By Dr Eric Carlin, Consultant, Public Health Expert (Alcohol Policies) with the World Health Organization (WHO) Regional Office for Europe and one of the authors of the WHO/Europe digital marketing of alcohol report.
In this post, Dr Eric Carlin first discusses that, as we now live much of our lives in digital spaces, we are exposed and vulnerable to “limbic capitalism”, with global industries marketing addictive, health-harming goods and services online. Dr Carlin then describes the findings of the new WHO/Europe report on digital marketing of alcohol which sets out that we need a global, comprehensive approach to make the internet a SAFER space for all.
In 1999, Bill Gates stated that, “The Internet is becoming the town square for the global village of tomorrow”. The meaning was clear and the prediction was prescient – online spaces would become the contexts where we would increasingly pass our time, build our relationships, construct our identities, spend our money and enact our social practices. The COVID-19 pandemic accelerated and made more evident to more people developments that had been happening already for many years. Over a longer period of time the shift to living our lives in digital spaces has been both rapid and in some ways insidious; while the opportunities to access knowledge stored online and to connect with geographically distant friends, families and colleagues are welcome, we may have been less aware of how economic operators can manipulate our experiences, including encouraging health-harming behaviours, such as consumption of alcohol.
A Foucauldian perspective views society as a network of relationships, whereby individuals’ behaviours are located within power structures, which include social, political and economic systems. A Marxist perspective on public health would develop this theme further, allocating to economics a causal role in the production and distribution of disease. Courtwright links these theoretical perspectives to neuroscience, with what he describes as ‘limbic capitalism’ as shorthand for global industries that not only “encourage excessive consumption and even addiction…they’re actually designing it”.
A key component of Courtwright’s theory is that addictive goods and services are marketed online with techniques based on sophisticated research that appeal to the limbic part of the brain that deals with pleasure, motivation, long-term memory, and other functions that are crucial for survival. In 2019, it was estimated that around 75% of European Union citizens (aged 16-74 years old) accessed the internet through mobile devices; the ubiquitousness of mobile devices leads Courtwright to consider the technology itself as encouraging compulsive behaviours. Courtwright makes clear that he is not per se anti-capitalist but he portrays “limbic capitalism” as “capitalism’s evil twin, a really cancerous outgrowth of productive capitalism…that cultivates addictive behavior for profit” and which especially targets the young.
The new World Health Organization (WHO) report, Digital marketing of alcohol: Challenges and policy options for better health in the WHO European Region, notes the substantial and growing body of evidence that, for many children and young people, social media engagement feels like an essential requirement for their participation in society. This validates Courtwright’s thesis that, especially for the young, digital technology has become so pervasive that it is an extreme and difficult act, contravening deeply embedded social norms, to opt out of its use. The new report cites a range of evidence demonstrating that children and young people are especially at risk of harm from exposure to alcohol marketing in any context, which makes alcohol consumption at a younger age more likely, as well as encouraging damaging drinking patterns.
WHO estimates that around one million people die every year in the WHO European Region directly because of alcohol consumption, including accounting for one quarter of all deaths among people aged 20–24 years. Restricting marketing of alcohol is a WHO recommended ‘Best Buy’, a cost-effective policy to reduce alcohol consumption, its associated health and social harms and preventable deaths. The United Nations Convention on the Rights of the Child proclaims the right to health. The new WHO report emphasises that this must include protecting children’s health from exploitation through their online social lives. The invasion of children and young people’s digital social spaces by companies promoting alcohol consumption normalises a drinking culture from a very young age, placing them especially at risk of harm. However, people of all ages are at risk of harm due to alcohol consumption. There is evidence that people who drink more alcohol will likely be targeted for more alcohol marketing in online settings because algorithms will target them with digital promotions for alcoholic products.
The new WHO/Europe report provides an overview of the spread, impact and challenges from digital marketing of alcohol, including giving examples of real-life techniques, while noting that this is a fast-changing environment. Publicly available data on alcohol marketing expenditures are scarce, but it is estimated that the global total marketing spending for six of the largest alcohol companies was US $17.7 billion (c. £13.4 billion) in 2017. Whereas traditional broadcast media show the same advertisement to all people who are consuming the media content, in the digital context the relationships between advertisers and consumers are often interactive, with increasing amounts of content which is shared by users themselves, often without an active awareness that they are carrying out the advertising task on behalf of the commercial company. The role of ‘influencers’ is specifically discussed; these online ‘personalities’ often present themselves as very natural in their behaviour, but their prescribed advertising activities rely heavily on sources of data about the intended consumers that enable the pitch to be as targeted as possible to an individual’s interests. Research is also cited that shows that influencers reach minors and are effective in making alcohol consumption popular and normative.
The dark and ephemeral nature of digital advertising, whereby the vast majority of this advertising is not published in any meaningful sense where it can be subjected to monitoring is only one of the challenges for regulators. The report provides an overview of existing international control systems, including their shortcomings, as well as case study examples of responses in a small number of European countries. In all the contexts described, it is clear that, regardless of the regulatory system and the law, enforcement systems need to be prioritised, at the very least to protect minors.
Returning to Courtwright, he has argued that “one of the strikes against limbic capitalism is that when it goes after children, which it has to do to find replacement users, that eventually becomes an issue and it leads to serious pushback”. We certainly need to harness that righteous anger and the WHO–UNICEF–Lancet Commission has called for an optional protocol to the Convention on the Rights of the Child, in other words an additional component to the treaty that must be independently ratified, to protect children from the marketing of a range of products, including alcohol. This optional protocol could address the transnational elements of the problem and simultaneously drive national action for legal protection.
The WHO Framework Convention on Tobacco Control (FCTC) could also provide WHO and other United Nations agencies with a model for an international instrument that could strengthen the implementation of national and international alcohol control policies. Just as with tobacco, a global and comprehensive approach is required to tackle global marketing and transnational advertising, promotion and sponsorship of alcohol. The new report lays out twenty policy options to be considered, including: age verification schemes (see a new Institute of Alcohol Studies (IAS) report on this); action on labelling in social media; use of algorithm processes to restrict access; and sanctions for inappropriate activities, with robust enforcement.
The more comprehensive the policy, the easier it will be to ensure clarity in communication and interpretation of the legal intention, and to monitor and enforce. What is clear is that the task is urgent and important, requiring a global and comprehensive approach to make the internet a SAFER space for children and young people, for all people, free from harm due to alcohol.
Space Invaders: Young people’s views about alcohol digital marketing
- Carah N, Brodmerkel S. Alcohol Marketing in the Era of Digital Media Platforms. J Stud Alcohol Drugs. 2021;82(1):18-27. doi: 10.15288/jsad.2021.82.18
- Courtwright, D.T., (2019). The Age of Addiction: How Bad Habits Became Big Business. Belknap Press, Cambridge MA. Available from: https://www.hup.harvard.edu/catalog.php?isbn=9780674248229
- WHO Regional Office for Europe (2021). Digital marketing of alcohol: Challenges and policy options for better health in the WHO European Region. Available from: https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2021/digital-marketing-of-alcohol-challenges-and-policy-options-for-better-health-in-the-who-european-region-2021
- WHO Regional Office for Europe (2021). Making the WHO European Region SAFER: developments in alcohol control policies, 2010–2019. Copenhagen: WHO Regional Office for Europe. Available from: https://apps.who.int/iris/handle/10665/340727
SHAAP Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of Scottish Health Action on Alcohol Problems.