumption and of
long-term health problems as well as drunk driving charges.
The epidemiological model has been contested also on more sociological
grounds. Robin Room (1999), for one, has discussed the historical conditions
in which "control policy" has emerged, operated and been successful. By
control policy he means approximately the Nordic approach of controlling
availability as a means of preventing harm. Although proven cheap and effective,
in contemporary European conditions, control policy faces a number of difficulties.
The expanded market generates interests that make change possible only
in the direction of further liberalisation (the ratchet mechanism); the
old supports of control policy are gone or distracted (temperance) or look
elsewhere (womens' movement, labour, employers). The alcohol research community
may no longer enjoy the non-partisan prestige it once had; and no organisational
solutions will replace the absence of political will so far apparent in
the EU context.
In the debate that ensued our analysis of the feasibility of the Nordic
control approach (Sulkunen et al. eds 2000; Tigerstedt 2001) Tigerstedt
argued that the great trends in post-war society – affluence, urbanisation,
equality – tend to lead to a consumer-oriented risk-management approach
were individuals themselves are held responsible for their own behaviour,
rather than the state held responsible for regulating the availability
and other clues to that behaviour, even when it entails potential risk.
The French case offers a useful possibility to look at these arguments
in a context that is even more individualistic and consumer-oriented than
the Nordic countries, and where both national tradition and vested interests
related to alcohol are strong. Besides, the Evin Law attacked one of the
sacred cows of the French cultural economy, that of advertisement. How
was this double victory of the public health camp over both the alcohol
and advertisement possible?
CYCLES OF ALCOHOL CONTROL IN FRANCE
Although still amongst the leading alcohol consumers in the world, the
level of consumption has declined in France since the 1950s. This was also
the period when the first initiatives to control the consumption were taken
at the political level.
During his short period as Prime Minister (June 1954 – February 1955),
Pierre Mend?s-France introduced more than 20 decrees and proposals related
to the objective of reducing the production and consumption of alcohol
in the French society. For instance, his government proposed new restrictions
in relation to the "bouiller de cru" system, which originally gave domestic
distillers the right to distil alcoholic drinks without being taxed or
supervised, as long as the alcohol was for personal or family consumption.
The legislation proposed by Mend?s-France implied that only those who were
actually engaged in farming would be permitted to claim the untaxed allocation.
It was estimated that this measure would reduce the number of bouilleurs
by 40 percent. The Mend?s-France government also proposed a set of fiscal
measures that would encourage production of sugar instead of alcohol. Further,
the government prepared a set of regulations that were intended to favour
milk in relation to wine. A government bill to reinstate a ban on advertising
of pastis and whisky was presented to the Parliament, as was a proposal
to ban the sale of aperitifs between 5 and 10 o'clock in the morning (Prestwich,
1988).
Perhaps most important, Mend?s-France established the High Committee
for the Study and Information on Alcoholism (Haut Comit? d’Etudes et d’Information
sur l’Alcoolisme) with Robert Debr? as its president in 1955. This committee
was an agency of the Prime Minister, and its main tasks were to provide
information on alcohol-related problems, to fund research and to provide
initiatives in order to reduce alcohol abuse in society.
All in all, the Mend?s-France actions represented a comprehensive approach
towards the fight against alcoholism in France. Although most of his proposals
were defeated, the attention concerning alcohol related problems was raised,
and this attention was institutionalized through the High Committee for
the Study and Information on Alcoholism. Public awareness of the risks
related to alcohol use increased and has ever since been an important factor
in the historical decline in alcohol consumption in France (Sulkunen 1989;
Aigran et al 1991).
Despite these initiatives during the 1950s, the public health interest
in relation to alcohol did not manage to make a consistent and continuous
impact in the French society. The economic and market interests seemed
to dominate the arena during the next decade, and the minister for social
affairs expressed his opinion on the state of the art in 1968, when he
claimed that "alcoholism is the worst and most poorly fought of all our
social diseases [fl?aux]" (Prestwich, 1988: 243). However, the public health
interests never disappeared completely, which is illustrated by the worries
of the minister for social affairs.
