Epidemiology and Public Policies

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The problem aspect of alcohol use was a focus of interest not only for scientists but also for practitioners in the fields of health and welfare, and for administrators seeking appropriate policies. To demonstrate that it should be of broad social concern, epidemiological studies were undertaken on a rapidly increasing scale. That became a major part of a combination of influences that converged to shape alcohol studies in the 1980s. Most psychological and social problems became increasingly medicalized as physicians extended their influence and assumed new importance throughout Western cultures.

Social and cultural research was generally marginalized by government and other funding agencies. Biochemistry, neurology, and genetics came to dominate the field of alcohol research.

The World Health Organization (WHO) was active in promulgating the idea that alcohol-related problems occurred universally in a direct and invariant proportion to the consumption of alcohol. They posited that not only for individuals but also, using average per capita consumption per month or year, among populations. Data from their own survey often contradicted that axiom, as when Luxembourg, France, Portugal, and some other countries that rated at the top of the international list for consumption tended to have low rates of most alcohol-related problems, whereas Ireland, the United States, and some others with much lower consumption reported higher rates of most problems. Nevertheless, a "control of consumption" model emerged as dominant among those constituencies who recommend policies. They continue to emphasize adoption of a bundle of measures intended to lessen such problems. These include increasing taxes on beverage alcohol, restricting advertising, mandating health-warning labels, increasing the minimum legal drinking age, curtailing sales outlets and hours of business, and other measures aimed at decreasing the overall consumption of alcohol.

Many individuals abstain and even so-called moderate drinkers generally consume very little. It should not be surprising that most control measures cut drinking among non-abusers while hardly affecting those who engage in heavy drinking. It is a concern that so little has been achieved in the way of reducing harm or preventing problems.

The inordinate emphasis on the consumption model has resulted in an imbalance in research and writing about alcohol by those who claim to have a primarily social or cultural interest. By far the greatest portion of such work is epidemiological, correlating the quantity and frequency of drinking with various alcohol-related problems and compiling quantitative data on alcohol as used by diverse demographic categories. Most such studies are conducted by means of social surveys, with close attention to the exact wording of the instrument or questionnaire, and to the process of sampling within the large population. Such studies can be conducted by unskilled personnel using standard survey instruments, and they yield quantitative data that can be tabulated and statistically manipulated, have the superficial appearance of "hard science," and are easily communicated in visual format. Unfortunately, too often even the principal investigator is at a loss to explain or to interpret findings in terms that would have meaning to the subjects or to colleagues.

By contrast, most ethnographic studies require close and sustained work by skilled observers and yield qualitative data that do not easily lend themselves to tabulation or visual presentation. Brief papers based on such qualitative studies too often are regarded as little more than interesting anecdotes and few bother to read the expository style that is often judged to be "soft" in comparison with numerical findings. Those who mistakenly confuse numbers with science give credibility to quantification, even while many methodological issues remain questionable among survey practitioners.

It is becoming commonplace to give lip service to the ideal of combining qualitative with quantitative methods and data in alcohol studies, but only a few pioneers are doing it systematically. One encouraging example is the use of ethnographic observation and interviewing as a preliminary to survey work. In that way, it is possible to get a good feel for what issues are important to the population and what terms are appropriate in the formation of questions before the instrument is created. Another imaginative combination is the subjecting of open-ended interviews to detailed content analysis, so that it is possible to quantify what the respondents said in their own words, rather than relying on a few pre-coded forced choices among alternatives worded by someone else.

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