Reviewing the myriad of connections in “Under the influence,” Jonathan Gornall’s account of the subversion of public health policy by the alcohol lobby, shows just how important complex “webs of influence” are in pushing forward corporate interests. To think clearly about how the tide can be turned for public health in this area requires us to grasp the complex interactions by which policy changes are accomplished. But it also helps us to clarify what changes would be necessary to turn the tide and enable policy to combat alcohol related harm effectively.

To do this, let’s start by reviewing the main actors and actions that are arrayed against a policy based on evidence. We must start with the corporations themselves. They are of course economic actors, but it is wrong to see them only in these terms. In order to act economically as well as politically, corporate leaders need to assess the economic and political landscape, both in terms of how they can compete in the market and in terms of how they can influence politics and policy. In other words, they are sensitive both to economic and political signals as opposed to blindly following the logic of profit making. This is bad news for public health because it means that corporations act politically to pursue their assessment of their own interest which, given their huge resources, is a problem. But it is also good news, because it suggests that corporations are able to compromise and change course when the balance of forces against them becomes a significant threat.

This means that any strategy for improving public health in relation to alcohol must also be a strategy for mobilising the broadest constituency in favour of public health and in favour of limiting the ability of the alcohol industry to determine alcohol policy. This must mean regulating both economic and political corporate activities.

This is easy to say and hard to do since the myriad connections of the corporate lobby machine are so intertwined with the political system in the UK. Amongst the key elements of this machine are financial contributions, direct lobbying, the use of indirect proxies such as think tanks or even “front groups” and the regular use of the revolving door. So all of these need to be effectively regulated if corporations are not to gain unfair advantages in policy debate:

Financial contributions: Alcohol companies donate to political parties and to individual candidates.  They also spend money on hospitality including giving free alcohol to politicians, as Jonathan Gornall’s piece shows.  Financial contributions should be disclosed and limited. Lobbyists, including corporations, should be banned from paying or giving gifts to ministers and civil servants.  At present, lobbying trade associations forbid financial contributions from their members to serving politicians. Even if their rules were effective—which there is cause to doubt—they don’t apply to non-members or to non-lobby firms such as the alcohol companies themselves.

Lobbying is the most important of the tactics used by the alcohol industry—its heavy guns.  All the rest of their political activity is geared to supporting the lobbying efforts. In the US, where lobbying disclosure has been in place for many years, it is possible to compare campaign contributions with lobbying expenditure.  In 2012, for example, drinks giant Diageo  spent more than half a million dollars on campaign contributions around a quarter of its $2 million plus lobby spend. Transparency on lobbying is a small but important step towards opening up the political system to public scrutiny. In the UK we have no idea how much the drink industry spends on lobbying, either in house or in hiring consultancies, what it lobbies on, and who it contacts.

Lobbying firms fought a rear guard action to prevent transparency for years.  They created their own lobby groups to do this, such as the Association of Professional Political Consultants and the UK Public Affairs Council. Now, however, lobbying firms appear to have come round to the need for a statutory lobbying register, which the government has been committed to introducing since May 2010.  The bill, presently making its way through the Houses of Parliament, is not likely to tell us much since the government seems determined to draw it so narrowly that it will leave out over 99% of lobbying activity. Nevertheless, a lobbying register is urgently needed to begin the process of opening up lobbying (including that by the alcohol industry) to the public eye.

A register of lobbyists needs to be reinforced by enhanced ethical rules for politicians, civil servants and ministers. The privileged access of alcohol lobbyists to decision makers disclosed in Gornall’s piece must be ended. If there is not a level playing field there is little chance of citizen or public health interests prevailing, no matter how strong the evidence. Information for policy consultations must be gathered on an open and clear basis (much like the consultations run by Select committees).  There should be no preferential access for corporations and no meetings on topics after consultations close as apparently happened with Minimum Unit Pricing.

Think tanks have become much more important in pursuing corporate interests in the past two decades.  In the past when stories about alcohol industry influence reached the media it was often about alcohol industry funding of academic research.  In one celebrated example, the Alcohol Research Group at the University of Edinburgh ran into difficulties after failing always to disclose industry funding in academic journal articles or in press reports. The group was in receipt of £500 000 core funding from the Portman Group a drinks industry lobby organisation.  Matters came to a head in the late 1990s when one of the researchers—John Duffy—was revealed to have tried to recruit anonymous reviewers for the Portman Group to write critical reviews of a WHO report on alcohol harm.

