Local Government Stakeholder Perceptions of Legitimacy and Conflict of Interest: The Alcohol Industry and the “Drink Free Days” Campaign in England

Document Type : Original Article


Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK


Industry involvement in alcohol policy is highly contentious. The Drink Free Days (DFD) campaign (2018-2019) run by Public Health England (PHE), an executive agency of government, and Drinkaware, an industry-funded ‘alcohol education charity’ to encourage middle-aged drinkers to abstain from drinking on some days was criticised for perceived industry involvement. We examine the extent to which the DFD campaign was supported by local-authority Directors of Public Health (DPHs) in England – which have a statutory remit for promoting population health within their locality – and their reasons for this.
Our mixed-methods approach included a stakeholder mapping, online survey, and semi- structured interviews. The stakeholder mapping provided the basis for sampling survey and interview respondents. In total, 25 respondents completed the survey, and we conducted 21 interviews with DPHs and their local authority (LA) representatives. We examined survey responses, and coded free-text survey and interview responses to identify key themes.
While some respondents supported the DFD campaign, others did not promote it, or actively opposed it, due mainly to concerns about conflicts of interest and the legitimacy of industry involvement in the campaign. These were considered to undermine PHE’s independence and deflect attention from more important, evidence-based policy interventions such as alcohol pricing while conferring vicarious credibility on Drinkaware. We also found low levels of knowledge about alcohol-related harm, the effectiveness of different policies to address these and the policy-influencing strategies used by the alcohol industry.

The findings highlight the dangers of industry partnership and potential conflicts of interest for government agencies and the ineffectiveness of the campaigns they run at local and national levels. They demonstrate the need for caution in engaging with industry-associated bodies at all levels of government and are thus of potential relevance to studies of other health-harming industries and policy contexts.


