The politics of alcohol and policy formulation

By Adam Bertscher, Leslie London & Marsha Orgill (all authors University of Cape Town)

Alcohol is contributing to a growing global burden of non-communicable diseases. Some of these diseases are referred to as ‘industrial epidemics’ because they are the result of social or commercial determinants of health. In other words, they are – at least in part – a result of the activities of business practices who aim to sell their products on mass.

A global health priority

Alcohol is recognized as a global health priority and a call to strengthen global and national alcohol control policies has been made – however health is political and drafting policies can often take years because multiple actors with power and vested interests may influence the process. Alcohol policy is particularly political because economic arguments and public health arguments are often at loggerheads.

Recognising that alcohol is a major public health burden and cost in South Africa – and that alcohol advertising often targets young people and encourages underage drinking – the South African Department of Health developed the 2013 draft Control of Marketing of Alcoholic Beverages Bill to restrict alcohol advertising as an evidence-based upstream intervention. The Bill has been subjected to repeated impact assessments and, 5 years on, has not been released for comment.  Through the research we sought to shed light on the politics of policy formulation and in our Health Policy and Planning paper we discuss a number of factors at play in the complex policy formulation process:

• There was an explicit use of economic arguments by industry representatives to counter public health arguments – and these economic arguments were disseminated more widely than public health arguments in the media, even though the research underlying the economic arguments was called into question
• The alcohol industry uses perception strategies to frame solutions to the alcohol problem, actively portraying the industry as a partner of government and proposing corporate social responsibility and public-private partnerships as solutions to alcohol-related harms
• The current silo model of government departments contradicts the Health in All Policies approach – government departments have concerns and interests not always aligned with public health
• Stakeholder consultative platforms are actively used by the alcohol industry to promote their message
• Two of the three impact assessments conducted in the process of considering the law were not put in the public domain for scrutiny

These results raise critical issues that should be considered:

1. Governments need to institutionalise appropriate governance structures to ensure a Health in all Policies approach
2. What is the role of regulatory Impact Assessments (RIAs) and/or Socio-economic impact assessments (SEIAS) in the policy formulation process if they are not made public? – who owns this process and the subsequent results?
3. What is the role of the media in public health in either promoting or undermining public health goals?
4. What constitutes ‘stakeholder consultation’ and what power does this give rise to?

Finally, with the growing push for public-private partnerships (PPPs) as a panacea to global problems, we must always question and investigate through research who stands to benefit from these PPPs and who is bearing the cost of the alcohol industry and alcohol-related harms in societies.

You can access the full Editor’s choice article in Health Policy and Planning: Unpacking policy formulation and industry influence: the case of the draft control of marketing of alcoholic beverages bill in South Africa.