Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study

Abstract

Background

The alcohol industry uses many of the tobacco industry’s strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence.

Methods

As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards.

Results

There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration.

Conclusion

Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.

WHAT IS ALREADY KNOWN ON THIS TOPIC.

WHAT THIS STUDY ADDS

• We documented the presence or absence of 22 indicators of alcohol industry penetration and government safeguards across 24 jurisdictions.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• We found high levels of alcohol industry penetration and few government safeguards against alcohol industry influence. Stronger measures are needed to protect government policies from alcohol industry influence.

Background

The alcohol industry drives harms and inequities via multiple pathways, enabled by a global political and economic system that increasingly privileges a handful of transnational corporations at the expense of public health.¹ These corporate pathways largely involve shaping the political environment, societal preferences, the knowledge environment and the legal environment.² Specific strategies used by the alcohol industry to influence policy-making include building long-term relationships with key policy actors, adopting multiple organisational forms (such as public relations organisations), reinforcing industry responsibility (such as through corporate social responsibility (CSR) activities) and manufacturing doubt over effective alcohol policies.^{3 4} These strategies have found success, with governments reporting alcohol industry interference as a barrier to implementing interventions that reduce alcohol use.⁵ Globally, the implementation of effective alcohol policies has also fallen since 2015.⁶ Underpinning the conflict of interest between the alcohol industry and public health is the industry’s reliance on heavy alcohol use for most of its profits,⁷ further supporting the need to protect public health policies from interference by the alcohol industry.

The alcohol industry’s sophisticated strategies to shape policy-making closely resemble the tobacco industry’s political activities, yet the former has gained relative acceptance in global health governance.^{8 9} This may be because alcohol industry actors have continued to promote themselves as good corporate citizens engaged in public relations activities, funding disaster relief, hospitals and education campaigns in the name of CSR and partnerships.¹⁰ These activities also aim to frame arguments focusing on drinkers rather than interventions to reduce alcohol supply.⁹ The absence of an international legal instrument for alcohol means that while Article 5.3 of the WHO’s Framework Convention on Tobacco Control (FCTC) provides explicit guidelines for governments to protect public health policies from tobacco industry interference,¹¹ no similar guidance exists for alcohol.

Compared with the alcohol industry, the tobacco industry’s political activities and government safeguards against policy interference are relatively well documented. For example, the Policy Dystopia Model describes a taxonomy of tobacco industry strategies and arguments based on a thematic analysis of studies on the tobacco industry’s political activities.¹² The Global Tobacco Industry Interference Index uses a survey to measure government efforts in implementing FCTC Article 5.3, ranking countries against 20 indicators of tobacco industry interference and government safeguards.^{13 14} Other indices have also been developed using routinely available data to assess the extent of corporate permeation and influence in policy-making,^{6 15} but none are specific to the alcohol industry.

In this paper, which is part of the International Alcohol Control (IAC) Study, we documented and compared the extent of alcohol industry penetration and government protections across different jurisdictions. We also recommend how measures to protect the development and implementation of effective alcohol policies should be strengthened.

Methods

Data collection

The IAC Study was designed to assess the policy environment in which alcohol is sold and used across place and time.¹⁶ Research collaborators in each national or subnational jurisdiction provided data in a standardised format online using the IAC Alcohol Policy Tool. Here, we developed a new module of the tool to document the activities employed by the alcohol industry aimed at exerting influence on the policy environment, and the presence of government safeguards that limit potential influence. We defined the alcohol industry as transnational or local actors including producers, wholesalers, distributors, retailers or sellers, contractors (eg, marketers, lobbyists and consultants), and organisations that represent alcohol industry interests (eg, business associations and social aspects or public relations organisations). In jurisdictions with government-controlled alcohol monopolies, the distinction between government and industry may be less clear than in largely privatised markets.

