Public Health England’s decision to partner with Drinkaware has raised questions about how it should engage with the public. Tom Moberly talks to delegates at PHE’s annual conference
The decision by a leading physician to quit his role as an adviser to Public Health England (PHE) was front page news last week. Ian Gilmore, a gastroenterologist and hepatologist, objected to a partnership that the agency had launched with the industry funded alcohol education charity Drinkaware, and resigned as co-chair of PHE’s alcohol leadership board the day after the campaign launched.1
But Gilmore’s objections to the campaign were not news to Duncan Selbie, PHE’s chief executive. In fact, the Alcohol Health Alliance, which Gilmore chairs, wrote to Selbie on 3 August 2018 saying that the partnership risked watering down public messages. “This would be very damaging to public health and to the reputation of Public Health England as an independent and trusted source of public health evidence and advice to the public,” Gilmore said in the letter.
The Alcohol Health Alliance was far from alone in these concerns. That letter, a copy of which The BMJ has seen, was co-signed by 39 organisations, including the BMA, the Faculty of Public Health, Royal Society for Public Health, the Royal College of Psychiatrists, the Royal College of Emergency Medicine, the Royal College of Nursing, and Alcohol Concern.
At the PHE conference last week, Selbie was publicly challenged about the partnership after his welcome address. Colin Shevills, a member of PHE’s alcohol leadership board, asked Selbie for evidence that such partnerships were effective.
Speaking to The BMJ, Shevills points out that previous governments’ efforts to partner with the alcohol industry, as part of the responsibility deal, have not been successful. “The independent peer reviewed evidence suggests that did not work, except that it helped the reputations of a number of corporations,” he says. “I don’t know what makes PHE think that it can succeed when the government failed.”
Shevills is also concerned by the decision to focus the campaign on increasing alcohol-free days. “Alcohol-free days are mentioned as part of the chief medical officers’ drinking guidelines, but it’s only part of their drinking guidelines,” he says.
“One of my concerns is that this push for two drink-free days almost begins to take precedence over the CMOs’ guidelines,” he says. “PHE is playing into the alcohol industry’s hands by essentially dismissing the guidelines and talking about two drink-free days, implying that actually if you drink five days a week that’s OK.”
But Selbie argues that the campaign was not a “partnership” with the alcohol industry. “We’re working closer with Drinkaware—that’s not the alcohol industry,” he tells The BMJ. “It is working with an educational charity that is charged with reducing the harm of alcohol. People are conflating Drinkaware with the alcohol industry. I think it is wrong to do that.”
Selbie says he decided to work with Drinkaware to reach the millions of people who are drinking at harmful levels. “We will work with people who engage directly with people we are trying to reach,” he says. “Drinkaware has this really vibrant thriving website which has nine million people visiting. We think we could help it to be more impactful in its work . . . It is speaking to people in their lives that they are leading where they happen to be.”
Selbie says he has spoken to Gilmore at length about his concerns. “I’ve listened and listened, and we just don’t agree with each other,” he says. “We’re just not in the same place. But I have to make decisions. I’m not entitled to just say something isn’t right—I’ve got to make it better.”
Greg Fell, director of public health for Sheffield, dismisses Selbie’s argument that there was an important difference between working with Drinkaware and working with the alcohol industry. “It is no different to any of the nice shiny cuddly front groups that industries use. All these industries want to sell us stuff that harms,” he tells The BMJ.
But Fell says that he does not feel “absolutist” about the issue. “Personally, I probably wouldn’t have gone into an agreement with the alcohol industry to do this,” he says. “But it’s a judgment that PHE has made.”
Rachel Flowers, director of public health for Croydon, has mixed feelings about PHE’s partnership with Drinkaware. She believes that the risks of alcohol have been poorly communicated to the public and that a different approach may be needed. But “I wouldn’t have done it,” she tells The BMJ. “It is about foisting a product that for many people will actually ruin their lives and may kill them.”
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.

