Throughout the series, participants explored several thematic areas to identify actions to reduce the harmful use of alcohol. These included: a whole-of-society approach to reducing the harmful use of alcohol; reducing the harmful use of alcohol in the time of COVID-19; effective regulatory actions to ensure responsible sale and delivery of alcohol; and sharing data and information to support reducing the harmful use of alcohol. Overcoming barriers to trust and collaboration among stakeholders also emerged as a strong recurrent theme during the dialogues.
Theme: Whole-of-society approach to reducing the harmful use of alcohol
Despite some reservations of engaging with the alcohol industry, participants from a wide range of backgrounds agreed that a whole-of-society approach is essential to have a meaningful impact on reducing alcohol-related harms. Such an approach means working with all interested and affected stakeholders, including new partners who are often not present.
All stakeholders in the alcohol ecosystem need to participate in identifying and implementing solutions. A whole-of-society approach needs to engage the whole supply chain including producers, retailers, advertisers, distributors and deliverers, and a range of other actors including government, academia, mainstream media, social media platforms, civil society, communities and consumers who are affected.
Addressing the harmful use of alcohol is not only the remit of the public health sector and a whole-of-government approach is required to support changes in consumer and industry behavior. Many other government sectors including finance, social welfare, police and justice, economic and community development, education and transport need to be engaged. A holistic, integrated, coordinated approach is necessary.
A whole-of-society approach also involves working at local, national, regional and global levels. Participants observed that there is often a lack of coordination and coherence between the different levels. For example, global guidelines and goals exist, but these have not been domesticated at a regional or national level. Similarly, national policies and programmes may be developed without adequate consultation with communities, and thus may miss critical pieces of the puzzle. Although different regions and contexts require specific tailored interventions, as articulated in regional discussions across sub-Saharan Africa, Asia-Pacific, and Caribbean, Central and South America, participants identified common areas for taking action towards a whole-of-society approach. This was particularly the case across three areas of harm: drinking and driving, drinking during pregnancy and underage drinking. It was far more challenging to identify how best to reduce harm in the areas of heavy-episodic or heavy-drinking, and chronic-heavy drinking. However, these are key areas of action that need to be explored further among stakeholders, using data and evidence.
Theme: Reducing the harmful use of alcohol in the time of COVID-19
The COVID-19 pandemic affected alcohol use in several key ways. The rapid acceleration of e-commerce opened up new patterns of drinking, including drinking alone, at home, and in some cases drinking more, to cope with the stresses and losses of the pandemic.
More positively, COVID-19 precipitated a seismic shift in openness, awareness and de-stigmatization of mental health issues. This created opportunities for more open discussions around the harmful use of alcohol, including both underlying mental health causes of harmful use, as well as the mental health consequences for the individual and the family.
A complicated landscape emerged regarding country experiences of alcohol use during lockdowns. Overall during the pandemic, the total volume of alcohol drinks sold decreased globally. In many countries, the data showed moderate drinkers consumed less, but heavy drinkers consumed more with alcohol-related deaths rising during this period.
During COVID-19, some countries banned alcohol completely or closed venues that sold alcohol. Examples from India and South Africa demonstrated that implementing a ‘dry law’ on alcohol to reduce COVID-19 contagion does not result in overall positive gains. In many cases, the law drove people to consume illegal and sometimes dangerous alcohol and when laws were lifted, people drank in public places, ignored social distancing measures, and risked COVID-19 infections. It is important to analyse and consider social, political and economic implications of actions to reduce the harmful use of alcohol.
Digital marketing and the use of influencers and social media to promote alcohol sales amplified during this period. This also presents new opportunities to promote positive health messages around alcohol consumption, and can potentially give more control to the consumer over their marketing choices. For example, in 2018 IARD established partnerships with Meta (previously Facebook), SnapChat and YouTube and created a set of standards around digital marketing to prevent minors from seeing alcohol advertising online, and explored ways to give users options to avoid alcohol advertising.
As a result of Wilton Park dialogues in 2019, IARD worked with these companies to further strengthen these standards to stop minors from seeing alcohol advertising and allowing users to opt out of alcohol advertising completely. The impact of COVID-19 and government responses to the pandemic has resulted in changes to alcohol policy and use patterns around the world. A renewed focus on public health in government, business, and the public may provide opportunities to renew the commitment to a whole-of-society approach in tackling the harmful use of alcohol. This could drive further engagement and challenges in the upcoming milestones for the 2025 UN High-Level Meeting on NCDs.