In designing our questions for this module, we drew reference from similar instruments in tobacco control and conceptual frameworks describing a broad range of corporate practices in relation to health.^{2 12 14} Our list of 22 questions included government ownership of the alcohol industry, 16 indicators reflecting alcohol industry penetration and 5 indicators of government safeguards (table 1). Government ownership of the alcohol industry may range from government shareholding of alcohol companies, which may reflect industry penetration, to government-owned alcohol monopolies that aim to minimise harm, which may be an indicator of government safeguards. Indicators of alcohol industry penetration covered the involvement of transnational alcohol corporations, partnership with government, industry contributions, preferential treatment, coalition management, the knowledge environment and the legal environment. Government safeguards included measures limiting engagement with the industry, prohibiting industry contributions and promoting transparency. To avoid subjective ratings and for comparability across jurisdictions, the options ‘yes’, ‘no’ and ‘no information available’ were provided as responses to each question. ‘No information available’ meant that the researcher was unable to ascertain the presence or absence of an indicator based on the information they could find.

Table 1. Summary of responses for 22 indicators of alcohol industry penetration and government safeguards.

Indicators	Responses
	Yes		No		NIA
	n	%	n	%	n	%
Government ownership of industry
1. Is any part of the alcohol industry owned by the government?	12	50	11	46	1	4
Industry penetration
2. Do any transnational alcohol corporations have headquarters/offices in your country/jurisdiction/state?	24	100	0	0	0	0
3. Has the government allowed the alcohol industry (national or transnational) to participate in any governmental agencies, committees or working groups involved in alcohol policy formulation, implementation or enforcement (excluding public submissions)?	11	46	6	25	7	29
4. Has the government entered into any partnerships or agreements with the alcohol industry, including corporate social responsibility activities (eg, industry involvement in education and charitable causes)?	14	58	5	21	5	21
5. Have any contributions been accepted (financial or non-financial) from the alcohol industry (eg, sponsorship of events) by the government?	10	42	2	8	12	50
6. Have any contributions been accepted (financial or non-financial) from the alcohol industry (eg, sponsorship of events) by political parties?	7	29	2	8	15	63
7. Have any contributions been accepted (financial or non-financial) from the alcohol industry (eg, sponsorship of events) by politicians?	6	25	2	8	16	67
8. Have any government officials or politicians (former or current) held roles in the alcohol industry (eg, ‘revolving door’ phenomenon)?	15	63	2	8	7	29
9. Has the government granted any incentives, privileges or benefits to the alcohol industry (eg, investments or tax exemptions)?	13	54	5	21	6	25
10 Has the alcohol industry supported or funded any non-governmental organisations, front groups, think tanks or consumer groups (excluding trade associations)?	12	50	0	0	12	50
11. Has the alcohol industry supported or funded any media outlets/media training?	5	21	2	8	17	71
12. Has the alcohol industry supported or funded any research?	10	42	1	4	13	54
13. Has the alcohol industry supported or funded any education (eg, schools, symposia or academic meetings)?	15	63	0	0	9	38
14. Has the alcohol industry supported or funded any scientific advisory boards or science institutes?	4	17	2	8	18	75
15. Has the alcohol industry mounted any legal challenges against health policy, government or opponents?	9	38	6	25	9	38
16. Has the alcohol industry used international trade agreements to attempt to influence alcohol policy?	11	46	4	17	9	38
17. Has the alcohol industry exploited loopholes in legislation or regulation?	10	42	1	4	13	54
Government safeguards
18. Is there any policy that limits government interactions with the alcohol industry?	1	4	17	71	6	25
19. Is there any policy that prohibits contributions (financial or non-financial) from the alcohol industry to the government?	1	4	18	75	5	21
20. Is there any policy that prohibits contributions (financial or non-financial) from the alcohol industry to political parties?	3	13	16	67	5	21
21. Is there any policy that prohibits contributions (financial or non-financial) from the alcohol industry to politicians?	3	13	15	63	6	25
22. Is there any policy that requires the government or politicians to make public any records of its meetings or interactions with the alcohol industry?	9	38	10	42	5	21

NIA, no information available.

