Every industry carefully plans how to advance its business agenda and counter threats to profitability. What makes industries change the strategies they use to respond to public pressure to modify health damaging practices? Do announced changes in practice reflect real change or are they simply old wine in new bottles? In this report, Corporations and Health Watchanalyzes changes in alcohol industry responses to criticisms of its marketing practices.
One source for such an analysis is the documents disclosed by the tobacco industry. One of the stipulations of the 1998 Master Settlement Agreement between the tobacco industry and the attorneys general of 46 states was that several million formerly confidential tobacco industry documents would be made publicly available.
1 Many of these documents also pertained to the alcohol industry (AI), since the tobacco giant Philip Morris had owned Miller Brewing Company from 1970 to 2002 and was closely involved with the Beer Institute.2 (Altria Group, Philip Morris’ parent corporation, continues to own 27% of the stock in the multinational alcohol company SABMiller.)
Earlier this year, researchers at the Curtin University of Technology in Australia sifted through the tobacco documents in order to identify alcohol industry themes, strategies, and tactics.2 They identified the following industry strategies designed to forestall regulatory action: 1) Industry-run education programs; 2) Focusing blame on individuals and groups with a “problem”, including minorities ; 3) Promoting responsible drinking; and, 4) Denying any association between advertising and consumption.
Granting the validity of their analysis, a question that arises is: Have the alcohol industry’s issues management (IM) strategies changed substantially since 2002, the last year studied by Bond and colleagues?
Source of alcohol industry profits
To understand the goals and tactics of the AI requires an understanding of the source of their profits. While the majority of Americans either do not drink or drink very little alcohol, a considerable portion of U.S. alcohol sales can be attributed to pathological and underage drinking. Greenfield and Rogers found that the top 5% of drinkers consume about 42% of the alcohol sold in the U.S.3 Moreover, about 17.5% of total consumer alcohol purchases are drunk by youth under the legal drinking age, according to Foster and colleagues.4
With that in mind, one can speak of the AI’s goal for alcohol sales to be As High As Reasonably Achievable (AHARA). This is analogous to the environmental health concept of ALARA (As Low As Reasonably Achievable) for exposure to radiation and toxic chemicals.5 (pp260-261) “Reasonably achievable” for the alcohol industry means avoiding a popular or political backlash which could drastically reduce sales.
As we shall see in examining the individual IM strategies, maintaining AHARA requires a risk analysis that is stable over the long term yet nimble with regard to details.
The Four Strategies
1) Industry-run education programs
Since even relatively well-designed education and persuasion interventions are largely ineffective in achieving sustained behavior change,6, 7 it is no surprise that they remain a favored AI intervention. In fact, industry-run education programs in particular could be said to have four benefits: 1) they do not appreciably affect consumption (and thus do not cut into industry sales); 2) they draw attention and resources away from more effective interventions; 3) they offer a branding opportunity; and, 4) they create a “halo effect”, making the industry look beneficent.8
Currently, many industry-created education efforts are directed at parents. Examples include Family Talk About Drinking(Anheuser-Busch); Let’s Keep Talking (MillerCoors); Parents, You’re Not Done Yet (Century Council); and, Are You Doing Your Part? (Century Council). These efforts seek to frame underage drinking as ultimately the responsibility of parents. While, certainly, parents are an important factor in underage drinking,9 a large body of research points to the role of alcohol availability in youth drinking, including alcohol prices,10 alcohol outlet density,11 and enforcement of underage drinking laws.12
Thus, industry education programs consist primarily of amplification of half-truths in conjunction with omission of other (especially environmental) factors and minimization of the full range of risks to public health and public safety.13
2) Focusing blame on individuals with a “problem”
As Dan Beauchamp made clear in his seminal Beyond Alcoholism: Alcohol and Public Health Policy,14 the rise of the alcoholism paradigm redirected attention away from the substance of alcohol and onto the problem drinker. While this perspective did have many positive aspects,15 it also gave the alcohol industry a “free pass,” since alcohol control strategies were seen to be irrelevant, at best.16, 17
Whereas within the mainstream alcohol studies community the alcoholism paradigm has largely been superseded by the public health paradigm, the AI and its apologists continue to embrace the former because of its IM utility. A prime example of that paradigm’s focus on the “problem” individual is the so-called “hard-core drunk driver,” the favored target of the Century Council and the American Beverage Institute. The Century Council defines these individuals as
those who drive with a high BAC of 0.15 or above, who do so repeatedly as demonstrated by having more than one drunk driving arrest, and who are highly resistant to changing their behavior despite previous sanctions, treatment or education.19
Chamberlain and Solomon19 observe that a disproportionate focus on the hard-core drunk driver tends to obscure the fact that “social” drinkers who binge occasionally are responsible for about 60% of alcohol-impaired driving trips and “are at a much higher relative risk of crash per trip than frequent drinking drivers with the same BACs” (p. 274). And yet, by blaming hard core drinking drivers, proponents of these stereotypes allow mainstream “social drinkers” to separate themselves from the impaired driving issue, without ever having to critically assess their own drinking and driving habits. (p. 272)
3) Promoting responsible drinking
Even the most cursory examination of alcohol advertising today will reveal the ubiquity of the “drink responsibly” message. In fact, many brands have even incorporated the r-word into their brand identity. For example, Captain Morgan message on rum commands: “Drink Responsibly – Captain’s Orders!”.
