March 12, 2024 by Wim van Dalen, Dutch Institute for Alcohol Policy STAP
The start and end of fruitless discussions about the alcohol problem
In 2018, Paul Blokhuis (then State Secretary of Health, Welfare and Sport) announced the National Prevention Agreement with the aim of a healthier Netherlands in 2040 by reducing smoking, obesity and problematic alcohol use. A total of 70 partners joined the agreement.
An important aspect of this agreement was that partners that had a commercial interest in the production and sale of alcohol, and groups that represented health interests, were expected to work jointly on the topic of reducing problematic alcohol use. The health organizations had reservations from the start about this approach and these reservations have proved to have been justified.
In 2022, the joint consultations ended without progress and Blokhuis’ successor Maarten Van Ooijen now meets the health and industry groups separately.
This article explains in broad terms why the joint Alcohol Table on tackling problematic alcohol use was unsuccessful. In particular, the role at the table of the alcohol industry is discussed. This information is partly based on documents requested on the basis of the Woo (Open Government Act) and on the basis of my own observations as a participant at the Alcohol Table.
Who was at the Alcohol Table?
At the table on behalf of the alcohol producers and retailers were: VNO-NCW (employer’s umbrella organization), STIVA (lobby association for all Dutch alcohol producers), the Dutch Brewers, Central Bureau for Food Trade, (supermarkets), chain liquor stores, independent liquor stores and the catering industry.
The health organizations at the table were: Addiction Science Netherlands, the Collaborating Health Funds, the Positive Lifestyle Foundation, the Gastroenterology doctors, including liver specialists, NVAB (company doctors), the Dutch Institute for Alcohol Policy STAP, the NVDI (Dutch Association for Liquor and Catering Inspectors), GGD GHOR (umbrella of regional health organizations), the KNOV (Association of Midwives) and the Youth and Alcohol Foundation.
In addition, NOC*NSF (Dutch Sport alliance), the VNG (umbrella of municipalities), UNL (Universities of the Netherlands), the LKvV (umbrella of student associations) and the ANBO (association of the elderly) were represented.
The Trimbos-Institute sat at the table as an independent expert. Leon Meijer (then CU councilor of the municipality Ede) was the independent chairman, and the Ministry Health, Welfare and Sports ran the secretariat. The National Institute for Public Health and the Environment (RIVM) was tasked with evaluating the progress of the Alcohol Table.
The goals of the Alcohol Table
As indicated, the consultation was aimed at making joint agreements to limit problematic alcohol use. The goals were set from the start. The most important goals were:
- by 2040, the number of students aged 12-16 who have ever drunk alcohol will have fallen from 45% to 25%;
- the percentage of adults who drink excessively must be reduced from 8.8% to 5% by 2024;
- the number of Dutch people aged 18 and over who drink heavily drops from 8.5% to 5%;
- and in 2040, only 2% of women who know they are pregnant will use alcohol (to reduce from current incidence of 4.6%)2.
According to the Prevention Agreement, achieving these goals should lead to a decrease in alcohol-related diseases and deaths, savings in healthcare costs, fewer traffic accidents and fewer problems in people’s personal lives. The agreement explicitly states that the approach will be ‘evidence-based’ in order to ultimately have demonstrable positive health effects.
The disappointing result after 4 years of consultation at the Alcohol Table
Based on the RIVM report, Van Ooijen wrote in a letter to the House of Representatives on January 17, 2024, that most of the alcohol targets of the Prevention Agreement as currently formulated will not be achieved in 2040.
The RIVM’s conclusion is that the activities carried out in recent years will have a minimal effect and that more efforts are needed.
The RIVM specifically mentions the absence of regulatory action, recommended as best practice by the World Health Organisation (WHO), such as price measures to reduce affordability, limiting availability through controlling numbers of outlets and hours of sale, and marketing bans. The RIVM’s view was that the absence of WHO’s recommended high impact interventions from the Alcohol Table’s recommendation meant that the targets were unlikely to be achieved.
What has been achieved?
In his recent letter, Van Ooijen mentions several aims that have been achieved, such as the (re)establishment of the Early Detection Alcohol Problems Partnership (SVA) and the information activities aimed at students and bar volunteers in sports canteens. Additional courses have also been given for catering staff and liquor stores, the NIX18 campaign has been renewed and the rules that the alcohol industry itself has drawn up regarding alcohol advertising have been tightened.
The alcohol industry indicates that they are very satisfied with what has happened at the Alcohol Table. In particular, they mention the promotion of no and low beer at student associations and marketing the alcohol free versions of well-known beer brands in amateur sports settings in collaboration with the Dutch Sport Alliance NOC*NSF. Health organizations argued that the positive impact of these measures are far from proved and could also been seen as a “back door” way to build beer brand awareness among participants and spectators.