The balance between health and social policy principles on the one hand,
and commercial and economic principles on the other in relation to alcohol
in the French society was not reached once and for all. In this context,
the public health interests became more visible again during the 1980s.
On request from President Giscard d'Estaing, Professor Jean Bernard
presented a new report on alcohol prevention, education and treatment in
1980. Since a total ban on alcohol advertising at that time was not a viable
option, it was instead adopted a law that was merely intended to regulate
the area of alcohol advertising. As will be illustrated, the adoption of
the Evin Law should be viewed against this background. In this sense, the
implementation of the Evin Law in 1993 marked a temporary end point in
this cycle of increased emphasis on alcohol from a public health perspective
that commenced in the early 1980s.
THE LOI EVIN
Law no 91-32 of 10 January 1991 is the official name of what has become
known as the Loi Evin or the Evin Law. Its objective is to reduce harm
related to tobacco and alcohol in society. The Evin Law focuses on the
aspects of advertising and sponsoring, education, as well as the supply
side in relation to tobacco and alcohol products, and in its background
documentation refers explicitly to the need to reduce alcohol consumption
among the whole population.
The law has been in force since 1. January 1993. It restricts the sale
of alcohol in sports arenas, in vending machines, in student canteens and
in petrol stations. The most controversial part of the legislation, however,
concerns advertisement. It prohibits direct or indirect advertising of
alcoholic drinks on television and cinema, in stadiums, public and private
sports grounds, swimming pools, competition arenas and all areas used by
youth associations or for education. Advertising was authorised in the
original law on radio only within certain specified time slots, on billboards
or notices only in zones of production, and it is permitted within sales
outlets and in the press, except for publications aimed at young people.
The content of the advertising messages was strictly limited to product
information concerning (Art. 18): the alcohol content, origine, the categorisation
(denomination), ingredients, the name and adress of the producer, the agents
and distributors, modalities of merchandising (packaging etc.), and the
manner in which it is supposed to be consumed (mode de consommation).
Specifically the permitted announcements must not include any encouragement
to minors. It is forbidden to give, distribute or send documents or objects
naming an alcoholic drink to those under age. Lastly, advertisements for
alcoholic drinks must include a health warning stating that alcohol abuse
is dangerous to health.
A specific aim of the legislation was to avoid the possibilities of
indirect advertisement that had been extensively used under previous legal
restrictions. Sponsoring involving advertisement for tobacco and alcohol
products was completely banned, which violated serious interests in mass
media sports, especialy soccer and formula racing, but was felt necessary
because of the widespread use of indirect advertisement before.
In the controversy during the legislative process the alcohol lobby
argued that tobacco and alcohol should not be combined in the same law
since the nature of the problem is completely different in the two cases.
The wine lobby attempted to exclude French quality wines from the law .
The negotiations that ensued introduced a number of compromises and minor
qualifications in the law that later proved fatal to its intents. Also,
a number of issues were to be ruled by the ministry later on by decrees,
and that also proved to be a problem for the implementation of the law.
The advertisement industry announced that the limits of the law would be
pushed as far as the letter will allow as regards the content regulations
.
The Campaign
The process that led to the adoption of this restrictive law on alcohol
became adopted in France was complicated and interesting as such. The initiative
came from five prestigious professors of medicine, G?rard Dubois, Claude
Got, Fran?ois Gr?my, Albert Hirsch and Maurice Tubiana. Their campaign
was carefully planned, and the outcome has been presented as the first
lobby victory within the public health field in France.
The background of their initiative can be traced back to 1984, when
the High Committee for the Study and Information on Alcoholism presented
a proposal for a ban on advertising of alcoholic drinks directed towards
adolescents. However, possible restrictions on alcohol advertising were
challenged by the new media situation. For instance, in 1985, it was decided
that advertising for alcoholic drinks with less than 9 percent alcohol
was to be allowed in the new private TV-channels.
