Power, influence and misinformation - alcohol industry opposition to public health measures

Introduction

The alcohol industry is a multi-billion-euro sector with considerable influence to shape government policy, public perception, cultural norms, and consumer behaviour through the power they wield with the media and at the highest levels of government.

Alcohol industry political power

The influence the alcohol industry wields at a political level was recently exposed by an original piece of academic research – ‘Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study’.[1] The study, published in the British Medical Journal, found high levels of alcohol industry penetration and few government safeguards against alcohol industry influence in all 24 jurisdictions analysed.

However, Ireland was the only European state in the research to record alcohol industry penetration across all five indices analysed, including areas such as government granting incentives, privileges, or benefits to the alcohol industry, government officials or politicians with current or former roles in the alcohol industry, and alcohol industry participation in alcohol policy formulation. The authors concluded by calling for stronger measures to protect government policies from alcohol industry influence.

Furthermore, Big Alcohol also wields its economic weight to sway politicians, influence policy, and shape public perceptions. Alcohol production is concentrated amongst a small number of highly profitable companies with the 10 largest global alcohol producers selling more than half of the world’s alcohol.[2] Moreover, the global alcohol industry has been valued at well over $1 trillion.[3] [4] That is higher than the GDP of 179 countries, or to put it another way, there are only 16 countries in the world that have a higher GDP than the alcohol industry makes in revenue each year.[5] Not surprisingly, their influence on government is extremely powerful.[6]

Company	Headquarters	World Share
Anheuser-Busch InBev	Belgium	16.0%
SABMiller	United Kingdom	9.5%
Heineken NV	Netherlands	7.4%
Carlsberg Breweries A/S	Denmark	5.2%
CRE Beverage Ltd	China	3.7%
Tsingtao Brewer Co. Ltd	China	2.7%
Grupo Modelo	Mexico	2.3%
Molson-Coors Brewing Co.	United States	2.2%
Beijing Yanjing Brewery (Group) Corp.	China	2.1%
Kirin Brewery Co. Ltd	Japan	1.9%
Total		53.0%

Table: Leading alcoholic beverage companies by production [7]

With such wealth comes the capacity to significantly impact policy making through multiple channels including direct lobbying and PR agencies for individual companies. However, the industry also uses sectoral groups, such as producers and retailers, at national and international level to lobby, influence, and shape public health policy. As has been noted in analyses of alcohol industry submissions to public consultations, Drinks Ireland, who represent producers in Ireland, and Spirits Europe, who represent spirits producers in Europe, are just two examples of well-coordinated industry bodies.

Such organisations actively involve themselves in the policy process through composing written submissions, participating in expert groups, and intense lobbying at national and EU level to undermine public health policy.[8] Indeed, government officials or politicians with current or former roles in the alcohol industry grant an extreme level of political power as this facilitates ease of access between government and industry.[9]

Alcohol industry media power

The alcohol industry also wields significant power and influence in the media through advertising, sponsorships, and media representation. Alcohol is one of the most heavily marketed products in the world, with the annual spend on alcohol marketing conservatively estimated at €115m in Ireland alone[10] – a significant amount of which is spent advertising in print media, online, on radio, and on television. Indeed, academics have often pointed to the significant revenue streams that come from advertisements and have highlighted that media outlets often feels it necessary to, at least subconsciously, protect these sources.[11] This was a point which Harry Browne, a lecturer in journalism in the School of Media of Dublin Institute of Technology, made in relation the role of the media during the Oireachtas Banking Inquiry when he stated that “Much of the mainstream media seems to me to be very conflicted because of their reliance on… advertising. That doesn’t mean reporters consciously avoid writing bad news stories, but it’s hard to run against the tide when everyone is getting rich.”.[12] Resultantly, the media may feel obligated to carry stories, or mute criticism, in order not to offend their advertising revenue sources and disturb a close, financially beneficial relationship.

Such soft power is so important for the alcohol industry because media coverage of alcohol-related policy measures can influence public debate. Indeed, academics found that Irish media coverage of alcohol policy measures is more aligned with the interests of the alcohol industry than public health. In ‘An Analysis of Media Coverage of Alcohol Warning Labels With a Cancer Message in Canada and Ireland’, the authors found news coverage of the cancer labelling provisions proposed in Ireland’s Public Health (Alcohol) Bill was primarily negative and consistently foregrounded alcohol industry perspectives.

