Addiction, January 2024; by Sally Casswell; Social and Health Outcomes Research and Evaluation (SHORE), SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
It is disappointing to see the Addiction publication ‘Restricting alcohol marketing to reduce alcohol consumption: A systematic review of the empirical evidence for one of the “best buys”’ reaching a misleading conclusion that evidence does not justify a ban on alcohol marketing as a ‘best buy’ (while mentioning evidence of the impacts of exposure to alcohol marketing, such as initiation of drinking and heavier drinking).
The conceptualisation of the analysis in the Manthey et al. [1] article is in line with useful research on availability and pricing interventions, but the marketing domain is characterised by a number of differences that make reliance on a similar approach inappropriate [2–4].
The differences between evaluation of the other ‘best buys’ and marketing include the difficulty of ensuring a real change as a result of policy intervention. Once policy is in place it is much more likely (although not inevitable) that increased taxes affect affordability and trading hours and minimum purchase age affects ease of access. It is well documented that marketing is effective via a great many different venues and modes and that when one avenue is restricted, it is very viable for the commercial interests to find alternative approaches to achieve the same ends. The increasing use of digital marketing, invisible to anyone other than the recipient, has further exacerbated this problem. This makes meaningless the uncritical inclusion of partial bans in the analysis of effectiveness, as the Manthey et al. [1] article does.
The lack of complete bans on marketing also limits possibilities for evaluating them. This is in marked contrast with taxation, where there are many recorded examples of changes, as well as in relation to the interventions that comprise the domain of availability, where here are more examples by far than available in relation to marketing, although fewer than for taxation.
Marketing performs a number of very important roles for commercial interests and each of these needs to be taken into consideration in assessing the value of policy intervention. Marketing recruits new consumers, including new cohorts of youthful drinkers in communities with a high prevalence of drinkers, and a range of sectors in communities where prevalence is low. Marketing also works to maintain consumption among heavier drinkers, a very important sector for the profits of the industry [5].
The function of marketing is also to normalise alcohol products as part of everyday life and create powerful positive associations with alcohol brands and products. This is important beyond the direct impact on consumption through effects on what policy responses are seen as appropriate.
Given the range of functions it will be useful to look for different impacts of alcohol marketing bans using a broader systems level evaluation approach [6]. Have the marketing bans in mainly Muslim countries slowed the increase in prevalence of drinking? In Norway, did the longstanding ban on alcohol marketing contribute to the presence of relatively high taxes and the public support for state owned retail outlets, which have a focus on restricting availability? These are difficult research questions, and we need more examples to draw on and more methodological sophistication to provide credible answers.
One thing for sure is that alcohol producers have worked hard to set up and promote ineffective voluntary codes (self-regulation) regimes and to deflect restrictions on alcohol marketing in other ways, demonstrating a stronger focus to prevent bans on marketing than their concern over availability and pricing. A broader question concerns the appropriate parameters for evaluating effectiveness and establishing criteria for ‘best buys’. There is an unquestioned assumption in the conclusion drawn in the Manthey et al. [1] article that quantitative analysis of relatively short-term changes in population wide consumption using a narrow band of methodological approaches is the only appropriate approach. This flies in the face of the need for transparent consideration of the fitness for purpose of the research approach used as well as methodological rigour [7]. More nuanced approaches with much deeper understanding of the reality and processes of marketing are required.