Our research collaborators came from a wide range of disciplinary backgrounds. To ensure consistency in responses, we provided standardised training to all the researchers involved in data collection in 2022. We contacted researchers to verify any responses that were unclear and to ensure that our questions were interpreted consistently. We also cross-checked responses against the information sources provided and undertook further online searches as needed.

In the IAC Alcohol Policy Tool, researchers supplied current information on industry penetration and government safeguards at the provincial, state or national level, as appropriate to their setting. Past examples of industry penetration were included if relevant. We also requested researchers to provide sources of publicly available information to support each response, such as government or alcohol industry reports, websites, media releases, news articles and research articles. Where the availability of public information was limited, interviews with key stakeholders such as government officials, public health advocates or academics were carried out to obtain further insight. Data collection took place from 2022 to 2023.

Jurisdictions included

We included a diverse range of 24 national and subnational jurisdictions across 5 WHO regions (Africa, Americas, Europe, South-East Asia and Western Pacific). These jurisdictions included 19 countries (Australia, Botswana, Cambodia, China, Colombia, Finland, Ireland, Kenya, Lao PDR, Lithuania, Nepal, Netherlands, New Zealand, Nigeria, Norway, Philippines, Sri Lanka, Thailand, Vietnam) and 5 provinces/states (the 4 largest provinces in Canada and Karnataka state in India). Of these jurisdictions, 13 were middle income (of which 9 were lower middle and 4 were upper middle income) and 11 were high income according to the World Bank’s income groups.¹⁷

Data analysis

We conducted a quantitative summary of the responses by indicator question (table 1) and jurisdiction (tables24). We have included the entire set of questions and responses in table 1, as the proportion of ‘no information available’ or missing data were substantial for some questions. For comparison, online supplemental table S1 shows the responses ‘yes’ and ‘no’ to each question as proportions of positive answers. For tables24, we have excluded 11 questions where data were relatively hard to find, that is, where >30% of responses across jurisdictions were ‘no information available’. Table 2 shows whether any part of the alcohol industry is government-owned and relevant examples in each jurisdiction. Tables3 4 summarise results for the remaining five indicators on industry penetration and five on government safeguards. For completeness, responses to the excluded questions are presented in online supplemental table S2. Our limited sample size prevented subgroup comparisons. For qualitative synthesis, we also extracted a range of examples illustrating industry penetration and government safeguards across jurisdictions (boxes1 2).

Table 2. Summary of responses to whether any part of the alcohol industry is owned by the government.

Jurisdiction	Response	Relevant examples
Australia	No
Botswana	Yes	Government-owned investment company, Botswana Development Corporation, is a major shareholder of Sechaba Brewery Holdings, which owns alcohol producer Kgalagadi Breweries.32
Cambodia	No
Canada (Alberta)	Yes	Government agency Alberta Gaming, Liquor and Cannabis holds a monopoly over alcohol wholesale, while alcohol retailers are privately owned.33
Canada (BC)	Yes	British Columbia Liquor Distribution Branch is a branch of government that maintains a monopoly over alcohol wholesale, and operates one of the province’s largest retailers, BC Liquor.34
Canada (Ontario)	Yes	Liquor Control Branch Ontario is a government-owned corporation with a near-monopoly over alcohol wholesale and retail in the province.35
Canada (Quebec)	Yes	Société des alcools du Québec is a government-owned corporation with a monopoly over alcohol wholesale in the province.36
China	Yes	China’s largest alcohol producers, Kweichow Moutai and Wuliangye Yibin, are state-owned enterprises.37 38
Colombia	Yes	Local government departments in Colombia have the exclusive power to produce and import distilled liquors directly or through third parties by prior authorisation.39
Finland	Yes	Government-owned company Alko holds a monopoly over the off-premise retail sales of beverages containing over 5.5% alcohol in Finland.40 Another government-owned investment company, Solidium Oy, is a major shareholder of alcohol producer Anora Group.41
India (Karnataka)	No
Ireland	No
Kenya	Yes	The government’s development finance institution, Kenya Development Corporation, is a major shareholder of alcohol producer Kenya Wine Agencies.42
Lao PDR	Yes	Lao Brewery, one of the country’s largest alcohol producers, is a joint venture company owned by the Lao government and the transnational corporation Carlsberg Group.43
Lithuania	No
Nepal	No
Netherlands	No
New Zealand	No
Nigeria	NIA
Norway	Yes	Government-owned company Vinmonopolet maintains a monopoly over the retail sales of beverages containing over 4.7% alcohol in Norway.44
Philippines	No
Sri Lanka	No
Thailand	No
Vietnam	Yes	Habeco, one of the largest brewers in Vietnam, is owned by the government and has a strategic partnership with the transnational corporation Carlsberg Group.45

