Brighton & Hove council has a complex relationship with alcohol: it poses public health risks but businesses rely on the night-time economy. Photograph: Chris Rout/AlamyThe fallout from the government u-turn on plain cigarette packaging and a minimum unit price for alcohol continues. To date, the Faculty of Public Health, the Association of Directors of Public Health and Birmingham city council have all withdrawn from the "public health responsibility deal". This "framework of trust and expectation" between the government, public sector and businesses, first launched in March 2011, includes a number of pledges across several public health issues. I would suggest these pledges were offered as much to ward off punitive legislation as in an effort to promote the wider public good.
The chief medical officer, Prof Dame Sally Davies, has remained mute on the matter, despite drawing attention last year to an epidemic of premature liver failure in women, fuelled in large part by alcohol consumption. Public Health England, the government's flagship leadership organisation for public health, has expressed its "disappointment" – a euphemism that probably says less about a failure to satisfy hopes, desires and expectations and more about the humbling experience of having been simply ignored.
Disappointment is understandable: the consultation on the government's draft alcohol strategy was after all about at what level the minimum price would be set – not on whether or not there would be a minimum price at all.
The draft strategy was very clear ("we will introduce a minimum price for alcohol," it stated) and the scientific evidence that supported the policy has not become any weaker in the meantime.
But will the health establishment refusing to play ball with the government, proclaiming their disappointment, have any effect? Will it put any pressure on the alcohol industry to put its house in better order?
The alcohol industry hardly speaks with one voice on this matter, and there is considerable tension between retail off sales and on sales in bars, pubs and clubs. The proposed minimum price met with mixed views.
The British Beer and Pub Association (BBPA), the Craft Brewing Association, BrewDog, Greene King and the Campaign for Real Ale all voiced their support. The Association for Licensed Multiple Retailers actually wanted the strategy to go further and "get a grip on bulk sales, price-led advertising and in-store promotions".
But the Wine and Spirits Trade Association, the British Retail Consortium and Budvar UK all voiced strong opposition – as did the UK Independence party.
The moral rectitude that brings many of us into public health means while we understand the "responsibility" element of a public health responsibility deal, we don't always get the "deal" bit.
Working in Brighton & Hove council, we know that alcohol presents us with a social and economic dichotomy. On the one hand the estimated annual health, social and criminal costs from alcohol total £107m; but on the other, the annual economic turnover from its sale in the city is a massive £329m. While in the NHS the message on alcohol may be pretty straightforward – don't drink so much – for local authorities it's more tricky.
Local public health is no longer the responsibility of the NHS; it belongs to local authorities. So if we are to have any success in solving both sides of an impossible equation, we need to get our heads around the "deal" we're expected to broker.
At the local level that is what we are doing: working with pubs, clubs and retailers on initiatives to curb consumption at high-risk public events; reducing the sale of high strength beers and cider; asking businesss to sign up to codes of good practice. We have a "cumulative impact zone" where we prohibit the establishment of any new licensed premises. We don't always agree and the public health team doesn't win every dispute, but we are sitting around the table together rather than walking away.
That national picture is different, and there may be something to be made from august bodies taking a stand, but public health and the government missed the opportunity to make a genunine deal.
As part of the original responsibility deal, 30 alcohol companies including major brands such as Heineken have pledged to take 1bn units of alcohol out of the market by December 2015 through the promotion of lower strength drinks. Why not compensate for the loss of a minimum price by arguing for a pledge to take yet more units out of the market, and tie any failure to future market restrictions?
Public health has an advocacy role but it isn't an NGO – many of which walked away from the responsibility deal early on. The moral high ground will not get us far, or far enough.
But let's not beat ourselves up about this (another tendency in public health). It was, after all, the government that chose to make a u-turn, not local authorities. It's time for a bit more reflection and to come back to the discussion table with new ideas.
Dr Tom Scanlon is director of public health at Brighton & Hove council
• What do you think? Email sarah.marsh@theguardian.com if you want to contribute an article to this debate.
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