Nowadays, think tanks are more likely to be mentioned.  This is partly because many academic researchers have learnt their lesson and are less likely to take alcohol industry funding.  But another reason is that with pressure on public funding of higher education, think tanks have increasingly come to occupy a space in public debate.  From the point of view of industry they are useful, because, think tanks still retain something of the image of disinterested research institutions as opposed to the corporate-funded lobby vehicles that many are. Think tanks are even less likely than lobby consultants to be transparent about their sources of funding, as can be seen in the cases of the Centre for Policy Studies or the Adam Smith Institute  in relation to minimum unit pricing. Perhaps not entirely surprisingly, one of the authors of the Adam Smith Institute report attacking the Sheffield University study was the same John Duffy—now retired and no longer in an academic post—who had been at the Alcohol Research Group in the early 1990s.

Revolving doors: The alcohol industry spends money on the above resources but also attempt to make sure that the people they retain to do this have as much insider or specialist knowledge of the policy making world as possible.  That is why corporations themselves, as well as lobby firms and think tanks, have helped to spin the so called revolving door both ways, by sending their employees into Whitehall and Westminster on secondment or on a career path that may not gain them immediate advantage but on which they can later capitalise, perhaps when the former staffer returns to their employ or when a career civil servant leave the “public service” to pursue the private interests of the alcohol industry as has been seen on many occasions in recent times. This is only part of the jigsaw.

Corporations must not be able to hire people at will from the civil service with no penalty or restriction.  Nor must corporations (or their proxies such as lobbying firms and think tanks) be able to send people into government for a short period either to pursue their interests directly or to gain knowledge that can be used when they return to the business world.

We recently highlighted the case of Miles Beale, who left his post at DEFRA in June 2012 to take up the post of chief executive of the Wine and Spirit Trade Association. Under the Civil Service Code, there are rules applying to “all serving civil servants and to former civil servants for two years after the last day of paid service” stating that they must make an application under the Business Appointments Rules if their current or intended future role meets one or more of seven criteria, including where “the proposed appointment or employment would involve making representations to, or lobbying the Government on behalf of a new employer.”

We asked DEFRA under Freedom of Information Act for a copy of Beale’s application and any recommendation in response to his request.  DEFRA replied that “Mr Beale sought advice from HR on the Business Appointment Rules prior to his resignation. Mr Beale’s Manager and the HR Director considered whether or not his appointment at the Wine and Spirits Trade Association was subject to application of the Business Appointment Rules and concluded that his appointment did not meet the criteria to require an application under the Rules, and therefore no application was made.” The WSTA has as one of its four “strategic” objectives: “To ensure WSTA members views are represented, understood and considered by policy makers at all levels of government.” Beale can hardly be considered not to be engaging in “lobbying” or “making representations” to government.

This case illustrates that UK rules on the revolving door are not fit for purpose. In the US where more information is available we can tell that 15 of the 26 lobbyists working for Diageo in 2012 previously held government jobs. No such information is available in the UK. The most recent official enquiry on the revolving door carried out by the Public Administration Select Committee recommended that the Advisory Committee On Business Appointments (which is responsible for the rules) should be “abolished” and ethics regulation placed on a “statutory” footing.

Taming the alcohol lobby will not be done overnight. It will take years of struggle by those in public health and wider society to adequately protect pubic health.  The measures outlined above will help incrementally, but together they can be more than the sum of their parts in helping to build towards a tipping point like that reached in the battle with the tobacco industry. As the case of Minimum Unit Pricing showed, even conservative governments can move to introduce positive public health measures.  In other words, though the current UK government may, almost by instinct, prefer to support the alcohol industry over public health, the evidence base and the strength of those forces promoting public health can overwhelm even apparently hostile political formations.

David Miller is professor of sociology in the department of social and policy sciences at the University of Bath in England. He leads WP 13 “Web of influence” in the ALICE-RAP project, which looks at the activities of industrial actors in relation to addictions.

Claire Harkins is a research officer and PhD student at the department of social and policy sciences at the University of Bath in England. She carries out research in the WP 13 “Web of influence” of the ALICE-RAP project, on the activities of industrial actors in relation to addictions.

All authors declare that that we have read and understood the BMJ Group policy on declaration of interests and we hereby declare the following interests:

David Miller is in receipt of funding from the European Commission for an FP7 project (ALICE RAP) that focuses on rethinking addictions in Europe. He is a director of Public Interest Investigations, a non-profit company which is behind two websites: spinwatch.org and powerbase.info.

Claire Harkins is a researcher at the University of Bath on the ALICE RAP project. The project is co-financed by the European Commission and focuses on rethinking addictions in Europe

Find out more at bmj.com/alcohol