5. Conclusions - Relating to social aspects organizations

In representing the beverage alcohol industry in policy debate and in social and public discourse about the harm done by alcohol, social aspects organizations will seek partnerships and joint activities with governmental and non-governmental sectors and scientific, research and professional bodies. How should these different sectors and bodies relate to such organizations?

5.1 Governmental sector

In formulating their overall alcohol policies, a wide range of different government departments at the national and international levels will need to receive information from and have dialogue with the beverage alcohol industry. However, in developing their policies, government institutions need impartial information of the evidence for effective alcohol policy and impartial information on the costs and benefits of different policy options. It should be noted that the information government institutions receive from social aspects organizations is not impartial and is inconsistent with the evidence base for effective policy that reduces the harm done by alcohol.

Governments will need to decide the extent to which they are partners or co-sponsors of the initiatives and programmes of social aspects organizations, such as school based educational programmes and designated driver campaigns. When considering partnership and co-sponsorship, it should be noted that the programmes and policy options put forward by the social aspects organizations lack evidence of effectiveness and are not impartial to the interests of the beverage alcohol industry. Governmental organizations should be concerned at spending public money on ineffective programmes. An alternative means for these activities is to use a proportion of alcohol taxes, hypothecated for the purpose, to fund relevant non-governmental organizations to implement independent evidence based programmes and campaigns.

Governmental organizations need to be cognisant of their obligations for alcohol policy. The European Member States of the World Health Organization are signatories to the European Alcohol Action Plan (81) and the European Charter on Alcohol (82) both of which call for the implementation of evidence based policies to reduce the harm done by alcohol. European Member State signatories to the 2001 Stockholm Declaration on Young people and Alcohol (83) agreed that:

"Public health policies concerning alcohol need to be formulated by public health interests, without interference from commercial interests".

Article 152 of the Treaty on European Union states that a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities (84). The public health functions of governments have a responsibility to ensure independence in their assessments of the impact of the policies of other governmental departments on health. When that independence is compromised, trust in public bodies is lost. Unfortunately, all too often it seems that public health policies concerning alcohol are compromised by the commercial interests of the beverage alcohol industry.

The government of the United Kingdom, which had been mindful to reduce the drinking driving limit from 0.8g/L to 0.5g/L changed its position in 2002.

Commenting on the change, the House of Lords European Union Committee noted that (85):

"The Department of Transport's position [on the drinking driving limit] coincides with that of the alcohol industry but is opposed by local authorities, the police, the British Medical Association, the Automobile Association, the Royal Society for the Prevention of Accidents, the Transport Research Laboratory and the Parliamentary Advisory Council for Transport safety".

Thus in one country at least it would seem that drink driving policy is being formulated by the commercial interests of the beverage alcohol industry, rather than by independent public health interests and the views of experts in road safety, law enforcement and alcohol policy, with, the consequence of failing to save unnecessary drink driving related deaths.

In his foreword to "Alcohol - Less is Better" (86), the report of the 1995 World Health Organization ministerial conference on alcohol held in Paris, Dr. Asvall, the then Regional Director of the organization's European Office expressed the opinion that taking up the challenge of dealing with alcohol problems requires "political courage". In mobilizing "political opinion" and the "political will" Dr Asvall recognized the important role of non-governmental organizations:

"A particularly important role can be played by enlightened non-governmental organizations, which can often speak with passion and insight on the true impact of alcohol on individuals, families and communities. Such organizations can also bring the commitment of energy to work even in the face of political risks."

In discharging their role, non-governmental organizations are bound to look to governments for adequate financial support and they should not be expected to seek financial support from the beverage alcohol industry. The health and social departments of governments ought to be flexible and mature enough to recognize that critical appraisal of government policy should not call financial support of non-governmental organizations into question.

5.2 Non-governmental sector

A wide range of non-governmental organizations deal with issues of alcohol policy. The European Alcohol Action Plan called on countries to ensure that support is given to nongovernmental organizations and self-help movements that promote initiatives aimed at preventing or reducing the harm that can be done by alcohol; to nongovernmental organizations and networks that have experience and competence in advocating policies at international and country levels to reduce the harm that can be done by alcohol; and to organizations and networks that have a specific advocacy function within their remit, such as associations of health care professionals, representatives of civil society and consumer organizations.