BC, British Columbia; NIA, no information available.

Table 4. Summary of responses by 24 jurisdictions for 5 indicators of government safeguards.

Jurisdiction	Indicators of government safeguards
	Policy that limits government interactions with the alcohol industry	Policy that prohibits contributions from alcohol industry to government	Policy that prohibits contributions from alcohol industry to political parties	Policy that prohibits contributions from alcohol industry to politicians	Policy that requires government or politicians to make public any records of meetings or interactions with alcohol industry
Australia	No	No	No	No	Yes
Botswana	No	No	NIA	NIA	NIA
Cambodia	No	No	No	No	No
Canada (Alberta)	NIA	No	No	No	Yes
Canada (BC)	No	No	Yes	Yes	Yes
Canada (Ontario)	NIA	NIA	Yes	Yes	Yes
Canada (Quebec)	No	NIA	Yes	Yes	Yes
China	NIA	No	No	No	No
Colombia	No	NIA	NIA	NIA	NIA
Finland	No	No	No	No	No
India (Karnataka)	NIA	NIA	NIA	NIA	NIA
Ireland	No	No	No	No	Yes
Kenya	NIA	No	No	No	Yes
Lao PDR	No	No	No	No	NIA
Lithuania	No	No	No	No	No
Nepal	No	No	No	No	NIA
Netherlands	No	No	No	NIA	No
New Zealand	No	No	No	No	Yes
Nigeria	No	No	No	No	No
Norway	NIA	NIA	NIA	NIA	Yes
Philippines	Yes	Yes	NIA	NIA	No
Sri Lanka	No	No	No	No	No
Thailand	No	No	No	No	No
Vietnam	No	No	No	No	No

BC, British Columbia; NIA, no information available.

Table 3. Summary of responses by 24 jurisdictions for 5 indicators of alcohol industry penetration.

Jurisdiction	Indicators of alcohol industry penetration
	Presence of transnational alcohol corporations	Alcohol industry participation in alcohol policy formulation implementation or enforcement	Government partnerships or agreements with alcohol industry	Government granting incentives, privileges or benefits to alcohol industry	Government officials/politicians (former/ current) held roles in the alcohol industry (eg, revolving doors)
Australia	Yes	Yes	Yes	Yes	Yes
Botswana	Yes	Yes	Yes	NIA	Yes
Cambodia	Yes	No	Yes	NIA	NIA
Canada (Alberta)	Yes	NIA	NIA	Yes	NIA
Canada (BC)	Yes	Yes	Yes	Yes	Yes
Canada (Ontario)	Yes	NIA	NIA	Yes	NIA
Canada (Quebec)	Yes	Yes	Yes	Yes	NIA
China	Yes	NIA	Yes	Yes	Yes
Colombia	Yes	Yes	Yes	Yes	Yes
Finland	Yes	No	No	No	Yes
India (Karnataka)	Yes	NIA	NIA	NIA	Yes
Ireland	Yes	Yes	Yes	Yes	Yes
Kenya	Yes	NIA	NIA	No	Yes
Lao PDR	Yes	Yes	Yes	Yes	No
Lithuania	Yes	No	No	Yes	No
Nepal	Yes	NIA	NIA	NIA	Yes
Netherlands	Yes	Yes	No	Yes	Yes
New Zealand	Yes	Yes	Yes	Yes	Yes
Nigeria	Yes	NIA	Yes	NIA	NIA
Norway	Yes	No	No	No	NIA
Philippines	Yes	No	Yes	No	NIA
Sri Lanka	Yes	No	No	Yes	Yes
Thailand	Yes	Yes	Yes	No	Yes
Vietnam	Yes	Yes	Yes	NIA	Yes

