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VIEWS & REVIEWS: Michael Farrell The alcohol industry: taking on the public health critics BMJ 2007; 335: 671 [Full text]

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Health cost of alcohol unregulated market

Ronaldo R Laranjeira   (2 October 2007)

Public health and reducing alcohol-related harms

Gerry V Stimson   (16 October 2007)

Health cost of alcohol unregulated market 2 October 2007
Ronaldo R Laranjeira, Senior Lecturer on Addictive Behaviour Federal University of São Paulo - Rua Borges Lagoa, 564 - São Paulo 04023-000 Send response to journal: Re: Health cost of alcohol unregulated market	The paper of Farrell touched upon a very important issue that is the alcohol industry strategies in the developing world. Brazil is a good example of these strategies. We have 1 million selling points for alcohol in a population of 180 millions. These points can sell alcohol at any time of the day, to anybody, including minors. We have a very agressive advertising strategy on television that reaches millions of children. In recent research on a random sample of drivers, 30% of them had alcohol in their blood. Brazil is by any account an unregulated market of alcohol, and the alcohol industry is trying their best to keep that way. This lack of regulation contributes to the increase of consumption at the rate of 10% a year. If all that was not enough, the alcohol industry is also approaching health professionals for a partnershhip in order to defend that harm reduction approach is the best option to Brazil. Farrell´s paper is a good warning of the health implications of this unwelcome partnership. Competing interests: None declared
Public health and reducing alcohol-related harms 16 October 2007
Gerry V Stimson, Executive Director, International Harm Reduction Association 40 Bermondsey St, London, SE1 3UD Send response to journal: Re: Public health and reducing alcohol-related harms	Michael Farrell (BMJ 29 Sept 200, p671) provides a limited view of the potential to intervene to reduce alcohol-related harms. In reviewing Drinking in Context: Patterns, Interventions and Partnerships (eds GV Stimson, M Choquet, M Grant and P Garrison: Routledge) his premise is that public health approaches to alcohol rely exclusively on reducing total consumption. Drinking in Context was written to show the inadequacy of population level approaches. These alone will not tackle the individual, community and social impacts of drinking alcohol. The book aims to highlight a wide range of opportunities for reducing alcohol related harms that do not require waiting for government action on tax and availability (indeed, barely an option for non-commercial alcohol which accounts for 50% of global consumption). Arguing solely for population level approaches also inhibits creative and needed local responses: municipalities cannot wait for governments to act, and much can be done now to reduce the impact of drinking and start the long process of cultural change. It is untrue that the book challenges any emphasis on population measures to reduce alcohol consumption. We clearly state that “a comprehensive alcohol policy needs population-level interventions, but there is also a need to disaggregate populations in order to develop a more nuanced and comprehensive approach to reducing alcohol-related harms.” This wider view of public health is in line with the insights and experiences gained with respect to changing other health behaviours, for example in HIV/AIDS prevention: the population interventions are important, as too are cultural and community level interventions (woefully absent in Farrell’s version of public health). Farrell devotes half the review to dismissing the book as a public relations exercise, at the expense of engaging with the arguments. Journalistic probity might have cautioned a check on my involvement before concluding it was “ill-judged”. I was main editor in a personal capacity. The editorial advisory group included five former WHO officials and one from the United Nations International Drug Control Programme, one from World Bank, academics from national research institutes, representatives of international NGOs, staff of the International Center for Alcohol Policies, and representatives from two beverage alcohol companies. This group attempted to develop a dialogue across organisational divides, in order to take alcohol polices forward from the population-level public health straitjacket. The book does not reflect the views of the organisation of which I am Executive Director (see the first page). However the International Harm reduction is committed to reducing harms from all psychoactive substances including alcohol. IHRA engages with all sectors. We have not been “hooked” (as he puts it). Reducing alcohol related harms requires working with alcohol and hospitably companies: we made the approach. We have some unlikely partners in our work on reducing harms from illicit drugs, and do not shy from unusual partnerships in reducing alcohol related harms. That decision was made in awareness that we risked attack from the alcohol control lobby. We maintain an independent and critical voice in pursuing our aim to reduce drug related harms. Gerry Stimson Executive Director, International Harm Reduction Association Honorary Professor, London School of Hygiene and Tropical Medicine Emeritus Professor, Imperial College London Competing interests: GVS received a fee from the International Centre for Alcohol Policy for editing Drinking in Context. The International Harm Reduction Association has received unrestricted donations from four beverage alcohol companies, and a grant to develop city based alcohol harm reduction interventions.