Alcohol industry and alcohol policy—the challenge ahead


There has been a remarkable increase in the attention paid to the alcohol industry by those working in the public health field in recent years, as illustrated by the meeting of which this volume is a record [1], other publications [2–4] and discussions held at various public health research meetings [5,6]. This represents a much-needed change; the brief discussions held in passing between public health researchers about various industry activities, documented only rarely in the literature [7], have now become a subject of rigorous scrutiny and analysis.

This change is, of course, a reflection of the changing context for alcohol use and alcohol-related harm and a changing industry. All our activities and analysis are taking place in a global context in which transgovernmental corporations of all types [8], including the producers and marketers of alcohol, are engaged in the facilitation and encouragement of consumption by marketing directly to the consumer but also by involvement in the policy process. The industry seeks global structural changes to ensure increased access to commercial products, even when these products have potential to cause harm, as in the case of alcohol [9]. For the industry, global pro-market liberalization has enabled enormous growth, allowing for expansion into new sectors in established markets and into emerging economies where the commercial alcohol market is currently much smaller [10]. At the same time, however, the industry has been mindful of the public health response to the harm done by tobacco use and has resolved to act more expeditiously to avoid a similar outcome [11]. In order to protect the legitimate interests of their shareholders and reduce uncertainty in their business environment, the industry has undertaken an active role in the policy arena and, as part of this, has sought a partnership status with the public health field via a variety of mechanisms [12].

The more active role taken by various groupings of the alcohol industry in the policy arena, as indicated by the existence of numerous social aspects organizations globally, and their active engagement in lobbying for global and national policy liberalization [13,14], has required a response from those engaged in alcohol public health and, at last, this is beginning to take shape. The data collation and analyses carried out in relation to alcohol-related harm as part of the World Health Organization (WHO)'s global burden of disease studies [15] have raised public health concerns and put effective alcohol policy on the international agenda. This has translated into a World Health Assembly Resolution on alcohol in 2005, the first for 22 years, and also a public health-orientated regional strategy in the Western Pacific Region [16] agreed to by all 37 member states of the region, including China, one of the most important emerging markets for the industry [17].

During the early stages of the industry's global development the public health field lacked a comparable organized international response. Faced with the international vacuum there was some cooption of a few public health researchers to ‘partnership’ endeavours, particularly those of the International Center for Alcohol Policies (ICAP) (funded by 11 transgovernmental corporations and established in 1995) [18,19]. However, by and large the engagement by the public health field was minor and peripheral, and a growing uneasiness was reported about the value of any relationship [20,21]. There is no longer representation of industry interests on the board of the International Council on Alcohol and Addictions (ICAA), one of the longest-established international Non-Governmental Organizations (NGOs), and industry interests have been forced to move to a new source of potential influence: the harm reduction arena, a grouping which emerged from illicit drug research and does not reflect well-established alcohol research.

Perhaps more important in terms of the impact of the industry within the policy arena was the early failure of the public health field to engage with the industry's framings. Within much of the research community efforts, many of the questions investigated appeared to take no cognizance of the kind of arguments the industry was making. In part, this may have reflected a relative lack of active NGO sector involvement with the research field. (This is in contrast to the situation with tobacco, where some 200 NGOS from more than 90 countries are members of the Framework Convention Alliance, which supported the development, ratification and implementation of the WHO's Framework Convention on Tobacco Control.) One key industry position about what are, and are not, effective environmental strategies to reduce alcohol-related harm has had an ongoing research focus [22–24], and there has been a challenge to the industry-friendly line that effective strategies, those limiting supply and increasing price, are inappropriate and that only education, which has been shown to be ineffective, is required [25]. However, other important framings require more attention from the public health field: the economic significance of the industry is used, particularly in poorer countries, as an argument to avoid controls; ‘cultural differences’ between countries have been used to argue against the applicability of evidence-based strategies [26], and increasingly the industry tries to focus attention on the informal and illegal supply of alcohol and away from commercial products [27].

At the same time there are key policy-relevant issues with which the public health research field has had relatively little engagement, partly because of the ongoing focus on the drinker and his or her immediate environment. The bigger picture, and particularly research questions relevant to the role of the industry in relation to alcohol-related harm, has had less focus. Marketing in the alcohol field has changed enormously in the past two decades; new methods of communication and the resources available to the global corporations, in the context of a culture of consumption [28,29], has meant a revolution with regard to the alcohol market: consumption is now driven by supply rather than by demand [30]. There has been relatively little research in this area. Similarly, the impact of trade treaties to facilitate this expansion of supply-driven consumption has had little attention outside the impacts of the European Union (EU) on Scandinavian states. The focus on the individual drinker has limited attention paid to the structure of the market (e.g. how much is consumed by heavier and underage drinkers; what are the means of expansion into new sectors). Similarly, there has been little coherent focus on the externalities of alcohol use, particularly the damage experienced by those other than the drinker, despite the importance of this in the policy arena (as indicated by the value accorded research demonstrating the impact of second-hand smoke) [31,32].

In the context of growing understanding of the importance of the industry and industry-friendly discourse, the public health research field is likely to address policy-relevant issues to a greater extent than before; it will also, collectively and consciously, develop appropriate ways of interacting with the industry. Lessons learnt from other sectors suggest the importance of limiting time spent in such interactions, in order that the focus on critique and government intervention is maintained [8]. Similarly, one role for research is to investigate the nature of the relationships between the government sector and industry, making transparent the way the influence occurs [33]; this is facilitated by the respectful detachment of the researcher from both sectors. The conflict of interest between the industry's legitimate responsibilities to their shareholders to sell their product and the goal of alcohol policy to reduce harms suggests to many that the industry cannot be accorded the status of a stakeholder alongside others engaged in the development of public policy [34,35]. However, they can make a contribution to the reduction of harm through their actions as producers, distributors, marketers and retailers; in other words, their appropriate focus is on implementation of policy within a regulatory framework. If this premise is adopted by the public health research field, our involvement in industry-led activities and also the use of industry funding for research [22] is likely to be judged to be inappropriate.

A positive model for public health researcher involvement in an issue requiring global governance to deal with the harmful effects of a powerful global industry is that provided by the tobacco control field. The alcohol field is at some disadvantage, in that it does not share the same access to financial resources that the tobacco field has had; whereas bequests to organizations such as Cancer Societies and Heart Foundations have provided a relatively autonomous source of funding, there is no clear equivalent in the alcohol field. Nevertheless, the potential exists for the kind of collaboration between alcohol public health researchers and the NGO sector which the tobacco field has enjoyed, and there are emerging signs of regional and global alcohol initiatives [36,37]. This is a moment in time in which the combined efforts of high-quality research and active and appropriate forms of dissemination are required to ensure that the alcohol public health field makes a contribution to alcohol policy and can, indeed, speak truth to power.

Declarations of interest