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DISCUSSION PAPER: ALCOHOL MESSAGING
Working Title - New Truths about Alcohol
1)
Purpose of Paper
The purpose of this paper is to facilitate discussion on the messaging work that is
required to support the overall work programme of the EU/US dialogue group. It is
hoped that the messaging work will complement the other work strands that have
been identified with the aim of supporting an international network of policy
advocates working towards the common goal of reducing the harm caused by alcohol
and addressing underage drinking. A series of recommendations are outlined at the
end of the report including a recommendation that given the cross-over between the
work of the messaging sub-group and the organising and advocacy strategies subgroup, these two sub-groups come together for the remaining dialogue sessions.
2)
Reframing the Problem
The conditions within which public health advocacy activities take place will vary
between localities and from country to country. It is suggested that a useful starting
point for public health advocates would be to undertake a critical analysis of the
‘frame’ of the ‘alcohol problem’ that is dominant in their own jurisdiction. The way that
policy problems are framed is important as the frame of the problem often dictates
both the messages that are employed and the policy solutions that will be
considered.1 With regards to alcohol policy, there are two competing frames – the
alcohol beverage industry frame and the public health frame. The industry frame
promotes the business interests of the alcohol beverage industry and the key
messages are that alcohol consumption is normal, fun and healthy, and that the
majority of people drink responsibly with the damage caused by alcohol affecting only
a small group of people who drink irresponsibly. Under this frame, the key message
is that it is not the alcohol that is the problem but the irresponsible behaviour of a
minority of drinkers. The policy solutions proposed under the industry frame are
education, self-regulation and partnership with the industry – all of which the
evidence indicates are the least effective measures to reduce alcohol-related harm.
Understanding alcohol industry framing and messaging is of critical importance when
seeking to address concerns about underage drinking given the role of the alcohol
beverage industry both in providing the means for young people to drink and in
implementing highly sophisticated marketing strategies which specifically target
young people.
Public health advocacy is concerned with promoting the public health interest and in
the case of the alcohol control movement, seeks to protect the vulnerable in society
from the risks associated with the consumption of a harmful and addictive product.
The key messages associated with the public health frame are that alcohol is an
addictive and harmful substance that is linked to over 60 diseases with alcoholrelated morbidity second only to tobacco in the developed world.2 In addition to the
health harm to individuals, a key message is that alcohol is linked to a significant
burden of social harm including crime, violence, child neglect, road traffic accidents,
fire fatalities and absenteeism. In short, the effects of alcohol-related harm are felt
across the whole population. The rise in alcohol-related harm is seen as an ‘industrial
epidemic’3 which has been created by the trans-national corporations who seek
unfettered access to markets to sell their products and maximise profits. The success
of big business in persuading governments of the primacy of the markets and the
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resulting widespread deregulation has led to an excessively pro-alcohol physical and
social environment which is sustained by extensive marketing and the easy
availability of alcohol. In the public health frame, the alcohol industry is considered
culpable in the epidemiological cascade of health and social harms caused by
alcohol. Public health messaging work on underage drinking has the potential to
illuminate the efforts of the alcohol industry to permeate society, influence young
people’s choices about alcohol usage and encourage underage drinking. Public
health advocates recognise that to stem the rising tide of harm and protect young
people from the risks associated with alcohol, a reduction in overall alcohol
consumption in the population is required. Policy solutions proposed by public health
are based on evidence of effectiveness and most require legislation to implement for
example - controls on price and availability, drink driving measures, age restrictions,
brief interventions and reduced exposure to alcohol marketing.4
3)
Advocacy Goals and Target Audiences
In most cases, achieving effective policy solutions and avoiding ineffective policies
will require public health advocates to develop and implement policy influencing and
advocacy strategies which target policy-makers and other key audiences. NGOs can
play an important role in advocating for alcohol policy in the public health interest and
establishing advocacy coalitions with individuals and groups who share their
advocacy goals. The overall approach a government takes to alcohol policy is of
fundamental importance in efforts to improve outcomes for children and young
people. An alcohol policy formulated by public health interests will work to reduce risk
factors and strengthen protective factors.5 Education work with young people may
increase awareness and knowledge about alcohol but the effect on drinking
behaviour is likely to be limited if nothing changes in the physical, social and
economic environment around them. Policy measures which focus on changing the
drinking environment through controls on price and availability are therefore central
to improving outcomes for children and young people.
It is suggested that discussion of messaging should be linked to discussions on
advocacy and policy influencing activities and that the EU/US dialogue group may
want to consider identifying the broad strategic advocacy goals which could provide a
framework for public health advocacy activity at local, national or international level.
Given the crossover between advocacy and messaging, there may be some merit in
the advocacy and messaging groups working together for the remaining dialogue
sessions. It has been noted that the tobacco control movement benefited from having
a clear consensus policy position from as early as 1975 and a similar approach could
benefit the alcohol control movement. A consensus advocacy framework to inform
local, national and international policy influencing activity could include three or four
overarching advocacy goals as follows:
Advocating for evidence-based, population approaches to alcohol policy and
in particular, controls on the price and availability of alcohol to reduce overall
consumption in the population in order to reduce the high levels of alcoholrelated harm.