Professors Dubois and Got were at that time members of the High Committee
for the Study and Information on Alcoholism (HCEIA), and together with
Gr?my, Hirsch and Tubiana they decided to launch a campaign to get a new
and more restrictive law on alcohol advertising. Then Prime Minister Jacques
Chirac announced that although alcohol advertising could be banned in public
television by administrative decision, a ban in the private TV channels
required a new law. In 1987, this initiative was formalised in a
new law (Loi no 87-588 30 July 1987), often referred to as the Loi Barzach
after the minister for Health Mich?le Barzach. This law banned alcohol
advertising on TV for the first time in France.
The five professors were however not content with this law, and when
Claude Got in 1988 was appointed to prepare a new policy paper on prevention
of AIDS, he decided with his close colleagues to also address public health
issues that were regarded as even more important, namely traffic accidents,
smoking and alcoholism. The process towards the Evin Law picked up
speed in 1989, when the five professors were commissioned to prepare a
white paper on these three issues by the minister for social affairs Claude
?vin. In this paper, they raised the need for firmer actions in order to
reduce the harm resulting from alcohol consumption. Their proposal for
the new legislation included a wide range of public health issues: screening
for certain cancers, reducing the number of traffic fatalities, and excessive
use of psychotropic drugs, which is high in France.
The Minister for Social Affairs accepted the propositions from the five
professors on tobacco and alcohol, and it was decided to present a proposal
for a new law before the Parliament in May 1990. The new law would be presented
as a matter of urgency. After a very intensive debate on alcohol - the
legislation concerning tobacco was less controversial - the law was accepted
by the National Assembly on the 27th of June 1990, and with some modifications
by the Senate on 16th of October the same year. The Senate, however, excluded
the reglementations on alcohol advertising. The revised text then when
back both to the National Assembly and the Senate were the final text was
adopted in December 1990 and became law in January 1991. In the Assembly
the Socialist Party voted in corpore for the legislation presented by the
socialist minister, but in the Senate the Socialists were first opposed.
The Communists were against throughout the process, whereas the bourgeois
parties were divided. Despite the amendments that were adopted in this
process, the final legislation was for the most part in line with the proposal
of the five professors.
An important part of the campaign was an article bearing the title No
to a minister of disease! that appeared in Le Monde the day after the white
paper was published. They claimed that "the government should not hesitate
in implementing a public health policy, and not delay measures that have
a general interest and the support from the majority of the population
and of the politicians” (Dubois et al., 1989). The media approach was combined
with active lobbying in the political arena. The whole medical community,
including the three Nobel Prize winners and the five medical faculties,
was mobilised to support the initiative.
The total consumption framework was central in the approach from the
five professors, and a number of references were made to the work of Ledermann
in the background material , and also in the document prepared by the ministry
of social affairs to introduce the legislation to the public. The universalism
of the Epidemiological Model was an important part of the campaign. The
restrictions of advertisement and availability that they proposed in the
name of the public good concern everyone in the same way. It is important
that especially the media to which all are exposed regardless of their
will should be clean of advertisement. A further aspect of the universalism
is the solidarity argument involved. The professors published a second
article just before the bill was presented to the Assembly, writing that
“the hundred million premature deaths caused by alcohol and tobacco are
not randomly distributed. The life expectancy of a manual worker at the
age of thirty-five years is eight years less than that of his age mate
belonging to the upper middle class. These inequalities are largely explained
by the capacity to manage the risk related to tobacco and alcohol by the
social groups that are in a favorable familial and educational environment”.
In their public articles the professors employ the rhetorical format
of the pending narrative , placing themselves on the side of the public
good against the threatening private interests (Sulkunen & T?rr?nen
1997). But they also wanted to get around the political elite, resorting
to the classical method of French intellectual movements - the petition
(Ory & Sirinelli 1986): “The group prepared, we had an idea, and since
we had the support of the Nobelists etc., yes, let’s make a petition to
the people: destroy the politicians! The politicians are intermediaries,
elected by the people. When you turn directly to the people, you ignore
the politicians, that’s for them the most disagreable thing. So we made
an appeal to people in le Monde asking them to subscribe, and to send us
money” (G. Dubois, interview 9 Octobre 1992)
The new and strange aspect of this self-definition is not that intellectuals
represent themselves as vanguards of the people; what is striking is that
this time the vanguards come not from the margins of intellectual life
– the literati and the artists, but from the center of the intellectual
field (Bourdieu 1986).
