A new EU Alcohol Strategy? - European Union Committee Contents


CHAPTER 9: RESEARCH


245.  As we said in Chapter 3, the Fifth Priority of the Strategy was to "Develop, support and maintain a common evidence base". This was underpinned by Aim 10: "To obtain comparable information on alcohol consumption, especially on young people; definitions on harmful and hazardous consumption". In our request for written evidence we specifically asked whether the EU's alcohol policies were in fact underpinned by a sound scientific base.

246.  Witnesses who answered this question thought, without exception, that any strategy and indeed any action on alcohol policy should have a sound scientific base. We agree. Indeed, this is true of any policy, and President Juncker, in a recent letter to the Chairman of this Committee, has confirmed that he is "a strong believer in the necessity to ground policies in solid evidence, with the help of independent scientific advice".[233]

Research Commissioned by the EU

247.  Sarah Godman from the NHS European Office described to us the relevant research over the last 10 years:

    "The EU's Health Programme has supported 37 projects since 2004 on alcohol-related harm in support of the alcohol Strategy. The existence of the strategy has helped to focus the funding that is channelled through that programme. There have been projects that supported all areas of the Strategy. It is probably also worth noting that the research programme, which has larger funds apportioned to it, has also funded a number of research programmes that underpin the research that is necessary for a lot of the public health work that is funded through the EU's public health programme. The 37 projects funded through the EU Health Programme came to about €15 million of EU support. There are four strong significantly relevant projects funded through the research programme, which amounted to another €15 million of support. Those four projects had strong involvement from the UK, particularly from higher education institutions."[234]

248.  Looking at rather different dates, the 2012 evaluation of the Strategy stated: "Since 2007, the EU Health Programme has supported alcohol related projects with approximately €9 million, and the EU Research Framework Programmes provided approximately €49 million for studies on alcohol and health. These amounts represent, respectively, less than 3% of the total budget of the Health Programme for 2008-2013, and less than 1% of the budget for health under Seventh Research Programme."[235]

249.  One of the projects we heard most about was AMPHORA.[236] This was a four year project funded by the 7th Framework Programme of the European Commission, which aimed to contribute new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. It involved research institutions from 12 European states in collaboration with organisations from all the Member States. Among the research areas covered by AMPHORA were an update on European epidemiological data; the definition of standard common indicators of alcohol consumption and harm; the measurement of the strength of alcohol policies; the study of contextual determinants of alcohol consumption, the analysis of the impact of marketing on youth; the availability of treatments at a European level; and two areas of harm reduction (contamination of illegal or surrogate alcohols and the reduction of harm in drinking venues).

250.  Ms Godman told us that one of the biggest projects funded by the research funds in the 7th Framework Programme was ALICE RAP,[237] "which did research into addiction—broadly, not just alcohol—and lifestyles in contemporary Europe. Around €8 million was given to that project alone. It had 42 participants, twelve of whom were from the UK."[238]

251.  For the future, DG Research currently has a programme, Horizon 2020, running from 2014 to 2020, which has a budget of €7.5 billion allocated to health, democratic change and well-being. Within this programme, Ms Godman told us that "the Council has recommended an ongoing area focusing on effective health promotion, disease prevention, preparedness, screening and research that tries better to understand health, ageing and disease. There is definitely scope for projects on alcohol harm-related projects or on understanding the impact of alcohol on health, ageing and disease."[239] In addition to the funding of Horizon 2020, the EU's health programme provides approximately €450 million for health research from 2014 to 2020.[240]

252.  DG Research provides funding in response to bids from researchers. In Ms Godman's words, it "basically waits for excellent proposals. It is a competitive funding line. It is driven by the kind of proposals that it receives. If there are excellent research projects on alcohol, they have every chance of success. This programme is demand driven. It is supposed to be grass-roots research on expert opinion."[241]

253.  Dr Ruxandra Draghia-Akli and her colleagues confirmed this in the evidence we took from them. They explained that they were sponsoring programmes "around the biology of ageing, addiction and the mechanism of ageing—it is not alcohol only, it is the link between alcohol and nicotine and the link between alcohol and transport, driving and behaviour and all these areas that are interlinked."[242] In other words, the policy of DG Research is not to take the initiative, but to respond to proposals from researchers, and requests for funding. This is essential to provide a scientific basis for developments in health and wellbeing, and it is right that researchers should take the initiative in proposing the topics for such research.

