Working Together to Reduce Harmful Drinking

Marcus Grant, Mark Leverton, Marcus Grant, Mark Leverton

• Publisher: Routledge
• Year: 2009
• Print ISBN: 9781138872660
• eBook ISBN: 9781135244316
• Topic: Psicología
• Subtopic: Adicción en psicología

This book is intended to contribute to the World Health Organization's (WHO) global strategy to reduce the harmful use of alcohol. It explores areas where alcohol producers' technical competence can and does make a positive contribution to reducing harmful drinking and where industry input has been welcomed by WHO. The book describes each of these areas: producing beer, wine, and spirits; addressing availability of noncommercial beverages; pricing, marketing, and selling beverage alcohol; encouraging responsible choices; and working with others. The final chapter sets out views of how alcohol producers can contribute to reducing harmful drinking in countries where they are present. The messages recurring throughout the book are that reasonable regulation provides the context for good alcohol policy, excessive regulation often leads to unintended negative consequences, leading producers have a proud record of making positive contributions to implementing effective alcohol policies - but there are opportunities to do much more.

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Introduction

Marcus Grant and Mark Leverton

What is this Book Setting out to Achieve?

This book lays out for the international community a coherent view of what it is that beverage alcohol producers can do to help reduce harmful drinking. It does not pretend to present complete solutions that will work for all people in all places. Indeed, one of its main messages is that very few strategies are universally applicable. Rather, what is required is a range of options so that different countries and communities can select which combination of measures is likely to work best for them given their drinking culture and health priorities. Alcohol producers are under no illusion that they are the most important players in developing and implementing balanced alcohol policies. Governments, health professionals, and civil society must occupy center stage. But, equally, alcohol producers are convinced that they do have a role to play. This book aims to demonstrate just how positive that role can be.

Of course, the beverage alcohol industry is diverse and complex (International Center for Alcohol Policies [ICAP], 2006), including many companies, trade associations, and others with no direct hand in the preparation of this book. Although the views presented here are those of individual authors, they broadly reflect the perspectives of those major international drink producers that sponsor ICAP.¹ The experience of other companies and other parts of the industry—particularly retailers—may differ from what is included here. Nevertheless, even if this is not the view of the industry, it does represent a significant international consensus among leading producers. In this connection, the terms industry and producers are not used interchangeably in the text.

The immediate impetus for this book arose from a renewed interest by the international community in balancing the positive and negative effects of alcohol. The World Health Assembly (WHA), which has over the years adopted a number of resolutions, particularly on the development of national alcohol policies, turned its attention in 2008 to strategies to reduce the harmful use of alcohol. The resolution adopted by the 61st WHA calls for the development by 2010 of a draft global strategy, based on all available evidence and existing best practices, to reduce the harmful use of alcohol. In responding to this challenge, the World Health Organization (WHO) Secretariat has been requested “to collaborate and consult with Member States, as well as to consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol” (WHO, 2008, p. 8).

Clearly, the terms of the resolution give pride of place to Member States as the primary constituents of WHO. However, the importance of the other stakeholders is acknowledged by being explicitly listed in the text of the resolution. As a consequence, in the latter part of 2008, WHO initiated a web-based open consultation for all interested parties and then convened two roundtable meetings, one for economic operators and the other for health professionals and representatives of nongovernmental organizations. In the early part of 2009, WHO organized a series of six regional consultations with Member States and went on to produce the draft global strategy, taking into account the results of its broad consultative process, for submission to the WHO Executive Board and, through them, to the WHA.

One effect of this process, which has been conducted in a clear and transparent manner, is to stimulate a wide-ranging international debate about alcohol policy and how it can best be implemented. The goal of this book is to contribute to that debate in a positive and considered way. The governing bodies of WHO will make decisions based on their assessment of whether the draft global strategy, as presented to them, adequately reflects the available evidence and charts a prudent and reasonable course through the competing claims and counterclaims made by the proponents of different points of view. A litmus test of these claims must be the extent to which they seem to offer practical solutions to persistent problems. WHO has been asking stakeholders what they can actually do to help reduce harmful use of alcohol. It is often a great deal easier to explain what others should do than to make specific commitments involving one’s own resources and energies, particularly if these commitments may result in some inconvenience or discomfort. What goes into the global strategy may turn out to be quite predictable. The challenge, as the world moves from planning to implementation, will be to ensure that what comes out of it really does provide a context for multi-stakeholder efforts to reduce harmful drinking.

What is Harmful Drinking?

