Published 8 September 2009, doi:10.1136/bmj.b3646
Cite this as: BMJ 2009;339:b3646

Editorials

Alcohol and social marketing

Is it time to stop peddling the myth?

The use and abuse of alcohol in society is complex. Although international evidence shows that the main drivers of consumption are price and availability, there are many other factors that are deeply embedded in society and individual behaviours that influence how, why, and how much people drink. A recent report from the BMA, Under the influence—the damaging effect of alcohol marketing on young people, provides a fascinating overview of the links between advertising, promotion, and consumption.¹

Its main author, Gerard Hastings, is the first professor of social marketing in the UK and is clearly disturbed by the accumulating evidence on the links between the £800m (915m, $1313m) spent annually by the alcohol industry on marketing and the nation’s consumption. The report’s analysis of the evidence confirms that alcohol marketing is independently linked to the age of onset of drinking in young people and the amount they drink. These factors are also predictors of alcohol problems in later life. Reports from Anderson and colleagues² and the European Commission³ had similar conclusions.

How are young people exposed to alcohol promotion? Alcohol Concern showed a peak of television advertising of beer and spirits in the late afternoon and early evening, whereas wine advertising peaked later.⁴ In cinemas alcohol advertising takes place where films are classified for children over 12. Even within non-advertising broadcasts, alcohol frequently plays a part and is usually portrayed in a positive light, all coming together with careful product design, pricing, placement, and distribution, to distort the social norms. It is the newer and more insidious forms of marketing that have not yet been properly assessed but are likely to be most influential on adolescents—the internet, mobile phone messages, sports and festival sponsorship, merchandising and social networking sites—the list is growing. The report highlights the huge awareness of drink brands by young people. Over 90% of 13 year olds could identify the brand of popular products even when the names were obscured, and nearly half of them owned a branded product, such as a soccer shirt. They were also aware of which products had a "cool" image among young people.

Of course voluntary regulation of advertising has taken place for years, but the report highlights many weaknesses. With the exception of television adverts, controls are applied only after the advertising is used and a complaint received. Current advertising codes attempt to control some aspects of content, such as the promotion of sexual success, but fail to tackle the complexities of associations and images, and many forms of sports sponsorship inevitably make links between the product and sporting success. Finally, little attention has been given to the impact that the volume of advertising can have.

The alcohol industry has been quick to offer assistance in promoting "responsible drinking". However, even non-industry educational initiatives have been shown to be the least effective approach to reducing alcohol related health harm,⁵ and when linked to a product such methods can subtly reinforce its use. The report is critical of the alcohol industry funded charity The Drinkaware Trust because of the influence of its funding on its culture and priorities.

What are the messages for policy makers in the UK? We should have learnt from tobacco that voluntary partnerships with the relevant industry do not work, but since the Alcohol Harm Reduction Strategy for England 2004 ⁶we have had to learn it again. The BMA’s report contains nine hard hitting recommendations, some of which do not relate directly to marketing, such as reducing licensing hours and ensuring that the density of existing alcohol outlets is considered when new licenses are sought. The headline recommendation, however, is for rigorous implementation of a ban on all marketing communications. This goes even further than the French "Loi Evin" alcohol policy law⁷ and will incite industry and media claims of huge damage to commercial television, other advertising outlets, and sports events. But it is a logical recommendation to attempt to reverse the all embracing pro-alcohol culture that has grown up in a period of deregulation and liberalisation over the last quarter of a century. The debate now must move beyond focusing on binge drinking and antisocial behaviour and focus on the health of the whole population, looking more closely at the huge burden of dependence, damage to third parties ("passive drinking" or "collateral damage"), and the social and economic costs of alcohol misuse. A bigger more public conversation is needed about our attitudes to alcohol as a society. The problem is not just about drunk, misbehaving adolescents. We can no longer ignore the many millions of people in the UK who are quietly over-consuming cheap, readily available, and heavily promoted alcohol, storing up major problems for the future.

Cite this as: BMJ 2009;339:b3646

¹ Royal College of Physicians, St Andrew’s Place, Regents Park, London NW1 4LE

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Competing interests: None declared.

Provenance and peer review: Commissioned, not externally peer reviewed.

References

1. British Medical Association. Under the influence—the damaging effect of alcohol marketing on young people. London: BMA, 2009. www.bma.org.uk/health_promotion_ethics/alcohol/undertheinfluence.jsp.
2. Anderson P, de Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systemic review of longitudinal studies. Alcohol Alcohol 2009;44:229-43.[Abstract/Free Full Text]
3. Science Group of the European Alcohol and Health Forum. Does marketing communication impact on the volume and patterns of consumption of alcoholic beverages, especially by young people? A review of longitudinal studies. 2009. http://ec.europa.eu/health/ph_determinants/life_style/alcohol/Forum/docs/science_o01_en.pdf.
4. Alcohol Concern. Not in front of the children——child protection and advertising. 2007. www.alcoholconcern.org.uk/files/20070829_113042_Not%20in%20front%20of%20the%20children%20published%20version.pdf.
5. Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: no ordinary commodity: research and public policy. Geneva: Oxford University Press/World Health Organization, 2003.
6. Prime Minister’s Strategy Unit. Alcohol harm reduction strategy for England. London: Cabinet Office, 2004.
7. Regaud A, Craplet M. The ‘Loi Evin’: a French exception. 2004. www.ias.org.uk/resources/publications/theglobe/globe200401-02/gl200401-02_p33.html, .

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