Public health policy in France - the challenges

Claude Rivière, ANPA (Association Nationale de Prévention de l'Alcoolisme)

Since this year's general Election in France, we have a new government which seems to be about to review public health policy concerning legal and illegal drugs.

Until this year the policy implemented through the inter-ministerial committee was based on two main studies commissioned by the former government:

• One was led by Professor Roques in 1998. It points out that alcohol, from a scientific point of view, is the major psychoactive substance compared to heroin or cannabis. So the most interesting aspect was that alcohol was looked upon as a drug, albeit legal.

The second study was carried out in 2001 by the National Institute of Health and Medical Research on the medical effects of alcohol consumption.

The new government, however, seems to be listening to the siren voice of the industry which absolutely refuses to recognise that alcohol can kill, even at the first time of use.

The response of the industry was to send out three million "sous-bocks", beer mats, to about 30,000 cafés and restaurants with the slogan:

"alcohol is not a drug and we are not dealers".

At the same time, they sent a letter to politicians saying that their products are legal, that moderation has never killed anyone, and that they never serve minors or drunk people in their bars. This is simply not true - witness the French café owner recently prosecuted because he had sold alcohol to someone who then killed somebody in a drink driving accident.

So the industry is actually lobbying determinedly in order to be associated with the building of a public health policy and implementing campaigns of prevention.

These are the reasons why ANPA is working to implement a nationwide campaign of prevention advocacy aimed at the government, Parliament, and all the local authorities. The intention is:

• to make clear the reasons why prevention is essential for young people and also for adults and must be supported;

• to make clear the social costs of alcohol which comes to about 17 billion Euros (at the moment 10 millions Euros are spend in France for the prevention of alcohol problems).

Seventeen billion represents about 53 per cent of the global social costs of all the drugs (legal and illegal). Tobacco represents 41 per cent and illegal drugs about six per cent.

These sums are based on a report commissioned by the former government and led by the economist Professor Kopp who produced the first estimates of social costs in France. The report measures the costs not only in terms of loss of life, but also of injury and road crashes, the impact on the criminal justice system and also of illness, disease, treatment costs and loss of productivity.

It is also important to draw your attention to the fact that the industry says it relies on "reasonable drinkers". But Professor Kopp's opinion is that "the economy of alcohol is an economy of drugs and does not escape its general laws. Let us admit the WHO idea according to which the consumption of three daily wine glasses does not involve a risk, but that if you drink anything above this amount, your risk increases.

The percentage of people consuming this recommended level of alcohol is very low, in fact negligible. Therefore, the heart of the target of the alcohol industry does not consist of "reasonable drinkers". In so far as a very significant percentage of drinkers exceeds this limit, it is plain that the marketing strategy of the alcohol industry is based on the exploitation of the excessive ones."

Meanwhile, what is the current thinking within the Commission? At the ICAP (International Center for Alcohol Policy) Conference in Dublin this October, Commissioner Byrne said that he expects results from the codes of practice and from self-regulation by the industry.

ANPA has recently attacked the industry, in the shape of Ricard and Kronenbourg, because these two firms sponsored student parties last June in France, offering alcohol to young people who were inexperienced drivers. In fact, this sort of behaviour is forbidden by the code of public health. The policy of the industry, says a representative of Entreprise et Prevention, an organisation created by the industry), is to "be present everywhere young people are, discotheques, bars, student parties". Furthermore, he adds that "this is not immoral".

In conclusion, the decision of Eurocare, the alliance of alcohol policy, prevention, and advocacy organisations throughout the Union, at their recent meeting in London, to collect and analyse the existing studies on the social costs in Europe is to be welcomed.