Alcohol consumption has the potential to be either harmful or beneficial, depending on the drinkers’ individual characteristics and circumstances, consumption patterns, and drinking context. The term harmful use was introduced in 1992 in WHO’s International Classification of Diseases (10th revision, ICD-10) to supplant “nondependent use” as a diagnostic term. In relation to alcohol, it refers to any drinking pattern that causes damage to health. The damage may be physical or mental. Harmful use commonly, but not invariably, has adverse social consequences. As applied in ICD-10, however, adverse social consequences are not in themselves sufficient to justify a diagnosis of harmful use. The closest equivalent in the other main diagnostic system, the American Psychiatric Association’s (2000) Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision, DSM-IV-TR), is substance abuse, which usually does include social consequences.

Not included in either ICD-10 or DSM-IV-TR but often referred to in public health discussions is the term hazardous use, which—in relation to alcohol—refers to a pattern of drinking that increases the risk of harmful consequences. This is sometimes limited to physical and mental health consequences but is often used to include social consequences. It can, therefore, include potential harm to the drinkers or others who might be adversely affected by their behavior.

For the purposes of this book, it will be important to cast the net wide to encompass all aspects of drinking behavior that can be reasonably taken to cause harm to individuals, their families and associates, and the society. It will also sometimes be relevant, particularly from the point of view of prevention programs and public policy, to consider drinking behavior that carries a significantly elevated risk of causing harm, even when it is not possible to document specific negative consequences in every instance. In other words, we need to go beyond narrowly defined diagnostic criteria to embrace a concept of harmful drinking that includes both harmful and hazardous use.

A similarly broad approach is necessary when attempting to define responsible drinking. There is no single source on which we can rely for a generally accepted definition since use of the term commonly reflects the characteristics of the cultures in which it is used. Broadly, it can be considered as a synonym for the term moderate drinking and usually denotes a drinking pattern that does not exceed a culturally accepted daily volume, carrying little or no risk of harm. For example, the Industry Association for Responsible Alcohol Use (ARA) in South Africa defines responsible drinking as “the enjoyable consumption of alcohol beverages within the limits set by your health, circumstances, and obligations to family, friends, and society.”² Of course, this is a rather fluid definition since what counts as responsible drinking at a meeting of Presbyterian churchmen in Scotland will likely be quite different from what counts as responsible drinking at a fiesta in Brazil. Nevertheless, for the purposes of this book, responsible drinking can probably be taken to encompass those patterns of alcohol consumption that do not, or are highly unlikely to, lead to any of the negative consequences described here as associated with harmful drinking.

It is beyond the scope of this book to describe specific health and social benefits that derive from responsible drinking. These have been extensively reviewed elsewhere, both in relation to protective effects for specific diseases, such as coronary heart disease and some metabolic disorders, and in relation to social and cognitive functioning (e.g., Ellison, 2007).³ The relationship between alcohol and subjective pleasure has also been analyzed, with particular attention given to issues such as sociability, relaxation, and quality of life (e.g., Baum-Baicker, 1985; Peele & Brodsky, 2000; Peele & Grant, 1999; Stranges et al., 2006; Valencia-Martin, Galán, & Rodríguez-Artalejo, 2009). Taking that literature into account, the basic premise of this book is that there is a clear and useful distinction between harmful and responsible drinking.

This distinction is important because it speaks to opportunities to develop policy approaches that are relevant to both individuals and societies. From a public health point of view, alcohol policy is one part of a broad approach to health and social policy that is intended to promote equity and improved quality of life at the same time as it eliminates preventable disease and injury. The WHO definition of health, enshrined in the constitution of the organization, states that it is “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” and goes on to note that “the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” (WHO, 1946, p. 1).

More recently, the aspirational language of the WHO Constitution has been taken up and given additional traction through the work of the Commission on Social Determinants of Health (2008). This approach, which stems from earlier work on health inequalities (for a review, see WHO, 2005), identifies socioeconomic factors as powerful determinants of health and advances the notion that the social and economic structure of society shapes the health of populations. It is important to recognize that this approach sees the potential for both positive and negative effects. On the one hand, a vigorous and successful alcohol production industry can contribute significantly to the economic health of a society and thus to the health status of its population. On the other hand, since some patterns of drinking clearly carry increased risk of harm, reasonable regulation and other interventions are required to protect populations, especially vulnerable groups, including the young.

What is the Case for Industry Involvement?

Interventions aimed at reducing the potential harm associated with drinking have traditionally been divided into two basic categories. One is the population-level approach to prevention, consisting of across-the-board measures that rely mainly on controlling the volume of drinking in society as a whole. The other approach involves interventions that are applied in a targeted way, focusing on particular groups, behaviors, drinking patterns, or settings where the potential for harm is elevated. Increasingly, these two approaches have come to be seen as complementary, with population-level measures providing a context within which targeted interventions can be developed (Stimson, Grant, Choquet, & Garrison, 2007).