Instead, the margins, social workers who were at the time in the process
of establishing their own national network of “alcoologists” as a counterbalance
to the medically dominated and temperance-affiliated treatment community,
were against. They considered the initiative a hypocrisy, and argued that
it is paternalistic to attack the availability and advertisement of alcohol,
while the real issues of poverty, exclusion and education were not addressed.
In sum, the Loi Evin was a victory for the public health lobby over
the alcohol and advertisement industries, and France had adopted the most
restrictive legislation on alcohol advertising in the European Union. Like
the beverage laws that were adopted by the Mend?s-France (Code de Boissons,
1959), the public health interests had won a more or less unexpected victory.
The campaign fought by the five professors of medicine was crucial in
this process, infused with references to the values of modern welfare state:
universalism, solidarity and justice as well as science and health.
The Evin Law on the national arena
The Evin Law has been highly controversial throughout its existence, and
its implementation has been systematically maimed by various groups in
the French society. One of its immediate effects have been said to deprive
the press about one fifth of its advertising revenue (Dorozynski, 1995),
and the press has also been supported by the drinks industry in their opposition
against the law.
With respect to alcohol, the controversies of the Evin Law have lead
to a number of important modifications following lobbying pressures. The
legislation has been watered down in relation to alcohol advertising, distribution
and sponsoring.
The first indication of the difficulties to come was the ministerial
decree specifying that the permissible hours of radio advertisement would
be from midnight to 5 pm on weekdays except Wednesdays (when children are
not in school). Symbolically the critical issue was advertisement
on bilboards. The Evin Law had originally forbidden this kind of advertising
in sport stadiums, public and private sports grounds, and areas used by
youth associations or for education. The amendment permitting it in “zones”
of production instead of “sites” or “regions” of production in the original
text, was intentionally vague, and the decree to define that term could
never be given. The courts were unable to decide whther that situation
implied that the whole of France is a “zone of production” or whether the
lack of definition implies that bilboard advertising is not allowed.
As a result, the ban was lifted by a legal amendment from 8. August 1994.
The billboards were still obliged to include a health warning but its formulation
has been under constant pressure from the industry.
Concerning alcohol advertising on TV, in 1995, the French government
set up a "voluntary code" through the CSA (Conseil Sup?rieur de l’Audiovisuel),
in charge of regulating the audiovisual sector. This code of conduct allows
alcohol advertising on TV under certain circumstances, and can therefore
be regarded as an exemption to the original law.
In 1996 the annual authorisations for sale of alcoholic beverages in
sport stadiums were increased from 1 to 10 (Law no 96-704 from 8 August
1996). At the request of the catering indusrty the High Court decided that
this is not legal, and therefore in 1998, the “Buvette” amendments were
adopted in the law to re-establish alcohol sales at sports stadiums. Since
they are thus also service areas, bilboard advertising is allowed, which
means a considerable extension of the permissible advertising regulations
as compared to the situation before 1991 (Conseil national d’evaluation
1999, p. 163).
These amendments and specifications to the Evin Law can be explained
in a number of ways. Firstly, it has been argued that the French government
was not aware of how much money the tobacco and alcohol industry sponsored
sport activities. Secondly, and more important, the watering down of the
Evin Law should be viewed against the strong forces on the national arena
that have consistently challenged the law since it became effective. Thirdly,
and as we will return to in the next section, also the international level
has had an impact on the Evin Law.
The Evin Law on the international arena
The Evin Law has not only been controversial among groups in France, but
the law has also been regarded as an infringement of the single market
rules by the European Union. During the summer of 1996, the European Commission
sent a reasoned opinion concerning this matter to the French government.
