5. ALCOHOL POLICY AND INTERVENTIONS
5.1 Situation analysis
5.1.6 Marketing restrictions
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5.1.6.1 Restrictions on alcohol advertising
The Global Survey on Alcohol and Health 2016 asked countries to report their national restrictions on advertising for three alcoholic beverage types (beer, wine and spirits) across 10 categories of media (national television, private television, national radio, local radio, print, billboards, point of sale, cinema, Internet and social media). Options for reporting included no restrictions, voluntary codes or self-regulation, partial bans and total bans across all media types. In this report, marketing restrictions are described in detail for beer only; however, the restrictions across media types were consistent for wine and spirits, and the relevant information is available online in GISAH.
Box 5.6 Finland’s ban on alcohol-branded social media communication
Since Finland changed its alcohol laws in 1995 to permit alcohol advertising, it has progressively introduced stricter restrictions on alcohol advertising practices (Tuominen, 2015; Montonen, 2017). The 1995 laws initially banned advertising for the most harmful products – strong alcoholic beverages, or beverages with more than 22% absolute alcohol (Tuominen, 2015). In 2008, Finland limited the time and placement of alcohol advertisements by banning advertising on television from 07:00 to 19:00 and in cinemas (except for X-rated movies) to reduce young people’s exposure to alcohol advertising (Tuominen, 2015). Again aiming to curb youth exposure to alcohol advertisements, Finland became one of the first countries to ban alcohol advertisements in social media in 2015 (Tuominen, 2015).
Finland’s social media ban prohibits advertisements and promotions that 1) involve games, lotteries or contests or 2) involve information networking service activity of textual or visual content produced by consumers or any such content produced by a commercial actor and intended to be shared by consumers. For example, competitions and prizes on Facebook, allowing people to share posts on their Facebook page, or producing viral videos intended to be shared on social media sites are all banned. In the context of a transnational alcohol industry, the Finnish regulations prohibit commercial actors from targeting Finnish persons with interactive alcohol advertisements even from outside Finland. However, these regulations permit conventional alcohol advertising online and do not apply to consumers’ personal social media pages (Tuominen, 2015).
Since Finland enacted this ban, several other countries in the Nordic-Baltic region have followed suit. In 2018, Lithuania enacted a comprehensive alcohol advertising ban that included digital media (Law on Alcohol Control, 2018), and Estonia is considering similar measures (Alcohol Ireland, 2017). In addition, a white paper was presented to the Parliament in Sweden on how to protect children and young people from online advertising (EUCAM, 2018).
Figure 5.12 shows the prevalence of restrictions on advertising for beer by media type.
Several countries have adopted advertising restrictions since 2012, and the majority of responding countries now have some type of restriction for all media types except Internet (48%) and social media (47%). Total bans were most common for national television (26%) and national radio (26%). As in 2012, the greatest number of countries reported no restrictions on the Internet and social media, suggesting that regulation in many countries continues to lag behind technological innovation in marketing. In 2016, 123 countries reported on alcohol marketing restrictions across all media and beverage types. Of these countries, 51 (41%) had total bans for all media types and 35 (28%) had no regulations on any media type. Most of the countries that reported no restrictions across all media types were located in the African (17 responding countries) or Americas regions (11 responding countries).
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Figure 5.12 Restrictions on advertising for beer by media type and percentage (in %) of countries, 2016
(n =162 reporting countries except 161 for billboards and national radio)
Ban Partial ban – time Partial ban – placement Partial ban – content Voluntary/self-regulation None 100
Percentage (%) of countries
National
television Private
television National
radio Local
radio Print Billboards Point of sale Media type
90 80 70 60 50 40 30 20 10
Note: The partial bans and voluntary/self-regulation are not mutually exclusive categories, and countries may be counted more than once. The numbers in each coloured bar indicate the number of countries in that category, whereas the length of each coloured bar indicates the percentage of countries in the category.
