Ethical considerations in alcohol policies and decisions on them

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Ethical considerations in alcohol policies and
decisions on them

• Robin Room
• AER Centre for Alcohol Policy Research,
• Turning Point Alcohol Drug Centre
• School of Population Health, University of
  Melbourne
• robinr_at_turningpoint.org.au
• Presented at a conference, The Alcohol Policy
  Arena
• Positioning Science, Knowledge and Policy in
• Relation to the Alcohol Industry, Dublin,
  Ireland 15-16 May, 2008

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Alcohol and other psychoactive substances as
objects of desire and as commodities

• Considerable natural demand
• Operating on pathways in the brain shared with
  eating, sex, other pleasures
• Multiple functions
• Physical stimulation, sedation, intoxicant,
  thirst-quenching, nutrition, solvent,
  performance-enhancing, medication
• Symbolic comradeship, celebration,
  disinhibition, status distinction, sacrament
• Psychoactive substances as commodities
• Plant products wide growing range for sources
  of alcohol
• Production often easily industrialized (beer,
  liquor)?
• Price of production often low
• Market economy and good transport ? increased
  availability
• Advertising and promotion stimulating demand

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Why control at all? -- Health and welfare

• Health harm
• Injuries to others
• Injuries to user (including poisoning)?
• Chronic health problems for user
• Addiction/dependence (a problem in itself)?
• Social problems
• Chronic and acute
• To user and to others
• Interpersonal and collective (e.g. worksite
  productivity)?

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Inherent harmfulness alcohol vs. other drugs1.
adverse effects for heavy users of the most
common form (Hall et al., 1999)
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Inherent harmfulness alcohol vs. other drugs2.
lethality, intoxication, dangerousness
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Options for controlling the market in a commodity
with inherent harmfulness

• Prohibition (heroin, cannabis, cocaine )?
• Prescription regime (valium, stimulants )?
• Market controls to restrict availability
  (alcohol, tobacco)?
• Time and place of sale
• Minimum purchase age
• Restrictions on advertising, promotion
• Restrictions on role of producers sellers
• State monopoly of market (disallowed in EU except
  at retail)?

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The alcohol policy response in (WHOs) Europe (as
of 2005)?

• Diverse amounts and patterns of drinking
• Threefold range in consumption levels
• Full range in adverse patterns (trouble per
  litre)?
• Diverse responses in alcohol policies/market
  control
• Policy score -- range 4-15 (of possible 0-16) on
• Age limits for purchase and drinking
• Time and place restrictions on purchase
• Hours and days of sale, places of sale, density
  of outlets
• State monopoly vs. specific alcohol licenses vs.
  neither
• Price beer vs. cola spirits price vs. national
  wealth
• Advertising restrictions
• Drinking driving blood alcohol limit random
  stop test

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The commercial interestEuropean alcohol
industries are large globally dominant, with
interests on every continent

• Beer 3 of the top 4
• SAB Miller (UK-based)?
• Inbev/Interbrew (Belgium-based)?
• Heineken (Netherlands-based)?
• Spirits the top 2
• Diageo (UK-based)?
• Pernod Ricard (France-based)?
• Wine Europe ...
• Produces 71 of the wine (France, Italy, Spain
  dominate)?
• Consumes 68
• Accounts for 75 of exports (but includes within
  EU)?

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The European industries have policy interests at
multiple levels

• Global
• European nations and the EU are often used to
  pressure for more open markets elsewhere, often
  against a public health interest
• Europe-wide
• The industries have deep interests in EU
  agricultural policy (wine), the single market
  (excise taxes and travelers allowances), the
  services directive (likely to weaken alcohol
  controls)?
• National
• Still the primary level for dealing with many
  issues, e.g. taxes, drink-driving and criminal
  law, industry policies, advertising restrictions
• Subnational
• Many alcohol policies are decided at subnational
  levels in federal states and the UK
• many problems created by drinking have to be
  dealt with at the local level

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The fundamental commercial interest the bottom
line

• Governments and intergovernmental organizations
  can affect this, so the fundamental industry
  demand is to be at the policy table
• In the interests of maximizing sales /or
  profits
• Use trade agreements, the EU single market, etc.
  to remove any hindrances to free sales
• Push down or hold down alcohol taxes
• Seek or maintain freedom to advertise and promote
• Oppose any public health or safety measures which
  threaten sales /or profits
• (But note that different segments/industries do
  not necessarily have the same interests)?

