Why be an alcohol policy advocate? Alcohol Policy and Adolescent Drinking: Using Science in the Public Interest Module 1 Why be an alcohol policy advocate? Reducing the devastating impact of alcohol on individuals, families and communities requires the implementation of effective public health solutions. Our capacity to effectively educate, motivate and engage the public in the development of public health policies that confront the harsh realities of young people’s exposure to alcohol harms require that we provide a practical “how to” toolkit of resources and information that can applied at the local, national and international level. The aim of this workshop is to facilitate implementation of evidence-informed alcohol policy at the local, national and international levels with a particular focus on protecting children and young people from alcohol harm. It is designed to provide logistical support for activities leading to the development of an international network of policy advocates working toward the common goal of reducing the harm caused by alcohol. A related aim is to provide logistical support for activities leading to the development of an international network of policy advocates working toward the common goal of reducing the harm caused by alcohol.

Tribute to Dr. Evelyn Gillan one of the founders of this project Tribute to Dr. Evelyn Gillan one of the founders of this project. She was a very talented and inspirational campaigner who set challenging goals but took everyone along with her. Remembering Dr Evelyn Gillan Chief Executive of Alcohol Focus Scotland and co-founder of the Zero Tolerance Campaign 1959–2015

Alcohol – the problem

Alcohol – the problem Globally 5th leading cause of ill health & premature death Harm to individual health includes increased risk of cancer (liver, breast, mouth, larynx…), ischemic heart disease, liver cirrhosis, poisoning, mental health Harm to society includes: violent crime, social disorder, domestic abuse, rape, suicide, accidents, homicides, RTAs… Harm throughout the life course: exposure during pregnancy can impair brain development of fetus, adolescent exposure increases risk of dependence in later life Major determinant of health inequalities and inhibitor of economic development Places huge strain on public services and economy Alcohol kills over three million people worldwide every year. It is the world’s 5th largest risk factor for premature death, disability and loss of health and is the leading risk factor in the Western Pacific and the Americas. In Europe, alcohol is the second largest risk factor and the single biggest killer of young men aged 16 – 24 years. Harmful alcohol use doesn’t just affect the health and well-being of the drinker, but also affects the people around the drinker. Children and young people are particularly vulnerable both in terms of their own exposure to alcohol harms and also by having their lives negatively affected by the drinking behaviour of the adults around them.

Why has alcohol become such a problem? Changing nature of alcohol industry – alcohol is a global commodity Mass marketing and global brands ‘Emerging markets’ targeted Affordability Availability Change in social perceptions Following a series of high profile mergers and acquisitions in recent decades, today the majority of alcohol sold around the world is produced and owned by a small number of companies. This means that global brands have been established as opposed to locally produced products – you can walk into a bar in Moscow, Shanghai or Addis Ababa and order a Budweiser been or a Smirnoff vodka. The economies of scale achieved through this globalisation has led to increased marketing, cheaper distribution costs and lowered trade barriers meaning alcohol has become more affordable and more available to communities around the world. The geographical distribution of alcohol sales have also changed over time, with companies focussed on developing economies as ‘emerging markets’. Alcohol producers have somewhat aggressively targeted these new emerging markets, for example in Africa, which they see as the jewel in the crown. They target low income groups to get them to move away from traditional, locally produced drinks or home brews, by cutting tax deals with governments. They also target traditionally non-drinking groups including women, with heavily targeted marketing campaigns linked to western aspirations such as liberation, freedom, social and financial success.

Alcohol: No ordinary commodity However, despite the fact that alcohol has been subject to the same forces of globalisation as other commodities such as coffee and coconut milk, public health advocates recognise that alcohol is not an ordinary commodity, and therefore it should not be treated in the same way as other everyday groceries. Alcohol is a toxic substance that leads to dependency and it is recognised by the WHO as a group one carcinogen, alongside tobacco and asbestos. In recognition of this principal, colleagues here today, together with other leading alcohol researchers, produced a comprehensive review of the international evidence to support effective alcohol policies, which went on to form the evidence base to support the WHO global alcohol strategy.

Seven policy areas for intervention Alcohol taxes and other price controls Regulate physical availability through restrictions on time, place, and density of alcohol outlets Regulate alcohol advertising and other marketing Alter the drinking context Drink-driving countermeasures Conduct screening and brief intervention in health care settings; increase availability of treatment programmes Education and persuasion: provide information to adults and young people especially through mass media, workplace and school-based alcohol education programmes * WHO ‘best buys’, endorsed by OECD

There is no silver bullet… A comprehensive framework of policies is needed to effectively tackle alcohol harm

Effective alcohol policy must… Have a strong evidence base Cover a range of policy areas Be supported by and understood by the public Be culturally sensitive Target the population as a whole and support at-risk individuals Be based on public health interests Be free from vested commercial interests In order to tackle the growing problem of alcohol harm we need effective public policies that are based on strong evidence.