Cinema Social
media Internet 0
42 38 16 35 21 49
20 56 26 29 86
20 68 26 30 84
33 15 11 26 30 67
28 7 14 27 27 73
34 3 20 26 26 66
32 7 20 33 27 65
38 37 14 35 23 49
42 35 13 32 21 48
33 41 16 36 22 53
Box 5.7 Advertising restrictiveness scores
Restrictiveness scores provide another way to analyse data on the stringency of policies that restrict alcohol advertising and marketing. Using a scale developed by Esser and Jernigan (first deployed in the Global status report on alcohol and health 2011), Figure 5.13 shows responding countries along the continuum of advertising restrictiveness. The advertising restrictiveness score assigns countries points according to the level of their policies (2 points for a ban, 1 point for a partial ban, and no points for voluntary/self-regulation or no restrictions) across 10 media types. Countries tend to have advertising policies that are lower on the spectrum:
about half (69 countries) have no advertising policies or have policies that are only slightly restrictive. However, countries are implementing more restrictive alcohol advertising policies over time. This growth is evident in the number of responding countries that reported “mid” or
“very high” levels of restriction, which has increased linearly since 2008.
Figure 5.13 Stringency of overall statutory regulation of alcohol marketing, by number of countries, 2008−2016
(n =144 reporting countries) 2008 2012 2016
Level of restrictiveness 80
70 60 50 40 30 20 10
Least restrictive
Number of countries
Most restrictive Least restrictive
0 68
54 50
22
8 19
25
34 38
14 16
13 9 11
18
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Figure 5.14 uses this restrictiveness score methodology to show the degree to which alcohol marketing is regulated (or not) overall by WHO region. Alcohol marketing is most regulated in the Eastern Mediterranean and South-East Asia regions, and least restricted in the African and Americas regions.
Note: The numbers in each coloured bar indicate the number of countries in that category, whereas the length of each coloured bar indicates the percentage of countries in the category.
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Percentage (%) of countries
AFR AMR EMR EUR SEAR WPR World
WHO Region Least restrictive Slightly restrictive Restrictive Very restrictive Most restrictive
Figure 5.14 Stringency of overall statutory regulation of alcohol marketing, by WHO region and the world and percentage (in %) of countries, 2016
(n =156 reporting countries)
90 80 70 60 50 40 30 20 10 0
23 7 8 2 5
55 23 41 15 22
8 2 5 1 1
1 1 1 5
19 8 4 1
4 6 22 10 8
1 3
5.1.6.2 Regulations on alcohol product placement
In addition to restrictions on alcohol advertising, countries also reported on their regulation of alcohol marketing that takes the form of product placement on television and at sporting events, as well as whether they had implemented bans on the sale of alcohol below cost.
As in the case of advertising, several countries have adopted restrictions on product placement since 2012, and the majority of WHO Member States (55–58%, depending on the beverage type) reported some type of restriction on product placement on public television in 2016. Of the 87 countries with some type of restriction, 47% (41 responding countries) had implemented a total ban on product placement of beer on television, 33%
(29 countries) had a partial ban, and 20% (17 countries) reported industry self-regulation.
Excluding the one country that reported a subnational policy, one third of reporting countries (34%, 53 countries) had a total or partial ban on beer company sponsorships of sporting events, while 16% (25 countries) relied on industry self-regulation, and 51%
(81 countries) had no regulation.
5.1.6.3 Regulation of alcohol sales promotions
Figure 5.15 shows the prevalence of regulation of producer promotions for beer, beer sales promotions below cost, and industry-sponsored free drinks. Fewer countries reported using these strategies than advertising, product placement and sponsorship restrictions.
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Note: The numbers in each coloured bar indicate the number of countries in that category, whereas the length of each coloured bar indicates the percentage of countries in the category.
Ban Partial ban Voluntary/self-regulation None Subnational
Figure 5.15 Regulation of beer sales promotions below cost by percentage (in %) of countries, 2016
(n =159 reporting countries)
100
Percentage (%) of countries
Producer promotions Below-cost promotions Bar promotions
Promotion strategy 90
80 70 60 50 40 30 20 10 0
1
24 23 24 87
1
28 16 20 94 1
32 9 20 97
5.1.6.4 Methods of detecting infringements of marketing restrictions
The Global strategy recommends setting up effective administrative and deterrence systems to handle infringements of marketing restrictions (WHO, 2010). Of the 129 responding countries reporting at least one marketing regulation, 125 (97%) also reported a method for marketing infringements. Some countries use more than one method of detecting infringements of marketing regulations: 71 countries (55%) use a complaint system; 68 (53%) use active surveillance by government, an NGO, or an independent body; and 63 (49%) rely on the police to detect infringements. Most countries (103 countries, 63%) reported having fines for infringement of marketing restrictions. These fines were more common in the WHO European (81%), Eastern Mediterranean (75%) and South-East Asia regions (75%) than in the Americas (45%), African (52%) and Western Pacific (59%) regions.