As a result of these dialogues, IARD agreed to look at the following possible actions:
- Step up communication to consumers about risks of harmful drinking during COVID-19 and lockdowns: shift from promoting responsible drinking to actively communicating messaging around harm and be explicit about low-risk guidelines where they exist.
- Accelerate standards on e-commerce, including better consumer information and explore, where possible, self-exclusion options for vulnerable consumers to opt-out of online advertising and marketing of alcohol
- Utilise growth in new online commercial channels (including e-commerce) to promote low and no alcohol by volume (ABV) drinks and support growth in trends for health and wellbeing
- Use digital marketing to support delivery of approved public health messages and harm reduction tools
- Take stronger action on influencer marketing; contracts and commercial relationships should be terminated with any influencers that promote irresponsible drinking
- Share more data and identify a space for where industry data can be accessed by other stakeholder groups
- Monitor, evaluate and share the implementation of codes and standards to ensure they work ‘in practice’; work with independent organisations to do this where possible.
Theme: Effective regulation and enforcement
Participants discussed how effective and enabling regulation and enforcement to reduce the harmful use of alcohol is critical,but differed on how to approach it. Participants held challenging conversations about the merits or otherwise of self-regulation, co-regulation and formal regulation particularly in the areas of marketing and advertising, and sales and delivery. Unrecorded, illicit, and traditional alcohol consumption complicates the picture of regulation, particularly in some parts of the world where this is highly prevalent.
Regulatory and enforcement gaps
Regulation and enforcement of advertising and marketing of alcohol, sales, and drinking driving are inconsistent across the world. In many countries, laws remain absent or are not enforced.
Policy development around regulation can be effective when it involves civil society, academics and activists who can hold irresponsible actors to account for their actions.
To some, self-regulation alone was seen as insufficient, while others, including industry, argued that co-regulation (i.e. acting in accordance with and building on government regulation) is both a positive standard-setter for the whole-of-industry and a sustainable business model, and that co-regulation can be an entry point for formal regulation.
From a business perspective, regulation will often be developed according to the worst practitioners and so there is an impetus to raise standards across the whole industry, and
a balance must be struck between what shareholders want, and operating a sustainable business.
Regulation for advertising and marketing
A range of stakeholders held important discussions across multiple meetings to find ways to shape and strengthen safeguards for responsible digital marketing, including influencer marketing, which can cross borders and evade regulation. Conversations focused on how to protect certain groups of vulnerable people including minors, pregnant women, and abstaining or non-drinking communities.
Digital marketing has grown rapidly in recent years, and while some stakeholders saw this as a threat to public health, others saw it as an opportunity to promote public health messages and responsible drinking advice.
During the discussions, the development of international standards for digital marketing was underway. Some companies produce legally binding contracts with marketing agencies requiring them to abide by codes of practice surrounding the responsible promotion of alcohol (i.e. not to minors, and not associating alcohol with sexual success).
As drinking alcohol is often a social activity, some described it as also being ‘socially regulated’. Marketing also has a great power to shape human behaviour, and is therefore also critical in regulating behavior and creating positive social norms around the responsible use of alcohol.
In January 2020 IARD developed Actions to accelerate reduction in underage drinking. Throughout 2020 IARD built on existing partnerships with digital platforms including Meta (previously Facebook), YouTube, and Snapchat to support for example greater controls for influencers to age-gate posts and profiles; allow users to opt out of alcohol advertising and not advertise alcohol on family-suitable content; and create more robust age controls. In September 2021, IARD published Influencer Guiding Principles to encourage responsibility by social influencers in alcohol marketing.
However, caution was expressed as while principles, standards and partnerships are welcome, the digital landscape is fast-paced and there is no control over consumers individually promoting alcohol through their social media accounts and reaching vulnerable populations. In addition, it can be difficult to engage influencers to act responsibly, especially those who are outside of IARD’s member companies. It was hoped that the principles would stimulate a social norm to which influencers conform.
Three specific Wilton Park dialogues focused on accelerating the development and refinement of digital marketing standards for alcohol, and two dialogues explored the development of influencer guiding principles.
Regulation for sales and delivery
COVID-19 resulted in a massive disruption of ‘on-trade’ hospitality venues and transfer to ‘off-trade’ purchasing. Industry stakeholders argued that, in the past, producers have found it easier to build partnerships and set standards with advertising agencies, digital platforms and e-commerce retailers. Traditional retailers are much harder to engage. One particular challenge in the area of e-commerce was the last mile of delivery. For example, how do you incentivise delivery agents on a low wage to do the right thing and not deliver alcohol to underage or inebriated people?