BC, British Columbia; NIA, no information available.

Box 1. Specific examples of alcohol industry penetration.

Alcohol industry participation in policy formulation, implementation or enforcement

Alcohol industry representatives have been appointed to government agencies responsible for alcohol policy formulation and implementation. A board member appointed by the Australian government to Food Standards Australia New Zealand, the statutory agency that develops food standards for Australia and New Zealand, chairs an industry trade association Australian Grape and Wine.⁴⁶ Similarly, a board member of the former Health Promotion Agency in New Zealand, a government entity that monitored the implementation of alcohol legislation, was also the chair of the industry trade association the New Zealand Food and Grocery Council.⁴⁷

Government partnerships or agreements with the alcohol industry

The alcohol industry supported or partnered with governments in a wide range of CSR activities. Kgalagadi Breweries in Botswana partnered with the Ministry of Health and Wellness to establish COVID-19 vaccination centres.⁴⁸ Guinness Nigeria established two Guinness Eye Centres located within government university teaching hospitals.⁴⁹ Lao Brewery, which is partly owned by the Lao PDR government, provides annual donations to support the government’s social development projects, such as the Poverty Reduction Fund Project.⁵⁰ Heineken collaborated with the Vietnamese government on drink-driving campaigns.⁵¹ Bavaria Brewery in Colombia funded public–private partnerships promoting regional forest conservation and training female business leaders.^{52 53} The Philippines’ San Miguel Corporation, which owns San Miguel Brewery, funds and builds large public infrastructure projects, including motorways and airports.⁵⁴

In Canada (Quebec), the government-owned alcohol import, distribution and retail monopoly Société des alcools du Québec funds the industry social aspects/public relations organisation Éduc’alcool through a levy on alcoholic beverages.⁵⁵

Government granting incentives, privileges or benefits to the alcohol industry

Governments granted a range of benefits to support the alcohol industry through the COVID-19 pandemic. In China, alcohol producers were offered financial incentives and tax exemptions by local governments.⁵⁶ Alcohol retailers in Ireland received a waiver of excise duties and court fees.⁵⁷ In Canada and New Zealand, alcohol retailers were allowed to operate as ‘essential services’ during lockdowns for COVID-19.^{58 59}

The alcohol industry has benefited from other government privileges. The Dutch government granted at least 6.6 million euros to Heineken to support its commercial activities in Africa.⁶⁰ The Sri Lankan government granted tax concessions to beer companies following flood damage to their production facilities.⁶¹ In Lithuania, tax exemptions were given to small breweries following a general increase in excise tax.⁶²

Government officials or politicians having held roles in the alcohol industry

There were multiple examples of current or former government officials and politicians taking up leadership roles in the alcohol industry. In Thailand, former high-ranking government officials at the Ministry of Public Health were appointed as independent directors of ThaiBev, the country’s largest alcohol producer.⁶³ Several alcohol producers in India (Karnataka) are owned or chaired by current or former politicians, including the Murugesh R Nirani Group and United Breweries.^{64 65} Similarly, a former legislator in Nepal heads the Khetan group that owns Gorkha Brewery.⁶⁶ In Finland, the chief executive officer position of industry trade association Panimoliitto has been held by a senior-ranking politician for the past few decades.⁶⁷

Box 2. Government policy to limit alcohol industry influence in the Philippines.

