Regulating Alcohol around the World

Policy Cocktails

Tiffany Bergin

• Publisher: Routledge
• Year: 2016
• Print ISBN: 9781409445258
• eBook ISBN: 9781317068884
• Topic: Medicine
• Subtopic: Health Policy

With the World Health Organization estimating that nearly four percent of global deaths are due to alcohol, alcohol misuse can be an extremely damaging social problem, and one that governments around the world have endeavored to address through a range of policy strategies. Regulating Alcohol around the World explores historical and contemporary case studies in multiple countries to gain a richer understanding of the political, economic, and other forces that influence alcohol-related policymaking. The case studies presented in the book investigate a range of different kinds of alcohol policies, including prohibition strategies, general efforts to reduce alcohol's social harms, and more targeted policies. The explanatory value of leading theories from political science, policy studies, anthropology, and other fields is assessed, with particular reference to the influence of cultural and historical factors on approaches to alcohol regulation. The book adopts a global perspective and offers guidance for students, researchers, practitioners, policymakers, and other stakeholders about the lessons that can be learned from previous efforts to change alcohol policies. As such, it will be of interest to practitioners in the fields of health and alcohol abuse prevention, as well as scholars and students of social policy, criminology, and the sociology of health, addiction, and social problems.

Chapter 1 Introduction

DOI: 10.4324/9781315604480-1

In late April 2012, a commentator argued in The Malaysian Insider that “Alcohol consumption will not stop, and what policymakers must concentrate on is changing the environment so persons who consume alcohol do not drink excessively, and that they are protected from alcohol-related harm” (Rahman, 2012).

Just over a week later, a Canadian newspaper article reported Quebec’s decision to join Ontario in imposing a blood-alcohol limit of zero for young drivers (Aylward, 2012). In the article, an activist said of the policy: “Places like Ontario have seen a significant drop in deaths and injuries right across the board, including young drivers. It’s working.”

That same day, Brazil’s Senate approved legislation allowing alcohol to be sold in stadiums during the 2014 World Cup—even though alcohol sales at matches have been banned since 2003 (“Brazil Senate …”, 2012). The passage of the legislation was controversial, with one Brazilian senator declaring that even though he voted for the bill he felt “violence in stadiums has decreased a lot because of the ban against alcoholic beverages.”

Six days later, a commentator in the British newspaper The Guardian questioned Scotland’s decision to impose a minimum unit price for alcoholic beverages, writing: “Will minimum pricing make us drink less? It is very unlikely that minimum pricing will affect David Cameron’s chaotic problem drinkers; some problems need deep solutions and some are not solvable at all” (Gold, 2012).

Two days after that, Kenya’s Presidential Cabinet voted in favor of tougher penalties for driving under the influence of alcohol among other driving offenses, with the goal of reducing fatal traffic accidents in that country (Ohito, 2012).

Less than a week later, an Australian politician stated that he and other members of a parliamentary committee had “received evidence that alcohol labels need to be introduced as part of a wider health promotion strategy and also evidence that alcohol labels don’t work,” prior to a series of governmental discussions on the issue (as quoted in “Alcohol warnings …”, 2012).

These six examples—from six continents during a single four-week period—illustrate the centrality of alcohol-related policymaking in twenty-first century society. The harm reduction strategies, blood-alcohol limits for drivers, retail bans, minimum prices, tougher penalties, and warning labels for alcoholic beverages discussed in these examples are just six of the myriad kinds of alcohol policies that policymakers, practitioners, activists, commentators, and citizens around the world debate on a regular basis. These debates often revolve around questions of evidence and effectiveness, as the examples above illustrate. Which policies are most effective at reducing alcohol’s social harms? What evidence is there of a particular policy’s success? Yet evidence is not the only force that can impact alcohol policymaking. History and culture can matter as well, as can political and economic forces such as globalization. Exploring the impacts of all of these factors on alcohol policymaking across time and around the world is this book’s central task.

Alcohol is a global concern, and policy decisions about alcohol are made in an increasingly-globalized context. Recognizing this—and warning that alcohol contributes to at least 2.5 million global deaths per year—the World Health Organization (WHO) in 2010 unveiled its Global Strategy to target harmful alcohol consumption. The strategy aims to increase awareness of alcohol’s harms and to promote the implementation of practices that can most effectively tackle these harms (p. 8). Such policies include establishing price incentives for nonalcoholic drinks, regulating the hours during which retail sales of alcohol can take place, and enacting minimum age limits for purchase (pp. 9–23). At the moment, however, these policies are only recommendations and no country is required to adopt them (Sridhar, 2012).

