This paper analyses input from global interests in the policy process leading up to the passing of alcohol control legislation in Vietnam in 2019. The global alcohol industry now relies on growth in ...volume in emerging markets in middle-income countries such as Vietnam, a large, rapidly industrialising country with a youthful population and emerging middle class. The industry's role in the alcohol policy process is compared with that of global health interests.
Document analysis of letters and English language media coverage was supplemented by and triangulated with data from key informants on changes in the content of draft alcohol legislation and participant observation.
The alcohol legislation was negotiated in the context of active engagement from the global alcohol industry and some input from global public health interests. The global alcohol industry established a partnership relationship with politicians using CSR and funded a local employee in Hanoi over the decade prior to the draft legislation being considered. Direct lobbying took place over the content of the legislation, which went through six published drafts. Trade and investment agreements provided a supportive environment and were referred to by both politicians and industry. In contrast public health resource was limited and lacked the support of a normative global policy to counter the economic imperatives. Vietnamese Ministry of Health proposals for cost effective alcohol policy were not enacted.
Global commercial interests employed their considerable resources to engage in corporate social responsibility (CSR) and build partnerships with policy-makers over a long period, contributing significantly to an environment unsupportive of enacting effective alcohol control policy. The absence of structural support from a global health treaty on alcohol and lack of an equivalent level of long-term sustained input from global health actors contributed to the legislative outcome, which excluded proposed cost-effective policies to reduce alcohol harm.
The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, ...alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public–private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public–private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.
Notable examples of public private partnerships with alcohol industry include Heineken’s partnership with the Global Fund to assist the transmission of vaccines and Diageo’s with UNITAR to work on ...drink-driving initiatives. Common framings which direct attention away from industry practices are the minority status of heavy drinkers, personal responsibility and the benefits of ‘moderate’ alcohol use. In cross country research, the proportion of alcohol sales consumed in harmful drinking occasions was about half in high income countries, 52% to 62% in middle income countries, and up to 90% in a province of South Africa 10. ...the uptake of effective measures to reduce heavy drinking would impact significantly on sales and profits; the TNACs lobby to avoid implementation of effective policy especially alcohol taxation and marketing. There is no level of alcohol use completely without risk and the much publicised benefits to cardiovascular health of alcohol are as irrelevant to a policy response aiming to reduce harm as are the health benefits of tobacco.
Reducing harm from alcohol: call to action Casswell, Sally, Prof; Thamarangsi, Thaksaphon, PhD
The Lancet (British edition),
2009, Volume:
373, Issue:
9682
Journal Article
Peer reviewed
Summary Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in ...most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.
Timely warnings and examples of industry interference in relation to tobacco, alcohol, food and breast milk substitutes are given in the editorial by Tangcharoensathien et al. Such interference is ...rife at national levels and also at the global level. In an era of 'private public partnerships' the alcohol and food industries have succeeded in insinuating themselves into the global health environment and their influence is seen in key recommendations regarding non-communicable disease (NCD) risk factors in United Nations (UN) reports. The absence of legally binding health treaties in these areas facilitates this industry engagement and the Framework Convention on Tobacco Control provides a valuable model to apply to control of other hazardous products.
Background The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective ...alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. Methods Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. Results The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. Discussion The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. Conclusions The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy. Keywords: Alcohol policy, IAC Policy Index, Stringency, Impact, Framework
Aims
To compare the current status of global alcohol corporations with tobacco in terms of their role in global governance and to document the process by which this difference has been achieved and ...the consequences for alcohol control policy.
Methods
Participant observation in the global political arena, review of industry materials (submissions, publications, conference presentations, websites) and review of published literature formed the basis for the current analysis.
Results
Recent events in the global political arena have highlighted the difference in perception of the alcohol and tobacco industries which has allowed alcohol corporations to participate in the global governance arena in a way in which tobacco has not been able. The transnational producers of alcohol have waged a sophisticated and successful campaign during the past three decades, including sponsorship of intergovernmental events, funding of educational initiatives, research, publications and sponsoring sporting and cultural events. A key aspect has been the framing of arguments to undermine perceptions of the extent of alcohol‐related harms to health by promoting ideas of a balance of benefits and harms. An emphasis on the heaviest drinkers has been used to promote the erroneous idea that ‘moderate’ drinkers experience no harm and a goal of alcohol policy should be to ensure they are unaffected by interventions. This leads to highly targeted interventions towards the heaviest drinkers rather than effective regulation of the alcohol market.
Conclusion
A sophisticated campaign by global alcohol corporations has promoted them as good corporate citizens and framed arguments with a focus on drinkers rather than the supply of alcohol. This has contributed to acceptance in the global governance arena dealing with policy development and implementation to an extent which is very different from tobacco. This approach, which obscures the contribution supply and marketing make to alcohol‐related harm, has also contributed to failure by governments to adopt effective supply‐side policies.
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