What “responsible” drinking means exactly is left to the individual imagination, leading Smith and colleagues20 to characterize the term as “strategically ambiguous” in that the messages engender a “high degree of diversity in meanings of message content” while serving to “subtly advance both industry sales and public relations interests” (p. 1). Other researchers have also raised questions about the true impact of alcohol industry’s promotion of responsible drinking.21, 22
One of the more blatant AI attempts to take advantage of the murky nature of the “drink responsibly” meaning was a highly-publicized Anheuser-Busch telephone survey in which 94% of responding drinkers claimed that they drank “responsibly” and “in moderation”.23 Again, “responsibly” and “moderation” were conveniently left undefined. Moreover, it is a well-known marketing research axiom that survey respondents will tend to give socially desirable answers, especially in regard to questions about potentially sensitive topics like alcohol consumption.24
By contrast, if alcohol companies were sincere about promoting true responsibility, they could use their considerable marketing muscle to design campaigns similar to the 0-1-2 Domino Strategy from FACE, a national, non-profit organization that educates the public’s understanding about alcohol and its impact, or the 0013 campaign from the U.S. Air Force. While these campaigns may have their limitations, at least they are direct, specific, mnemonic, and use evidence-based guidelines.
4) Denying any association between advertising and consumption
A key element of the alcohol industry IM program—and, indeed, of any industry which knowingly harms human health—is the deliberate obfuscation of scientific knowledge.25, 26 This practice has been variously termed manufactured doubt,27denialism, and agnotology.28
With regard to the relationship between alcohol advertising and consumption, it was once a relatively easy task to deny a link, since many econometric studies found little evidence, perhaps due to methodological shortcomings.6,
The denialist task is now more difficult given the recent spate of well-designed longitudinal studies showing a significant effect of alcohol advertising and marketing on the alcohol consumption of adolescents, in particular.7
Despite this, the AI and its allies prefer to ignore the last decade of research, with industry talking points repeated by corporate-libertarian think tanks such as the Cato Institute,29 the American Enterprise Institute,30 and the Washington Legal Foundation,30 as well as related front groups such as the Statistical Assessment Service.31
Clearly, the AI has maintained a continuity in its IM strategies since the late 1970s, about the time the American public health community began to identify the AI as a significant factor influencing patterns of alcohol consumption.
Three of the four IM strategies identified by Bond, et al.2 (industry-run education programs; focusing blame on individuals and groups with a “problem”, including minorities ; and denying any association between advertising and consumption) tightly parallel strategies from other industries. For example, the automobile industry’s nut-behind-the-wheel defense identified by Ralph Nader in his 1965 book Unsafe At Any Speed32 was also an attempt to shift the blame to “problem” individuals.
The third strategy, to feature vague messages in advertising about responsibility, however, seems to be peculiar to the alcohol industry, although the “responsibility” meme has been increasingly adopted by the gambling industry (Griffiths, 2009).33
Countering these IM strategies and their concomitant deleterious effects on health and safety requires that public health practitioners, advocates, and activists to master two key competencies: Familiarity with the ways that the AI and its partners operate, and the research base that points toward truly effective prevention. (See Box 1 below for resources) , and Capabilityto communicate those concepts in ways that citizens can comprehend and appreciate, combined with facility with media advocacy techniques in order to effect a new social movement for the prevention of alcohol-related problems.34 See Box 2 below for resources.