THE PERCEIVED QUALITY OF RESEARCH

254.  Where the formulation of policy requires additional research into specific issues, this has to be commissioned by DG SANCO, which is responsible for the formulation of the Commission's alcohol policy. The fact that those formulating the policy are also commissioning the research does not in our view mean that the quality of that research is necessarily compromised, but it can give rise to such a perception, in particular where the alcohol industry might be adversely affected by policies which the research might support. SpiritsEUROPE told us they had "concerns about the way research on alcohol-related harm is funded, conducted and presented by DG SANCO, believing much of the 'evidence' generated provides misleading signals to policy-makers."[243]

255.  Speaking for the WHO, Dr M¾ller told us that they had been "extremely happy" with the quality of the EU-supported research: "we published a book … where we went through all the 10 action areas [of the Strategy] and the evidence for all these policies. A lot of that was based on the EU-supported research, so we had a very good evidence base when we drafted our action plan."[244]

256.  However, the quality of much of the research was the subject of sustained criticism from the industry, retailers and advertisers. The WSTA told us that "The quality of the research in a number of projects funded by the European Commission has been poor and this has been challenged by the European body representing national trade associations and the alcohol industry."[245] Mr Baker too thought that the quality of research was "patchy and haphazard".[246]

257.  The Scotch Whisky Association wrote:

    "It is important that research used by policy-makers is relevant, neutral and objective, fair and transparent, robust and based on appropriate engagement with all stakeholders, and subject to the highest levels of scrutiny and accountability. It should be conducted to the highest methodological standards, with data sources that are transparent and accessible. These principles have not always been respected in the past. We have seen projects funded by the EU which have been presented to the EAHF. In our opinion, a number of those reports have had pre-judged conclusions and been conducted with the aim of justifying a particular policy recommendation. These reports are now being widely quoted by health stakeholders as irrefutable evidence."[247]

INDEPENDENCE OF RESEARCHERS

258.  The problems are compounded when the researchers and the policy-makers who are also in charge of the funding are seen to be getting too close. Mr Skehan told us:

    "What we see time and again is that we have a whole group of people who are not quite making a living from this but certainly it is a part of their life and they are drawing down funds to produce material that we do not have trust in. We are not against research. I come back to this. We firmly believe it is the way it should be, but we would love to see it be more neutral, less biased, with oversight by some neutral body."[248]

259.  SpiritsEUROPE made a similar point, saying they had "concerns about the way research on alcohol-related harm is funded, conducted and presented by DG SANCO, believing much of the 'evidence' generated provides misleading signals to policy-makers … We have noted that the funds available have been repeatedly allocated to the same entities, even though the quality of the reports produced was consistently questioned. Of nearly €15 million awarded in research contracts between 2009 and 2012 across 10 projects, RAND Europe were awarded three projects,[249] the Dutch Institute for Alcohol Policy (STAP (NL)) gained three, and the same researchers—and research topics—crop up time and again."[250]

260.  The same point was made by Mr Beale: "Eleven projects have been conducted, to the tune of €15 million, and some organisations—and I shall not name them—appear four or five times, so that is almost 50%."[251] Mr Duffy said: "My view of the AMPHORA and ALICE RAP projects is that while they may well be extremely worthy, they always involve the usual suspects. The scientific quality is variable."[252]

261.  The criticism of a lack of independence is not all one way. ScHARR told us that "Senior researchers have encountered inappropriate involvement of the alcohol industry in the research process, particularly around the lack of promotion and utilisation of research findings which are contrary to industry interests."[253] On the other hand, as Mr Ashworth said, "If the drinks industry were to do research, the public health community would not accept that research."[254]

262.  The Minister thought it unrealistic to expect all concerned to agree on evidence: "I do not think that we see it as [a] primary aim to obtain universal consensus on evidence, because I think we fear that we would never act if that was the bar that was set. It is almost inevitable that there will be disagreements about evidence, and even if we have really good evidence, such as on the relationship between high levels of alcohol consumption and increased health risks or the relationship between price and consumption, it might not be accepted by some, so I think it is always the case that even when one group says, 'We are absolutely convinced that this is solid evidence', there will be others who will dispute it."[255]

263.  We accept that there will be disagreements about the value of evidence and the strength of any conclusions based on it. But we do not think progress will be made unless there is a degree of mutual trust in the researchers and their work. Policies cannot sensibly be discussed, whether at EU or national level, unless there is a basis of evidence derived from research which is trusted by all, including the public health lobby and the industry.