  1. Institute of Alcohol Studies, The rising affordability of alcohol. February 2018. http://www.ias.org.uk/uploads/pdf/IAS%20reports/sb20022018.pdf. Accessed February 12, 2021.
  2. Public Health England, The Public Health Burden of Alcohol and the Effectiveness of and Cost-Effectiveness of Alcohol Control Policies: An evidence review. December 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/733108/alcohol_public_health_burden_evidence_review_update_2018.pdf. Accessed February 12, 2021.
  3. Alcohol: no ordinary commodity--a summary of the second edition. Addiction. 2010;105(5):769-779. doi:10.1111/j.1360-0443.2010.02945.x
  4. Holden C, Hawkins B, McCambridge J. Cleavages and co-operation in the UK alcohol industry: a qualitative study. BMC Public Health. 2012;12:483. doi:10.1186/1471-2458-12-483
  5. Hawkins B, Holden C, McCambridge J. Alcohol industry influence on UK alcohol policy: a new research agenda for public health. Crit Public Health. 2012;22(3):297-305. doi:10.1080/09581596.2012.658027
  6. Nicholls J, Greenaway J. What is the problem?: Evidence, politics and alcohol policy in England and Wales, 2010–2014. Drugs (Abingdon Engl). 2015;22(2):135-142. doi:10.3109/09687637.2014.993923
  7. Miller D, Harkins C. Corporate strategy, corporate capture: food and alcohol industry lobbying and public health. Crit Soc Policy. 2010;30(4):564-589. doi:10.1177/0261018310376805
  8. Anderson P. The beverage alcohol industry's social aspects organizations: a public health warning. Brussels: Eurocare; 2003.
  9. McCambridge J, Kypri K, Miller P, Hawkins B, Hastings G. Be aware of Drinkaware. Addiction. 2014;109(4):519-524. doi:10.1111/add.12356
  10. Meier P et al. Open Letter from UK-Based Public Health Scientists to Public Health England Regarding Partnerships with the Alcohol Industry. 2018. https://www.sheffield.ac.uk/polopoly_fs/1.809460!/file/Open_letter.pdf.
  11. 23 Red, Independent Review of The Drinkaware Trust (2006–2012). 2013. https://www.drinkaware.co.uk/media/.  
  12. McCoy MS, Emanuel EJ. Why there are no "potential" conflicts of interest. JAMA. 2017;317(17):1721-1722. doi:10.1001/jama.2017.2308
  13. Maani Hessari N, van Schalkwyk MC, Thomas S, Petticrew M. Alcohol Industry CSR organisations: what can their twitter activity tell us about their independence and their priorities? a comparative analysis. Int J Environ Res Public Health. 2019;16(5). doi:10.3390/ijerph16050892
  14. Department of Health. UK Chief Medical Officers’ Low Risk Drinking Guidelines 2016.  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf?_ga=2.30468927.1605885231.1566988169-499156835.1504789637. Accessed  August 28, 2019.
  15. Moberly T. Public health experts split over deal with industry funded charity. BMJ. 2018;362:k3942. doi:10.1136/bmj.k3942
  16. Varvasovszky Z, Brugha R. A stakeholder analysis. Health Policy Plan. 2000;15(3):338-345. doi:10.1093/heapol/15.3.338
  17. Hawkins B, Cassidy R. Interviewing key informants from the corporate sector. In: Lee K, Hawkins B, eds. Researching Corporations and Global Health Governance: An Interdisciplinary Guide. London: Rowman & Littlefield; 2016:127-138.
  18. Brinkmann S. Qualitative Interviewing. Oxford University Press; 2013.
  19. Rubin HJ, Rubin IS. Qualitative Interviewing: The Art of Hearing Data. 3rd ed. London: Sage; 2012.
  20. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
  21. McCambridge J, Mialon M, Hawkins B. Alcohol industry involvement in policymaking: a systematic review. Addiction. 2018;113(9):1571-1584. doi:10.1111/add.14216
  22. Adams PJ. Assessing whether to receive funding support from tobacco, alcohol, gambling and other dangerous consumption industries. Addiction. 2007;102(7):1027-1033. doi:10.1111/j.1360-0443.2007.01829.x
  23. Hawkins B, Holden C. 'Water dripping on stone'? industry lobbying and UK alcohol policy. Policy Polit. 2014;42(1):55-70. doi:10.1332/030557312x655468
  24. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet. 2009;373(9682):2234-2246. doi:10.1016/s0140-6736(09)60744-3
  25. Kim Y, Park SY. Promoting public health or underlying business interests? The effectiveness (or ineffectiveness) of responsible drinking social causes by the alcohol industry versus non-profits. J Promot Manag. 2018;24(6):774-797. doi:10.1080/10496491.2017.1408524
  26. Katikireddi SV, Hilton S. How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? comparative analysis of newspapers, evidence submissions and interviews. Drugs (Abingdon Engl). 2015;22(2):125-134. doi:10.3109/09687637.2014.977228
  27. Hawkins B, Holden C. Framing the alcohol policy debate: industry actors and the regulation of the UK beverage alcohol market. Crit Policy Stud. 2013;7(1):53-71. doi:10.1080/19460171.2013.766023
  28. Yoon S, Lam TH. The illusion of righteousness: corporate social responsibility practices of the alcohol industry. BMC Public Health. 2013;13:630. doi:10.1186/1471-2458-13-630
  29. Hawkins B, McCambridge J. Public-private partnerships and the politics of alcohol policy in England: the Coalition Government's Public Health 'Responsibility Deal.’ BMC Public Health. 2019;19(1):1477. doi:10.1186/s12889-019-7787-9
  30. Bertscher A, London L, Orgill M. Unpacking policy formulation and industry influence: the case of the draft control of marketing of alcoholic beverages bill in South Africa. Health Policy Plan. 2018;33(7):786-800. doi:10.1093/heapol/czy049
  31. Jiang N, Ling P. Vested Interests in addiction research and policy. Alliance between tobacco and alcohol industries to shape public policy. Addiction. 2013;108(5):852-864. doi:10.1111/add.12134
  32. Walls H, Cook S, Matzopoulos R, London L. Advancing alcohol research in low-income and middle-income countries: a global alcohol environment framework. BMJ Glob Health. 2020;5(4):e001958. doi:10.1136/bmjgh-2019-001958
  33. Holden C, Hawkins B. Health policy, corporate influence and multi-level governance: the case of alcohol policy in the European Union. In: Kenworthy N, MacKenzie R, Lee K, eds. Case Studies on Corporations and Global Health Governance: Impacts, Influence and Accountability. London: Rowman & Littlefield; 2016.
  34. Hawkins B, McCambridge J. 'Tied up in a legal mess': the alcohol industry's use of litigation to oppose minimum alcohol pricing in Scotland. Scott Aff. 2020;29(1):3-23. doi:10.3366/scot.2020.0304
  35. Hawkins B, McCambridge J. Policy windows and multiple streams: an analysis of alcohol pricing policy in England. Policy Polit. 2020;48(2):315-333. doi:10.1332/030557319x15724461566370
  36. Hawkins B, Holden C, Eckhardt J, Lee K. Reassessing policy paradigms: a comparison of the global tobacco and alcohol industries. Glob Public Health. 2018;13(1):1-19. doi:10.1080/17441692.2016.1161815
  37. Van Mol C. Improving web survey efficiency: the impact of an extra reminder and reminder content on web survey response. Int J Soc Res Methodol. 2017;20(4):317-327. doi:10.1080/13645579.2016.1185255
  38. Galea S, Tracy M. Participation rates in epidemiologic studies. Ann Epidemiol. 2007;17(9):643-653. doi:10.1016/j.annepidem.2007.03.013
  39. Morton LM, Cahill J, Hartge P. Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol. 2006;163(3):197-203. doi:10.1093/aje/kwj036
  40. van Gelder MM, Bretveld RW, Roeleveld N. Web-based questionnaires: the future in epidemiology? Am J Epidemiol. 2010;172(11):1292-1298. doi:10.1093/aje/kwq291
  41. Silverman D. Interpreting Qualitative Data. Sage; 2015.
Volume 11, Issue 8
August 2022
Pages 1505-1513
  • Receive Date: 11 November 2020
  • Revise Date: 13 April 2021
  • Accept Date: 09 May 2021
  • First Publish Date: 19 June 2021