Box 1: Resources on Alcohol Industry
American Medical Association (2004). Alcohol industry 101: Its structure & organization. Chicago: American Medical Association. Available at:http://www.alcoholpolicymd.com/pdf/AMA_Final_web_1.pdf
American Medical Association (2002) Partner or foe? The alcohol industry, youth alcohol problems, and alcohol policy strategies. Available at: http://www.alcoholpolicymd.com/pdf/foe_final.pdf
Jahiel, R. I., & Babor, T. F. (2007). Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields. Addiction, 102(9), 1335-1339.
Jernigan, D. H. (2009). The global alcohol industry: an overview. Addiction, 104(Supp 1), 6-12.
Marin Institute. http://www.marininstitute.org/site/
Stenius, K., & Babor, T. F. (2009). The alcohol industry and public interest science. Addiction, doi: 10.1111/j.1360-0443.2009.02688.x.
Resources on Media Advocacy
Dorfman, L., Wallack, L., & Woodruff, K. (2005). More than a message: framing public health advocacy to change corporate practices. Health Education & Behavior, 32(3), 320-336; discussion 355-362.
Freudenberg, N., Bradley, S. P., & Serrano, M. (2009). Public health campaigns to change industry practices that damage health: An analysis of 12 case studies. Health Education & Behavior, 36(2), 230-249.
Harwood, E. M., Witson, J. C., Fan, D. P., & Wagenaar, A. C. (2005). Media advocacy and underage drinking policies: A study of Louisiana news media from 1994 through 2003. Health Promotion Practice, 6(3), 246-257.
Mosher, J. F. (1999). Alcohol policy and the young adult: Establishing priorities, building partnerships, overcoming barriers. Addiction, 94(3), 357-369.
Wallack, L., & Dorfman, L. (1996). Media advocacy: a strategy for advancing policy and promoting health. Health Education Quarterly, 23(3), 293-317.
Wallack, L., Dorfman, L., Jernigan, D., & Themba, M. (19963). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications.
Robert S. Pezzolesi, MPH is Founder and President of the Center for Alcohol Policy Solutions in Syracuse, New York and blogs at Upstreaming Alcohol Policy at http://alcoholpolicy.org
1 Healton, C. G., Haviland, M. L., & Vargyas, E. (2004). Will the master settlement agreement achieve a lasting legacy?Health Promotion & Practice, 5(3 Suppl), 12S-17S.
2 Bond, L., Daube, M., & Chikritzhs, T. (2009). Access to confidential alcohol industry documents: From ‘Big Tobacco’ to ‘Big Booze’. Australasian Medical Journal, 1(3), 1-26.
3 Greenfield, T. K., & Rogers, J. D. (1999). Who drinks most of the alcohol in the US? The policy implications. Journal of Studies on Alcohol, 60(1), 78-89.
4 Foster, S. E., Vaughan, R. D., Foster, W. H., & Califano, J. A. (2006). Estimate of the commercial value of underage drinking and adult abusive and dependent drinking to the alcohol industry. Archives of Pediatrics & Adolescent Medicine, 160(5), 473-478.
5 Michaels, D. (2008). Doubt is their product: How industry’s assault on science threatens your health. Oxford: Oxford University Press.
6 Babor, T.F., Caetano, R., Casswell, S., Edwards, G., Giesbrecht, N., Graham, K., et al. (2003). Alcohol: No ordinary commodity. Oxford: Oxford University Press.
7 Anderson, P., Chisholm, D., & Fuhr, D.C. (2009). Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet, 373(9682), 2173-2174.
8 Klein, J., & Dawar, N. (2004). Corporate social responsibility and consumers’ attributions and brand evaluations in a product–harm crisis. International Journal of Research in Marketing, 21(3), 203-217.
9 Van der Zwaluw, C. S., Scholte, R. H. J., Vermulst, A. A., Buitelaar, J. K., Verkes, R. J., & Engels, R. C. M. E. (2008). Parental problem drinking, parenting, and adolescent alcohol use. Journal of Behavioral Medicine, 31(3), 189-200.
10 Hollingworth, W., Ebel, B. E., McCarty, C. A., Garrison, M. M., Christakis, D. A., & Rivara, F. P. (2006). Prevention of deaths from harmful drinking in the United States: The potential effects of tax increases and advertising bans on young drinkers. Journal of Studies on Alcohol, 67(2), 300-308.