It is evident that the alcohol industry also used its participation in the Alcohol Table to advance business goals, among other things, from an email sent by the Dutch Brewers to State Secretary Van Ooijen on July 7, 2022 about the planned increase in the consumption tax on non-alcoholic beer. The email reads: “Thank you for your message. Unfortunately, very disappointing news. It remains incomprehensible to us that the consumption tax on non-alcoholic beer is increasing while we use non-alcoholic beer as a means to combat problematic alcohol use. A very important point in the coalition agreement and for the National Prevention Agreement.”
Industry activity to prevent action on alcohol availability.
At the start of the Alcohol Table, it appeared that there was the prospect of agreed action to reduce alcohol availability. In 2018, the VVD political (liberal) party had proposed the extension of alcohol sales into bookstores, hairdressers, launderettes and other outlets. These ideas were clearly incompatible with WHO best practice recommendations, particularly in the Netherlands which already has a high number of outlets and low rates of age verification checks.
Opposing this sales expansion was agreed as an early priority for the Alcohol Table, however, the story turned out to have several twists. The part of the published agreement referring to availability disappeared from the text two days before the document was due to be signed, apparently as a result of political pressure from the VVD.
Proposals to increase availability appeared again in 2022 as part of the new Government’s coalition agreement. The majority of Alcohol Table participants agreed to send a letter to the Government highlighting concerns about a further expansion in alcohol availability. Despite this, the Chairman of the Alcohol Table, declined to send the letter to policy makers. Industry groups argued that the Table should not involve itself in policy issues and should only discuss issues where all partners are in agreement, a position which gave the industry groups the power of veto over any recommendations which followed the WHO high impact measures. This was a further signal to the Health Groups that the “joint table” was not an approach which would lead to effective action on prevention.
The Table was not allowed to provide advice on necessary legal measures
The Prevention Agreement that was launched in 2018 explicitly states that the goal is to limit the problematic alcohol use of young people, excessive and heavy drinking adults, and pregnant women. It became clear that there were very different views on the nature of prevention and the factors influencing problematic use. The industry approach was to interpret the term “problematic use” to focus on the responsibility of individual drinkers for developing problems and away from the capacity of the product alcohol itself to cause problems.
Yet, alcohol consumption leads to risk for all drinkers with the risk increasing as consumption increases. Health groups such as the SGF, the collaborating health funds, argued that preventing harm from alcohol requires a population based approach in addition to treatment and support for those who have already developed problems. This is the reason the WHO and other expert groups identify action on price, availability and marketing as the most important measures to reduce harm.
At the Alcohol Table, commercial partners have continually said: “We are not talking about legal measures here, we must focus on the common ground ” (STIVA), “it is implausible to indicate that we are in favor of price measures, which detracts from the credibility of the Alcohol Table” (Dutch Brewers), “we criticize the RIVM because they mention the importance of policy measures such as excise duties, the Table is now becoming a lobbying instrument and the emphasis must remain on problematic alcohol use” (chain liquor stores, affiliated with the supermarkets). There was a fundamental disagreement between the health and industry groups on the nature of prevention work and this difference proved impossible to resolve.
Better compliance with the Health Council’s alcohol guideline should not be a goal of the Prevention Agreement
The Dutch Health Council’s alcohol guideline states: do not drink alcohol or at least not more than one glass per day. Recent figures from Statistics Netherlands show that 56.5% of adults drink more than one glass per day. During the consultations at the Alcohol Table, the Health Parties regularly pointed out to no avail that compliance with the Health Council’s guideline should be included in the goals of the Prevention Agreement. This is partly due to the fact that drinking 1 glass of alcohol per day contributes to increasing the risk of cancer. For the commercial partners, problematic alcohol use had to remain the starting point of the goals and actions. And it is clear that the alcohol industry finds the Health Council’s guideline unacceptable.
WHO advice to the Ministry of Health, Welfare and Sport: do not involve the alcohol sector in determining alcohol policy
The WHO Framework Convention on Tobacco Control (FCTC) is a treaty of the member states of the WHO that stipulates, among other things, that ministries and politicians may not consult with representatives of the tobacco industry when formulating policy. The aim of this is to exclude any form of influence by the tobacco industry on the government’s tobacco policy. For this reason, the tobacco industry did not participate in the ‘Tobacco Table’ of the National Prevention Agreement.
There is not yet a comparable ‘Framework’ for alcohol and this experience in the Netherlands shows why this is needed. The impetus for this is already there: in a recent report, the WHO expressly discourages politicians and civil servants involved in alcohol policy from collaborating with the alcohol industry due to the high risk of conflict of interest.
The decision at the time to invite commercial partners to the Alcohol Table was a predictable mistake. Valuable time and money have been lost in taking effective measures to reduce the harm of alcohol to individuals and society. To use a familiar phrase, prevention is better than cure. Where a sector opposes effective prevention because it conflicts with their business interests, they cannot play a role in developing prevention policy.
Written by Wim van Dalen, Director, Dutch Institute for Alcohol Policy STAP.
All IAS 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 the Institute of Alcohol Studies.
link: https://www.ias.org.uk/2024/03/12/the-game-the-alcohol-industry-played-with-the-dutch-national-prevention-agreement/