By Benjamin Hawkins (London School of Hygiene & Tropical Medicine) and Chris Holden (University of York)
Despite the substantial health harms associated with alcohol, and the emerging literature on the activities of the alcohol industry, policies at the national and global levels remain extremely weak in comparison with tobacco control policies. Moreover, whilst the tobacco industry has been marginalised from policy debates in many contexts, alcohol industry engagement in policy-making remains extensive. There is no equivalent of the Framework Convention on Tobacco Control (FCTC) for alcohol and certainly no equivalent of Article 5.3, which mandates governments to guard against industry interference in policy making. For researchers working across both industries, the difference in approach taken to tobacco and alcohol can be a source of both intrigue and frustration. Consequently, we sought to interrogate alternative rationales for the regulatory status quo through a comparative analysis of the political economy of each industry (Hawkins et al., 2016).
Different Regulations, Different Products
Existing policy regimes reflect both the different socio-cultural positions of these products and the success of a unified tobacco control movement in agitating for policy change. The success of tobacco control advocates has depended in part on promoting an idea of ‘tobacco exceptionalism’; that unique policy responses can be considered for tobacco and the tobacco industry because they are uniquely harmful in nature. When consumed precisely as intended by their manufacturers, tobacco products kill 50% of their long-term users prematurely. This is not true of alcohol, whose producers at least claim to promote moderate consumption. Yet alcohol is extremely harmful causing an estimated 3.3 million deaths per year (5.9% of global mortality), versus 5.4 million death per year (8% of global mortality) for tobacco, and is associated with a range of wider social harms. Whilst tobacco may be uniquely harmful, the differences in harm do not appear to provide sufficient rationale for such radically different policy approaches.
Political Economy
Political economy approaches acknowledge the inseparable nature of the political and economic spheres and recognise that corporations will employ both market and political strategies (which seek to shape the regulatory environments in which they operate) in pursuit of their interests. They recognise also that corporate strategy is a key driver of non-communicable diseases (NCDs) (Moodie et al., 2013). Consequently different strategies or market structures may provide a rationale for regulating products and engaging with industries in different ways.
Market structure, particularly the degree of concentration and trans-nationalisation of a sector and the size and profitability of corporations within it, affects their ability to execute both their market and political strategies. For example, high degrees of concentration allow individual companies to control pricing, whilst large, profitable companies have extensive resources to deploy in influencing policy. Whilst the degree of concentration in the tobacco industry exceeds that in the alcohol industry, both industries are dominated by a small number of large, transnational, and highly-profitable corporations, which use their dominant positions to control and structure product pricing. Moreover, the current trend in the alcohol industry appears to be towards even greater consolidation and trans-nationalisation (Jernigan and Babor, 2015). Transnational alcohol companies (TACs) are the only corporations approaching the levels of profitability seen in the tobacco industry (Gilmore et al., 2010). There are also significant similarities in the policy influencing strategies used across industries. These include lobbying key decision makers and efforts to shape policy debates by funding research and influencing the interpretation of policy relevant evidence.
The differences which exist between the alcohol and tobacco industries, and the products they make, do not appear to be significant enough to justify such widely diverging regulatory approaches given the similarities which exist in terms of the market and political strategies pursued, and the industry structures which facilitate these. Above all, the rationale for the ‘partnership’ approach often extended to alcohol corporations, and their common status as ‘insiders’ in the policy-making process, must be called into question.
Knowledge Gaps
Since the public release of internal industry documents, principally as a result of litigation during the 1990s, an extensive literature has documented the strategies employed by transnational tobacco companies (TTCs) to further their corporate interests at the expense of public health. Despite increasing attention to the activities of the alcohol industry recently, one key difference between the two industries is simply that we know much less about the political strategies of alcohol companies.
Policy Spillover
This calls for additional research on the alcohol industry (and other health harming industries) to inform policy debates. There is a clear opportunity to learn from the case of tobacco to develop more effective evidence-based policies to address NCDs and mitigate the attempts by industry actors to undermine these. This does not mean losing site of the unique harms of tobacco consumption or assuming that the tobacco industry is no longer able to influence policy. Recent investment in the e-cigarette industry as a means to re-engage policy makers shows that industry craves legitimacy and is constantly working to undermine existing exclusions from the policy-making process.
—
Acknowledgements
This research was funded in part by the National Cancer Institute, US National Institutes of Health, Grant No. R01-CA091021. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the funder.
Related content in Health Policy and Planning
Comparing global alcohol and tobacco control efforts: network formation and evolution in international health governance
Uwe Gneiting and Hans Peter Schmitz
