Making public health policy: what place for the alcohol-dependent?

Although public policy in general, and health policy in particular, can be powerful and effective tools in shaping a "healthy" environment for citizens, the influences and agendas that underpin them are often lacking in transparency. In the case of the alcohol-dependent, the critical importance of identifying strategies appropriate to their specific needs is often sidelined. This, it is argued, results in part from the influence of the alcohol industry on governments and on social conditions and in part from the ethical underpinnings of public health policy, which depends on maximising social benefits even at the expense of "hard to reach" groups. In addition, much of alcohol policy rests on the kind of' "healthy living" message that appeals to the otherwise healthy While not infantilising people who are dependent on alcohol, consideration must be given to the extent to which their ability to choose health is compromised by the nature of dependence itself.