Media Coverage of the Public Health (Alcohol) Bill

Industry arguments opposing alcohol warning labels (AWLs) and the cancer warning mentioned in news articles	Number of mentions in news articles published between 2017–2019
Stating alcohol can cause cancer is inaccurate / misleading / unproven / incomplete / overreach	25
Alcohol and cancer link is too complex for a single label	7
AWLs are not effective/there are better/less anti-trade alternative measures that industry supports	23
Alcohol has health benefits and AWLs should not just mention risk	11
Cancer labels will hurt or disadvantage alcohol industry (and small/craft breweries/distilleries) and will cause stigma/reputational damage	38
No legislative authority for applying AWLs and represents trademark infringement	3
Industry is being unfairly singled out with AWLs and cancer warning	7
Alcohol is not the same as tobacco	2
Industry not consulted about AWLs and should have input	1
Cancer labels will cause export/trade barriers and impede growth	31
Cancer labels are a disproportionate response not required in other countries	23
AWLs will be expensive/logistically difficult to implement	18

Table: Industry arguments opposing alcohol warning labels (AWLs) and the cancer warning mentioned in news articles [13]

Julien Mercille expanded on such points in his research paper ‘Media Coverage of Alcohol Issues: A Critical Political Economy Framework-A Case Study from Ireland’.[14] His research revealed that in relation to the Public Health (Alcohol) Bill Ireland’s four main newspapers carried more articles opposed to, or neutral, toward public health measures than supporting them.[15] The research indicates that the media reflect the views of the political and economic establishment on public health measures with a clear reluctance to support strong public health strategies.[16]

Furthermore, power in the media space is also ceded by the state to industry through bodies such as the Advertising Standards Authority (ASA), which is the self-regulatory body set up and financed by the advertising industry, including advertisers, agencies, and media outlets, to promote advertising standards in Ireland.[17]

This situation means the alcohol industry have proven adept at shaping government policy and the media narrative around their product. To do this they have exerted soft power and hard power, but in more difficult situations when faced with the evidence and facts regarding the health harming nature of alcohol, the industry has resorted to denial, dishonesty, and misinformation.

If the alcohol industry is so powerful, why does it resort to misinformation?

Misinformation is an industry tactic. Just like the tobacco industry before it, the alcohol industry is adept at doing anything to protect its health-harming product – including denying the health risks associated with alcohol, opposing efforts to inform the public of these risks, and lobbying against public health measures aimed at reducing alcohol consumption and harm.[18] [19]

Despite the power and influence the industry wields, they resort to the tactic of misinformation because they need to obfuscate the harm their product causes at an individual level, a community level, and a national level. For instance, despite recent reductions in alcohol consumption volumes in Ireland, drinking levels and patterns remain problematic, especially when measured against modest government and Health Service Executive (HSE) targets. There is still a high level of consumption across the population, at 9.9 litres per capita over the age of 15 years. This is 10% above the modest reduction target of 9.1 litres per capita which was set by government in 2013, to be achieved by 2020.[20] Very concerningly it is 40% above the level if the adult population who consume alcohol stayed within the current HSE lower risk drinking guidelines.[21] These guidelines are acknowledged as being very high compared to other jurisdictions and are currently being examined for revision.

Furthermore, even 1-2 drinks per day carries increased cancer risk, with around 1,000 alcohol-related cancers diagnosed annually in Ireland, liver disease death rates have steadily increased over the past 20 years and Ireland has one of the highest rates of foetal alcohol spectrum disorders in the world.[22] Additionally, at least 1,500 of hospital beds are in use daily[23] and up to 30% of Emergency Department presentations are caused by alcohol consumption.[24] It has devastating impacts on mental health with national research indicating that alcohol may be a factor in close to half of all suicides.[25] Tragically, we also know that four people lose their lives every single day because of alcohol.[26]

The outworking of this high level of consumption are the associated harms that alcohol causes. We know that alcohol seriously impacts health services, workplace productivity and is a critical factor in multiple crimes. It costs the state at least €12 billion annually but is feted as integral to our society.[27]

These are the facts which alcohol industry seeks to obfuscate or minimise through misinformation and disinformation – and they do this to protect their product and their profits.

