Holding the Alcohol Industry to Account: Q&A With David Jernigan, Professor of Health Law, Policy & Management at Boston University 

Some three million deaths a year, yet many countries are still reluctant to move aggressively on policies concerning alcohol-harm reduction. Why?

When we survey countries about barriers they face, one of the leading ones is the alcoholic beverage industry. It’s highly concentrated, and the leading players will do everything they can to keep effective strategies [that reduce alcohol use] from being adopted.

On the other side of the coin, they’ll also do everything they can to point countries in the direction of voluntary measures that are less effective, like education campaigns in schools or designated drivers.

How do you advocate for common-sense reform without coming across as prohibitionist?

Look, no matter how we thread the communications needle, the industry is going to call us those things. Now, given that, how do you thread the needle? The WHO SAFER [package] is a good lesson in point. It’s the public-health mantra that suggests less is better. That’s at the individual level. At the government level, some of the powerful arguments to be made are how much it [alcohol] costs governments, opposed to how little money they take in from it.

There’s also a huge equity issue here. The same amount of alcohol in a poorer context will cause far more damage than in the wealthier context. If a parent is drinking heavily, they’re taking away scarce resources from the family budget.

Can we look to tobacco reform as a cause for optimism?

Absolutely. We all derive hope from the tobacco story, but the alcohol story has just been much more complex. More people use alcohol now than used tobacco at its peak. Alcohol is sewn into culture in the way that tobacco was in some cultures, but never to the same extent.

How can politicians shape messaging around this without alienating voters?

It’s pretty simple actually, in that consumption in this industry is highly skewed towards the heaviest consumers, so we can make huge progress if we can simply lop off the heavy consumption. Now, the industry says we’ll do this through treatment. But we will never get there through treatment. We won’t have the resources, and there aren’t enough people who drink heavily enough over time to qualify for treatment.

Is there a country that can be looked at as a model of enacting bolder policy?

There are lots of examples. Russia has done amazing things this century to bend the curve on drinking and alcohol-related problems. They’ve done everything WHO suggests, including limiting advertising, reducing the number of places [one can] buy alcohol, and raising taxes, and lo and behold, they massively reduced the problem in a country where everybody assumed it was impossible.

Thailand is a country where you would expect the trajectory would’ve been the same as Japan and South Korea, which is that with rapid economic development, alcohol consumption would just shoot pretty much straight up. What Thailand was able to do was to flatten that curve by primarily relying on taxes and advertising restrictions. They’ve also taken those tax dollars and funded The Thai Health Promotion Foundation, which has done excellent [alcohol awareness] social marketing campaigns and community organizing campaigns around alcohol [harms].

Does the data bear out that in countries where there have been limitations on advertising, there’s a corresponding reduction in alcohol harms?

It’s a really difficult set of studies to do. What we do have is a really solid body of literature on the other end, which shows that the more that young people are exposed to alcohol marketing, the more likely they are to drink or drink more. There are some studies that have found that countries that have pulled back [on advertising] have found measurable effects. There are also studies that have found no effect. It’s just really hard to control for everything you’d have to control for, particularly in this age of digital marketing, algorithmically driven marketing, and marketing that does not respect national borders.

Are you heartened at all that, in some countries, it’s become trendy to keep Dry January, order mocktails, and purchase non-alcohol beer and spirit alternatives?

That’s a great question. The crude answer there is the more people are talking about something, the more there is the possibility to do something about it as a society. The evidence isn’t there that that alone is going to make a difference in the epidemic of alcohol-related problems that we’re suffering. To the degree that people are talking more about alcohol, thinking more about their drinking, I think that’s all great.

Taxes, as you’ve mentioned, are a crucial lever. But how do we overcome the perception that taxation is a punishment on the consumer?

My favorite advisor and communicator about this is Vincent DeMarco, President of Maryland Health Care for All. Every time he’s interviewed, all he says is, “Alcohol taxes save lives,” over and over again. This is pennies per person for tens of thousands of lives saved. Alcohol taxes save lives.