Doctors and the alcohol industry: an unhealthy mix?

We are disappointed at Dr Chan’s negative reaction in the BMJ on 11 April to the Commitments of leading beer, wine and spirits producers, which are a sincere contribution to reducing harmful use of alcohol. The ‘Commitments’ were developed as a contribution to support WHO’s Strategy to Reduce Harmful Use of Alcohol as WHO, and Dr Chan personally, have encouraged the beverage alcohol industry to do more in this area.

We agree with Dr Chan that the development of national alcohol policies is the primary responsibility of national authorities. It is our experience that many governments do not agree with WHO’s view that the private sector has no role in policy formulation, as private sector companies from a range of sectors are often invited by governments to contribute their views and expertise to the policy development process.

It is increasingly recognised that effective responses to address serious societal issues require the involvement and mobilisation of a range of actors, including the private sector. The World Bank in its publication ‘The Growing Danger of Non-Communicable Diseases – Acting Now to Reverse Change’ (Sept 2011) for example, acknowledges this saying ‘NCD risk factors can rarely be modified through policies and interventions within the health sector alone. Rather, prevention measures that address these risk factors typically embrace a range of different sectors…………..along with civil society and the private sector’.

We welcome constructive debate on the most effective policy options to reduce the harmful use of alcohol, and believe in the merit of including a range of stakeholders in such policy discussions. Groups such as GAPA who seek to exclude those with views different from their own do a disservice to the very serious work of addressing harmful drinking worldwide and we encourage them to adopt a more inclusive approach.

It is an over-simplification to say that the ‘ideological schism’ that divides the public health community is between those who are prepared to work alongside the industry in an effort to reduce harm, and those who are not. The public health and NGO community recognise that the alcohol industry is a stakeholder and can contribute to the reduction of harm in their role as producers and retailers of alcohol. Producing low strength products, labelling and server training are areas where it is legitimate for the industry to have a role. However, the alcohol industry seeks a role for itself in policy areas which extend far beyond their responsibilities as producers and retailers and in which they have no expertise. They are avid promoters of ‘partnerships’ because this provides an opportunity for them to influence the policy agenda in ways that favour their business interests at the expense of the public health interest [1].

Evidence clearly indicates that the most effective strategies involve the reduction of alcohol consumption at the population level {2}. Yet the global CMO of Diageo was quoted in a recent interview with Marketing Week saying “We need to tackle alcohol harm but population approaches don’t work.” [3}. In Scotland, the industry was enthusiastic about ‘partnership working’ when it resulted in alcohol awareness weeks and campaigns on responsible drinking. However, when the Scottish Government signalled its intention to introduce minimum pricing legislation with the full backing of the public health community and civil society, the industry immediately launched a lobbying campaign against the measure. When they were unable to prevent the successful passage of the legislation, they did what the tobacco industry has done for the last fifty years and mounted a legal challenge. During the passage of the minimum pricing legislation, industry representatives frequently called on the Scottish Government to "drop minimum pricing and work together in partnership with the industry to tackle alcohol problems."

Marcus Grant says the industry cannot increase taxation or limit availability as these are government actions. But that doesn’t stop the industry from consistently lobbying against such measures in different jurisdictions all over the world [2]. In reality, what partnership working means for the alcohol industry is steering discussion away from effective measures like controls on price and availability and ensuring that less effective measures are adopted.

If the alcohol industry is serious about reducing the harm that alcohol causes then they should cease all lobbying against those measures that the evidence indicates will be most effective in reducing harm. It is entirely reasonable for the public health and NGO community to insist on this as a pre-condition for any ‘partnership’ working.

[1] Babor T, Robaina K. Public health, academic medicine, and the alcohol industry’s corporate social responsibility activities. Am J Public Health 2013; 103 (2).
[2] Babor T, Caetano R, Casswell S,et al. Alcohol:no ordinary commodity – research and public policy. 2nd ed. Oxford. Oxford |University Press:2010.
[3} http:/www.marketingweek.co.uk/news/qa-with-diageos-global-cmo-andy-fennell/400 accessed 10/04/2013.
[4] Jernigan DH. Global alcohol producers, science and policy: the case of the International Center for Alcohol Policy. Am J Public Health 2012; 102 (1).