The WHO has long emphasized an international approach to tackling alcohol’s social harms. Twenty-seven years before the release of the Global Strategy, in 1983, the WHO’s decision-making body pronounced alcohol one of the world’s foremost health hazards (Jernigan et al., 2000, p. 491). The WHO’s approach is also based on rigorous empirical research. Indeed, in the years leading up to the adoption of the Global Strategy, the organization’s Secretariat released a report entitled Evidence-Based Strategies and Interventions to Reduce Alcohol-Related Harm (WHO, 2007). An evidence-based approach is also endorsed by other supranational bodies. In its 2006 alcohol strategy, the European Commission advised EU member states that, when it comes to measures to control alcohol misuse, “every measure has to be considered on a case-by-case basis; in all cases, they should be evidence-based” (p. 14). The United Nations’ Office on Drugs and Crime has undertaken reviews and disseminated lists of “evidence-based” programs to prevent the misuse of alcohol and other drugs (2009, p. 2).

National governments have also promoted the importance of evidence-based policies and practices to reduce alcohol’s social harms. As early as the 1980s, the Dutch government emphasized an evidence-based approach to combat the harmful use of alcohol (Bongers, 1998, p. 44). In more recent years, Ireland’s Health Service Executive issued the report Towards a Framework for Implementing Evidence Based Alcohol Interventions (Barry and Armstrong, 2011), while Hong Kong’s Department of Health Action Plan to Reduce Alcohol-Related Harm is said to be “built on detailed examination of the local situation on alcohol use, while drawing references from overseas evidence as well as recommendations of the WHO” (2011, p. v; emphasis added). A recent announcement on the Scottish government’s (2012) website proclaimed that the “Scottish Government is developing interventions which are informed by a strong evidence base.” Meanwhile, Bermuda’s Department for National Drug Control has underlined the importance of implementing “evidence-based substance abuse services throughout the criminal justice system” to tackle dependencies on alcohol or other drugs.

As these examples illustrate, many governments have, unsurprisingly, expressed interest in evidence-based strategies to combat alcohol’s social harms. Such interest ostensibly matches the recommendations of numerous researchers from around the world who have argued that “policies should be based on scientific evidence showing the effectiveness of various alcohol policy options” (König and Segura, 2011, p. 49). However, endorsing evidence-based rhetoric is one thing—actually adopting and implementing evidence-based practices is quite another. What political, economic, historical, cultural, and other factors impede the adoption and implementation of evidence-based alcohol strategies? Do theories from other policymaking literatures offer insight into the forces that influence alcohol policies? What lessons can countries learn from past experiences?

Building on the small but growing literature on alcohol policymaking, this book explores historical and contemporary case studies to gain a richer understanding of the factors that impact alcohol policies around the world. The explanatory value of leading theories from political science, policy studies, and other fields is assessed, and research about the cross-national transfer of policies and beliefs about evidence is presented. The book therefore adopts a global, historical, and interdisciplinary perspective to examine the critical issue of alcohol policymaking. Despite the issue’s prominence in contemporary societal debates, and despite landmark related work by Stevens (2007), Schrad (2010), Room (1991), Johnson and colleagues (2004), and other scholars, the alcohol policymaking process still strongly needs more attention from researchers. This book therefore offers researchers, practitioners, students, and other stakeholders, a highly accessible synthesis of existing works and studies, illuminating the many forces that shape alcohol policy decisions. The book also advances guidance for policymakers about how evidence can best inform policymaking, as well as summarizing lessons that can be learned from previous efforts to change alcohol policies.

Key Themes

Policies that address alcohol’s social harms are the focus of this volume. Room’s (2000, p. 94) definition of social harm as a “perceived misperformance or failure to perform in major social roles—as a family member, as a worker, as a friend or neighbour, or in terms of public demeanour” is employed here. This broad definition is used to capture the range of negative consequences that can result from alcohol misuse. In particular, long-term health impacts to drinkers, violence, traffic accidents, and other impacts are explored in detail.

The severity of these various kinds of harms underlines the importance of the research discussed in this book. Alcohol consumption has been found to play a causal role in at least 60 different medical conditions (Room et al., 2005), and the WHO reports that four percent of global deaths are due to alcohol (2011b, p. 20). Alcohol may be involved in nearly a third of homicide deaths and a quarter of suicides (Smith et al., 1999) and one report based upon US data found that alcohol was involved in almost 40 percent of violent victimizations (Greenfeld, 1998). Alcohol may increase the incidence and severity of domestic violence (Leonard and Quigley, 1999; Testa et al., 2003) and produce serious developmental and cognitive deficits following excessive prenatal exposure (Fast and Conry, 2009).