5.1.7 Pricing
Increasing the price of alcohol is one of the most effective strategies for reducing the harmful use of alcohol (WHO, 2010). Studies repeatedly find that increasing the price of alcohol is associated with reductions in harmful use of alcohol and alcohol-related morbidity and mortality, including liver cirrhosis deaths, violence, teenage pregnancy and sexually transmitted diseases (Wagenaar, Salois & Komro, 2009, Elder et al., 2010;
Wagenaar, Salois & Komro, 2010; Xu & Chaloupka, 2011). A small part of the literature also suggests that the benefits of higher alcohol prices also extend to the education sector, increasing the likelihood of secondary school graduation as well as post-secondary enrolment and graduation.
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The Global strategy recommends that WHO Member States establish a system for specific domestic taxation which may take into account the alcohol content of the beverage, accompanied by an effective enforcement system (WHO, 2010). The strategy also encourages countries to review prices regularly in relation to inflation and income levels;
to ban or restrict sales below cost and other price promotions; and to establish minimum prices for alcohol where applicable (WHO, 2010).
Box 5.8 Botswana’s increasing excise taxes
Since attaining independence in 1966, Botswana has had a drinking pattern marked by high levels of both abstention and heavy episodic drinking. With HIV/AIDS prevalence rates as high as 18%, the National AIDS Coordinating Agency (NACA) developed a position paper in 2002 linking alcohol with HIV infection. The following year, national frameworks identified alcohol intoxication as a risk factor for exposure to HIV, and alcohol continues to be an obstacle to effective HIV prevention efforts (Sinkamba, 2015).
Alcohol excise duties were first developed through the Southern African Customs Union (SACU).
After a long history without formal alcohol policies at the national level, the Ministry of Trade and Industry in Botswana prepared a regulatory framework referred to as Liquor Regulations in 2005 (Pitso & Obot, 2011). Three years later, tax levies were introduced in the Control of Goods (Intoxicating Liquor Levy) Regulations, 2008 (Pitso & Obot, 2011). These regulations proposed a 70% alcohol levy on all domestically produced intoxicating liquors, with the aim of reducing consumption specifically among young people (Lucas, 2008; Sinkamba, 2015). At the same time, revenue collected from the levy would be invested in efforts to reduce the harmful use of alcohol and minimize its negative consequences (Sinkamba, 2015). In response, the alcohol industry argued that the levy had made imported alcohol more affordable than domestic alcohol, causing a shift in consumer preferences, and that the regulations would thus result in harm to the business sector and job losses (Pitso & Obot, 2011; Burgis, 2009). As a result, the levy was reduced to 30% (Burgis, 2009). However, the alcohol tax was increased to 40% two years later under the Levy on Alcohol Beverages Fund (Amendment) Order, 2010 (Sebego et al., 2014).
Traffic crash rates fell by 12% seven months after the first alcohol excise tax and by another 12% five months after the 2010 levy increase; however, other changes were made during this time so the authors were unable to attribute these full decreases to the taxes (Sebego et al., 2014).
Botswana increased the alcohol levy by a further 10% to reach 55% in 2015 to prevent the incidence and consequences of alcohol abuse (Matumo, 2015). This measure also increased the scope of the tax to include imported alcoholic beverages and production costs for the first time (Matumo, 2015).
Price policies are the most cost-effective WHO best buy for reducing the burden of harmful alcohol use. Figure 5.16 shows that almost all of the responding countries (95%) have alcohol excise taxes; however, fewer than half of the countries use the other price strategies highlighted in the Global strategy – such as adjusting taxes to keep up with inflation and income levels, imposing minimum pricing policies, or banning below-cost selling or volume discounts.
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89 100
Percentage (%) of countries
AFR AMR EMR EUR SEAR WPR World
WHO Region
Excise tax for beer Adjust for inflation for beer Minimum unit pricing Ban below-cost selling Ban volume discounts
Figure 5.16 Implementation of selected price and tax measures by WHO region and percentage (in %) of countries, 2016
(n = 164 reporting countries, except 137 countries reported on inflation adjustment)
90 80 70 60 50 40 30 20 10 0
18 4 0 4
95
26
7 2 4 38
6 0 0 100
0 13
0 0 98
32
12 6 6 88
40
0 0 0 94
23
3 3 3
100