However, in a meeting of the full Commission in March 1997, the public
health aspects were said to outweigh the single market considerations (European
Voice, 1997). Despite opposition from the Single Market Commissioner, the
Commission maintained the decision to not proceed with legal action against
the French government in June 1998 (European Voice, 1998). Nevertheless,
in March 2000, the new Single Market Commissioner, Fritz Bolkestein, declared
his intention of pursuing the Commission’s investigation of the Evin Law,
and the Commission has recently made an attempt to resolve the dispute
by trying to make it explicit that the law will not be applied beyond French
borders (European Voice, 2000a). The aim of the Commission has here been
to reach an agreement with France, without bringing the matter before the
European Court of Justice. The Commission has claimed that one way to proceed
would be to restrict alcohol advertising through the adoption of more voluntary
codes of conduct instead of binding regulations. The exceptions to the
Evin Law that has developed over the years should therefore also be viewed
in this international perspective.
However, the Commission’s strategy of keeping the Evin Law out of the
Court has not succeeded, and the law was brought before the Court by an
order for a preliminary ruling by the High Court of Justice in the UK (Case
C-318/00). The question that was referred to the Court concerns whether
the French ban on advertising of alcoholic beverages is compatible with
the EC Treaty. This case stems from complaints by two drinks firms, which
were forced to remove their adverts from a match at Newcastle United Fotball
Club’s ground because the game was to be broadcast in France. This happened
even if the billboards were legal under UK law. The European Court of Justice
is currently seeking comments from the EU member states on this case (European
Voice, 200b).
The 1999 evaluation report
The Evin Law was evaluated in 1999, and the evaluation report that was
given to the Prime Minister clearly stated that the law had more or less
failed with respect to alcohol. Concerning alcohol "le status quo n’est
pas acceptable" (Conseil national de l’?valuation, 1999: 6). The main reason
for this was the numerous modifications and exceptions to the law that
had been given over the years. The results of this had had led to inconsistencies
between the law and the established practices, but also between different
practices. A major problem has been the large number of court cases over
the interpretation of the content regulations of the law. The associations,
especially the Association Nationale de Protection contre l’Alcoolisme
(ANPA) has had a major role as a civil party.
The report therefore concluded that with regard to alcohol the law had
lost its original intent and must be completely rewritten in order to make
the regulations legally consistent. The Evin Law had not been implemented
in a manner that the five experts had hoped for. Economic and market interests
had successively managed to empty the law of its public health content,
taking advantage of the almost unnoticeable needle-holes introduecd in
the amendments of the original text, and by 1999 its future was unclear.
Concerning tobacco, the Evin Law has been assessed as successful by
the Commission of evaluation, although also here a number of exemptions
from the original law had been granted over the years.
The 2001 Kouchner Plan: A New Cycle
The adoption of the Evin Law in the early 1990s represents a high point
in relation to alcohol control in France. However, as was underlined in
the 1999 evaluation report, the law did not live up to the expectations
viewed from a public health perspective.
However, when it seemed like the public health interest had lost in
relation to alcohol, a new strategy paper was presented by the French minister
for Health Bernard Kouchner on 27th of September 2001 (Strat?gie d'action
alcool, 2001). This paper indicates a new cycle in the approach on alcohol
in France, and the public health interests are again brought to the forefront.
The main conclusions of this paper can be formulated in three points. First
of all, the established objective of promoting "moderate alcohol consumption"
is suggested replaced by "low alcohol consumption". Second, it is argued
that the traditional focus on problem drinkers must be replaced by a new
focus on the overall level of consumption in the French population. Third,
the Loi ?vin is assumed to play a key role in this new approach.
To the first point, the paper claims that the objective of French alcohol
control policies should be "low alcohol consumption" based on the recommendations
of the WHO and the scientific literature. It is claimed that the idea of
moderate drinking has to be abandoned because this notion allows individuals
to define for themselves what is moderate drinking. These individual definitions
are said to be too often above what is epidemiologically defined as low
risk.
