Home > Waiting for the wave: political leadership, policy windows, and alcohol policy change in Ireland.

Doyle, Anne (2021) Waiting for the wave: political leadership, policy windows, and alcohol policy change in Ireland. Drugnet Ireland, Issue 79, Autumn 2021, pp. 17-19.

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Background

Alcohol consumption has long been a source of major health and social problems in Ireland. A combination of factors undermined previous attempts to address alcohol as a public health issue, including the considerable political and economic power wielded by the alcohol industry and the failure of the Government to develop a fully integrated approach across its departments and agencies.

Methods

Using the multiple streams approach (MSA), a 2021 study focused on the period between 2008 and 2018 to explore how these barriers were overcome, how the Public Health (Alcohol) Bill made its way onto the Government agenda, and how the legislation was subsequently formulated.1

Results

Policy context

The public health community and the alcohol industry formed two opposing coalitions and competed to influence the direction of alcohol policy. Public health actors have historically found it difficult to counter the alcohol industry’s influence within successive Irish Governments. Economic priorities have dominated public health issues in discussions over alcohol policy. However, since the mid-2000s, the public health community has steadily gained more influence, helping shift the debate over alcohol. Increased public attention to alcohol-related harms (problem stream), developments within the institutional location of policymaking (the policy stream), and the political pressure exerted by politicians and advocates (the political stream) combined to open a policy window. 

The problem stream

Alcohol-related harms were highlighted by the Health Research Board (HRB) and provided the Government with data to validate the claims being made and enabled advocates to link alcohol-related harms to broader problems with the health system, thereby mainstreaming alcohol as a health policy issue. Concerns about the health service in Ireland had become a ‘hot political issue’1 and the hospital trolley crisis of the late 2000s had generated a key opportunity for those advocating a public health approach to alcohol.

Pressure on the Government mounted following explicit links made between the HRB research and the fiscal pressures on the health system coupled with increasing public dissatisfaction.

The policy stream

When the Government decided to integrate alcohol and drugs into a combined National Substance Misuse Strategy (NSMS), it established a steering group with Dr Tony Holohan, the chief medical officer (CMO), as co-chair in 2008. Its task was to specify measures that could ‘tackle the harm caused to individuals and society by alcohol use and misuse’.2

The steering group report of 2012 recognised alcohol as a major societal problem and argued that the Government must take action and identified ‘price, availability and marketing’ as the key drivers of alcohol consumption.2 The report included key international research, stressing that a reduction in overall drinking was needed for harms to be reduced across society because they were so closely related at a population level.

The steering group’s comprehensive review of the international and national evidence, its broad membership, and its concrete set of policy recommendations set it apart from earlier institutional processes. The CMO used his institutional position to ensure that the Minister for Health gave proper consideration to the report. Furthermore, research carried out by the HRB confirmed public support for the steering group’s key policy recommendations.

The political stream

Between the appointment of the steering group and the release of its recommendations in 2012, the political landscape had shifted profoundly with implications for the development of alcohol policy. Several Government ministers wanted to act on the recommendations of the steering group but there was pushback within the coalition parties (Fine Gael and the Labour Party), particularly around the proposed plan to ban the alcohol industry from any sports sponsorship. During 2013, conflicts between the health ministers and their colleagues prominently included Leo Varadkar TD, the Minister for Transport, Tourism and Sport. Key sporting organisations lobbied Varadkar, who had maintained that there was insufficient evidence that marketing or sponsorship restrictions would reduce under-age drinking. In autumn 2013, the Cabinet dropped the sports sponsorship ban from the proposed Bill. Industry lobbying and Varadkar’s opposition were identified as key influences on that decision.

In October 2013, the Government released its alcohol strategy proposals. The legislation would comprise four main pillars: (1) minimum unit pricing; (2) the structural separation of alcohol from other products in shops; (3) restrictions on alcohol advertising and marketing; and (4) health information on alcohol products and marketing. The plan represented the first time the Government addressed alcohol as a public health issue.

Despite the backing of the Government, the alcohol legislation was slow to progress. However, a major Cabinet shuffle in 2014 saw Varadkar installed as the new Minister for Health. Notwithstanding activities in his earlier ministerial brief, Varadkar enthusiastically took up the legislation and his attention to alcohol harms and the potential role of population-level measures in curbing these harms dramatically shifted in his new position. Advocates described the-then Minister for Health’s medical background as conducive for policy learning.

The opening of the policy window

In 2015, the Government published the Public Health (Alcohol) Bill. The general election in February 2016 saw Fine Gael retaining power and the new government announced in its Programme for Government a commitment to enact the Bill. Structural separation became a key target for industry lobbying. Retail trade associations claimed that the new regulations would burden small businesses. Fine Gael senators threatened to vote against the Bill if the Government failed to amend the structural separation provision.

The alcohol industry’s efforts to build a broader coalition of opponents to the structural separation was successful in slowing down the legislative process.

However, broader political shifts prevented the alcohol Bill from languishing in the upper house. In June 2017, Varadkar was appointed both leader of Fine Gael and Taoiseach and Simon Harris TD (Fine Gael) as Minister for Health, who was instructed to progress the Bill as soon as possible.

One former policy advisor explained:

Back in 2014 [Varadkar] could have stalled [the Bill], he could have put the brakes on it but … he did the opposite … When he [later] became the leader of the country … he made it one of his priorities … Once he did that, it was game, set and match.1

Along with political leadership backing the Bill’s enactment, between 2016 and 2018, Alcohol Health Alliance Ireland waged a sophisticated campaign to advance the legislation. It was chaired by Prof Frank Murray, a highly respected liver specialist whose political astuteness and calm and effective communication skills commanded respect. This constellation of forces exerted enormous pressure in forming the wave that washed through the political system.

In October 2018, after nearly three years of debate and more than six years since the steering group’s report, the Irish parliament passed the Public Health (Alcohol) Bill.

Discussion

Previous observations have identified a lack of political leadership as a key impediment to legislative action. In this more recent period, advocates have been better organised and the Department of Health has benefited from a string of strong and highly capable ministers keen to develop the application of the public health approach to alcohol-related harms in Ireland. Across interviews and other key documents, Leo Varadkar, Tony Holohan, and Frank Murray emerged as the central players.

1   Lesch M and McCambridge J (2021) Waiting for the wave: political leadership, policy windows, and alcohol policy change in Ireland. Soc Sci Med, 282: 114116. https://www.drugsandalcohol.ie/34443/

2   Department of Health (2012) Steering group report on a National Substance Misuse Strategy. Dublin: Department of Health. https://www.drugsandalcohol.ie/16908

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
Alcohol
Intervention Type
Policy
Issue Title
Issue 79, Autumn 2021
Date
December 2021
Page Range
pp. 17-19
Publisher
Health Research Board
Volume
Issue 79, Autumn 2021
EndNote

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