Out of Africa: Three Threads Tying the Alcohol Industry to an Emerging Alcohol Epidemic
The March 2018 issue of the Journal of Studies on Alcohol and Drugs contains three threads that highlight an emerging issue not readily apparent in a cursory review of the table of contents.
The first thread is a brief report by Amanuel et al. (2018), which shows that, among women of childbearing age in both urban and rural settings in South Africa, easy access to alcohol and exposure to alcohol advertisements were associated with adverse health and social outcomes, including complications during pregnancy—this in a country with the highest rates of fetal alcohol effects in the world.
The study is important not only because of its public health implications but also because it illustrates both what is right and what is wrong with current alcohol studies.
- What is right is that epidemiological methods are now very capable of identifying risk factors for, as well as potential inducers of, alcohol-related problems in the far corners of the world where a variety of natural experiments are occurring, such as a massive infusion of alcohol marketing targeted at women.
- What is not right about current alcohol studies is their inability, if not unwillingness, to consider the alcohol industry as an inducer of alcohol-related problems.
The second thread comes in the form of a letter to the editor from colleagues (Odeigah et al., 2018) working in Africa’s most populous country, Nigeria, where alcohol stands out as the country’s most important risk factor for burden of disease and road traffic injuries. The authors note that despite these consequences, Nigeria has yet to implement an alcohol control policy containing the kinds of strategies—such as the enforcement of alcohol-purchase age restrictions, retail licensing, product labeling, and marketing controls—that have been recommended by the WHO since 2010 (WHO, 2010).
In the third thread, a letter to the editor from Ajiji and Constant (2018) notes that most of the international health agencies (with the exception of the WHO), in their understandable preoccupation with infectious diseases, poverty, and injuries, have ignored the growing threat of alcohol use as a risk factor for a variety of health and social problems. They argue that most local governments tend to consider the alcohol industry only as a driver of economic development, ignoring the active role played by some industry segments, especially the large, transnational producers, in the promotion of alcohol consumption to such an extent that it is creating the potential for an epidemic of alcohol problems.
They suggest three solutions:
- include alcohol control issues in international development projects,
- improve the use of public health surveillance of risk factors and alcohol problems, and
- expand the use of primary care services focusing on alcohol, especially e-health.
Trail of evidence
All three communications implicate the alcohol industry directly or indirectly in the emerging wave of alcohol-related death and destruction, and none of them suggests that the industry can be trusted to play a role in the solution. Their concerns with the alcohol industry are not unfounded, as indicated by the reports received from investigative journalists, nongovernmental organizations, and concerned academics.
For example, in a recent book, van Beemen (in press)describes the results of 3 years of research and hundreds of interviews throughout Africa, concluding that Heineken’s operations have not only failed to benefit the continent, but also seem to have contributed considerable harm by stifling indigenous competition, collaborating with authoritarian governments, avoiding taxes, and being implicated in high-level corruption.
A recent statement (Sperkova et al., 2018) from a coalition of nongovernmental organizations (IOGT International, Global Alcohol Policy Alliance, and NCD Alliance) identified alcohol as a major obstacle to sustainable development and asked the United Nations Global Fund, which supports sustainable development activities around the world, to reconsider their partnership with Heineken because of the inherent conflicts of interest.
Part of the strategy seems to be based on the emerging concept of “stakeholder marketing,” a new tactic that combines social marketing with brand advertising under the umbrella of corporate social responsibility activities.
Pull the thread
There is an expression that says “pull the thread, and watch the sweater unravel.” Pulling these threads, one by one, is an opportunity to unravel the new strategy of the alcohol industry to make Africa an enormous global profit center at the expense of public health and sustainable development.
There is now growing evidence (Babor et al., 2015; Ferreira-Borges et al., 2015, 2016; Matzopoulos et al., 2012) that the alcohol industry is part of the causal chain linking upstream influence on government controls with downstream modifications of the commercial environment in which alcogenic norms, attitudes, and distribution networks are leading to increased binge alcohol use and inadequate alcohol controls.
It is time again for national governments, this time the emerging economies of Africa, along with international agencies (including trade), nongovernmental organizations, and academia to declare a moratorium on further marketing of alcohol in the continent. It is time to get the global alcohol producers out of Africa, at least until a framework of alcohol control policies recommended by the WHO (2010) has been put in place from the Atlantic coast to the Indian Ocean, from the Mediterranean Sea to the Cape of Good Hope.