Researchers have long studied these social harms. Indeed, the American physician Benjamin Rush, Surgeon General in George Washington’s army and a close friend of John and Abigail Adams, pioneered the idea of “addiction” to alcohol in the 1780s and 1790s (Butterfield, 1950; Ferentzy, 2001). One of his works from this period, An Inquiry into the Effects of Spirituous Liquors on the Human Body (1785), was among the earliest comprehensive attempts to “medicalize” the study of alcohol abuse. In this publication Rush described the relative dangers of different types of alcoholic beverages and connected excessive alcohol consumption to pneumonia, tuberculosis, and other medical conditions; some of these links have since been proven by contemporary studies (Lönnroth et al., 2008; Rehm et al., 2009; Szabo et al., 1997).

Although research about alcohol policymaking is still nascent, research into alcohol’s social harms has a long history, and enthusiasm for applying this research to policy has increased in recent decades in many parts of the world. As Babor (2002) has reported, cross-national collaboration in alcohol research—often conducted under the auspices of major public health bodies such as the WHO—has grown dramatically since the 1970s; such research has helped foster a new “what works” culture that is focused on identifying and applying effective policies and programs to reduce alcohol’s social harms.

Of course not all of alcohol’s potential social harms can be addressed in one volume. Instead, this book presents case studies of attempts to: sharply reduce (and even prohibit) the sale of alcohol; reduce alcohol’s social harms in general without prohibiting alcohol; target specific social harms related to alcohol misuse; and address multiple specific social harms in concert. The details of each case study are first explored. Then theories from the general policymaking literature and various research traditions are applied to each case to test their explanatory value. Finally, wider lessons are then identified from the case studies, including lessons about how to better facilitate the inclusion of research evidence in policy decisions. To show how such ideas are explored in this book, the next section presents an introductory case study. This case study illustrates the contemporary challenges of alcohol policymaking, and highlights several essential themes that are revisited in future chapters.

A Case Study: Pine Ridge and Whiteclay

Approximately 4.5 million cans of beer are sold each year in Whiteclay, Nebraska—a town with a population of just 14 people (Melecki, 2009). Demand for alcohol is so high in the town that a New York Times reporter recently noted that beer prices there were higher than in New York City (Williams, 2012). Whiteclay’s location is the reason for these anomalies. The town lies close to Nebraska’s border with South Dakota; on the other side of that border is the Pine Ridge Reservation, which was established in the late nineteenth century, belongs to the Oglala Sioux Nation, and is the second-largest Native American reservation in the US (Oglala Sioux Tribe, 2012). Nearly half of the reservation’s population lives below the poverty line (Ford, 2011). Some 80 percent of adults are unemployed (Oglala Sioux Tribe Department of Public Safety, 2010). Only 10 percent of young people finish high school and tuberculosis rates are around eight times higher than the US average (Kristof, 2012 b). The average life expectancy on the reservation is between just 45 and 52 years—lower than in Haiti and Iraq (Gadkari, 2012; WHO, 2012 a, 2012 b).

Alcohol’s social harms are particularly evident at Pine Ridge, where fetal alcohol spectrum disorders affect a quarter of children born on the reservation, and tribal law enforcement made 20,000 alcohol-related arrests in 2011—even though Pine Ride has a population of just 45,000 (Williams, 2012). Dealing with alcohol-related offences further burdens the already-stretched resources of the Oglala Sioux Tribe Department of Public Safety (2010); the Department is so busy that its officers do not have partners—they must make patrols on their own.

The prevalence of alcohol-related social harms in Pine Ridge is even more striking because alcohol is officially banned on the reservation’s grounds. In 1832, the US federal government prohibited Native Americans from consuming alcohol outside of reservations; more than a century later, in 1953, the federal government overturned this ban and also, for the first time, effectively gave tribes authority to regulate alcohol policies on their reservations (May, 1977). Yet the Oglala Sioux initially maintained a ban on alcohol possession and sale at Pine...

Table of contents

• Cover Page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgments
• 1 Introduction
• 2 Research into Alcohol’s Social Harms
• 3 Alcohol and Policymaking
• 4 History, Culture, Context, and Transformation
• 5 Key Lessons from Prohibition Policies: Beyond the 1920s
• 6 General Efforts to Reduce Alcohol’s Social Harms
• 7 Targeted Policies: Minimum Drinking Age Laws
• 8 Concluding Thoughts
• Bibliography
• Index