Incidences of industry misinformation

Ireland

As the Public Health (Alcohol) Bill moved through the Oireachtas the alcohol industry positioned themselves against several aspects of the legislation which continued into the EU notification processes. To bolster their arguments they made demonstrably false claims regarding the health benefits of alcohol, while downplaying the risks.[28] Indeed, the myth that wine, in moderation, is good for the heart has often made appearances in the Irish media landscape, so too have industry claims that the linking of alcohol and cancer is disproportionate, inaccurate, and complex.[29]

The use of such tactics has been especially evident in the industry’s opposition to alcohol health information labelling. A particularly egregious example of this came to light during Ireland’s notification alcohol labelling regulations to the EU Commission through the Technical Regulations Information System (TRIS). In their submissions to the process many of the industry’s well-coordinated submissions used the ‘complexity’ argument, i.e., that the association between alcohol and cancer risk is apparently complex and cannot be adequately explained in a single warning label and that this is a complicated scientific and policy issue that people couldn’t possibly get to grips with by giving them public health information.[30] While in the media, the industry continuously distorted, downplayed, and otherwise obfuscated the evidence linking alcohol and cancer.[31] Indeed, in many instances, industry arguments claimed the cancer warning was inaccurate, unproven, and based on false or unsound evidence.[32]

The evidence linking drinking and cancer is well established. In 1988, the World Health Organisation’s International Agency for Research on Cancer (IARC) concluded that alcohol is carcinogenic to humans.[33] Research in the decades since has only strengthened the conclusion, including for breast, liver, colorectal and oesophageal cancers. While in 2023, the WHO and the IARC declared in a joint statement: “No safe amount of alcohol consumption for cancers can be established.”.[34]

Commenting on Big Alcohol’s tactics the WHO said there was evidence of a concerted effort by industry to denigrate the well-established scientific findings that alcohol causes cancer and liver disease, through bodies such as Drinks Ireland, citing reports they had commissioned from authors and organizations, such as the Gradient Corporation.[35] It should be noted that the work of the Gradient Corporation has been called ‘science for sale’ and their workers labelled ‘rented white coats’.[36] As with their work defending the tobacco, asbestos, arsenic, and lead, the aim of the Gradient Corporation in relation to Ireland’s alcohol health information labelling was to obscure the truth and fact.[37] Laughably, however, it was Drinks Ireland who accused the Department of Health of misleading behaviour during debates on the PHAA.[38]

Nevertheless, such approaches are in keeping with the industry globally where Big Alcohol has consistently attempted to downplay the health risks of alcohol, particularly concerning cancer. For instance, when the WHO called for cigarette-style cancer warnings on alcohol packaging, a move supported by cancer charities, the alcohol industry opposed this, arguing that such warnings are unfair and could create unnecessary anxiety.[39]

Furthermore, misinformation is not just used to attack scientific facts, but it is also deployed to create confusion and fear in relation to the economy. Hence why industry spuriously argued the public health measures contained in the PHAA would stifle trade and negatively impact businesses. Despite these claims, industry profits have remained steady or continued to rise since 2018, notwithstanding the Covid-19 pandemic.

Diageo, AB InBev, and Heineken earnings before interest, taxes, depreciation, and amortisation since the Public Health (Alcohol) Act was passed in 2018. [40] [41] [42]

To create a cloud of confusion and misunderstanding the alcohol industry uses a classic model called ‘policy dystopia’. Basically, Big Alcohol creates alarming economic stories that spread in newspapers, through constituents in TD’s local areas, commissioning research that agrees with its view, and meeting with ministers and policy makers.[43] As Sara Burke, Associate Professor of Health Policy and Management in the School of Medicine at Trinity College Dublin, and Norah Campbell, Associate Professor in the School of Business at Trinity College Dublin, have stated “the policy dystopia model is designed to scare politicians, to get them to buckle from their original commitments.”.[44] Moreover, this is the industry’s current tactic as we see it muddying the waters in relation to EU-US trade difficulties in order to lobby for labelling to be postponed or rescinded. To achieve this, Big Alcohol has again claimed, incorrectly, that labelling will harm Irish exports. Unfortunately, some in the media and government appear to have fallen for this ruse.

However, the facts are that labelling is a health matter with the regulations and has absolutely nothing to do with exports; indeed, the regulations place no burden whatsoever on export businesses as the measures only apply to goods sold in Ireland. While in relation to imports, small producers, or home-produced products, the legal onus is on retailers of alcohol, not manufacturers, to ensure products are labelled.[45] Therefore, a supermarket or off-licence can simply add a sticker to the product. It should also be noted that alcohol producers already produce a range of labels for different markets including the USA which has its own specific conditions.

