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Are consumer surveys useful as a basis for alcohol and other public health policy?

The recent post by VicHealth CEO, Todd Harper, about community support for alcohol labelling has clearly generated some considerable thought by health policy analyst Jennifer Doggett, who recently responded with this post.

She’s now come back to the discussion with some more points to make. She writes:

“We would be outraged if the airline industry determined aircraft safety standards by a telephone poll of the general public.  We rightly expect that these standards are based on evidence that they will result in safer plane travel.

However, when it comes to public health, we often seem happy to accept consumer surveys and opinion polls as evidence to support the implementation of a proposed policy.

For example, the Victorian Health Promotion Foundation (VicHealth) recently claimed that Victorians supported the introduction of labels detailing health information on alcohol products, based on research commissioned by them and conducted by The Social Research Centre.

The research involved a state-wide telephone survey of approximately 1500 Victorians who were asked a range of questions, including whether they supported labels on alcoholic beverage containers.  The study found (among other things) that 85 per cent of respondents supported labels which included recommended daily guidelines for low risk alcohol consumption; 89 per cent supported a warning message advising that exceeding the recommended guidelines may be harmful; and 91 per cent supported health warnings for specific groups – for example, pregnant women, young people.

When releasing the report, in a media statement titled “Victorians call for health labelling on alcohol products”, VicHealth Chief Executive Officer Todd Harper said  “The message is clear. Victorians support mandatory consumer information labels on all alcohol products, so they can make more informed decisions about their drinking.”

Even allowing for a little media latitude, this statement is misleading.

Asking consumers whether or not they support alcohol health warnings, in the absence of providing any alternative options for the use of the resources involved, is meaningless as a basis for policy making.  When it comes to health, consumers generally want more of everything – as long as there are no costs attached.

If they had asked the same group of consumers if they would support building a new state-of-the-art hospital in their local neighbourhood, most would probably have said yes.  That doesn’t mean that Victorians are calling for an additional 500 new hospitals in their state.

Policy making is about balancing multiple needs and determining the best use for limited resources. If it costs the alcohol industry (say) $10 million to put health information on their products then this is $10 million which cannot be spent elsewhere, for example on alternative alcohol harm-reduction programs, additional health services, other social welfare programs or simply provided to consumers directly.

Whether or not consumers (or the government) would bear the cost of these strategies directly is irrelevant. The opportunity cost (the cost of the nest best policy alternative) of implementing alcohol health warnings is the same, regardless of where the dollars come from.

Therefore, in order to accurately assess whether consumers support health warnings above other alcohol harm reduction strategies, they should be asked whether they would prefer to have health warnings included on their beverages OR targeted youth alcohol programs OR additional law enforcement efforts OR more treatment services OR another alternative strategy.  To find out whether alcohol harm-reduction programs are a priority for consumers they need to be asked whether they would prefer the $10m to be spent on alcohol programs or allocated elsewhere.  Of course, if consumers’ views can be informed by evidence of the effectiveness of different strategies, the results of such a survey would be even more useful.

The VicHealth research does provide useful information about the content and tone of health messages that consumers would prefer, if such information is going to be included on alcohol product labels.  However, this is a separate issue from whether or not they support a mandatory alcohol health warning policy overall.

Alcohol misuse is a serious health and social problem. Getting alcohol harm-reduction policies right can reduce the health, social and economic costs that it imposes on our community, not to mention save lives. Reaching agreement on what does (and does not) constitute evidence to support competing policies is a great place to start.”

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