The Administrative Order Health Promotion Framework Strategy 2030 issued in December 2021 by the Philippines’ Department of Health has the general objective to ‘provide the framework, direction and strategies for the planning, development and implementation of health promotion policies, programmes, plans and activities’ that applies to all national government agencies.⁶⁸

Section VI (policy framework), E (implementation strategies), point c (partnerships for health) states that:

1. All partnerships with the public health sector shall be developed and implemented in accordance with the goals and objectives of the HPFS, and in conformity with the public health sector’s strategic directions, technical norms and standards.

2. Conflicts of interest in relation to the development and implementation of policies, programmes and activities of the partnership shall be effectively managed and, where appropriate, avoided to prevent any potential risks and undue influence, and to protect the independence and objectivity of the public health sector in the performance of its mandates.

3. All engagements, projects or activities with entities including the tobacco and alcohol industries or milk industries within the scope of prohibition of the Executive Order No. 51 or the Milk Code, whose interests, goals and objectives contradict those of the DOH or the public health sector shall not be permitted.

Patient and public involvement

There was no patient or public involvement in this study.

Results

Table 1 summarises all the responses to each question. Half (50%) reported some part of the alcohol industry being owned by the government. All jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported senior government officials or politicians having held roles in the alcohol industry, known as ‘revolving doors’. About half (58%) reported government partnerships or agreements with the alcohol industry, while 54% reported government incentives, privileges or benefits for the alcohol industry. Just under half (46%) reported the alcohol industry being allowed to participate in governmental groups involved in policy formulation or implementation (ie, beyond public submission processes). Although missing data were >30%, all positive responses (‘yes’ or ‘no’) reported the alcohol industry supporting or funding non-governmental organisations and other front groups, and the alcohol industry supporting or funding education (eg, schools and symposia) (online supplemental table S1).

In contrast, few jurisdictions had government safeguards limiting potential industry influence. Only one jurisdiction (4%; the Philippines) had a policy limiting government interactions with and contributions from the alcohol industry. Another three jurisdictions (13%) had policies limiting financial contributions from the alcohol industry to political parties and politicians. More jurisdictions (38%) reported policies requiring the government or politicians to publish any engagement records with the industry. These policies included public registers of lobbyists and their interactions with government officials (eg, for Australia, Ireland and the four Canadian provinces), diary records of government officials (New Zealand) and legislation allowing public access to government information (Kenya and Norway).

Table 2 summarises the responses to government ownership of the alcohol industry. This ranged from government ownership of individual alcohol companies (eg, in Botswana, China, Lao PDR, Kenya and Vietnam), which may reflect industry penetration; to government-controlled alcohol wholesale or retail monopolies (eg, in Canada, Finland and Norway), which aim to reduce harm by removing the private sector’s profit motive. In Colombia, local government departments control the production and import of spirits.

Table 3 shows the responses to our questions on alcohol industry penetration. Five of 24 jurisdictions (Australia, British Columbia, Colombia, Ireland and New Zealand) reported the presence of all five indicators. One jurisdiction (Norway) reported only the presence of transnational alcohol corporations. Specific examples of industry penetration are highlighted in box 1. Notably, government partnerships or agreements with the alcohol industry were commonly in the form of CSR activities, such as supporting healthcare facilities, drink-driving campaigns and conservation programmes. There were multiple examples of government privileges or incentives for the alcohol industry during the COVID-19 pandemic. Examples of revolving doors were also common.

