FEDERAL RESEARCH PROGRAM ON DRUGS FINAL REPORT ALMOREGAL Assessment of alternative models for regulation of alcohol marketing in Belgium Contract - DR/02/77 Researchers and partners: Tom Decorte (UGent) Ruben Kramer (UGent) Marieke Vlaemynck (UGent) Else De Donder (VAD) Martin de Duve (Univers Santé) Published in 2019 by the Belgian Science Policy Avenue Louise 231 Louizalaan 231 B-1050 Brussels Belgium Tel: +32 (0)2 238 34 11 - Fax: +32 (0)2 230 59 12 http://www.belspo.be Contact person: Aziz Naji Tel: +32 (0)2 238 36 46 Neither the Belgian Science Policy nor any person acting on behalf of the Belgian Science Policy is responsible for the use which might be made of the following information. The authors are responsible for the content. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without indicating the reference : Decorte, T., Kramer, R., Vlaemynck, M., De Donder, E., de Duve, M. Assessment of alternative models for regulation of alcohol marketing in Belgium. Final Report. Brussels : Belgian Science Policy 2019 – 289 p. (BRAIN- be - (Belgian Research Action through Interdisciplinary Networks) Federal Research Programme Drugs ii TABLE OF CONTENTS INTRODUCTION ........................................................................................................... 1 1.1 BACKGROUND & AIMS ................................................................................................................ 1 1.2 METHODOLOGY .......................................................................................................................... 2 1.3 IN-DEPTH INTERVIEWS .............................................................................................................. 3 1.4 CONCEPTUAL FRAMEWORK: POLICY ANALYSIS .......................................................................... 7 MARKETING, PUBLIC HEALTH & POLICY TOOLS ......................................................... 9 2.1 INTRODUCTION .......................................................................................................................... 9 2.2 MARKETING & ADVERTISING: A DEFINITION .......................................................................... 10 2.3 MARKETING MIX: TYPES OF MEDIA ACTIONS AND (CUMULATIVE) EFFECTS .......................... 12 2.4 NEW MEDIA: THE DIGITAL ERA ............................................................................................... 21 2.5 EFFECT OF ALCOHOL MARKETING ON CONSUMPTION AND ATTITUDES .................................. 24 2.6 ALCOHOL INDUSTRY & PUBLIC HEALTH ................................................................................. 29 2.7 EFFECT OF POLICY MEASURES: VOLUME, CONTENT AND SUPPORTING FRAMEWORK ............ 32 2.8 BELGIUM: OVERVIEW OF REGULATIONS.................................................................................. 45 2.9 SUMMARY ................................................................................................................................ 54 CASE STUDIES: ASSESSMENT OF ALTERNATIVE REGULATIONS ................................ 55 3.1 INTRODUCTION ....................................................................................................................... 55 3.2 BACKGROUND OF THE CASES ................................................................................................... 55 3.3 FINLAND .................................................................................................................................. 57 3.4 THE NETHERLANDS ................................................................................................................ 79 3.5 UNITED KINGDOM ................................................................................................................... 99 3.6 NORWAY ................................................................................................................................ 111 3.7 POLAND ................................................................................................................................. 133 3.8 FRANCE .................................................................................................................................. 146 3.9 COMPARATIVE ANALYSIS ...................................................................................................... 158 3.10 SUMMARY .............................................................................................................................. 165 QUALITATIVE ANALYSIS ......................................................................................... 167 4.1 THE BELGIAN CONTEXT ........................................................................................................ 168 4.2 DEFINITION OF ALCOHOL-RELATED HARM ........................................................................... 172 4.3 APPROACHING ALCOHOL MARKETING .................................................................................. 174 4.4 VOLUME RESTRICTIONS ........................................................................................................ 181 Federal Research Programme Drugs iii 4.5 CONTENT RESTRICTIONS ....................................................................................................... 205 4.6 REGULATORY FRAMEWORK .................................................................................................. 209 4.7 APPROACHING THE DEMAND SIDE ........................................................................................ 218 DISCUSSION ............................................................................................................ 221 5.1 THE NOTION OF HARMFUL ALCOHOL USE AND INDIVIDUAL ACCOUNTABILITY .................... 222 5.2 ALCOHOL IN THE BELGIAN CONTEXT .................................................................................... 224 5.3 BANS ON ALCOHOL MARKETING ............................................................................................ 225 5.4 RESTRICTING THE CONTENT ................................................................................................. 230 5.5 RESTRICTING THE VOLUME ................................................................................................... 233 5.6 FRAMEWORK ......................................................................................................................... 247 CONCLUSION ........................................................................................................... 253 RECOMMENDATIONS .............................................................................................. 259 A. THE CONTENT AND VOLUME ................................................................................................. 259 B. THE SUPPORTED FRAMEWORK ............................................................................................. 261 C. THE FUTURE RESEARCH AND OTHER MEASURES .................................................................. 262 Federal Research Programme Drugs iv LIST OF FIGURES & TABLES Figure 1. Marketing mix as portrayed by Hastings & Angus (2009, p. 5) ............................... 13 Figure 2. Heuristic model of the effect of marketing (McClure et al., 2013, p.13)............... 27 Table 1. Criteria for evidence-based policy framework (De Bruijn et al., 2010) .................... 7 Table 2. Total of investment in alcohol advertisements in Belgium in 2015 (Unie Belgische Adverteerders, 2016).................................................................................................................................. 11 Table 3. Based on WHO Global status report on alcohol and health (2014) ......................... 57 Federal Research Programme Drugs v Introduction Introduction 1.1 Background & aims The WHO European region is the world’s heaviest drinking region (World Health Organization, 2014)1. This region is home to 14.7% of the world’s population aged 15+ years, but consumes more than a quarter (25.7%) of the total alcohol consumed worldwide. Rates of youth drinking are particularly problematic (EMCDDA, 2016). On average, 48% of European youngsters drink alcohol at least once a month. About three quarters of 15- year olds have drunk some alcohol at least once in their lifetime (72%) (= European average (71%)). Belgian youngsters score above this average (54%). Belgium scores average on 30 days at least on one occasion 5 or more drinks in ESPAD (35%), and the European average is the same. Considering alcohol marketing as one possible determinant of alcohol consumption and alcohol-related harm, regulation of alcohol marketing is an important policy tool to protect (young) people against exposure to alcohol advertising or marketing and subsequent alcohol use. The general objective of our study is to contribute to a better understanding of the strengths, weaknesses and conditions of the Belgian alcohol marketing regulatory system in light of the existing knowledge in this domain. In particular, this study describes and critically examines the regulation in Belgium and also the system that supports it (legal context, complaints system, sanctions, and monitoring). In the light of the feasibility and effectiveness of alternative policy options and interventions (e.g. bans on alcohol advertising and coregulatory frameworks) as documented in the existing (European) studies, our aim is to develop a "best fit design" for Belgium, taking into account