264.  It is clear from our witnesses that there is scarcely a single matter on which the evidence is currently trusted by all concerned. Whether what is at issue is an attempt to measure the harm caused by excessive and irresponsible drinking or the effect which pricing, advertising or labelling policies have in reducing alcohol-related harm, or any other relevant issue, research is currently trusted only if its results happen to coincide with the interests of those considering it.

265.  We are not ourselves qualified to evaluate any of the research which has been criticised, and we do not take a position on the criticisms of its quality. Nor are we suggesting that there is or has been any bias in the selection of researchers, or defects in the conduct of research, or lack of integrity in its conclusions.

266.  Where those responsible for formulating policy, in this case DG SANCO, identify a need for further information, they are best placed to commission such research.

267.  The quality of research will be questioned if it is carried out by researchers who are perceived to have vested interests in the outcome. The best way to diminish any such perception is to commission research from as wide and varied a network of researchers as possible. This should be done through competitive tendering.

268.  It should be no part of the researchers' task to suggest what policies should be based on their findings. Any attempt to do so will give rise to the perception of a lack of independence.

Where research is needed

269.  We received a considerable quantity of evidence on the matters which witnesses felt needed further research. Mr Acton commented: "We need to distinguish between areas of policy that are under-researched and those where there is lots of evidence … there is a lot of evidence on alcohol, taxation and price. There are a lot of areas of alcohol policy that are under-researched, including harms to young people. Although having a lot of evidence does not guarantee consensus, if you have very little evidence there is still less chance of consensus." The Minister agreed: "We would be keen to see the EU focus on areas that have been under-researched and where the research would be the most helpful."[256] Four such areas identified to us by witnesses were behavioural change; the impact of advertising on consumption by children and young people; harm to others; and alcohol-related crime.

BEHAVIOURAL CHANGE

270.  Dr M¾ller advocated further research into behavioural change:

    "We know very little about how to change behaviour, but we know that policies do change behaviour. We can see that with the smoke-free environment … A little more about behaviour, binge drinking and so on would be interesting … We have these differences: some countries binge drink, while other countries do not, and we see much more harm when you binge drink … We do not have very good evidence about whether education, training and awareness has any impact. So far the evidence is that it is not very useful."[257]

THE IMPACT OF ADVERTISING ON CONSUMPTION BY CHILDREN AND YOUNG PEOPLE

271.  We have already quoted[258] the view of Mr Acton that, although there is "quite solid" evidence for the effect of advertising on adults' alcohol consumption, there are evidence gaps on the effect of advertising on consumption by children and young people. There was also, in his view, very little evidence on effective interventions to restrict advertising.[259] Given that such research as there has been on these topics, and the evidence and findings derived from it, are so strongly contested, we agree that this must be a priority area for future research.

HARM TO OTHERS, AND ALCOHOL-RELATED CRIME

272.  Data on alcohol-related harm to others are at best patchy, both at UK and EU levels. Ms Brown told us: "there are definitely gaps with regard to monitoring levels of harm, particularly harms to third parties: rates of alcohol-related domestic abuse, child abuse, rates of foetal alcohol spectrum disorder, and … rates of exposure of alcohol marketing and advertising to children…. If we can quantify that burden and that harm, that will produce more evidence and more incentive to governments to take action and implement effective policies, and that is where better data collection will be able to help. Dr Gillan agreed: "Where we have the gap is harm to people other than the drinker. We did a national survey in Scotland that showed that one in two people reported being harmed in some way as a result of someone else's drinking, and one in three people had a heavy drinker in their life."[260]

273.  Mr Ashworth made the same point in relation to alcohol-related crime: "There is no comparable alcohol-related crime data, such as government statistics comparing one country to another in terms of alcohol-related crime. We know in the UK that violent crimes related to alcohol have decreased 32% since 2004 and 47% since 1995. Are we doing better or worse than other countries, and why would that be?"[261]

274.  Behavioural change, the impact of advertising on consumption by children and young people, harm to others and alcohol-related crime are some of the many areas where there are gaps in knowledge and where further research would significantly assist policy formulation.