Table 4 shows the responses to our questions on government measures that limit industry penetration. Most jurisdictions (14 of 24) reported no measures at all or had no such information available. The Canadian provinces (British Columbia, Ontario and Quebec) reported the most government safeguards overall (three of five indicators), with policies prohibiting contributions from the alcohol industry to political parties and politicians, and policies requiring the government or politicians to publish any records of engagements with the alcohol industry. However, current policies in these Canadian jurisdictions only prohibit political donations from corporations in general and are not specific to the alcohol industry. Only the Philippines reported a policy by the Department of Health prohibiting interactions of the government with the alcohol, tobacco and milk industries, including engagements, projects and activities (box 2).

Discussion

Our sample of 24 diverse jurisdictions reported high levels of alcohol industry penetration. Specifically, all indicated the presence of transnational alcohol corporations, which have enormous resources to market their products and influence policy both nationally and locally.¹⁸ Almost two-thirds reported government officials or politicians having held roles in the alcohol industry, suggesting it is common for the industry and decision-makers to have close relationships. There were also multiple examples of government partnerships or agreements with the alcohol industry as forms of CSR, as well as government incentives for the alcohol industry during the COVID-19 pandemic. In contrast, we found few government safeguards against alcohol industry influence, with only the Philippines reporting policies limiting government interactions with and contributions specifically mentioning the alcohol industry, along with the tobacco and milk industries. There were more examples of policies requiring transparency of engagements, such as in the form of lobbyist registers and ministerial diaries.

To our knowledge, this is the first study to measure the extent of alcohol industry penetration of policy-making environments and government safeguards against such activity. Nonetheless, they suggest a widespread imbalance exists between the two, which may impede global efforts to accelerate the uptake of policies that reduce the harmful impacts of alcohol. In this context, the findings suggest there is value in refining and using instruments such as the IAC Policy Tool to evidence the need for improving national and international protection of policy environments from alcohol industry influence.

Limitations

Our tool is intended to be used by researchers from diverse backgrounds so we have attempted to keep the questions as simple as possible and limited the focus to publicly available information. However, our study had several limitations. First, it was challenging to obtain publicly available information on multiple indicators, particularly for industry contributions accepted by political parties or politicians, as well as industry support for media outlets, research and scientific advisory institutes. Missing information meant we may have underestimated the true extent of alcohol industry penetration. The paucity of information could reflect limited reporting by governments or industry, making any industry contributions hard to track. A lack of transparency requirements could also have contributed, as suggested by our finding that only a minority of jurisdictions had policies requiring the government to publish any engagement records with industry. Nonetheless, even where missing data were >30%, all the jurisdictions that provided a positive response reported the alcohol industry supporting or funding front groups and education, suggesting that the prevalence of these activities may be underestimated. For these indicators, missing data could in part be due to difficulty ascertaining the absence of such activities if their presence was not identified. Second, even where there were transparency requirements in place, any information provided may be sparse. Limitations of publicly available government data sources, such as ministerial diaries and lobbyist registers, include the low level of detail provided, the exclusion of political advisors or more informal interactions and reporting delays.^{19 20} To maximise the amount of information captured, we have not specified a time frame for reports of industry activities. This meant that some reports may have pertained to events that occurred years ago, while others may reflect more recent or common occurrences. For simplicity, we have also not recorded the frequency of these reports. Single and multiple occurrences were both coded as ‘yes’, as the limited quality of publicly available information meant that any comparisons of frequency may not be reliable. Third, alcohol industry penetration comes in many forms, some of which can be contextually specific, complicating comparison across jurisdictions. For example, the Vietnamese government was reported to have invited the alcohol industry to participate in policy consultations, which may not be perceived elsewhere as the alcohol industry having a formal role in the policy process. However, multiple indicators should provide a reasonable picture of the overall extent of industry penetration. Fourth, we have not assessed inter-rater reliability as we only had one researcher complete the questionnaire for most jurisdictions. This meant that the variation in responses across jurisdictions may have been due to the low reliability of some questions. Lastly, we have not scored the level of alcohol industry penetration and government safeguards across jurisdictions. The Global Tobacco Industry Interference Index used a sliding scale for most indicators to develop a scoring system representing the collective perception of tobacco control advocates in a country.¹⁴ While a scoring system may facilitate comparisons and provide a more nuanced assessment of each indicator, we have provided a simple analysis as a starting point. We also have not examined the effects of alcohol industry influence on government policies, which is a different research question.

