How to wine friends and influence people
| Date | 14 October 2009 |
| Published date | 14 October 2009 |
| Pages | 2-3 |
| DOI | https://doi.org/10.1108/17466660200900007 |
| Author | Nick Axford,Michael Little |
| Subject Matter | Education,Health & social care,Sociology |
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How to wine friends
and influence people
So, rather than focus on the tail of the
distribution, by treating individuals with established
difficulties, a public health approach seeks to shift
the whole risk factor distribution. It targets the
average person, promoting positive change in all –
including those at the tail.
Of course, it is not just about alcohol or
tobacco. In this edition, Jim Stevenson calls for
a mandatory ban on six common food colours.
These play a causal role in hyperactivity in the
general child population, as well as exacerbating
attention-deficit hyperactivity disorder (ADHD)
among some children. Banning them from foods
would create a clinically relevant change. In this
case the notion is intriguing because it advocates
a population-wide solution to a problem that
affects some children not at all. But it rests on
the same principle: care better for the average
child and fewer children will experience severe
behaviour problems.
The public health approach is attractive, for
several reasons. It appeals to our conformist
instincts; part of us wants to be like everybody
else. It appeals to a good conscience, and it avoids
the awkward politics of dealing directly with the
marginalised and belligerent as if they were pariahs.
Public health style interventions appeal to the
paternalist, particularly if they can be supported
by legislation – compulsory seatbelts, smoking
bans, lead-free petrol. If it is a matter of improving
children’s nutrition by greening the school canteen
menu, liberals will have a vested interest too.
Economist Richard Thaler and legal scholar Cass
Sunstein cite this last example in Nudge, where
they explore the potential for influencing people’s
decisions and behaviour by reconfiguring ‘choice
architecture’ (Thaler & Sunstein, 2008). Over time
this could reduce levels of obesity.
I’m in the off-licence buying a bottle of red wine,
and there’s a wobbly drunk ahead of me in the
queue buying six multipacks of cheap lager. I think
to myself ‘If I drink less, he drinks less, his girlfriend
gets less depressed, his children go to school more
often. And the world is a better place’.
Can it be true? Can it be that what Mr Average
does on a Friday night affects the well-being
of others who are more vulnerable? Believe in
the public health model and you must believe
it. It deals with more tangible practicalities,
but there is an underlying moral principle: that
human populations are more than a collection of
individuals; in certain circumstances – for good
or ill – they behave as one: my destiny and Mr
Carlsberg’s intertwined.
The premise is articulated eloquently in
Geoffrey Rose’s (1992) The Strategy of Preventive
Medicine. The population, he says, cannot ‘disown
the tail of its own distribution’; alcoholics are an
intrinsic element of it. It sounds as if it might be
the motif of a Christian parable, but it leads into
a discussion about risk – high risk at that ‘tail’,
lower risk inside the ‘mean’ and my Friday night
carrier bag.
Like many risks or outcomes, alcohol intake
operates along a continuum. It varies for individuals
within a population, ranging from low through
normal to high relative to that population. There is
indeed a link between the number of people with
severe drink problems in a society and the amount
of alcohol that the average person consumes.
People in the US drink less on average than
people in the UK. The US has fewer alcoholics.
Cross-sectional data suggest that reducing the
amount of alcohol that the average person in a
population consumes by 1.5 units might reduce the
proportion of heavy drinkers by about 2%.
Nick Axford
Michael Little
The Social Research Unit, UK
Editorial
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