Written evidence submitted by the Alcohol Health Alliance

Alcohol Health Alliance’s response to the Misinformation and trusted voices call for evidence

September 2022

The Alcohol Health Alliance (AHA) is an alliance of more than 60 non-governmental organisations working together to promote population-level evidence-based policies to reduce the harm caused by alcohol. Members of the AHA include medical royal colleges, charities, unions, treatment providers and other organisations that want to tackle alcohol harm.

Considering the mix of organisations providing information on alcohol harm as well as research on misinformation about alcohol harm, we welcome the opportunity to submit evidence. Significant parts of the British public remain either uninformed or misinformed about the harm that alcohol can cause. Yet, research has shown that some of the sources providing information on alcohol harm may seem trustworthy, but due to their connection with the alcohol industry, they could instead be misinforming people. There is a need for wider public recognition of the risks about receiving health information from alcohol industry funded sources.

1. Which organisations are the most trusted sources of information in the UK?

Alcohol causes significant harm across the UK: it is the leading risk factor for death, ill-health, and disability amongst 15-49-year-olds in the United Kingdom.[1] Alcohol plays a causal role in more than 200 different diseases and injuries, including seven cancers such as mouth and breast cancer.[2] The coronavirus pandemic has further exacerbated alcohol harm levels, with deaths from alcohol increasing by 19% in 2020.[3]

Yet, large parts of the British public remain uninformed or misinformed about alcohol harm and the Government’s guidance on alcohol consumption. A third of people are unaware that it is safest not to drink during pregnancy.[4] Just a quarter of people know that alcohol causes breast cancer.[5] Only 18% of people can correctly identify the UK Chief Medical Officers’ low risk weekly drinking guidelines of 14 units.[6] At the same time, debunked myths such as that red wine is healthy or has cardiovascular benefits continue to be shared widely.[7]

A mix of organisations are currently working to provide information about alcohol harm in the UK. One of the key sources for information about alcohol consumption is the NHS and its ‘Alcohol advice’ webpage, which covers various topics such as unit recommendations, support for cutting back on drinking, and drinking during pregnancy.[8]

There are also independent organisations such as alcohol harm charities, alliances and public health bodies that are providing information about alcohol harm and support services to tackle alcohol harm across the UK. Examples include Alcohol Change UK, the Institute of Alcohol Studies, Balance North East, Alcohol Focus Scotland as well as the AHA and its member organisations. Alcohol Change UK, which runs one of the most visited alcohol information pages in the UK, also organises Dry January and hosts Alcohol Awareness Week.[9]

However, among the organisations providing information about alcohol harm are also industry-funded organisations, including business associations, charities, corporate philanthropic organisations, and social aspect (public relations) organisations (SAPROs). These organisations either represent or are largely funded by alcohol industry actors. Examples of these organisations include Drinkaware, DrinkIQ, European Forum for Responsible Drinking, Drinkwise and Wise Drinking.

There is a growing body of research analysing and comparing the content of materials by alcohol industry (AI) funded and independent organisations, with the key results often finding that AI organisations misrepresent or omit the negative impacts of alcohol consumption. An analysis of 27 AI-funded organisations’ text relating to cancer found that these sources often deny or dispute the evidence about the link between alcohol and cancer, misrepresent the risk, or focus the text away from the independent impact of alcohol on cancer.[10] AI-funded organisations are statistically significantly less likely to advise that no amount of alcohol is safe during pregnancy or provide information about Foetal Alcohol Spectrum Disorder.[11] AI organisations were found to be more likely to suggest that alcohol is protective in the development of some heart conditions, while non-industry funded sites were more likely to label alcohol as a risk factor in important cardiovascular diseases such as hypertension and stroke.[12] These findings are also consistent with evidence from other industries, such as the tobacco industry.[13]

This misinformation and/or omission of information around alcohol poses a significant risk to the public, especially when links between such sources and the alcohol industry are not widely acknowledged and the sources are considered trusted and authoritative. Additional trust also comes from the high visibility of some of these organisations, such as DrinkAware, which features on many alcohol advertisements and products as the source for additional information.

