Intended for healthcare professionals

Opinion

Commercially driven efforts to frame alcohol harms have no place in UK health policy development

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q800 (Published 04 April 2024) Cite this as: BMJ 2024;385:q800

Linked Analysis

Minimum unit pricing for alcohol saves lives, so why is it not implemented more widely?

  1. Nason Maani, lecturer in inequalities and global health policy, Global Health Policy Unit, School of Social and Political Sciences, University of Edinburgh,
  2. May CI van Schalkwyk, honorary research fellow, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine,
  3. Alice Wiseman, director of public health, Gateshead, Gateshead Council, Gateshead,
  4. Mark Petticrew, professor of public health evaluation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine

Including the alcohol industry and allied organisations in decision making around alcohol regulation and policy can promote industry commercial interests over the health of the public

There is considerable evidence of the role of commercial actors, particularly harmful commodity producers, and the trade associations and third party organisations they fund, in shaping policy and public discourse to their own ends.12 These actors undermine the adoption of effective prevention policies3 while presenting themselves as health experts and self-regulators.4 The cross-industry use of such strategies, including by the alcohol industry, is well documented. The World Health Organization (WHO) thus recommends that alcohol producers should not be part of policy considerations, beyond policy implementation.56

Despite this, in the UK, the alcohol industry remains an active participant in alcohol policy development. A recent parliamentary oral evidence session7 focused on preventing alcohol harms serves as a pertinent reminder of how industry influence is an important obstacle to progress at a time of record highs in alcohol harm.8

The first oral evidence session of the Health Select committee’s work stream on preventing alcohol harm7 included four organisations, all of which either represented, or received funding from, the alcohol industry. None of the panellists were asked to declare any conflicts of interest at the opening of the session. The session provided an opportunity to observe how the alcohol industry can, directly and through its funding and promotion of industry-favourable narratives, seek to influence discussions.

First, on redefining alcohol harm prevention. Despite the committee’s aim of gathering evidence on preventing harm, it is striking that the WHO recommendations for policy “best buys”—that is, policies tackling the affordability (such as alcohol taxation or minimum unit pricing), availability (such as restricting outlet density or opening hours), and marketing of alcohol9—were largely absent from discussion throughout the session. Instead, industry participants emphasised a need for more public information campaigns, despite the lack of evidence for the effectiveness of privately sponsored public messaging on alcohol harms.10 These suggestions are at odds with the evidence,10 civil society,11 and guidance from the WHO.12

Second, on industry claiming credit for positive trends while downplaying its role in alcohol harms. The alcohol industry has claimed credit for positive trends in alcohol use (for example, declines in youth drinking),13 while downplaying, or avoiding responsibility for, negative trends (for example, all time highs in alcohol related deaths across the UK).8 This recurred throughout the session, including unevidenced claims that industry initiatives have contributed to declines in young people drinking, and that the UK was an example of a “gold standard” of self-regulation.7 By contrast, none of the respondents suggested that record levels of alcohol harm might be influenced by alcohol industry activities. This interpretation is deflective, ascribing responsibility for alcohol harms to government and individuals, and responsibility for reduction in harm to industry sponsored or industry preferred initiatives.

Third, on shaping notions of evidence. There are well documented efforts by harmful product manufacturers to redefine what evidence is considered relevant in decision making. This is termed “evidential landscaping” in the context of the tobacco industry. It includes disputing independent scientific evidence, while promoting an evidence base that aligns with their policy goals to deflect attention away from any perceived responsibility for product harms and from effective policies which would restrict their commercial interests.14 During this session, evidential landscaping occurred in relation to statements on minimum unit pricing (MUP), including claims that the evidence was inconclusive. This contrasts with the final evaluation report from Public Health Scotland which found a positive impact on health outcomes, particularly evident in the most deprived areas.15 The MUP evaluation, published in the Lancet in 2023, found MUP was associated with significant reductions in deaths, and hospital admissions, with the greatest reductions in the 40% most socioeconomically deprived areas.16

In relation to the MUP, the panel referenced commissioned polling and surveys of the public, emphasising their importance, while downplaying, or avoiding, the weight of independent evidence on effective policy options to prevent alcohol harm. This is notable given the role the alcohol industry played in delaying the uptake of MUP legislation in Scotland by successfully lobbying against its adoption and then mounting a lengthy legal challenge against the policy when it was eventually enacted under the majority Scottish National Party government.17

This session shows how the choice of including industry and industry funded organisations in evidence gathering can shape the narrative, in ways that are consistent with maintaining industry interests, over population health. It provided opportunities for these harmful framings to be disseminated by actors with significant conflicts of interest and, in the case of Drinkaware, a track record of disseminating misinformation to the public including in schools18 to present themselves as legitimate experts in the prevention of alcohol harm.

More broadly, this session offers an example of the indirect effects of alcohol industry corporate social responsibility activities, self-regulatory approaches, and funding of charitable organisations. These practices collectively contribute to the creation of a narrative of progress rather than of record levels of alcohol harm; of self-regulation and partnership without acknowledging or seeking to manage fundamental conflicts of interest; and a focus on education and new product categories rather than evidence based policy approaches supported by authoritative health bodies,12 a recent independent commission,11 and wider civil society.

The UK needs a new alcohol strategy that prioritises health and equity, is informed by guidance from the WHO and independent civil society, and aims to prevent alcohol harms, and protect policymaking, research, and public health practice from undue influence from the alcohol industry.11 Policy discourse regarding such a strategy should not be polluted from the outset by commercial interests.

Footnotes

  • Conflicts of interest: MP co-chaired the committee which reviewed and revised the UK CMO’s guidelines. The other authors declare no relevant conflicts of interest.

  • Provenance and peer review: not commissioned, not externally peer reviewed

References