Recommendations

Based on this initial study, we identified several areas where our data collection can be improved. First, as revolving doors appeared relatively common, policies requiring management of conflicts of interest and stand-down periods for government officials and politicians should be captured. Second, the presence of political lobbying activities should be assessed, as policies requiring the disclosure of lobbyists and their activities were reported by several jurisdictions. However, given existing lobbying registers may not sufficiently account for in-house lobbying or revolving doors,^{21 22} and the acceptance of favours or gifts by government officials or politicians is often only self-declared,²³ the full extent of industry lobbying activities would be challenging to measure. Here the tracking of politicians’ voting patterns in parliament on alcohol control policies may help to identify who is being lobbied.²⁴ Third, the alcohol industry’s CSR activities may be considered a form of political lobbying, being used to influence the framing of alcohol-related issues and gain access to policy-makers.²⁵ These activities were prominent so those beyond government partnerships should be included. Fourth, while we have assessed the presence of transnational alcohol corporations for comparability across jurisdictions, collecting further data on local alcohol industry actors, including retailers, may be particularly relevant to local policy impact. Finally, our module could be broadened to capture mechanisms promoting government accountability and compliance to policies, such as an ombudsman system or the use of sanctions, which are important to policy impact.²⁶ Enhanced surveillance of industry penetration and government safeguards would enable public scrutiny of such activities and contribute to advocacy efforts around limiting the influence of commercial interests on public policy. From a research perspective, studies of this kind would also strengthen our understanding of the relationship between industry penetration and government policy.

Our results highlight the contrast between the considerable extent of alcohol industry penetration and the absence of government safeguards, especially when considered against tobacco control policies. This finding is expected, given the lack of an international framework convention for alcohol.²⁷ Even in the Philippines, where existing government policy limits interactions with the alcohol industry, a bill encouraging CSR in the private sector was recently approved by the House of Representatives, highlighting the challenges in limiting alcohol industry influence.²⁸ Given the similar tactics used by the alcohol and tobacco industries to influence policy-making and the extent of alcohol harm,²⁹ we suggest that governments use the FCTC as a template for alcohol policies, establishing measures to limit government interactions with the alcohol industry and rejecting any partnerships with the industry, including CSR activities.³⁰ As the alcohol and tobacco industries are closely connected, future research could also focus on documenting these links.

The economic impacts of the COVID-19 pandemic may have made governments more vulnerable to alcohol industry influence, as seen in the examples that we have illustrated. Even in countries that are parties to the FCTC, the tobacco industry similarly exploited the pandemic by persuading governments to accept their political contributions and compromise on tobacco tax policies.¹³ This underlines the need for governments to strengthen policies on political contributions (both financial and non-financial), limiting the ability of the alcohol industry to influence the public sector. For example, the Canadian government has set an annual limit on political donations and prohibits donations from corporations and trade unions to political parties and politicians.³¹

Lastly, our results suggest that more robust policies are needed to enhance the transparency of any government interactions with the alcohol industry. These may include policies requiring the disclosure of detailed meeting records, political lobbying activities and conflicts of interest for government employees and politicians. To limit revolving doors, stand-down periods for government officials and politicians should also be considered and enforced with meaningful sanctions.

Conclusions

We found high levels of alcohol industry penetration and very limited government safeguards against alcohol industry influence across 24 diverse jurisdictions. Learning from experiences in tobacco control, governments should adopt stronger measures to protect policies from the alcohol industry’s vested interests, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Our tool may be used to monitor progress in implementing government safeguards to address alcohol industry influence across space and time. While this research remains a work in progress, we have suggested areas where data collection can be improved and hope to include more collaborators in future studies.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.