Advocating for policy-makers to make a clear distinction between
organisations representing the public interest and those representing
business interests and ensuring that the role of the latter is confined to policy
implementation rather than policy development.
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
Advocating for measures to protect children and young people from the risk of
alcohol harm by reducing their exposure to alcohol marketing through
increased regulation and an end to alcohol sponsorship of sports events and
events with youth appeal.
Agreeing a strategic advocacy framework would enable public health advocates to
identify their own advocacy priorities within the broad framework depending on the
national and local conditions that prevail. For example, a group could decide to
develop an advocacy campaign that focuses specifically on the price of alcohol; or on
the availability of alcohol or on alcohol marketing. The policy implementation
literature provides a range of theoretical frameworks that seek to explain why some
policy issues get taken up by policy-makers whilst others are left to languish and this
literature may offer some insight into policy influencing strategies that could be
helpful for the alcohol control movement. Frameworks including the policy advocacy
coalition (Sabatier and Jenkins 1993); the multiple streams approach (Kingdon 1984,
1995) and the punctuated equilibrium model (Baumgarter and Jonesn1993) may
resonate with public health advocacy although it should be noted that much of the
policy process literature describes rather than explains. Frameworks which
foreground the role of ideology and politics in the policy process and identify the
essence of policy making as a ‘struggle over ideas’ (Stone 1997) may be more
useful given the powerful commercial interests involved in alcohol policy. It is
suggested that the research sub-group considers whether providing a brief overview
of the policy process literature would be useful to help inform advocacy and
influencing activity.
A useful starting point for public health advocates in individual countries would be to
assess the extent to which the problem of alcohol harm has been identified in their
own jurisdiction and the way that the problem has been ‘framed’ which will in turn,
determine the policy solutions that are being considered. This will involve analysing
the political conditions that prevail i.e. does the government (at local or national level)
lean towards a pro-market, deregulation and liberalisation agenda or does it lean
more towards social democratic principles which might make it more amenable to
population based policy solutions involving increased regulation. The EU/US
dialogue group could consider what resources would help advocates identify where
their region/country is positioned in a model of change which might range from:A (no interest in alcohol control measures)
B (beginning to be interested)
C (legislation being proposed)
D (legislation implemented and enforced).
Conducting an analysis of the policy and political environment and identifying where
public health advocacy is positioned will help to inform the advocacy and messaging
strategy that public health advocates adopt. Different advocacy and messaging
strategies could be suggested for different positions on the model of change. For
example, a region/country which places itself at A on the model for change may
initially need to orientate most of its advocacy and messaging activity towards
gaining recognition that alcohol harm is a problem (problem recognition). A
region/country which places itself at B may want to focus advocacy and messaging
activity on ensuring that policy-makers are considering effective rather than
ineffective policy solutions (population approaches). This is not to suggest that there
is a linear separation between each stage simply that the emphasis of influencing
activity may differ somewhat depending on the political conditions that prevail.
However, regardless of the different levels of advocacy activity within the alcohol
control movement in each country, it is likely that the target audiences for policy
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influencing activity will be broadly similar in every jurisdiction. Key target audiences
that public health advocates will be seeking to influence will include:



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Politicians and policy-makers (at local, national and international level)
General public
Print and broadcast media
Professionals (health, education, criminal justice, welfare and other sectors)
Parents
Community activists
Civil society groups
Young people.
Messaging tasks include identifying what information would be most relevant to each
target audience and what would be required to secure their engagement and support
for advocacy goals. For example, if the advocacy goal is reducing young people’s
exposure to alcohol marketing, the messaging information targeting parents may
focus on the link between increased exposure, intention to consume and increased
risk of alcohol problems in later life. The messaging information targeting young
people may focus on the way that the alcohol industry tries to manipulate their views
by associating alcohol with fun, free time, belonging and social success. Similarly,
information targeting health professionals and policy-makers may seek support for
‘upstream’ activities and market regulation. It is suggested that the EU/US dialogue
group seeks consensus on the broad advocacy goals and target audiences whilst at
the same time recognising that the strategic advocacy framework should allow for
local flexibility.
4)
Messaging Tasks and Communication Strategies
This section of the report identifies the key messaging tasks that are linked to the
broad advocacy framework highlighted in the previous section and outlines the
communication strategies that could be employed. Potential key messages for each
messaging task are highlighted as are the specific outcomes sought from each
messaging task and the supporting evidence that could be used to give weight to the
messaging task. It is suggested that the EU/US dialogue group identifies case
studies from different jurisdictions which illustrate both the action that is required i.e.
by providing case studies of industry activity and also case studies of public health
advocacy and messaging strategies that have been effective.
Messaging Task One: Re-framing the Problem
Communication strategies to include:

