Friday, 5 December 2014

Alcohol marketing and evidence

Two contrasting stories in the weekly mailbag.

Item the first: Sally Casswell takes one look at the evidence in a viewpoint article in the NZMJ and concludes:
Stepping back and looking at the harm alcohol does in our society, the evidence on marketing’s effect on young people’s consumption and the popular support evinced for change, the only reasons to maintain alcohol marketing in its current largely unrestricted state are to: first, protect the profits of the transnational corporate producers by allowing them to appeal to new cohorts of young people with marketing which recruits them as consumers as early as possible and encourages drinking of larger amounts and second, to protect the financial interests of the advertising and media industries.
It is hard to avoid drawing a conclusion that government’s failure to act was based on a decision to protect the interests of these large corporations at the expense of protecting the health and wellbeing of future generations of New Zealanders.
A restriction on alcohol marketing similar to that adopted more than 20 years ago in relation to tobacco (Smoke-free Environments Act, 1990) or specific to alcohol similar to that in France (LoiEvin, 1991) will not impact in any meaningful way on adult consumers’ knowledge of the availability of alcohol.
Significant restrictions on alcohol marketing will, however, likely effect the normalisation of alcohol. Normalisation, the acceptance of ubiquitous and perception of unproblematic use, makes it more difficult for health promotion and social marketing to affect consumption among heavy drinking social networks or for family and whanau to place limitations on access to alcohol by vulnerable young people.
The ideal is a complete ban on alcohol marketing. This is feasible and a useful model is available in the Smoke-free Environments Act 1990. It has the advantage of thorough coverage of all marketing and sponsorship and includes internet marketing. 
Casswell's piece argues that the evidence on the harms of alcohol marketing to youths is so obvious, lack of government action means the government must have been subverted by evil evil industry.

Item the Second: Cochrane has been running systematic reviews of all kinds of things. Here's Cochrane on alcohol advertising.
OBJECTIVES: To evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter-advertising, on alcohol consumption in adults and adolescents.

AUTHORS' CONCLUSIONS: There is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base.
And here's what I'd said at the Ministerial Forum on Alcohol Advertising and Sponsorship back in the fall.
Bans on advertising, in a free society, are only justifiable on solid evidence of substantial net harm reduction. The existing evidence shows only weak associations between exposure to advertising and consumption behaviours.


No further restrictions to alcohol advertising are justifiable on current evidence. However, if the government is determined to impose such restrictions, it could at least design them in such a way as to allow for programme evaluation. If you decide to ban billboards, set up a rolling phase-in design across a set of towns to assess whether the ban has had any effect; if it has not, then remove the ban. If you decide to ban alcohol advertising in print, use a similar rolling phase-in design to allow for evaluation.
So Cochrane concluded there was no evidence sufficient for restricting alcohol advertising and said any measures should be done within a research design allowing for evaluation. I said that there was no evidence sufficient for further restricting alcohol advertising in New Zealand and that any measures undertaken should be set up to allow for evaluation.

But Casswell's piece argues that the evidence is so strong that only industry subversion can explain lack of action.

It remains astonishing that a government so deeply in Big Alcohol's pockets somehow keeps giving grants to Casswell's research outfit.

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