Non-governmental organizations with a specific role with regard to alcohol policy have been charged with (87):

"informing and mobilizing civil society with respect to alcohol-related problems, lobbying for policy change and effective implementation of policy at government level, as well as exposing harmful actions of the alcohol industry."

In discharging their role, and in maintaining their respect with civil society, such specific non-governmental organizations would do well to remain completely independent of any association or partnership with social aspects organizations.

Any communications, dialogues or meetings between non-governmental organizations and the social aspects organizations should be transparent, and placed in the public domain.

5.3 Scientific, research and professional organizations

Although there has been a considerable debate about the relationship between public health science and the beverage alcohol industry (88), the International Center for Alcohol Policies was successful in recruiting a large number of scientists to contribute to the first five publications in its series on alcohol and society. All independent scientists that are paid by or undertake work for the social aspects organizations and the beverage alcohol industry should recognize their responsibility in stating their declarations of interest in their scientific publications.

Research scientists in high income countries should also consider an ethical responsibility not to profit from or contribute to the beverage alcohol industry's actions in emerging markets in low income countries which often lack the infrastructure, resources and experience to respond to and effectively regulate the beverage alcohol industries' marketing practices (89)

Writing in the year 2000, Babor proposed the following guidelines for public health and scientific bodies (90):

First, we must resist industry attempts to manipulate public debate, and the crude attempts by some sources to legitimize the irresponsible promotion of beverage alcohol.
Greater vigilance and monitoring of industry behavior is needed, especially their issues management activities, which are likely to include intelligence-gathering, image management actions such as industry-initiated dialogues, active agenda-setting in the areas of research or publishing; and the real or intended image transfer effect of industry connections with reputable scientists and public health organizations.
Promotion of a freedom of information principle that calls for the sharing of corporate data that deal with marketing, distribution and sales research.
Taking steps to prevent industry from enhancing its image by token amounts of funding for irrelevant research and prevention activities. If these activities are to be supported, this should be done through dedicated tax levies or unrestricted grants that contain no limits on the types or topics of research or prevention.
Development of more broad-based coalitions of health, scientific and social organizations that are concerned about irresponsible industry behavior in marketing, product design, product safety and advertising, and which can pool resources to monitor adherence to international codes of conduct.
Guidelines for disclosing conflicts of interest and the marketing of alcoholic beverages in the developing countries.
Research on such issues as conflict of interest, publication bias and bias in choice of topic or study design. There is now enough evidence from the sponsorship of research by the pharmaceutical industry and the tobacco companies to suggest the possibility of bias.
Finally, it is time to declare a moratorium on further dialogues with industry sources until alcohol scientists and the public health community can agree to what is in their legitimate interests, and how to avoid compromising our well-earned integrity. It is time for our addiction journals and professional societies to take the lead in examining their own connections with industry sources, and develop clear positions on the need for strict codes of ethics regarding the design and marketing of alcohol products. If industry sponsors do not adhere to them, then there can be no dialogue with, or support from, their third-party organizations. Although we do not by nature make it our business to engage in conflict and controversy, neither do we have a duty to engage in dialogue with organizations whose activities are inimitable to public health. Let the public debate clearly represent both sides of an issue, instead of having our issues managed by third party organizations whose agenda is approved by only one of the parties.

References:

81 European Alcohol Action Plan 2000-2005. Copenhagen, World Health Organization Regional Office for Europe.

82 The European Charter on Alcohol. 1995. Copenhagen, World Health Organization Regional Office for Europe.

83 The Stockholm declaration on young people and alcohol 2001. . Copenhagen, World Health Organization Regional Office for Europe.

84 ARTICLE 152 of the Treaty on European Union.

85 See Report of House of Lords European Committee 2002. Quoted in Alcohol Alert. www.ias.org.uk.

86 Alcohol Less is Better. Copenhagen, World Health Organization Regional Office for Europe, 1996.

87 European Alcohol Action Plan 2000-2005. Copenhagen, World Health Organization Regional Office for Europe.

88 Editorial Science and the drinks industry: cause for concern Addiction (1996) 91(1), 5- 9

89 Jernigan, D.H. & Mosher, J.F. Permission for profits Addiction (2000) 95(2), 190-191

90 Babor, T.F. Partnership, profits and public health Addiction (2000) 95(2), 194-195