To the second point, it is claimed that today's goal of a public health
policy is to speed up the process of reducing the total consumption by
focusing on the mean consumption of drinking and heavy drinking occasions,
and not only the fight against alcoholism (Strat?gie d'action alcool, 2001:
4). And further, "to speak to the total population in order to reduce the
total consumption does not mean to address an abstract population but to
put into place means which are aimed at different segments of population
and its different consumption patterns" (Strat?gie d'action alcool, 2001:
18).
Third, the Evin Law is assumed to play a key role in connection with
this new strategy, and the ambition is to strengthen the law. It is claimed
that the ideas behind the Evin Law are good, but it has not worked in practice
(Strat?gie d'action alcool, 2001: 15). Also the evaluation report that
was given to the Prime Minister in October 1999 underlined the incoherence
between the legislative dispositions and the present regulations. In the
conclusions of the paper, it is therefore emphasised that the Evin Law
has to be strengthened. One way to achieve this will be to eliminate the
number of exceptions from the law in the area of publicity within sports,
as well in the fields of cultural and scientific activities.
CONCLUSIONS
The debate between control policy or availability approaches and "harm
reduction" is undoubtedly the key point in understanding what European
alcohol policies will be like and what measures will be possible and reasonable
to elaborate in detail, considering the role of the state, the legal and
institutional structure of the EU and the less tangible cultural or ideological
dispositions of the population towards policy-making in this and similar
areas of private risks with public consequences. The contrast between the
two orientations is real and important. However, the French example shows
that it should be seen less as a contrast between two epidemiological models
which, at the end of the day, in fact do not even seem to be in conflict.
It is difficult to see in what circumstances (other than possibly total
legal prohibition) this would not work in the direction of reducing total
consumption, and work especially on the high end of the consumption distribution,
rather than vice versa. A better terminology would be harm-oriented versus
consumption-oriented policy, or targeted versus non-targeted approaches.
The paradigmatic case of harm-reducing policy is to separate alcohol
from situations where it is likely to cause serious damage and/or to induce
minors to drink. Both were the intentions of the Evin Law in its attempt
to restrict the availability of alcohol in traffic, sports contexts and
work, as well as to limit the exposure of youth to alconol advertisement.
However, its underlying philosophy was based on the Epidemiological Model.
The French policy cycle demonstrates that the viability of the Epidemiological
Model depends not on the epidemiological arguments per se but on a contrast
between two different social philosophies, and that in two senses: (a)
what is implicitly assumed about the social world in the policy discourse
itself; and (b) what is assumed to be assumed about the social world by
those who formulate and enact the policy and by those who are affected
by it and react to it - consumers, voters, market forces, political parties,
local communities, the associations and not least, the state administration
itself.
The attractiveness of the Epidemiological Model and its success in justifying
the initial formulations of the Evin Law was based on two of its properties.
First, it is an expert position – only research can provide the necessary
evidence on the relationship between the number of deaths and the consumption
of alcohol in the population. Secondly, it appeals by its universalism,
and by the argument of solidarity that it implies. It is an apparently
neutral position in terms of the value of the pleasure itself, and only
makes an argument about the consequences of indulging in that pleasure
on the population level. Both of these values are well adapted to contemporary
modern and pluralistic societies where it would be very difficult to agree
on whose drinking and what kind of drinking should be permitted or rejected,
and where the calculation of risks rather than guarding over behaviour
is the proper role of experts.
But the French public health cycle shows that these two aspects of the
epidemiological argument are also its weaknesses. The statistical relationship
between total consumption and the prevalence of problems is not obvious
to the public, and evokes the issue of trust in a world, which is impregnated
with suspicion for hidden interests. And the struggle against total consumption
is never only a technical matter but always also involves a setting of
priorities, and some priorities necessarily imply a sacrifice of others.
The French public health cycle shows that there is no absolute reason why
the values of solidarilty and the public good could not stand up to private
interests and individualism even today, but there is no guarantee of their
success either.
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