Lecture notes on medical sociology 1988

Lecture notes on medical sociology 1988

Sot. Sci. Med. Vol. 31, No. II, pp. 1285-1286,1990 Printedin Great Britain 0277-9536190 S3.00+ 0.00 Pergamon Press plc BOOK REVIEWS Akohol, Polit...

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Sot. Sci. Med. Vol. 31, No. II, pp. 1285-1286,1990 Printedin Great Britain

0277-9536190 S3.00+ 0.00

Pergamon Press plc



Politics and Social Policy, by Avebury. 176 pp. f28.50.


This is an excellent and important book. It is a pity that the price may confine its popularity to a specialist readership. It is principally concerned with the political and economic issues involved in the formulation of public health policy concerning alcohol in the United Kingdom. It traces the development of alcohol policy from Victorian times to the present. Views concerning alcohol related problems have changed during that time from a predominantly moralistic perspective to a disease model and most recently a public health point of view. Essentially the more a community drinks the more alcohol related problems it will experience. There is, therefore, an in-built tension between the desire of the drinks industry to expand and create more customers and the interests of those concerned with public health and public order. There are at least 14 different government departments involved in different aspects of alcohol use, including, for example, Agriculture, The Treasury, Home Office, Road Transport, Health and Social Welfare. Alcohol is also an important aspect of trade with whisky, for instance, being a major component of Scotland’s export. The Foreign Office, is, therefore, a further department with significant interest in this area. This international dimension of alcohol policy has, of course, grown with the develop ment of the European community and its commitment to a single market by 1992. Britain has always avoided formulating an explicit alcohol policy. The recent creation of a ministerial group concerned with alcohol implies a belated recognition of the importance of bringing together the many different points of view involved who have a legitimate interest in this area. The author points out that the relationship between price of alcohol in relation to disposable income is one of the most potent influences on consumption. The British Government has always been reluctant to use fiscal policy as a means of influencing consumption, despite the promptings of an increasingly vociferous health lobby in this area. The book described the magnitude of the drinks industry’s influence, an industry whose annual profits from production in 1986 were f 1300 million. A considerable number of MPs have some kind of financial interest in and commitment to the drinks industry. The significance of this lobby is ably analysed. In recent years the industry has acknowledged the social and health costs of alcohol and has contributed to research into these areas. They have, however, continued to promote the view that alcohol problems reside more in the drinker than in the drug itself. In contrast the health lobby has always seemed to be the poor relation in this arena and by comparison seem poorly organised and often late in making clear the damaging social and health consequences which may follow from attempt

Lecture Notes on Medical Sociology HANNAY.

1988, by DAVID R.

Blackwell, Oxford.

This relatively recent addition to the extensive Blackwell Lecture Notes series attempts to introduce the basic con-

image to increase the availability of alcohol or reduce the relative price. Dr Baggott describes the elements in this debate throughout the century. He also recognises that the issue has taken on a new dimension with the creation of the European community which accounts for an eighth of the world population and half of the recorded world production of alcohol. Alcohol policy must now take on a European flavour and the taxation policies of individual members of the community are now susceptible to the commission’s overall aims. For example, he illustrates the way in which the European community called on the U.K. Government to alter the structure of their duties on alcohol on the grounds of the system at that time discriminated against wine. The Commission believed that the U.K. was protecting its brewing industry by levying a disproportionate level of tax on imported wine. At first the British Government took the view that they were not protecting domestic brewers, claiming that the two products were not substitutes for one another. The Commission took the U.K. Govemment to the European Court which decided in favour of the Commission. This forced the Chancellor in 1984 to reduce the duty on wine by 18~ per bottle which led to a further rise in the consumption of wine in this country. In this, as on other occasions, the views of the health lobby were often very muted. Dr Baggott says “the lobby’s weakness was mainly due in this particular case, at least, because it failed to get its act together, it did not engage in lobbying to the same degree as the brewers and the licence trade, indeed by the time the alcohol misuse lobby realised the full implications of the proposed changes for alcohol prices it was far too late”. The same case might be made for the Commission’s proposals for harmonisation of rates of Excise Duty amongst the constituent members. This could result in a marked decline in the price of all alcohol drinks in this country with major implications for health and social welfare. The debate continues and its seems likely that the original proposals will be attenuated. How far the health of the community will be a significant factor in modifying the proposals is far from clear. This readable account of recent history should help increase awareness of the issues and forces involved. Economics and social policy may seem far removed from the day to day encounter with a client or patient in the consulting room. This book shows clearly why the health professions must take an active interest in politics and social policy. This book lucidly recounts one example of the general truth that economic and social policy often have far more profound effects on individual health than the advances of medical science or pharmacology. Department of Psychiatry Edinburgh University Edinburgh EH8 9YL Scotland



cepts of sociology as applied to medicine, to medical students and practising doctors. The approach is broad and general resulting in superficial treatment of themes and issues. It is also dated, much of evidence and no doubt a good deal of the text was produced in the 70s. There is



Book Reviews

almost no contemporary data or research. Although the book is offered as a possible component of a broader social science contribution to the medical student’s curriculum it shows little appreciation of, or linkages with, cognate disciplines, e.g. economics and the policy sciences all of which, together with sociology have much to offer the medical student. There is very little, alas, to enable a student to examine notions of community care and nothing on market oriented behaviour. Clearly an opportunity has been

missed and the readership to whom the book was directed would be better advised to consult the suggested further reading. Department of Social Policy and Professional Studies University of Hull Hull HU4 7RX U.K.