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Public Health Advocacy and Alcohol Policy: Broader Lessons from the Irish case

Dr. Matthew Lesch, University of York.

The adoption of the Public Health (Alcohol) Act in 2018 marked the first time the Irish government has legislated alcohol as a matter of public health. The legislation is underpinned by four main pillars: (1) minimum unit pricing; (2) the structural separation of alcohol from other products in shops; (3) new restrictions on alcohol advertising and marketing, particularly as relating to children; and (4) new requirements for labelling.

In a recent study published in Addiction, Professor Jim McCambridge and I explore the role of public health advocates in securing the passage of this landmark legislation. Drawing primarily on interviews with key advocates, experts, and public officials, our research identifies three mutually reinforcing tactics that were key to the success of advocates in Ireland in getting the legislation passed.

First, advocates created a broad based advocacy coalition, led by Alcohol Action Ireland and the Alcohol Health Alliance Ireland. The coalition included 62 organisations based in Ireland, representing physicians, public health experts, charities, youth organisations, among others. The coalition’s impressive breadth meant that there was a range of voices unified by an overarching concern: tackling alcohol-related health harms.

Second, advocates made a concerted effort to focus on the content of the policy problem, rather than examining the particular measures included in the legislation. Rather than debating whether minimum unit pricing or structural separation were the best means for reducing alcohol-related harm, advocates focused their messaging on the cost of inaction. Throughout their public health campaign, for example, Alcohol Action Ireland reminded policymakers of the loss of life due to alcohol-related harms.  Liver specialists and psychiatrists drew from their experiences to help the public and politicians better visualize the damage caused by alcohol.

Finally, advocates possessed a keen understanding of how the political system worked in Ireland. Many coalition members had previous experience in politics and public health campaigns, and as a result, advocates knew which levers to pull and when. Using records from Ireland’s lobbying registry, advocates showed the public the magnitude of the alcohol industry’s lobbying campaign, turning the industry’s traditional advantage into a political liability. Advocates were sensitive to the local nature of Irish politics. To put pressure on individual legislators, the coalition engaged with local media, local activists, and travelled across the country to build public support for the legislation in communities throughout Ireland.

Ireland’s experience is potentially instructive for public health campaigners in other contexts. First, to be successful advocates need to focus on building strong and broad-based alliances. Coalition-building can significantly strengthen advocates’ credibility in the eyes of policymakers and the public. Second, issue-framing and message discipline are essential to securing public support. Focusing on the health harms associated with alcohol can make the issue much more relatable to the general public. Finally, medical professionals might be the key secret weapon for public health advocates. Doctors and nurses see the enormous toll that alcohol takes on patients, families and communities. As the current COVID-19 crisis reminds us, these professionals are also trusted by the public. Medical professionals are thus uniquely equipped to explain why a public health approach to alcohol is so necessary.

For more information, please see Lesch and McCambridge (2021) “Coordination, framing and innovation: the political sophistication of public health advocates in Ireland.” Addiction. doi:10.1111/add.15404

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