International incidences of industry misinformation

Britain

In Britain, and Ireland, for example, the alcohol industry funded bodies – Drinkaware and Drinkaware Ireland – have been shown to selectively omit and/or misrepresent the risks of breast cancer.[46] [47] While a recent British Medical Journal investigation described how industry-friendly misinformation about breast cancer appears in materials for school children produced by the charity Talk About Trust (formerly the Alcohol Education Trust), which has indirect alcohol industry funding.[48]

Research by the London School of Hygiene and Tropical Medicine and the University of Edinburgh has shown how the alcohol industry and the charities and other groups that it funds downplay and misrepresent alcohol harms in ways that align with commercial incentives. In doing so they misinform the public about how alcohol increases the risk of cancers, the risks of drinking in pregnancy, and the risk of cardiovascular disease.[49] This misinformation has been found to be disseminated by Drinkaware in particular to adults and to school children, but also by the Portman Group, the trade group composed of alcoholic beverage producers and brewers in the United Kingdom.[50]

Sweden

Research from Movendi International revealed that Drinkwise Sweden, a group connected to major alcohol producers such as Diageo, Pernod Ricard, and Bacardi, has been actively promoting the debunked J-curve theory, which falsely claims low-dose alcohol consumption provides health benefits, particularly for cardiovascular health.[51] This theory has been widely discredited by independents scientists and the World Health Organization, which states that no level of alcohol use is safe or healthy. As stated in ‘Exposing Big Alcohol’s Predatory Practices in 2024’, “this misinformation campaign exemplifies how industry funded organizations deliberately create confusion about alcohol’s health impacts.”. [52] By perpetuating this myth, the alcohol industry seeks to create confusion about the health risks caused by their products, misleading the public and policymakers.

Uganda

In Uganda, the alcohol industry managed to destroy the Alcoholic Drinks Control Bill by using the classic ‘policy dystopia’ model of promoting questionable claims that it would lead to job losses. Big Alcohol and their lobbyists launched a coordinated campaign, pushing misleading narratives about economic harm, including claims that the bill would hurt small businesses and lead to job losses.[53] The industry was able to torpedo the legislation even though their claims lacked substance and were at odds with the evidence.

Scotland

In Scotland, the alcohol industry has consistently made spurious claims about Minimum Unit Pricing (MUP), often suggesting that it would fail to address harmful alcohol consumption and lead to unintended negative economic consequences. However, all these claims have been disproven since the introduction of the policy. [54]

Canada

Although the World Health Organization declared alcohol a Class 1 carcinogen 30 years ago, few governments have communicated this fact to the public. In Canada, a federally funded scientific study examining the introduction of cancer warning labels on containers was shut down following industry interference, despite industry complaints about the study having no legal merit.[55]

In their pursuit to have the study shut down, the alcohol industry consistently distorted, downplayed, and otherwise obfuscated the evidence linking alcohol and cancer.[56] In many instances, industry arguments claimed the cancer warning was inaccurate, unproven, and based on false or unsound evidence.[57]

Australia

In 1996 the first attempt was made at the federal level in Australia for mandatory pregnancy warning labels on alcoholic products. Regrettably, due to the interference and lobbying from the alcohol industry, it was 24 years before mandatory pregnancy warnings became law.[58]

Conclusion

Misinformation is a classic industry tactic which they deliberately deploy to create confusion about alcohol’s health impacts. Through misinformation the alcohol industry seeks to create confusion about the health risks caused by their products, misleading the public and policymakers.

Misinformation, however, is not a victimless crime. Misinformation perpetuated by the alcohol industry has contributed to a dangerous gap in public awareness, because while the negative health effects of alcohol have for a long time been clear, many of the dangers of alcohol are still unknown to the public.[59] For instance, fewer than one in three Europeans know that alcohol increases cancer risk, and despite one in 8 breast cancers being linked to alcohol,[60] just 20% of women have the information necessary to make informed choices about alcohol consumption.[61] Therefore, this increases alcohol-related harm and makes it harder for citizens to make informed choices when it comes to alcohol consumption and how alcohol affects their health.[62]

Misinformation is just one tactic wielded by the alcohol industry, but it is a dangerous one. In addition to wielding their political and media power, the industry uses misinformation to undermine the public health policy. Most recently, we have witnessed the alcohol industry deploy misinformation towards a specific public health policy in Ireland – alcohol health information labelling. This is a public health policy that the industry has been working against for some time and they are now using EU-US trade difficulties to misinform the public, the media, and politicians in relation to labelling. It is a clear example of the industry using misinformation to undermine a public health policy of a sovereign state.