Transcript Drinking in America: Myths, Realities, and

Reducing the Role of the Global
Alcohol Industry in Health
Education
David H. Jernigan Ph.D.
Department of Health, Behavior and Society
Johns Hopkins Bloomberg School of Public Health
And
Director,
Center on Alcohol Marketing and Youth
Disclosure and Acknowledgment
• No financial interests to disclose.
• Acknowledge Dr. Thomas Babor for his
leadership in tracking and evaluating alcohol
industry actions that I will discuss.
2010 GBD (% of total burden of disease)
GBD Men 2010 (% of all burden)
GBD women (% of all burden)
Alcohol’s role in the global
burden of disease for 15-24 yearolds
• Leading cause of DALYs for males 15-24 everywhere but EMRO
• Leading cause of DALYs for females 15-24 in high-income and
Americas region
Source: Gore et al., Lancet 2011;
377:2093-2102
Alcohol Producers and Public Health:
The conflict of interest
Alcohol industry self-regulatory (voluntary)
codes:
Distilled Spirits Council of the U.S. (“DISCUS”):
“DISCUS members encourage responsible decisionmaking regarding drinking, or not drinking, by adults of
legal purchase age, and discourage abusive
consumption of their products.”
Beer Institute (U.S.):
“Brewers strongly oppose abuse or inappropriate
consumption of their products.”
What is “abusive consumption”?
• The alcohol industry will never define this.
• In the U.S., “binge consumption” is defined as:
– More than 5 drinks in two hours for males
– More than 4 drinks in two hours for females
Binge drinking dominates the
alcohol market
• More than half of adult consumption in the
U.S. is in the form of binge drinking (CDC)
• 90% of youth consumption in the U.S. is in the
form of binge drinking
Office of Juvenile Justice and Delinquency Prevention. Drinking
in America: Myths, Realities, and Prevention Policy.
Washington, DC: U.S. Department of Justice, Office of Justice
Programs, Office of Juvenile Justice and Delinquency
Prevention, 2005. Available at
http://www.udetc.org/documents/Drinking_in_America.pdf
Even if we limit “abusive consumption”
to DSM-IV criteria and underage
drinking…
The alcohol market in the U.S.:
– Value of underage drinking: $22.5 billion
– Value of abusive and dependent drinking (DSM-IV
criteria): $25.8 billion
– Total combined loss to industry if underage and
pathological drinking eliminated: $48.3 billion, or
37.5% of sales (Foster et al. 2006)
The Conflict of Interest
• If everyone drinks in a safe and responsible
manner:
– Alcohol companies face a market less than half
the size of what we have today
– Alcohol companies lose at least a third of their
profits.
– No publicly-traded company can intentionally lose
this much of their market and survive.
– The alcohol industry has a conflict of industry with
safe and responsible drinking.
WHO Global Strategy to Reduce Harmful Use of Alcohol:
Role of the Alcohol Industry
• “Public policies and interventions to prevent and reduce alcoholrelated harm should be guided and formulated by public health
interests and based on clear public health goals and the best available
evidence.”
• “The appropriate engagement of civil society and economic operators
is essential.”
• “Economic operators in alcohol production and trade are important
players in their role as developers, producers, distributors, marketers
and sellers of alcoholic beverages. They are especially encouraged to
consider effective ways to prevent and reduce harmful use of alcohol
within their core roles mentioned above, including self-regulatory
actions and initiatives. They could also contribute by making available
data on sales and consumption of alcohol beverages.”
WHO Global Strategy to Reduce Harmful Use of Alcohol:
Role of the Alcohol Industry
• The strategy and WHA resolutions leading up to it very clear:
collaborate with Member States, but only consult with the
economic operators, NGOs, etc.
• WHO DG Dr. Margaret Chan:
– “…member states have a primary responsibility for formulating,
implementing, monitoring and evaluating public policies to reduce the
harmful use of alcohol. The development of alcohol policies is the sole
prerogative of national authorities. In the view of WHO, the alcohol
industry has no role in the formulation of alcohol policies, which must be
protected from distortion by commercial or vested interests.” (BMJ)
• ICAP’s interpretation:
– “the adoption of the WHO Global Strategy…has legitimized industry’s ongoing
efforts and has opened the door to inclusion of producers as equal stakeholders.”
(Source: Grant M and Martinic M, Harmful alcohol consumption, NCDs and post-2015 MDGs. ICAP: Washington DC, 2012)
ICAP’s “Global Actions on Harmful
Drinking”
• Focus
– Drink-driving
– Non-commercial alcohol
– Self-regulation
• Help industry to avoid effective steps – quote
from mid-term evaluation:
– “Recent calls from some quarters to reduce
advertising and increase taxation…show the
importance of the Self-Regulation initiative for
ICAP members.”
ICAP’s “Global Actions on Harmful
Drinking”
• Evaluators’ recommended response to PAHO
refusal to collaborate with the industry:
– “Potential opposition in some quarters could be
circumvented by the deployment of efforts
targeted at areas with greater potential for
success, such as possibly turning to different
states in Mexico, where WHO/PAHO is less active.”
Fund Junk Science:
“Tale of Two Surveys”
• Compared WHO alcohol policy survey to ICAPsponsored alcohol policy survey
• Both surveyed health policy professionals, used
similar methodologies
• ICAP survey conclusions belie its own data:
– Claims public education on alcohol favored by 70% of
respondents in “emerging” market countries
– Re-analysis shows only 38% favor this
Source: Babor and
Xuan, 2006
“FLACSO” study
• Surveyed 1800 persons in nine countries:
– El Salvador, the Dominican Republic, Costa Rica,
Peru, Nicaragua, Venezuela, Mexico, Colombia,
Brazil
• Used WHO protocols and cited WHO and
PAHO liberally in its report
• Funded by Cerveceros Latinoamericanos and
brewers in each country
“FLACSO” study
• Apparently a market research study - no
evidence of academic human subjects review
• Mis-used WHO concepts, e.g. AUDIT
• Made misleading comparisons across
countries, without statistical checks or
confidence intervals
“FLACSO” study
• Reached industry-friendly conclusions
– “There is no direct relation between the prevalence of
annual alcohol consumption and rates of harmful
consumption, especially binge drinking.”