This book includes a discussion of population-level measures, such as the control of price and access to alcohol (e.g., through setting and enforcing a minimum purchase age). It is worth making clear at the outset that alcohol producers do not favor an exclusive reliance on such measures. Even if they can be demonstrated to have a positive impact on alcohol-related harm, they are usually difficult to introduce and often have detrimental unintended effects (Stimson et al., 2007, pp. 173–191). In addition, their implementation requires elaborate political negotiation, and they are frequently unpopular, at least in part because they are perceived to be discriminatory. However, producers certainly acknowledge the need for a reasonable regulatory framework with opportunities for interventions that address particular groups, settings, and behaviors. How the balance between population-level measures and targeted interventions is created will vary from one country to another, reflecting prevailing attitudes, social and economic circumstances, and culture.

Major alcohol producers understand that reducing harmful drinking is in the enlightened self-interest of their enterprises and their shareholders as well as other stakeholders. While it has been argued that some of their profits derive from excessive or irresponsible drinking, the fact is that such behaviors create a negative image of drinking—and even of producing companies and their brands—that is bad for business. Moreover, left unaddressed, excessive or irresponsible drinking results in calls for high, even punitive, taxes and restrictions. Add to this the fact that people manage and operate alcohol-producing companies, and they also wish to prevent harmful drinking and its ill effects, just as we believe most citizens do. Alcohol producers, therefore, support a range of efforts to encourage responsible drinking. These begin with effective self-regulatory mechanisms so that product marketing promotes only responsible drinking. They also support appropriate governmental regulation in areas such as licensing, purchase age restrictions, and drink-driving laws, as well as reasonable taxation. Further, industry can and should partner with governments, public health, and other civil society organizations that provide effective alcohol misuse prevention and harm reduction programs. In this context, public health and economic interests need not be at odds—they are quite complementary.

There is considerable variation among countries in the salience of alcohol as an issue of public concern. In some, there is little attention paid to it at the political level, whereas in others it is a high priority on the political and public agendas. Not only are there different views among the various stakeholders in each country—governments, industry, the scientific and health communities, and nongovernmental organizations—but also there are many shades of opinion within each sector. The challenge in developing alcohol policy is to balance these different interests by both meeting their many demands and harnessing the contributions they can make.

We have noted that WHO perceives Member States to be its main partners in developing the draft global strategy. But, the governments of Member States are not single entities. Different departments of government have distinct and sometimes competing perspectives on alcohol. Finance departments are likely to be conscious of their significant reliance on alcohol taxes and may be reluctant to raise them as a means of regulating consumption if there is a risk that total revenue will fall. Agriculture and industry departments may have a general inclination against regulation and may promote the alcohol production and hospitality industries as important contributors to the economy. Tourism and culture departments may wish to support the role of alcohol consumption as a contributory factor to quality of life and leisure. Justice departments are likely to focus on public order and, thus, on the regulation of retail drinking establishments. All of these are legitimate perspectives, reflecting a concern for the public good.

Of course, public health is an important component of the public good, and health departments, more than any other sector of government, are likely to give priority to preventing harmful drinking as well as to treating alcohol-related diseases and injuries. The cost of health services, whether privately or publicly funded, tends to increase at rates well beyond those of general inflation or many other government programs. This tends to lead to resistance from other government departments that may see their own budgets threatened. The response of health departments is often, at least at the rhetorical level, to focus on disease prevention, which is compatible with the goals of a global alcohol strategy, but the reality is that politicians tend to take a short-term view of their options and favor policies that are most likely to prove popular in the short term. Whether this is a fair assessment is open to dispute, but no alcohol policy can be sustained unless it balances the perspectives of different government departments and other important stakeholders from outside government.

Beyond government, the health and scientific communities exercise signi...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• About the Editors
• Contributors
• Disclaimer
• Acknowledgments
• Chapter 1. Introduction
• Chapter 2. Producing Beer, Wine, and Spirits
• Chapter 3. Unders tanding Alcohol Availability: Noncommercial Beverages
• Chapter 4. Marketing Beverage Alcohol
• Chapter 5. Pricing Beverage Alcohol
• Chapter 6. Selling and Serving Beverage Alcohol
• Chapter 7. Making Responsible Choices
• Chapter 8. Working Together
• Chapter 9. Implementing the WHO Global Strategy to Reduce Harmful Use of Alcohol: The Producers’ Contributions
• Index