Policy actors’ perceptions of conflicts of interest and alcohol industry engagement in UK policy processes

Introduction: Alcohol industry organisations occupy a prominent position in UK alcohol policy settings, but their involvement has been contested by public health bodies on the basis that a conflict of interest (COI) exists between industry economic objectives and public health goals. It has been argued that a number of alcohol policy failures have been due to alcohol industry involvement in and/or influence over policy making processes, however the issue of alcohol industry COI is conceptually ill-defined and empirically under-researched. This qualitative study investigates understandings of COI, and the implications of engagement with alcohol industry, among UK alcohol policy actors (i.e. decision makers and advocates). More specifically, it explores how different policy actors perceive the risks and benefits associated with alcohol industry involvement in public policy. Methods: Semi-structured interviews with a range of policy actors (n=26) including medical professionals, parliamentarians, civil servants, academic researchers, health campaigners and alcohol industry representatives were conducted between January-September 2018. Due to a low response rate, interviews with alcohol industry representatives were supplemented with a documentary analysis of industry sources. Interviews were transcribed verbatim and data were subjected to detailed thematic analysis. The Advocacy Coalition Framework (ACF) was applied to explore how beliefs of policy actors converged and diverged between and across different sectors. Results: All participants identified the existence of COI in alcohol policy settings although many struggled to articulate a clear definition of this. Risks associated with engaging alcohol industry bodies in policy processes were identified by the majority of interviewees. Two competing advocacy coalitions were identified: a “public health coalition” and an “industry partnership coalition”. Beliefs about risks linked to alcohol industry engagement varied between these two coalitions according to the type of industry actor, type of engagement, type of alcohol policy and the stage of policy process. Members of competing coalitions expressed some shared beliefs about certain policy scenarios. Multinational alcohol producers were identified as presenting the greatest risk, with industry involvement in the early stages of the policy cycle identified as especially problematic. Some participants identified risks with involving any non-governmental actors in policy making, although the threat to public health was deemed greatest with commercial alcohol industry involvement. Conclusions: Findings from this research underline that alcohol policy is a complex and contested space in which policy actors identify varying risks and COI associated with alcohol industry engagement. Guidelines on how to identify, manage and protect against COI in alcohol policy settings, informed by the experiences and perceptions of policy actors, would assist both decision makers and non-governmental actors in managing potential COI in order to promote public health.