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Arenas of action for industry interests

• Political
• International
• Trade and commercial agencies WTO, EU
• Public health WHO, the EUs DG-SANCO
  (Directorate for Health Consumer Protection)?
• National and subnational
• Governments, political parties, departments
  agencies
• Public opinion and the media
• The professions and researchers as influencers
• Can speak with authority /or help or harm
• ? Industry efforts to influence them

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Mechanisms for action - 1

• The firm itself (public relations, legal depts,
  etc.)?
• National trade bodies
• e.g., British Beer and Pub Association
• European trade bodies
• Brewers of Europe
• European Spirits Organization (CEPS)?
• Comité européen des entreprises vins
• LAssociation des Industries des Cidres Vins de
  fruits de lU.E (AICV)?
• Lobbying institutional and personal

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Mechanisms for action - 2

• Social aspects organizations
• Global International Center for Alcohol Policy
  (ICAP)?
• Europe-wide European Forum for Responsible
  Drinking (EFRD)?
• National e.g., Portman Group in UK
• In W. Europe Belgium (2), Czech Rep., Denmark,
  France, Hungary, Ireland, Italy (2), Malta,
  Netherlands, Portugal, Spain, UK
• Research funding or hosting bodies
• International e.g. International Life Sciences
  Institute (ILSI)?
• Europe-wide European Research Advisory Board
  (ERAB)?
• National e.g. IREB in France

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Indirect methods co-optation of the research
world Europe-wide

• European Research Advisory Board (ERAB)?
• Established 2003, funded by Brewers of Europe
• Modeled on Alcohol Beverage Medical Research
  Foundation (ABMRF) in north America
• 6 members of 14-member Board from industry
• 3 MDs on Board, including
• President of ABMRF
• Author of a book on Wine and Health
• 23 grants listed so far
• 15 biomedical, 4 clinical, 4 psychosocial
• 8 UK, 4 each Italy Germany, 2 each Neth.
  Finland, 1 each Denmark, Sweden, Portugal

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Indirect methods co-optation of the research
world - national

• Institut de recherches scientifiques sur le
  boissons (IREB)?
• Funded by 12 mostly French-based firms, led by
  Pernod Ricard
• Focusalcoologie 9 (2005) reports on work
  supported by IREB
• 21 biomedical studies, including 10 on rats
• 9 social science studies
• Some ideological tinges in the report
• 2 studies are fighting the idea that alcohol
  consumption is related to familial alcoholism

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The processes of pressure influence glimpsing
the woodpecker in the forest

• Social aspects organizations directly controlled
• Research funding or hosting bodies have industry
  represented in governance (and funding can be cut
  off)?
• Industry participation in NGOs influence is
  often less visible
• Industry influence in politics often invisible
• Visible traces e.g. calls from the minister to
  civil servants clearly prompted by industry
  pressure

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Some observations differential strength within
European countries

• Big exporting/multinational firms have had strong
  influence in headquarters countries
• Particularly UK
• Centralization weakens their influence in other
  states where they operate
• The relatively dispersed wine industry has had
  enormous EU influence through the growers
• Minimum EU wine tax 0 as a signal of power
• Zero tax in 6 wine-growing states
• Where there have been state monopolies, alcohol
  industry influence has been weak
• Dissolution of production and wholesale
  monopolies in Finland, Sweden, Norway creates a
  space for new industry influences, but so far
  they are weak
• National social aspects organizations in 14 of 25
  EU states
• Strongest in middle and southwest Europe
• Reflecting strong industries and national
  contention over alcohol?

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Some observations international venues

• In the EU
• Given the EUs inception as a market agreement
  and its late and weak jurisdiction over public
  health,
• there is a long tradition of alcohol industries
  sitting at EU tables,
• a much weaker tradition of NGOs and civil
  society being there
• Industry influence has weakened the EU Strategy
  on Alcohol
• WHO and WHO-Euro are pulled two ways
• Strong pressure for collaboration with the
  industry from the US and some European countries
• But previous cautionary experiences from tobacco,
  pharmaceuticals, baby formula industries
• Industry interests often rely on national
  delegations as paladins in international
  organizations.
• The UK and Germany have often acted in alcohol
  industry interests on alcohol policy in the EU

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Countering the influence of private interests in
public alcohol policy

• Setting limits on co-optation
• Public health policies concerning alcohol need
  to be formulated by public health interests,
  without interference from commercial interests.
• Declaration on Young People and Alcohol, WHO-Euro
  Ministerial Conference, Stockholm 2001
  httpwww.euro.who.int/Policy/20030204_1
• Levelling the playing field
• Legitimated and routine representation of public
  health interest in trade and commerce policy
  matters
• WTO, trade dispute adjudications, commercial
  policymaking
• Negotiation of Framework Convention on Alcohol
  Control
• as counter to WTO and EU trade interests
• providing models for national policies
• Legitimating a public health or public order
  rationale for state pre-emption of the market