– “The data also indicate that countries where alcohol
consumption is less prevalent may have higher rates of the
population prone to long-term and occasional risk.”
• Conclusions not supported by study’s own
data…
“FLACSO” study
• Independent statistical analysis finds that numbers in
report do not support the conclusion
– Correlations between per capita consumption and percentage of binge
drinkers all positive and statistically significant for totals, males and
females across the 9 countries
• Conclusions support industry-favored approach to
alcohol: target the “high-risk” drinkers with
punishments, do NOT take population-level steps
• “Findings” presented at side meeting at WHA in
Geneva, and to LA health ministries
GAPG 5 Commitments (Oct 2012)
1.
Reducing underage drinking, via enforcement of current laws and
encouraging governments to introduce and enforce minimum purchase
ages
–
To be achieved through increased enforcement and action by the industry “to develop,
promote and disseminate educational materials and programmes designed to prevent
and reduce underage purchase and consumption…”
•
•
2.
Evidence base is clear: educational approaches ineffective with young people
Doing this is violation of industry role in the Global Strategy
Continuing to strengthen and expand marketing codes of practice that
are rooted in our resolve not to engage in marketing that could
encourage excessive and irresponsible consumption, with a particular
focus on digital marketing
–
Abundant evidence in multiple countries that industry self-regulatory codes are
ineffective both in protecting against offensive content and in shielding young people
from alcohol advertising
GAPG 5 Commitments (Oct 2012)
3.
Making responsible product innovations and developing easily
understood symbols or equivalent words to discourage drinking and
driving and consumption by pregnant women and underage youth
–
Industry product innovations:
– “We commit not to produce any beverage alcohol products that contain excessive
amounts of added stimulants…” No definition of excessive…
– There is no evidence that warnings – either in symbols or in words – will reduce harmful
use of alcohol.
GAPG 5 Commitments (Oct 2012)
4. Reducing drinking and driving by collaborating with
governments and non-governmental organizations to
educate and enforce existing laws
–
–
Industry has historically opposed effective laws.
American Beverage Institute (begun with seed money from Philip Morris)
opposing ignition interlocks for all except “hardcore drinking drivers,” move
to .05, etc.
5. Enlisting the support of retailers to reduce harmful drinking
and create ‘guiding principles of responsible beverage
alcohol retailing’
– Evidence is that “reliance on manager training to promote responsible
establishment alcohol policies is not sufficient to prevent illegal alcohol sales
to obviously intoxicated patrons and to reduce alcohol-related problems.”
(Toomey et al. 2008)
WHO Global Strategy to Reduce Harmful
Use of Alcohol:
“Best Buys” for alcohol
• Regulating commercial and public availability of
alcohol
• Using pricing policies such as excise tax increases
on alcoholic beverages
• Restricting or banning alcohol advertising and
promotions
Active opposition to the “best buys”
• Regulating commercial and public availability of
alcohol
– Brazil – producers lobbied successfully to repeal ban on
alcohol sales in sports stadia
• Using pricing policies such as excise tax increases on
alcoholic beverages
– Scotland – producers lobbying against minimum pricing
• Restricting or banning alcohol advertising and
promotions
– South Africa, Lithuania – producers lobby against bans on
alcohol advertising
The opposition
• Alcohol: $1 trillion globally
• At least $4 billion per year on marketing in the U.S.
alone
• Primarily in hands of small number of large global
companies
• U.S. – one lobbyist for every two members of Congress
(2009)
• U.S. states - $150 million in political donations to state
legislatures from 2000 to 2010
• WHO: GAPG spent >$1 million lobbying WHO since 2005
Public health intervention:
“Global Statement of Concern”
• Drafted by an international coalition of 17 public
health professionals, health scientists and NGO
representatives, send under the auspices of GAPA
• In the form of public letter to WHO Director General
Dr. Margaret Chan
• In less than a month received endorsements from
more than 500 academics, health professionals, and
NGO representatives from over 60 countries.
Recommendations
• Refrain from all marketing including sponsorship and
product design (e.g., caffeinated alcohols, alcopops,
sweetened alcohol beverages) in order to protect
children, young persons, high risk alcohol users and
females in their child bearing years
• Refrain from further lobbying against effective public
health measures
• Refrain from further engagement in health-related
prevention, treatment, and traffic safety activities, as
these tend to be ineffective, self-serving and competitive
with the activities of the public health community
Recommendations
• Refrain from direct funding of alcohol research because
of the potential for agenda setting and
• Cease political activities designed to reduce or eliminated
evidence-based alcohol control policies
• Respect the rules of science and the integrity of
researchers and research organizations, e.g. quote and
use the research in appropriate ways, and not use
sponsorship of scientific research for marketing or
political lobbying purposes
• Review and otherwise meet the standards of academic
publishers
Recommendations
• Secure its own supply chains and cooperate with all
aspects of the law when it comes to preventing the
diversion of commercially produced alcohols to the
informal market
• Further recommendations for WHO, Member States
and the public health community
• Full Statement of Concern is available at
http://www.globalgapa.org/pdfs/who-statement-ofconcern-080213.pdf.
Thank you very much!