Thus, there is a clear need to educate the public about the funding sources of the organisations providing information about alcohol harm and how this can impact the reliability of the information provided. Governmental bodies should also be careful in forming associations with industry-funded bodies, as these can further boost their perceived trustworthiness.

2. Where do you seek authoritative information to make up your mind about matters of national debate (such as vaccines and climate change)?

As discussed under the previous question, there are several independent evidence-based sources, such as NHS Alcohol Advice and Alcohol Change UK, that provide authoritative information on alcohol and alcohol harm. However, AI-funded organisations are also presenting themselves as authoritative sources, despite research on these organisations demonstrating that they can misinform the public. There is a need for wider recognition about the funding sources and the impacts of this on the information provided to the public.

3. Are you able to “do your own research” on matters of national debate?

Alcohol is a complex field, so it is highly important that there is reliable research available for members of the public to access. Research on alcohol harm and harm reduction policies, as well as the alcohol industry’s involvement in this area, is a growing area of study.

Like many industries, the alcohol industry funds research on alcohol harm. However, funding from the alcohol industry raises concerns about whether this involvement could bias research agendas to follow commercial needs instead of public health interests, as well as whether the funding source could bias the research itself, either directly or indirectly.[14] 

However, recent research has also outlined that alcohol industry actors conduct surveillance of researchers, which sometimes leads to direct actions.[15] Examples of these actions include industry responses to journal articles, contacting scientific organisations to discuss the research, and in a few cases threats of legal action.

The study highlighted that researchers felt such actions to be an occupational hazard, and that there is currently a lack of support from professional organisations and universities on this, especially for people at the early stage of their career.[16]

4. What role should the National Academies have in being a source of authoritative, trustworthy information?

NI

5. Are National Academies prominent enough voices in engaging with the variety of debates on the internet?

NI

6. Is the provision of authoritative information responsive enough to meet the challenge of misinformation that is spread on social media?

Authoritative information about alcohol on social media faces a two-fold upstream battle: it contends with wide-spread alcohol marketing as well as with the misinformation by AI-funded sources.

It is understandable that alcohol marketing has spread to social media, and it is self-evident that alcohol marketing portrays alcohol in a positive light, ignoring its impacts on the consumer’s health. However, alcohol marketing on social media poses several risks. Marketing on social media is very easily accessible to young people, with 42% of under-18s in the UK having seen alcohol advertisements on social media in the last month, and 19% having interacted with it.[17] Exposure to alcohol marketing leads children to start drinking earlier and drink more than they otherwise would.[18]

Additionally, social media “blurs the boundaries between official marketing and user interaction” as user generated content about alcohol, brands or products makes users into “co-creators and distributors of alcohol marketing messages.”[19] The lack of health-warning regulations for alcohol marketing, however, means that the picture that emerges via social media about alcohol and its effects is largely positive. For example, in an analysis of the top 100 most popular videos including the tag ‘#alcohol’ on the popular platform TikTok, 98% were found to express pro-alcohol sentiment.[20] Furthermore, their content was found to promote rapid consumption of multiple drinks and to juxtapose alcohol use with positive associations such as humour and camaraderie.

In a stream of both official marketing as well as user generated content, authoritative voices that provide evidence-based information about the impact of alcohol consumption can get lost. Moreover, the key issue of a layperson rightly distinguishing between an independent evidence-based source versus an AI-funded one, further discussed above, also plays out on social media. Like in other formats, the lack of awareness amongst the public means that AI-funded sources seem evidence-based and authoritative.

Thus, more alcohol marketing restrictions – including on social media – as well as improving the public’s understanding about AI-funded organisations would help to address the challenge of misinformation about alcohol harm on social media. In the long-term, however, work to make sure that independent and evidence-based organisations are seen as the most trustworthy organisations in the field is necessary.