- Fiona Godlee, editor, BMJ
News that the UK has one of the highest rates of underage drinking and teenage pregnancy in the industrialised world (doi:10.1136/bmj.b3635) comes in the same week that the BMA calls for a ban on alcohol advertising because of its damaging effects on young people (doi:10.1136/bmj.b3637). The BMA’s report, Under the Influence (www.bma.org.uk/health_promotion_ethics/alcohol/undertheinfluence.jsp), says that a whole range of policies are to blame for steadily increasing sales of alcohol, especially among the young. It calls for price increases and a ban on all marketing communications, including price promotions and sport and music sponsorship.
It’s interesting to see the inevitable parallels with the fight against tobacco advertising. In both cases industry’s response has been that advertising doesn’t increase usage, it just strengthens brand loyalty (young people are certainly brand aware; according to the report, over 90% of 13 year olds could identify popular products even though the names were concealed). There are no randomised trials of advertising, but there’s enough evidence mounting around the world, much of it summarised in this report, to support an outright ban. Studies have found strong links between spending on advertising and usage of tobacco and alcohol, and that usage of tobacco falls when bans are imposed. As for pricing, primary care trusts in major cities in England recently agreed that the most important thing they could do to reduce harm from alcohol was to lobby for a minimum price on alcohol.
The authors of the report are particularly critical of the government for allowing the industry funded Drinkaware Trust to take part in health education. The trust’s stated aim is to promote responsible drinking, and its money must seem like a godsend for cash strapped public health budgets. But as the authors say, it’s like putting the fox “on a par with the farmer”: good for the fox’s reputation but no good for the chickens.
In his editorial (doi:10.1136/bmj.b3646) Ian Gilmore welcomes the report, although he stops short of backing its call for a complete ban on marketing. Instead he would like to see a public conversation about our attitudes as a society to alcohol. “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.” My own view, for what it’s worth, is that (as with tobacco) the UK and Europe will get to ban eventually. Industry will lose the argument as more and more people, at younger and younger ages, succumb to alcohol related liver disease. But it will be a hard slog and the BMA’s report is an important milestone. Tell us whether you think advertising should be banned: send us a rapid response and vote in our poll on bmj.com.
Perhaps Tom Frieden, the new head of the US Centers for Disease Control and Prevention (CDC), will take on this battle. Karen McColl reports (doi:10.1136/bmj.b3565) that in his previous role as New York City health commissioner he was known for his willingness to use the law to control health risks. He built a reputation for bold action on smoking and unhealthy eating, in the face of fierce industry opposition.
Cite this as: BMJ 2009;339:b3681