STANDARDISED TERMINOLOGY AND MEASUREMENT

275.  Member States have different ages of majority and different minimum ages for buying alcohol, so that the use in research of words like 'child', 'young person' and 'adult' may not compare like with like, and should therefore be avoided. The WHO refers to 'adult (aged 15+)'. It seems to us that the only sensible classification is to refer to ages, and that the EU could influence researchers and the authorities of Member States to use common age ranges.

276.  Mr Beale thought that "Better comparability of data across the EU can really only be done at EU level, for the Commission, for Eurostat, for others. One area where this is a problem, for example, is that WHO, Eurostat and Member States all have slightly different definitions of alcohol­related harm, and that gives you obvious comparability problems in looking at the figures across the union."[262]

277.  Eurocare suggested that: "Common measurement standards could be agreed across the EU in order to monitor and evaluate alcohol harm and interventions to reduce harm and help to prevent cross-border discrepancies. For example, a common unit of alcohol or standard drink would harmonise consumption trend data across the region and also allow for common EU consumer information such as low risk drinking guidelines and health information on labels."[263]

AROLE OF THE SCIENCE GROUP

278.  Prof Sheron said: "There is a role here for the Science Committee, perhaps reporting to CNAPA or to the Commission itself, not only giving a verdict on establishing the evidence base and stamping its imprimatur on it, but outlining where the research gaps are."[264]

279.  The Science Group could play a useful part in identifying gaps in the knowledge surrounding alcohol-related harm, and suggesting the parameters for research. It could also promote standardised terminology and common measurement standards to improve the comparability of research across the EU.


233   Letter of 16 January 2015 from the President of the Commission to Lord Boswell of Aynho, Chairman of the House of Lords European Union Committee, and the Earl of Selborne, Chairman of the House of Lords Science and Technology Committee. Back

234    Q21 Back

235   COWI-Milieu, Assessment of the added value of the EU strategy to support Member States in reducing alcohol-related harm, Final Report (December 2012), paragraph 2.5: http://ec.europa.eu/health/alcohol/ docs/report_assessment_eu_alcohol_strategy_2012_en.pdf [accessed 24 February 2015]. These figures were cited by a large number of our witnesses in written evidence, including Eurocare (EAS0006), Alcohol Health Alliance UK (EAS0012) , Balance (EAS0017), Institute for Alcohol Studies (EAS0002), and SHAAP (EAS0001), and Katherine Brown  Q45  Back

236   Alcohol Measures for Public Health Research Alliance Back

237   Addictions and Lifestyles in Contemporary Europe Reframing Addictions Project Back

238    Q22 Back

239    Q21 (Sarah Godman) Back

240   European Commission, The Third Health Programme 2014-2020: Funding Health Initiatives Factsheet http://ec.europa.eu/health/programme/docs/factsheet_healthprogramme2014_2020_en.pdf [accessed 24 February 2015] Back

241    Q21 Back

242    Q141 (Maria Vidal, Head of Unit for Medical Research) Back

243   Written evidence from spiritsEUROPE (EAS0025) Back

244    Q80 Back

245   Written evidence from WSTA (EAS0016) Back

246    Q64 Back

247   Written evidence from SWA (EAS0020) Back

248    Q134 Back

249   One of these was the report by RAND Europe on the assessment of young people's exposure to alcohol marketing in audiovisual and online media, which we have referred to in Chapter 5. Back

250   Written evidence from spiritsEUROPE (EAS0025) Back

251    Q198. The bodies Mr Beale declined to name are those listed by spiritsEUROPE in their written evidence, quoted in the previous paragraph. Back

252    Q65 Back

253   Written evidence from the University of Sheffield Alcohol Research Group (ScHARR) (EAS0014) Back

254    Q36 Back

255    Q236 Back

256    QQ236-237 Back

257    Q96 Back

258   Paragraph 172 Back

259    QQ23-24 Back

260    QQ42-43 Back

261    Q216 Back

262    Q187 Back

263   Written evidence from Eurocare (EAS0006) Back

264    Q44. See also the evidence from Lundbeck Ltd (EAS0011) quoted in paragraph 227. Back


 
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