Global alcohol policymaking processes are long and involve many stakeholders: from the World Health Organization (WHO) and governments, to non-governmental organisations (NGOs) and – controversially – the alcohol industry. Broad policy engagement can make policymaking processes more accessible and equitable, for example through public consultations. However, there is strong evidence that involving the alcohol industry can undermine progress in alcohol control due to conflicts of interest.

One way in which stakeholders can influence policy outcomes is through language use and ‘framing’. By promoting certain ideas over others, framing can influence how a policy problem is understood and what policy options are considered.

In our recent study published in the International Journal of Health Policy and Management, we aimed to understand how different stakeholders in alcohol policymaking frame alcohol harms, their causes and possible solutions. We did this by analysing the responses to a WHO consultation on the implementation of their global alcohol strategy.

How are alcohol harms and policy solutions framed?

Different policy stakeholders used different framings in their consultation responses. Framing differed in terms of:

  1. How the problem of alcohol harm was defined
  2. What the causes of alcohol harm were believed to be, and
  3. What policy solutions were suggested

Framings were supported with data and evidence and drew on specific value systems.

Alcohol industry stakeholders tended to only emphasise the individual risks of heavy drinking and drinking by vulnerable groups, such as minors. Similar framing was also used by a small group of governments, most notably the United States and Italy. This rather narrow problem definition was typically paired with framing that focused on individual responsibility and social norms as the main reasons for harmful use of alcohol.

Consequently, the solutions that were proposed by these stakeholders tended to target ‘at-risk’ individuals. For example, through education campaigns and industry-led responsible marketing practices – both of which have a relatively weak evidence base. On the other hand, population-level regulation of alcohol was discouraged in this framing, as this would unnecessarily affect ‘moderate drinkers’ and create problems of illicit alcohol production.

Unsurprisingly, the alcohol industry was often framed as a ‘partner’ in alcohol control without acknowledging conflicts of interest – emphasising values of individual choice and corporate freedom.

The other dominant framing instead focused on the risks of alcohol use per se, and the broader health, social and economic harms caused by drinking. This framing was found in the consultation responses of NGOs, academic institutions, and most governments and international organisations.

Under-regulation of alcohol was believed to be the biggest cause of alcohol harms, as well as policy interference by the alcohol industry. Proposed solutions thus involved regulation, such as the WHO ‘best buys’, and global solutions like a binding treaty (similar to the Framework Convention of Tobacco Control). While there was some overlap in the framing used by different stakeholder groups, the vast majority of non-industry stakeholders argued against engagement with industry in alcohol policymaking, drawing on public health and human rights values.

What’s next?

Understanding how alcohol harm and control measures are framed in policymaking processes can give insights into the values and interests of different stakeholders. Research shows that the framing used by alcohol industry stakeholders consistently aims to divert attention to individuals rather than addressing environmental factors and societal impacts of alcohol misuse. The WHO should therefore carefully consider how it can ensure that engagement with industry through consultations does not undermine public health goals.

Many NGOs and academic institutions that took part in the consultation have called for the WHO to reconsider the formal role it gives to industry stakeholders in alcohol policymaking processes, like it did with tobacco.

Regardless, public health advocates should continue to strengthen their capacity to counter misleading and harmful framing, and develop their own persuasive evidence-based narratives.

Written by Chiara Rinaldi, NIHR School for Public Health Research (SPHR) Fellow at the London School of Hygiene and Tropical Medicine

All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.