Highlighting the range and magnitude of the health and social harm alcohol
causes to individuals, communities and countries.
Highlighting the harm alcohol causes to people other than the drinker.
Key Messages
Alcohol is linked to over 60 diseases.
Every day x people die from alcohol.
Every problematic drinker negatively affects the lives of two other family members.
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One in two prisoners were drunk at the time of the offence.
There are now more negative than positive consequences of alcohol consumption.
Outcome: Individuals, communities and countries have increased awareness of
individual and population risk factors relating to alcohol health and social harm and
recognise that this is not an issue that affects a minority of drinkers but one that
impacts on the whole community.
Supporting evidence: Work by Jurgen Rehm and colleagues on global burden of
alcohol harm; work by Robin Room and colleagues on alcohol’s harm to others;
national and local data on consumption trends, health and social harm including
alcohol-related deaths, hospital admissions and alcohol-related crime.
Case Studies: (to be inserted)
Messaging Task Two: Promoting Whole Population Approaches
Communication strategies to include:


Raising awareness of the need to have alcohol policies that target the whole
population, increasing awareness of the evidence base on effective policy
and the need for regulation of a harmful and addictive product.
Countering the misinformation and myths perpetrated by the alcohol industry
and highlighting the actions taken by the industry to encourage legislators and
policy-makers to adopt ineffective policy measures.
Key Messages
Good alcohol policy saves lives - bad alcohol policy kills people.
Increasing the price and reducing the availability of alcohol will save lives.
Alcohol industry makes most of their profits from heavy drinkers.
Alcohol industry opposes any measures which will reduce their profits.
Outcome: There is broad public support and consensus about the state’s role in
regulating a harmful and addictive product and increased understanding of the
conflict of interest between commercial vested interests and the public health interest
in the development of effective alcohol policy.
Supporting evidence: WHO effectiveness table, work by Babor et al and others,
position adopted by Chief Medical Officers and the Medical Royal Colleges.
Case studies: Minimum pricing in Scotland, tax increases in Estonia, age restrictions
in US.
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Messaging Task Three: Protecting Children and Young People
Communication strategies to include:


Raising awareness of the particular vulnerability of young people to the health
and social risks associated with the consumption of alcohol.
Increasing awareness of the actions of the alcohol industry in deliberately
targeting young people through excessive alcohol marketing including the use
of social media and sponsorship.
Key Messages
Alcohol is the single biggest cause of death among young men aged 16 – 24 years.
The younger a person starts drinking, the greater the chance they will develop
alcohol problems later in life.
11 year olds see as much alcohol marketing on a daily basis as 18 year olds.
Alcohol industry spends millions trying to entice young people to drink their products.
Alcohol industry creates products that deliberately mask the taste of alcohol to attract
first time drinkers.
The goal of alcohol marketing is to make people life long users of alcohol.
Outcome: Young people, parents, policy-makers and the general public are aware of
the specific health and social concerns associated with young people’s consumption
of a harmful and addictive substance. There is increased awareness of the activities
of the alcohol industry in deliberately targeting young people through alcohol
marketing including social media and sponsorship activities and a general consensus
that government has a key role in protecting young people from alcohol marketing.
Supporting evidence: Epidemiology and physiology of the effects of alcohol on
developing organs and the adolescent brain. Work by Jernigan, Hastings, Anderson
and others on the effects of alcohol marketing on young people’s consumption of
alcohol.
Case Studies: Diageo and Facebook; Heineken and Google. Work by EUCAM to
raise awareness about industry marketing activities. Loi Evin in France.
5)
Recommendations for Discussion

The advocacy and organising sub-group and the messaging sub-group work
together for the remaining dialogue sessions.

The EU/US dialogue group agrees a broad strategic advocacy framework to
help inform advocacy and messaging work at local, national and international
level.

The EU/US dialogue group identifies key messages and target audiences to
support the advocacy framework.
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
The EU/US dialogue group considers developing a model of change which
would assist public health advocates in identifying the position of public health
advocacy in their own jurisdiction to help inform advocacy and messaging
strategies.

The EU/US dialogue group identifies case studies to illustrate both industry
influencing and messaging activity and examples where industry activity has
been successfully countered, using visual communication where possible.

The EU/US dialogue group considers how this paper can be translated into
specific advocacy and messaging tools and resources that could be made
available to an international network of public health advocates to assist them
in influencing activity to reduce the harm caused by alcohol.
References
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