IAN WEBSTER.- Advocacy is hard going against the alcohol lobby.

Jan 17, 2020

It is a loss powerfully felt,but subdued. Not by politicians or the alcohol industry, but by doctors and nurses in the clinics and rehab. centres. The highly respected Michael Thorn has departed from the Foundation for Alcohol  Research and Education(FARE) as the CEO. What is the real story?

Multitude of tweets followed the CROAKEY article, “Concerns raised about the National Alcohol Strategy, amid the shock departure of a key public health advocate” on 4th December 2019. They came from across the health spectrum – providers, policy makers and academics. They said two things – Michael Thorn had been an outstanding advocate for reform of alcohol policies and puzzlement as to how FARE could part company with him. The combination of Thorn and FARE has been the preeminent pressure point on the alcohol industry, Government and the evolving National Alcohol Strategy. Michael Thorn pushed hard and stood on toes. He had courage more than most of us. He needed it.

The validity of his criticisms of the alcohol lobby and the acquiescence of governments – exposure of children to alcohol brands, sport as the major platform for alcohol promotion, the emasculated National Alcohol Strategy and now the New South Wales Government’s ending of the life-saving lockout laws – are in Pearls and Irritations, 9th January 2020.

FARE and advocacy

FARE owes its origins to the late Senator Meg Lees, former leader of the Democrats, who pressured the Howard Government to allocate $115 million to the newly created Alcohol Education and Rehabilitation Foundation (AERF).

During the introduction of the GST, $ 120 million had been collected from the sales of draught beer but the Coalition had promised draught beer would be exempt.

The $ 115 million allocated to the Foundation was to fund alcohol education and rehabilitation projects with 80% to be spent in the first five years; the other $5 million went to the Historic Hotels initiative.

The inaugural board members, invited by Prime Minister Howard, were mainly people who worked directly with alcohol problems and knew well its impact in the community.

I wrote at the time:

“The Board Directors are representative of a wide range of interests and each one of them could be regarded as contributors to the national good in their own right. But together they are a formidable team of experience, knowledge, skill and above all compassion – compassion especially for some of the people against whom our society most vigorously discriminates.”

Treatment, rehabilitation and education projects were funded in the first five years; an achievement in anyone’s terms.

The Western Australian bed-capacity for alcohol treatment and rehabilitation was doubled; ground-breaking research showed the true costs and nature of alcohol’s community harms; and, $1.0 million went to the Rio Tinto Child Health Partnership with the Telethon Institute for Child Health Research Centre in Perth, to assess the impact of alcohol on Aboriginal children across northern Australia.

After the initial phase, the Foundation had to move on. It was renamed – the Foundation for Alcohol Research and Education (FARE) – indicating a move to use data to tackle the big picture issues of controls on alcohol availability and marketing, especially to children, and links to sport – End Alcohol in Sport Campaign. It took leadership stands on domestic violence, Foetal Alcohol Spectrum Disorders (FASD) and in global, national and state ‘actions on alcohol’.

Michael Thorn’s leadership was seminal in these initiatives.

Where lies the power?

The eminent pathologist, Rudloph Virchow, on investigating a typhus epidemic in Berlin in1847, found impoverishment was the root cause of the outbreak. He said, “Medicine is a social science and politics but medicine on a grand scale”. Public health at its roots is political.

But there are strong headwinds for Virchow’s “medicine on a grand scale” and there are road blocks.

Taking on sectional interest, self-interest, ignorance, fanatism and greed is not for the faint-hearted. It is tough stuff, it’s far more comfortable to be a doctor or nurse treating thankful patients who appreciate your intent, than to stand against powerful interests.

Even immunising children against meningitis can set off a counter campaign. But when commercial interests are threatened, and our personal appetites, choices and behaviours are challenged, opposition is of an order of magnitude greater. The cashed-up industries that live off our addictions – tobacco, alcohol, drugs, sex and gambling – become more than headwinds but a road-blocks. They have the dollars and connections to undermine health and social policies and to garner the votes of politicians.

Government, NGOs and advocacy

Anyone in the non-profit sector will know the perils of advocating for social and health reforms not endorsed by the government of the day. Not only is there direct pressure but NGOs will self-censor their public positions as a matter of their survival. The Commonwealth’s message is that it is only interested in funding direct frontline services and is opposed to advocacy. Both Coalition and Labor governments have added “gag” clauses in their funding agreements with NGOs.

Jonathon Hunyor and Cassandra Goldie, CEOs of the Public Interest Advocacy Centre and the Australian Council of Social Service (ACOSS) wrote in March 2019, that NGOs are restricted from – “commenting on, advocating support for or opposing a change to any matter established by law, policy or practice of the Commonwealth”. ACOSS has been told its “advocacy activities” will not be funded.

Of course, there must be transparency about public funding of the not-for-profit sector, but this is peanuts compared with the opacity of the blandishments the ‘addictive’ industries offer to politicians and their parties.

When commercial interests align with political power, the ability to effect change is stacked against civil society. This is happening with sport promotion of alcohol, exposure of children to alcohol branding, and, the National Alcohol Strategy. Precisely the issues that Michael Thorn and FARE have campaigned against.

But as happened with the defunding of the long-serving Alcohol and Drug Council of Australia by the Abbott Government in 2013, when the alcohol industry has the ear of Government, and can twist that ear, the cards are stacked against advocates for sensible reform of alcohol policy and legislation.

How well FARE with a new CEO will take forward its legacy of advocacy is a moot point.

The current board of FARE has corporate and media experience and, as noted in CROAKEY, strong political and polling connexions. The potential is there to influence national and state alcohol policies and legislation but the zeal of battle-hardened front-liners will not be there as at the start of the Foundation in 2001.

The watchers will hope that the future FARE will advocate forthrightly for evidence-based alcohol policies with real bite based on what is known to work.

Ian Webster AO is Emeritus Professor of Public Health and Community Medicine, UNSW, formerly Chairman of the Alcohol Education and Rehabilitation Foundation (AERF), now FARE, and formerly Patron of the Alcohol and other Drug Council of Australia (ADCA).

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