Big Alcohol and the Commercial Determinants of Health: What can public health do?

By Callie Anderson

Callie Anderson is completing her Masters of Public Health at the University of Waterloo. She currently works as a Health Promoter developing programs and advocating for policies to improve public health and health equity at the community level.

What are the Commercial Determinants of Health?

The commercial determinants of health (CDoH) are “the strategies and approaches the private sector uses to promote products and choices that are detrimental to health” 1. The concept of the CDoH has only relatively recently emerged as an area of inquiry despite its connection to one of the most urgent public health challenges worldwide, the prevention of non-communicable disease (NCD). 

The inquiry into the CDoH over the past decade has led to a focus on the leading risk factors (e.g., tobacco use, alcohol consumption, poor diet, physical inactivity) for NCDs and how the burden of disease can be attributed to the significant influence exerted by Big Tobacco, Big Alcohol, and Big Food 2,3. While these three industries are most common in CDoH research, discussion of the CDoH can also be extended to include other industry and products of concern including fossil fuels and gambling 4.

Earlier this year, the Canadian Centre on Substance Use and Addiction (CCSA) released a revised version of the Low-risk Alcohol Drinking Guidelines with new guidance for alcohol consumption 5. To lower one’s risk of alcohol related health harms, it is recommended to limit alcohol intake to two standard drinks per week 5. This recent revision has brought a renewed attention to the societal impact of alcohol and has spurred my interest in exploring some of the ways commercial interests of the alcohol industry can shape consumption patterns and even alcohol policy.

Use of the “Corporate Playbook”: A few examples from Big Alcohol

Lacy-Nichols et al. have synthesized and defined the key strategies commonly used by industry to protect business interests, largely at the expense of public health, as the ‘corporate playbook’ 6. Here I discuss only a few of these strategies deployed by Big Alcohol specifically. 

Normalization, denial, and the spread of misinformation

The alcohol industry deploys several strategies to normalize alcoholic beverages, effectively framing the public’s understanding and perceptions of alcohol 4. We can observe these strategies in plain sight, for example, through marketing and advertising at sporting events, on social media, on bus shelters and billboards, to product placements in our favorite TV shows and movies. 

However, many of these strategies are less visible. For example, youth educational programs have been found to teach students about peer pressure and ‘responsible’ alcohol consumption while largely leaving out discussion of industry marketing and advertising tactics, as well as the health harms associated with alcohol 4. These strategies present alcohol as a normal behaviour that one must learn to navigate, thus placing any blame for irresponsible consumption on the individual and away from the industry 4.

Beyond strategies to normalize alcohol consumption, the alcohol industry has also played a significant role in shaping the perception of alcohol-related harm through denying and distorting scientific evidence 7. Leading alcohol industry bodies have been found to deny, for example, that a relationship between alcohol and cancer exists or have omitted any mention of cancer in messaging 7. Further, industry has also been found to distort the facts, implying that the risk depends on consumption patterns (i.e., binge drinking is associated with higher risk) 7. Distraction is yet another strategy used to take attention away from health harms and the role alcohol plays, in which industry has been found to focus attention on the various other risk factors for cancer 7. Such actions have led to the spread of misinformation that has largely allowed alcohol consumption to remain stigma-free. 

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