International Journal of Alcohol and Drug Research

Alcohol policy and advocacy in Low- and Middle-Income Countries: Recommendations and lessons learned

Monica H. Swahn — 2024-05-30

Alcohol policy in the low- and middle-income countries

Thomas Babor — 2024-03-29

Abstract

This article describes the relevance of the book, Alcohol: No Ordinary Commodity to policy development in Low- and Middle-income Countries (LMICs). Per capita alcohol consumption is growing in the emerging economies of Asia and Africa, and it is already high in Latin America and the Caribbean. In the context of limited policy controls, this expansion has created a “perfect storm” driving increased alcohol consumption and harms. Along with the alcohol industry’s attempts to subvert evidence-based policy, these trends signal the need for the kinds of policy solutions proposed in the book. Implications for global health are also discussed.

Alcohol policy development in Sierra Leone: An assessment of the role of civil society

boi-Jeneh Jalloh — 2024-05-15

Objective: To assess the value addition of civil society collaboration with Government in the development of Sierra Leone’s National Alcohol Policy (NAP).

Policy Development Process: We reviewed the entire process of lobby, advocacy, and support for the development of the NAP from 2015 when the Siera Leone Alcohol Policy Alliance (SLAPA) was formed to the launch of the NAP in 2023. It also assesses the level of collaboration between FoRUT, SLAPA and Ministry of Health of Health and Sanitation (MoHS). The MoHS coordinated the policy formulation process with substantive technical support from civil society.

Results: The quality of the NAP was rated high as it reflected appropriate policy areas and interventions from the Global Strategy to Reduce the Harmful Use of Alcohol, the WHO SAFER initiative, and the Global Action Plan for Alcohol Control (202-2030). The NAP is a solid reference material for the development of a new alcohol bill. MoHS recognized FoRUT and SLAPA as the national champions for alcohol control in the country. FoRUT, directly and through SLAPA influenced the process of developing the NAP and its quality through advocacy, collaboration and technical and financial support.

Conclusions: The development of the NAP in Sierra Leone truly reflects civil society-government collaboration, built on mutual trust and a common health and development agenda. Connecting national level lobby and advocacy with regional global advocacy actions to prioritize, influence, support, and monitor the alcohol control agenda is a critical catalyst for civil society to advancing the development of NAPs.

Global alcohol policy implementation in Thailand: A narrative review

Muhammadfahmee Talek — 2024-05-17

Alcohol consumption is growing in emerging economies. Thailand is an upper-middle-income emerging economy in Southeast Asia where the alcohol market has been under an oligopoly, which political groups are attempting to amend. The Thai Ministry of Public Health works in close partnership with the non-profit sector in alcohol control, and has recently adapted the World Health Organization’s (WHO) SAFER initiatives as part of the national alcohol agenda. In light of these ongoing changes, we conducted a narrative review with the following objectives: (1) to describe the development of alcohol control policy strategies in Thailand; and (2) to describe the current situation on alcohol policy implementation. We performed a search of the published and grey literature in both Thai and English languages using keywords related to topics of interest, and reviewed data on SAFER's effectiveness using a group of indicators (policy-attributable health outcomes). We found that Thailand has laws and regulations covering various domains of SAFER. However, gaps do exist with regard to regulation of alcohol outlet density, relatively low alcohol sales permit fees, control of online and surrogate marketing of alcoholic products, and enforcement of drinking-and-driving deterrence measures, among others. A review of the indicators showed that annual per capita alcohol consumption (APC) and prevalence of drinkers have remained constant since 2008, whereas the prevalence of binge-drinking has been on a decline since 2014. However, deaths attributable to alcohol have increased in both men and women. The findings of this narrative review may have implications for policymakers and stakeholders in behavioral health.

Implementing intersectoral alcohol policies at the local level in Santiago, Chile, 2014-2017

Sebastián Peña — 2024-05-30

Background. Local governments have a crucial role to play in alcohol control policies. However, there is a lack of descriptions of comprehensive intersectoral alcohol control strategies led by them. The study describes the experience of developing and implementing an intersectoral alcohol strategy in the Municipality of Santiago, Chile, between 2014-2017.

Methods. We used a case study design. We used data from municipal documents, including reports from fee agreements, official sources of information, municipal service calls and police records, georeferenced data on alcohol outlets and photographs of storefront signs. We used data from interviews with community stakeholders and municipal workers conducted during the study period.

Results. The first stage (2014-2015) consisted of using local evidence to build political will. The main activities were introducing screening and brief alcohol interventions in high schools, supporting a public consultation on reducing the opening hours of liquor stores, and introducing economic incentives to reduce street-level alcohol marketing. The second stage (2015-2017) included a community-action pilot plan and the development and implementation of an intersectoral alcohol control plan involving twelve municipal departments. Activities aimed at reducing the number of alcohol outlets, enhancing transparency on alcohol licensing procedures, and improving the quality of brief interventions. The strategy implemented actions in nine out of ten WHO Alcohol Policy domains.

Conclusions. The experience of Santiago demonstrates the untapped potential for alcohol control at the local level. Political will, local evidence, sharing common goals and medium-term budget frameworks are important facilitators of comprehensive intersectoral alcohol interventions.

Examining the power of the alcohol and tobacco industries in policymaking: Lessons and challenges for the Philippines and Singapore

Gianna Gayle Amul — 2023-10-18

Abstract

Aims: Transnational alcohol and tobacco corporations are expanding operations in Southeast Asia. This study has two objectives: to examine the power of the tobacco and alcohol industries in shaping tobacco and alcohol policies in the Philippines and Singapore, and to identify key lessons and challenges for alcohol and tobacco control.