11 Truong, K. D., & Sturm, R. (2009). Alcohol environments and disparities in exposure associated with adolescent drinking in California. American Journal of Public Health, 99(2), 264-270.
12 MMWR (2004). Enhanced enforcement of laws to prevent alcohol sales to underage persons–New Hampshire, 1999-2004.Morbidity and Mortality Weekly Report, 53(21), 452-454.
13 Lindsay, G. B., Merrill, R. M., Owens, A., & Barleen, N. A. (2008). Parenting manuals on underage drinking: Differences between alcohol industry and non-industry publications. American Journal of Health Education, 39(3), 130-137.
15 Roizen, R. (1991). The American discovery of alcoholism, 1933-1939 (Doctoral dissertation). Retrieved on November 20, 2009, from http://www.roizen.com/ron/disshome.htm.
16 Bacon, S. (1971) The role of law in meeting problems of alcohol and drug use and abuse. In: Kiloh, L.G. & Bell, D.S. (eds) 29th International Congress on Alcoholism and Drug Dependence, Sydney, Australia, February, 1970 (Australia, Butterworths), pp. 162–172.
18 Century Council (n.d.). Hardcore drunk driving sourcebook. Arlington, VA: Century Council. Retrieved on November 19, 2009, from http://www.centurycouncil.org/files/materials/hdd_sourcebook1.pdf
19 Chamberlain, E. & Solomon, R. (2001). The tooth fairy, Santa Claus, and the hard core drinking driver. Injury Prevention, 7, 272–275.
20 Smith, S. W., Atkin, C. K., & Roznowski, J. (2006). Are “drink responsibly” alcohol campaigns strategically ambiguous?Health Communication, 20(1), 1-11.
21 Barry, A. E., & Goodson, P. (2009). Use (and misuse) of the responsible drinking message in public health and alcohol advertising: A review. Health Education & Behavior. doi: 10.1177/1090198109342393
22 DeJong, W., Atkin, C. K., & Wallack, L. (1992). A critical analysis of “moderation” advertising sponsored by the beer industry: Are “responsible drinking” commercials done responsibly? The Milbank Quarterly, 70(4), 661-678.
23 Harris Interactive (2008, November 12). Anheuser-Busch responsible drinking survey. Retrieved on November 23, 2009, from http://www.alcoholstats.org/mm/docs/6741.pdf.
24 Mick, D.G. (1996). Are studies of dark side variables confounded by socially desirable reporting? The case of materialism.Journal of Consumer Research, 23(2), 106-119.
25 Freudenberg, N. (2005). Public health advocacy to change corporate practices: Implications for health education practice and research. Health Education & Behavior, 32(3), 298-319.
26 Freudenberg, N., & Galea, S. (2008). The impact of corporate practices on health: Implications for health policy. Journal of Public Health Policy, 29(1), 86-104.
27 Krimsky, S. (2003). Science in the private interest: Has the lure of profits corrupted biomedical research? Lanham, MD: Rowman and Littlefield.
28 Proctor, R., & Schiebinger, L. (2008). Agnotology: The making and unmaking of ignorance. Stanford, CA: Stanford University Press.
29 Basham, P. & Luik, J. (2009). Banning alcohol ads won’t cure alcoholism. Retrieved on November 18, 2009, from http://www.cato.org/pub_display.php?pub_id=10371.
30 Calfee, J.E. (2004). A critical look at the new litigation against alcoholic beverage advertising. Retrieved on November 18, 2009, from http://www.aei.org/speech/20558.
31 Szalavitz, M. (2005). Alcohol and advertising. Retrieved on November 18, 2009, from http://www.alcoholnews.org/advertising.html..
32 Nader, R. (1965). Unsafe at any speed: The designed-in dangers of the American automobile. New York: Grossman.
33 Griffiths, M. D. (2009). Minimizing harm from gambling: what is the gambling industry’s role? Addiction, 104(5), 696-697.
34 Wallack, L., Winett, L., & Nettekoven, L. (2003) Preventing alcohol-related problems: Prospects for a new social movement [PowerPoint presentation]. Alcohol Policy XIII Conference, Boston, MA, March, 14, 2003. Retrieved on November 23, 2009, from http://www2.edc.org/alcoholpolicy13/presentations/wallack.ppt.