中文翻译：

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公共卫生专家与行业资助的慈善机构分道扬deal

英格兰公共卫生局与Drinkaware合作的决定提出了有关如何与公众互动的疑问。汤姆·莫伯利（Tom Moberly）在PHE的年度会议上与代表们进行对话
。一位领先的医师决定辞去英国公共卫生（PHE）顾问职务的决定是上周的头版新闻。肠胃病专家和肝病专家伊恩·吉尔摩（Ian Gilmore）反对该机构与行业资助的酒精教育慈善机构Drinkaware建立的合作伙伴关系，并在竞选活动的第二天辞去了PHE酒精领导委员会的联席主席一职。
但是，吉尔莫尔（Gilmore）对竞选的异议对PHE首席执行官邓肯·塞尔比（Duncan Selbie）而言并不是新闻。实际上，吉尔莫（Gilmore）主持的酒精健康联盟（Alcohol Health Alliance）于2018年8月3日写信给塞尔比（Selbie），称该伙伴关系有可能削弱公众信息。吉尔莫尔在信中说：“这将损害公共卫生，并损害英格兰公共卫生作为公共健康证据和建议的独立和可信赖的来源的声誉。”
酒精健康联盟在这些问题上并非孤军奋战。那封信，BMJ的副本由BMA，公共卫生学院，皇家公共卫生学会，皇家精神病医生学院，皇家急诊医学学院，皇家护理学院和酒精关注组织等39个组织共同签署。
在上周的PHE会议上，Selbie在致欢迎辞后就合作伙伴关系向公众提出挑战。PHE酒精饮料领导委员会成员Colin Shevills向Selbie询问了这种伙伴关系有效的证据。
谈到BMJ，Shevills指出，作为责任协议的一部分，先前的政府与酒精工业合作的努力并未取得成功。他说：“独立同行审查的证据表明，这种做法行不通，只是它有助于提高许多公司的声誉。” “我不知道是什么让PHE认为当政府失败时它可以成功。”
Shevills还对决定将运动重点放在增加无酒精饮料的日子上感到担忧。他说：“无酒精日列为首席医务人员饮酒指南的一部分，但这只是他们饮酒指南的一部分，”他说。
他说：“我关注的一个问题是，为期两天无饮酒的努力几乎开始优先于首席营销官的指导方针。” “ PHE从本质上取消了指导方针，谈论了两天无酒的日子，从而在酒精行业中发挥了作用，这实际上意味着，如果您一周喝五天，那是可以的。”
但是塞尔比认为，这场运动并不是与酒精行业的“伙伴关系”。“我们正与Drinkaware，这不是酒精行业密切，”他告诉英国医学杂志。“它正在与一个教育慈善机构合作，该慈善机构负责减少饮酒的危害。人们正在将Drinkaware与酒精行业混为一谈。我认为这样做是错误的。”
塞尔比说，他决定与Drinkaware合作，以接触数以百万计处于有害水平的饮酒人群。他说：“我们将与直接与我们想要接触的人打交道的人一起工作。” “ Drinkaware拥有一个非常活跃，蓬勃发展的网站，有900万人次访问。我们认为我们可以帮助它在其工作中发挥更大的作用。。。这是对人们生活中的一句话，他们引领着他们所处的位置。”
塞尔比说，他已与吉尔莫尔（Gilmore）谈了很久，他对此感到担忧。他说：“我听了，也听了，我们只是不同意。” “我们只是不在同一个地方。但是我必须做决定。我无权只说不对的东西，我必须把它变得更好。”
谢菲尔德公共卫生总监格雷格·费尔（Greg Fell）驳斥了塞尔比（Selbie）的论点，即与Drinkaware合作与与酒精行业合作之间存在重要区别。“这与行业使用的任何漂亮的，闪闪发光的可爱前线群体都没有什么不同。所有这些行业都希望向我们出售有害的产品，”他告诉BMJ。
但是费尔说，他对这个问题并不感到“绝对”。他说：“就个人而言，我可能不会与酒精行业达成协议来做到这一点。” “但这是PHE做出的判断。”
克罗伊登（Croydon）公共卫生总监雷切尔·弗劳斯（Rachel Flowers）对PHE与Drinkaware的合作关系抱有不同的看法。她认为，酗酒的风险未能充分向公众传达，因此可能需要采取其他方法。但是“她不会做的，”她告诉BMJ。“这是关于强化一种产品，对于许多人来说，这实际上会毁掉他们的生命并可能杀死他们。”
利益冲突：我已阅读并理解BMJ的利益声明政策，没有相关利益声明。
种源和同行评审：委托；没有外部同行评审。