Special Issue: The Regulation of Alcohol Marketing: From Research to Public Health Policy
Addiction presents the latest evidence on alcohol marketing and its impact on children in publishing a series of reports in a supplement to the scientific journal, January 2017.
Guest editors: Thomas F. Babor, David Jernigan, Chris Brookes
New evidence, key findings
Key findings from the collection of peer-reviewed manuscripts include:
- Exposure to alcohol marketing is associated with youth alcohol consumption
- Analysis of alcohol promotion during the 2014 FIFA World Cup indicates alcohol marketing practices frequently appeared to breach industry voluntary codes of practice’
- Alcohol industry self-regulatory codes do not sufficiently protect children and adolescents from exposure to alcohol promotions, especially through social media
The Addiction supplement comprises 14 papers, with research presented from around the world.
Introduction to the special issue
Alcohol marketing, promotion, and sponsorship are widespread in most of the world today. Alcohol marketing is evolving constantly and utilizes multiple channels, including youth-oriented radio, television, sports events and popular music concerts, websites, social media, mobile phones and product placements in movies and TV shows. Marketers are moving increasingly to digital and social media, where efforts at regulation have fallen far behind industry innovations in producing audience engagement and brand ambassadorship.
Alcohol is a psychoactive substance with numerous negative consequences to the health and wellbeing of consumers as well as others affected by drinkers’ behavior. With the advent of recent restrictions on tobacco marketing as a result of the Framework Convention on Tobacco Control, no other legal product with such potential for harm is as promoted and advertised in the world. Most countries have no statutory legislation regulating the exposure of children or adults to alcohol marketing, so they must rely only upon self-regulatory codes developed and implemented by the alcohol industry .
Harmful use of alcohol is increasing among young people and women in some regions of the world, especially in the Americas region [2, 3]. Given the causal role of harmful use of alcohol in negative health outcomes to drinkers and others (regardless of their drinking status), the promotion of alcohol consumption by means of marketing needs to be controlled by governments as part of their duty to protect the health of their populations, particularly among the most vulnerable groups.
In 2010, the World Health Assembly (WHA) adopted the Global Strategy to Reduce the Harmful Use of Alcohol (WHA 63.13). Among the guiding principles of the Global Strategy, three are particularly relevant to alcohol marketing control. The first is that preventing and reducing the harmful use of alcohol is a public health priority; another is the importance of protecting populations at high risk of alcohol-attributable harm; and the third is that children, teenagers, and adults who choose not to drink alcoholic beverages have the right to be supported in their non-drinking behavior and protected from pressures to drink.
The World Health Organization’s  global strategy has 10 areas for policy action, including one on the marketing of alcoholic beverages (area 6). For this area, the policy options, and interventions include:
a] Setting regulatory or coregulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures, for alcohol marketing by:
- regulating the content and the volume of marketing;
- regulating direct or indirect marketing in certain or all media;
- regulating sponsorship activities that promote alcoholic beverages;
- restricting or banning promotions in connection with activities targeting young people; and
- regulating new forms of alcohol marketing techniques, for instance, social media.
b] Development by public agencies or independent bodies of effective systems of surveillance of marketing of alcohol products.
c] Setting up effective administrative and deterrence systems for infringements on marketing restrictions.
Many governments have attempted to protect young people in particular from inappropriate exposure to alcohol marketing through regulations. These have ranged from total marketing bans to voluntary self-regulation using industry codes of practice . Thus far, however, the industry’s codes of practice have been ineffective in protecting individuals from potentially harmful exposure .
In 2011, the Directing Council of the Pan American Health Organization (PAHO) adopted a regional plan of action in line with the WHO Global Alcohol Strategy. PAHO then created a regional network of focal points responsible for alcohol issues in Ministries of Health in order to discuss gaps and establish priorities. In two meetings of the network, held in 2012 and 2014, alcohol marketing regulation was identified as a priority for action and further technical guidance.
In line with the above initiatives, PAHO organized an exploratory meeting in January 2015 to discuss the situation in the Region and globally, and to consider possibilities for moving forward in assisting Member States . Because of the global nature of alcohol marketing, participants from several regions of the world came together to review relevant experience, evidence and policies.
The information shared at the meeting was considered to be of such relevance to a global audience that participants agreed to submit their background manuscripts to a peer-reviewed journal. This Supplement to Addiction now presents this collection of 13 papers and one editorial comment .
The papers represent the highest level of scholarly attention devoted to this issue that has been brought together in the pages of one scientific journal. Three compelling themes emerge from this collection of systematic and narrative reviews, original research, commentaries, editorial statements and debate pieces.
The first theme is because alcohol marketing contributes to the initiation of drinking and alcohol-related problems in adolescents and other vulnerable groups, its regulation can be justified on the grounds of public health, public safety and human rights.
The second is that the current range of national responses, including legally binding partial bans (e.g. some type of beverage, some media, some hours and places, some sponsorship and promotion restrictions or some restrictions on product placement) and industry self-regulation, is insufficient in fulfilling the public health mission for which it was designed.