Barriers to effective alcohol policies

Barriers to effective alcohol policies Evidence based policy versus political expediency Increased taxes and restrictions on alcohol politically unpopular Population level approaches seen as state interference Political priorities and other distractions Economic arguments and influence of drinks industry

Policy windows of opportunity Policy change occurs when three streams of activity collide: Problem Stream (evidence of need for action) Policy Stream (evidence of effective solution) Political Stream (political will to act) Policy entrepreneurs can work to bring these streams together to create windows of opportunity for policy change Policy entrepreneurs can come from a range of backgrounds, including public interest NGOs & industry bodies

Three Policy Streams Political scientists have identified that policy change requires three key steams of activity: Identification of a problem, good evidence for a workable solution and political will to act. Just one of these streams alone is unlikely to stimulate policy change, however when the three streams collide a window of opportunity arises for ‘policy entrepreneurs’ to take advantage and set their policy agenda Both civil society organisations and private interest groups can act as policy entrepreneurs to achieve their desired change – either by working to bring these three streams together, or by being fully prepared to promote their own interests when these windows of opportunity arise. Module III describes in detail how alcohol policy advocates can prepare to take advantage of these opportunities and also how they can work to bring the streams together by presenting evidence of problems, solutions and influencing political decision makers.  

Alcohol industry activities Estimated US $1 trillion global industry Fund Social Aspect PR Organizations Promote ‘drink responsibly’ messages - puts focus and responsibility for harm on the drinker, not the product Promote ineffective measures and oppose effective measures – e.g. voluntary codes on advertising (‘self regulation’) Active engagement in alcohol policy arena - lobbying, political donations, policy development (especially in emerging markets) Engagement in research - publishing, funding, sponsoring conferences, discredit research into effective policies

Role of alcohol policy advocates The alcohol control movement works to reduce the devastating impact of alcohol harm on individuals, families and communities around the world The movement needs advocates who can engage with politicians, opinion formers and the general public to raise their awareness of the importance of protecting people – especially children and young people – from exposure to alcohol harms The alcohol control movement is working to reduce the devastating impact of alcohol harm on individuals, families and communities around the world. The globalisation of the production, trade and marketing of alcoholic beverages means that many children now grow up in an environment saturated with pro-alcohol messages which promote both access and excess.   To counteract the alcohol epidemic, the alcohol control movement needs advocates who can engage with politicians, opinion formers and the general public to raise their awareness of the importance of protecting children and young people from exposure to alcohol harms. Advocacy has played an important role in shaping public health policy to prevent loss of health and save lives. For example, effective public health advocacy led to the introduction of tobacco control policies in many countries including a ban on tobacco advertising, the introduction of laws to increase the age of the sale of tobacco and laws to ban smoking in public places. Smoking is no longer a majority habit in many countries of the world and thousands of lives have been saved as a result of successful public health advocacy. There are many parallels between the tobacco and alcohol control movements. Both movements use advocacy to counteract the efforts of powerful vested interests who stand to lose financially from the implementation of effective public health policies.

What do we want – the objectives of alcohol control advocacy Fewer lives cut short as a result of alcohol Fewer people suffering ill health and disability due to alcohol Fewer people negatively affected by other people’s drinking We want children and young people to grow up in a society which protects them from exposure to alcohol harms The alcohol control movement wants to reduce the damaging effects of alcohol on individuals, communities and countries with: fewer lives cut short as a result of alcohol less people suffering ill health and disability due to alcohol less people negatively affected by other people’s drinking.   Most importantly, the alcohol control movement wants children and young people to grow up in a society which protects them from exposure to alcohol harms.

Strategic advocacy goals Evidence-informed, population approaches to alcohol policy and in particular, controls on price and availability. A clear distinction to be made in the public policy process between organizations representing the public interest and those representing commercial vested interests. Measures which protect children and young people from exposure to alcohol harms, including increased regulation of alcohol marketing and restrictions on alcohol sponsorship of sports events and events with youth appeal. The broad strategic advocacy goals of the alcohol control movement which provide a framework for public health advocacy at local, national, and international level are as follows:   To advocate for evidence-informed, population approaches to alcohol policy and in particular, controls on the price and availability of alcohol to reduce overall consumption in the population. To advocate for a clear distinction to be made in the public policy process between organisations representing the public interest and those representing commercial vested interests and to ensure that the role of the latter is confined to policy implementation rather than policy development. To advocate for measures which protect children and young people from exposure to alcohol harms including increased regulation of alcohol marketing and restrictions on alcohol sponsorship of sports events and events with youth appeal.

A successful advocacy strategy will seek to influence both decision-makers, opinion leaders and grassroots groups. Decision-makers = the people who make the decisions about what kind of alcohol policies will be implemented at local, national or international level. Opinion leaders = the people who influence the decision-makers. Grassroots = Everyday citizens/residents who when joined into groups and coalitions can influence decision makers and opinion leaders Alcohol control advocates are encouraged to identify their own advocacy priorities within the broad strategic goals outlined above to take account of the national and local conditions that prevail. For example, a group could decide to develop an advocacy campaign that focuses specifically on the price of alcohol or on alcohol marketing. Advocates are also encouraged to identify the key target audiences that their campaign seeks to influence. Decision-makers are the people who take the decisions about what kind of alcohol policies will be implemented at local, national or international level. Opinion formers are the people who influence the decision-makers. A successful advocacy strategy will seek to influence both decision-makers and opinion formers.

Summary: Why be an alcohol policy advocate? Alcohol has enormous health and social costs, particularly for young people Policies are available that can reduce these costs, but they are not used consistently due to barriers Advocacy in the policy arena can make a difference between good policy and bad policy