With the fast-pace of change in the area of alcohol sales and delivery (especially online), governments have sometimes found it difficult to regulate and enforce positive action. IARD training tools and incentives have supported this, ensuring that systems are strong enough to support the driver to make the right decision such as Frontline delivery agent training in several languages.
Three specific Wilton Park dialogues focused on E-commerce standards to stress-test and co-create IARD standards.
Illegal, informal or traditional alcohol use
Illegal or informal alcohol sales are 25% of the overall alcohol market on average globally, and in some countries it is as much as 60%.
The unregulated alcohol market – illegal, informal, and traditional alcohol production and use – is outside of government regulation and control, and as an informal sector, is impossible to tax. It is a complex and varied market. Illegal or illicit alcohol can contain toxic ingredients and be harmful to health or threaten life, and is also a big driver of crime. Informal or traditional production of alcohol is widespread in many low and middle-income countries, and is an accepted and longstanding part of culture and society.
For example, in many parts of Africa, it is commonplace for women to run informal drinking establishments, selling traditional brew made from local crops. While acknowledging that excessive drinking can cause a range of harms, these women rely on this income for their families’ survival in the absence of other types of employment. Understanding this context with sensitivity is important for addressing the harmful use of alcohol, and support can be given to local producers to increase safety and improve standards.
Community engagement and participation in identifying and solving problems is key, as culture and society play a huge role in maintaining or changing concepts, values and practices around the use of alcohol, particularly when alcohol use is informal.
Alcohol use and impact of harmful drinking also depends on the social determinants of health such as poverty, unemployment, housing, family and community structures and these social determinants should also be considered when taking decisions and action.
Sharing data and information to support reducing the harmful use of alcohol
In response to the challenge set forth in the WHO Global Alcohol Action Plan 2022-2030, three Wilton Park dialogues focused on data-sharing to explore what data is required by public health researchers, what data the industry can share, and the alignment of principles for sharing data that is robust, transparent and objective.
For effective action and interventions, all stakeholders need reliable and accurate data, and public health stakeholders need access to industry data. Strong demand exists for information, evidence and evaluations of industry interventions to reduce harmful drinking, and a data gap exists in relation to women and young people.
However, data alone is insufficient and a nexus of events and evidence must occur before policies change. Communities are legitimate stakeholders in this agenda, and must contribute. Recognising the two ends of the spectrum of policy making and community action is key to building trust to find common solutions to reducing the harmful use of alcohol. Alcohol industry stakeholders were strongly of the opinion that they should not fund research on alcohol and health, due to perceived conflict of interest. However, further discussions are urgently needed about sustainable, transparent, and ethical funding mechanisms that could support researchers to conduct independent evaluations on industry’s and others’ actions to reduce harmful drinking.
How can industry work alongside others to make progress?
During the final meeting of the series in September 2023 in New York, participants identified key ways in which the alcohol industry and other stakeholders can work together more effectively to reduce the harmful use of alcohol. These included:
- Build trust and collaboration among a wider group of partners: find specific areas of agreement between multiple stakeholders and work together to innovate, evaluate, and learn. Leave bias behind when you enter dialogues and rely on evidence.
- Common ground among stakeholders, including industry and public health actors, can be found in the specific area of harm reduction, and this should be the focus as we move forward. Industry should be pragmatic and work with partners where there is common ground, even where there is not agreement on everything.
- Guidelines for industry and non-industry actors should be developed to support collaborative working with clear boundaries about what can be discussed and achieved, and what is off limits.
- Financing: there is a need for an independent model addressing the conflict of interest between financing and engagement, especially for data and evaluation of actions to reduce harm.
- Improve documentation of interventions and outcomes, share knowledge and information about good practice and successful outcomes, disseminate learning, use storytelling, and scale up action.
- The private sector has knowledge, tools and techniques, including on digital marketing, which can be applied to public health goals to reduce drink driving, underage drinking, and drinking in pregnancy. This can also be used to tackle the problems of heavy-episodic (or binge) drinking and chronic-heavy drinking.
- Take partnerships, conversations and knowledge from the global level to the regional and country levels. Start dialogues in countries that define spaces in which to intervene collaboratively according to country contexts.
- Expand and engage communities as key stakeholders and consumers, and co-design interventions with the community.
- Take into account regional various and country contexts, particularly as alcohol e-commerce levels vary and are not relevant in some places. Policy solutions should be explored and tailored accordingly.