Methods: We developed a conceptual framework from the literature on power and political, commercial, and legal determinants of health. We conducted a literature review and content analysis of official government documents, corporate documents, and news articles on the tactics of the alcohol and tobacco industries. To triangulate findings, we also conducted a thematic analysis of 30 interviews that we conducted in the Philippines and Singapore.

Findings: Transnational and national alcohol and tobacco corporations used various tactics to influence the policy process for alcohol and tobacco control in the Philippines and Singapore. These industries utilised lobbying, litigation or threat of litigation, revolving doors, and marketing to exercise their instrumental power. They exercised their structural power by exploiting their market dominance and promoting public-private partnerships and alcohol marketing self-regulation. In the Philippines, the tobacco industry benefitted from regulatory capture. Both industries tapped framing tactics, corporate social responsibility, and public-private partnerships to exert their discursive power.

Conclusions: Our study detailed how the alcohol and tobacco industries have exercised their instrumental, structural, and discursive power to influence and interfere in alcohol and tobacco control policies in the Philippines and Singapore. Less regulated, the alcohol industry retains an advantage over the tobacco industry in both countries.

Evaluating the progress of alcohol policies in Burundi against the WHO ‘best buy’ interventions: implications for public health.

Egide Haragirimana — 2024-05-30

Introduction: Alcohol use is a major global health risk, with Global South countries experiencing greater harm per litre of alcohol consumed than those in the Global North. In Burundi, a country with a low-income economy, 16.6% of people aged 15 and above binge drink, and over 30% of women drink during pregnancy. This paper examines current alcohol policies in Burundi, how well they match the WHO ‘best buy’ policy options, and stakeholder views on their implementation.

Methods: We searched for policy documents via online searches, visits to government offices, and snowball sampling from contact with key stakeholders. Semi-structured interviews were conducted with ten stakeholders. The WHO-European Action Plan to Reduce the Harmful Use of Alcohol (EAPA) tool was used to analyse the extent to which Burundi has adopted recommended policy standards. Interviews were thematically analysed using NVivo software.

Results: Only nine of the 34 WHO-EAPA indicators are addressed, seven out of 34 indicators are mentioned with no clear actions, and 18 are not addressed in the eight policy documents that met our inclusion criteria. The large proportion of indicators absent from Burundi policy relate to availability, pricing and taxation, drinking-driving, taxation, and marketing. An absence of legislation to support existing policies, industry interference, corruption, and cultural norms around alcohol were identified as key barriers to implementation.

Conclusions: Burundi should enact laws to support existing policies and design regulations targeting marketing and advertising. Government and civil society coalitions should report and address any alcohol industry influence in policymaking and implementation.

RESET Alcohol: A Global Alcohol Policy initiative

Jacqui Drope — 2024-03-13

The RESET Alcohol initiative supports national governments in low- and middle-income countries to implement three policy actions from the World Health Organization SAFER technical package: increasing taxation, regulating availability, and restricting marketing. RESET Alcohol is working in up to 15 countries primarily in Latin America, Africa, and Asia and is led by Vital Strategies, a global public health organization, in partnership with University of Illinois Chicago Tobacconomics, Movendi International, Global Alcohol Policy Alliance, NCD Alliance and the World Health Organization. The initiative is funded by the grantmaking organization Open Philanthropy. This article provides an overview of the initiative and the countries’ progress in its first year of implementation.

Safeguarding South African schools: Civil society action against alcohol sales in educational settings

Terri-Liza Fortein — 2024-05-17

The Southern African Alcohol Policy Alliance (SAAPA) in South Africa vehemently opposed Clause 8 of the Basic Education Legislation Amendment Bill (BELA) allowing alcohol sales at schools. This stance was grounded in the 2016 National Liquor Policy, advocating for distance between schools and liquor outlets. SAAPA's multifaceted approach included engaging government, experts, media advocacy, social mobilisation, and active participation in the legislative process. Their efforts, culminating in over 5000 submissions and an oral presentation, led to the removal of Clause 8 in September 2023. This success underscores the pivotal role of civil society in shaping evidence-based policies for public health and child welfare.

A growing need for advocacy skills and knowledge in promoting population health and well-being: Recommended strategies for alcohol prevention advocacy

Matej Košir — 2024-04-23

Public health advocacy plays a crucial role in promoting and protecting the health and well-being of communities. It involves the efforts of individuals, organizations, communities, and coalitions to influence public health policies, practices, and systems to address health disparities, improve health outcomes, and create healthier environments. Advocacy strategies used in public health include raising awareness about health issues, mobilizing communities, engaging policy- and decision-makers and media, and influencing legislation. Public health advocates utilize various communication channels, such as traditional and social media, and community forums, to disseminate information and build support for their cause. They also collaborate with stakeholders, including government agencies, non-profit organizations, and community leaders, to amplify their impact. Public health advocacy has been successful in achieving significant improvements in health outcomes. Examples include the adoption and implementation of smoke-free policies, the adoption of evidence-based alcohol strategy and policy, such as the WHO Global Alcohol Action Plan (2022-2030), and many more. However, challenges exist, such as lack of advocacy knowledge and skills among public health workforce, resistance from powerful interest groups (e.g., unhealthy industries), limited resources, and the need for sustained efforts to address complex health issues. In conclusion, public health advocacy is a vital component of efforts to improve population health. It involves advocating for policies and practices that address the social determinants of health and promote health equity. Public health advocates can create positive change and contribute to healthier communities. Continued support and investment in public health advocacy are therefore essential.