For many years now, it has been a 'given' fact that governments in developed countries do not work in partnership with the tobacco industry. They do not heed industry advice in developing evidence-based policies aimed at ridding society of cigarettes and the accompanying burden of disease. The policy aim to abolish the use of tobacco and the conflicts of interest for cigarette manufacturers are so clear that there is no room for debate. Yet, in many parts of the world, including the United Kingdom, governments still work hand in glove with the drinks industry in its various guises in the apparent belief that this will bring about a speedier reduction in harm.1

This paradox cannot be because the scale of the 'alcohol problem' is any less. Indeed, it is the biggest single risk factor globally for men losing disability-adjusted life years below the age of 602 and when the harm to others is factored in the damage from alcohol exceeds heroin.3 One likely reason is the difference in policy aim - the much clearer aim of abolition of tobacco compared to the more nebulous 'some degree of control' of alcohol. Of course, throughout history, there have been, and still are, examples of attempted alcohol prohibition, often linked to particular religious or moral frameworks. Whatever one's viewpoint, practical experience in the early 20th Century United States does not lend encouragement to this goal.4 It is estimated that at least 25% of alcohol produced globally is totally unregulated and up to 90% in parts of Africa.5 But the corollary is that 75% of alcohol production is subject to some regulatory framework such that our governments could do more about the global burden. The problem is that alcohol producers are at the front of the line to offer assistance, and all too often the offer is accepted, even solicited.

Public health advocates in the field of tobacco have been successful in getting policy makers to treat tobacco differently from other commercial products, not to be left entirely to the free market to be priced/sold/marketed at will. Despite the evidence laid out by Babor et al.6 in the thoughtfully named book 'Alcohol: no ordinary commodity', we are not in the same place with alcohol, and so governments feel it is legitimate to engage with the drinks industry in finding solutions to control. However, the tactics that this entree allows industry to employ are highly reminiscent of the way 'big tobacco' has operated over the past half century. But we should not forget, in our impatience for alcohol to be treated as 'the new tobacco', how long it took to bring about legislation on smoking. For instance, the Royal College of Physicians called for a ban on smoking in public places in a report of 1962, and it took a further 45 years to see the recommendation implemented.

A classic example of partnership working between government and industry has been the Responsibility Deal Alcohol Network in England. Conceived in the weeks following the election of the Conservative-led coalition government in 2010 as a tripartite partnership between industry, public health and government, it was launched the following year and is still in existence. However, many public health bodies soon concluded that the agenda had been fixed between the other two parties before the start, and that meaningful, evidence-based policies were unlikely to be considered. Those who did not leave before the formal launch did so when the Westminster government reneged on its commitment to a minimum unit price for alcohol, and the only two remaining have had industry funding.7 The flagship industry commitment has been to take out a billion units of alcohol through lower strength drinks, and an interim analysis has not been encouraging.8

There are areas that are legitimately within the drinks industry remit to contribute to, such as training of bar and supermarket staff and to ensure enforcement of existing legislation. Here, the outcomes are variable, with, for example, test purchases by underage customers often unchallenged. In large parts of Europe, there are little data on sales to underage drinkers. In a recent study in the North-West of England, actors trained to simulate extreme inebriation were served in bars on 84% of occasions, and indeed were encouraged to buy more than they asked for (such as a larger measure) on nearly one in five occasions.9

It is in areas out with their legitimate sphere of interest that the drinks industry has been particularly active - for example, SAB Miller assisting African countries to develop national alcohol strategies10 and opposing strategies to tackle alcohol-related harm through evidence-based pricing policies.11 Also, although the Adam Smith Institute denies funding from the alcohol industry, this 'libertarian think-tank' with a history of tobacco funding produced a remarkably timely non-peer reviewed report purporting to debunk the evidence produced by the University of Sheffield for minimum unit pricing.12 Indeed, the whole series by Jonathan Gornall and the Br Med J have served to shine a very timely light on the ways in which the drinks industry have sought, often successfully, to influence alcohol policy in the United Kingdom, and it is most unlikely that this country is alone in its susceptibility. Gornall also drew attention to the way that Brazil was required by FIFA to suspend its ban on alcohol sales in stadia for the purposes of that country holding the soccer World Cup, and he speculated that this was related to Budweiser being one of FIFA's commercial partners. Brazil was also required to waive taxes on the profits of these partners.13

What do we need to do to put evidence to the fore and commercial interest to the rear when our governments are developing public health strategy? Certainly, the light has been shone quite regularly on industry practices by many public health researchers across the world and without much effect. Perhaps, we need to understand our politicians and their priorities better in order to seek 'win-win' solutions. They rarely set out to do harm to health, but must be elected to serve and make a difference. Our strongest allies are our patients and the public, and we need to 'help' our politicians see that what we want is what the electorate wants too. There is hardly a family - never mind local community - that has not been damaged by the effects of alcohol, and we desperately need to find better ways of harnessing and working in partnership with them. This, more than anything else, will help our elected representatives work in the interests of the 'public' health.

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