Health promotion seen as 'pious aspiration'

TheState's efforts to promote healthy lifestyles have largely failed to change people's attitudes towards drink and drugs, according to a new book.

As a result, there is a big gap between the ambitious rhetoric of health promotion and the realities of human behaviour and public policy, writes Mr Shane Butler, co-chair of the Addiction Research Centre in TCD.

"As things stand, health promotion is not a realistic proposition, but merely a pious aspiration," he writes in Alcohol, Drugs and Health Promotion in Modern Ireland.

The first step to closing this gap involves acknowledging its existence, he says. Ireland had a balanced approach to alcohol until American ideas about alcoholism as a disease gained ground. These gave rise to a perspective that exaggerated the importance of individual predisposition while understating the negative attributes of alcohol.

They continue to be popular because they propose - wrongly - that alcohol in itself is relatively harmless for most people.

In contrast, illicit drugs have been portrayed as "unspeakably evil", and public policy was framed in terms of the "war on drugs". However, neither supply reduction strategies nor demand reduction strategies have any real chance of making society drug-free, says Mr Butler.

"One has only to consider the failure of prison authorities to make Irish prisons drug-free to realise how unrealistic it is to aim at insulating the country as a whole, so as to exclude illicit drugs."

To some extent, drug use had become "normalised" especially among young people. As a result, it was better to accept that society must learn to live with some level of drug use. It should also avoid policies that inflated harm as well as promoting health through harm reduction strategies.

Mr Butler says, however, that many people regard harm reduction strategies as "immoral and quite unacceptable" and remain devoted to the idea of a war on drugs and the ideal of a drugs-free society. On alcohol, he says public policy should become "drier", and greater controls should be put in place.

Mr Butler's book studies the evolution of health policy on alcohol and illegal drugs from the mid-1940s to the mid-1990s. It is published by the Institute of Public Administration.