The third theme is that there are several reasonable and promising options that can be considered by governments and civil society organizations to address this issue, including public health protections in trade agreements and statutory regulations on marketing at the national and international levels, similar to those adopted by governments to address the problem of controlling marketing of tobacco and breast milk substitutes.
Theme one: alcohol marketing causes harm to vulnerable populations
Moral philosopher Chapman  describes the legal and moral case against alcohol marketing to which children and adolescents are frequently exposed, tracing the evolution of international law and other measures designed to protect vulnerable populations from the marketing of potentially harmful products. In a related paper, Babor et al.  consider the public health implications of an expanded definition of vulnerability as it relates not only to alcohol marketing reaching children and adolescents, but also pregnant women and people with alcohol dependence.
Jernigan and colleagues  reviewed the recent literature on the association between alcohol marketing and youth drinking, focusing upon newer studies using sophisticated longitudinal designs. The systematic review identified 12 new studies reporting findings from nine unique cohorts including more than 35 000 people across several countries. All studies found a significant association between youth exposure to alcohol marketing and subsequent drinking behavior.
These findings are similar to the results of a narrative review of digital marketing studies conducted by Lobstein and colleagues . Their review of the scientific evidence and policy literature concludes that marketing through digital media uses approaches that are attractive to young people and for this reason it is likely to have an impact on their drinking behavior. Moreover, the authors suggest that current marketing regulations are likely to be undermined by the commercial use of digital media.
Theme two: industry self-regulation is ineffective in protecting vulnerable populations
The issue of self-regulatory codes is an important component of the discussion on alcohol marketing control in this Supplement. Several papers by Jonathan Noel and colleagues evaluate the legal history and current research [6, 12-19] on industry self-regulation of alcohol marketing. A systematic review of the literature  demonstrates that the industry codes are largely ineffective in reducing youth exposure to potentially harmful sales promotions. Of the 19 studies evaluating a specific marketing code and 25 content analysis studies reviewed, all detected content that could be considered potentially harmful to children and adolescents, including themes that appeal strongly to young men. Of the 57 studies of alcohol advertising exposure, high levels of youth exposure and high awareness of alcohol advertising were found for television, radio, print, digital and outdoor advertisements. In a literature comprising more than 100 studies, none were identified that supported the effectiveness of industry self-regulation programs.
Another review  showed that the industry’s complaint process fails to address the need to remove marketing materials that have been identified as non-compliant with industry codes. To illustrate this point, a study on alcohol marketing in selected countries of the Americas and Spain during the 2014 FIFA World Cup  demonstrates the massive exposure and lack of compliance by numerous national and transnational producers who marketed alcoholic beverages during this global event.
Taken together, the papers dealing with multiple aspects of the alcohol industry’s self-regulation activities indicate that the current self-regulatory systems governing alcohol marketing practices are not meeting their intended goal of protecting vulnerable populations.
Theme three: alternatives are available to address the problem
An evaluation of the French Loi Évin described by Galopel and colleagues  provides insight into marketing controls considered to be more effective than industry self-regulation. It suggests that while laws strictly limiting the promotion of alcohol products may have been successful in preventing certain kinds of potentially harmful marketing, legislative inaction and industry weakening of the 1991 legislation may have reduced its effectiveness. Similarly, a case study prepared by legal scholar Vendrame  documents a failed attempt by public health authorities to change the current marketing law of Brazil. Because the law excludes beer and many wines from any control, it allows children and adolescents to be exposed to massive alcohol marketing on television and radio.
Landon and colleagues  discuss the implications of international codes and agreements for the control of alcohol marketing. Legally binding global health treaties and non-binding codes have been developed to restrict the marketing of tobacco, breast milk substitutes and unhealthy foods, based on evidence of a public health crisis. Under the umbrella of international public health treaties and codes, national governments can strengthen their own legislation, assisted by technical support from international agencies and non-governmental organizations (NGOs). Having commercial operators account for their marketing practices is a critical element in the continued development and strengthening of public health policies that may ultimately require a global agreement on alcohol marketing. Finally, the implications of international trade and investment agreements on alcohol policy  are discussed in terms of their possible effects on the control of alcohol marketing.
Despite the promise of public health measures to limit exposure to alcohol marketing, several papers suggest the difficulties of implementing effective policies because of the opposition of the alcohol industry [15, 16, 19] which, in itself, could constitute an important agenda for future research that will be needed to guide policy .
Using a broad public health perspective to describe the issues surrounding the marketing of alcoholic beverages, the papers in this Supplement provide a wealth of information to support renewed action by governments to control alcohol marketing with statutory measures, independent of the alcohol industry’s self-regulatory programs, implemented and monitored by governments and/or civil society organizations with a primary interest in public health and the prevention of alcohol problems. To the extent that remedial action is needed urgently, the way forward is described clearly in the concluding paper to this Supplement .