Unpacking Policy Formulation and Industry Influence: The Case of the Draft Control of Marketing of Alcoholic Beverages Bill in South Africa
Alcohol is a major contributor to the Non-Communicable Disease burden in South Africa. In 2000, 7.1% of all deaths and 7% of total disability-adjusted life years were ascribed to alcohol-related harm in the country. Regulations proposed to restrict alcohol advertising in South Africa present an evidence-based upstream intervention. Research on policy formulation in low- and middle-income countries is limited. This study aims to describe and explore the policy formulation process of the 2013 draft Control of Marketing of Alcoholic Beverages Bill in South Africa between March 2011 and May 2017. Recognising the centrality of affected actors in policy-making processes, the study focused on the alcohol industry as a central actor affected by the policy, to understand how they—together with other actors—may influence the policy formulation process.
A qualitative case study approach was used, involving a stakeholder mapping, 10 in-depth interviews, and review of approximately 240 documents. A policy formulation conceptual framework was successfully applied as a lens to describe a complex policy formulation process.
Key factors shaping policy formulation included: (1) competing and shared values—different stakeholders promote conflicting ideals for policy making; (2) inter-department jostling—different government departments seek to protect their own functions, hindering policy development; (3) stakeholder consultation in democratic policy making—policy formulation requires consultations even with those opposed to regulation and (4) battle for evidence—evidence is used strategically by all parties to shape perceptions and leverage positions.
This research (1) contributes to building an integrated body of knowledge on policy formulation in low- and middle-income countries; (2) shows that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and (3) shows that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.
- There is a lack of research focusing on health policy analysis in low- and middle-income countries and a lack of research on policy formulation processes in particular.
- This study contributes to theory building by successfully applying the Berlan et al. (2014) framework to the draft Control of Marketing of Alcoholic Beverages Bill, contributing to building an integrated body of knowledge on policy formulation in low- and middle-income countries.
- The inherently political nature of the policy formulation process shows how government departments seek to protect their own and their constituents’ interests and prioritize their own policy objectives, which poses a challenge to achieving policy coherence for health across government.
- Networks of powerful actors, including non-state actors with commercial and financial interests, can use diverse strategies to influence health policy formulation processes in a low- and middle-income country context.
The authors write that the research raises the following critical issues which must be considered:
- Governments need to institutionalise appropriate governance structures to ensure a Health in all Policies approach
- What is the role of regulatory Impact Assessments (RIAs) and/or Socio-economic impact assessments (SEIAS) in the policy formulation process if they are not made public? – who owns this process and the subsequent results?
- What is the role of the media in public health in either promoting or undermining public health goals?
- What constitutes ‘stakeholder consultation’ and what power does this give rise to?
Finally, with the growing push for public-private partnerships (PPPs) as a panacea to global problems, we must always question and investigate through research who stands to benefit from these PPPs and who is bearing the cost of the alcohol industry and alcohol-related harms in societies,” states the authors of the study, as per LSHTM Health Policy and Planning Debated.