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Time for precautionary action on alcohol industry funding of sporting bodies

2009; Wiley; Volume: 104; Issue: 12 Linguagem: Inglês

10.1111/j.1360-0443.2009.02711.x

1360-0443

Kypros Kypri, Kerry O’Brien, Peter Miller,

Behavioral Health and Interventions

Findings of a recent study suggest that receiving alcohol industry sponsorship may increase sports participants' drinking 1. The study involved a cross-sectional survey of 1279 participants from 14 team and individual sports in three large provinces of New Zealand. Level of involvement in sport ranged from social/club level through to provincial or national representation. Almost half the respondents received some form of alcohol industry sponsorship. Receiving such sponsorship, particularly in the form of free or discounted alcohol, was associated with higher scores on the Alcohol Use Disorders Identification Test. To those familiar with the alcohol research literature these findings will have come as no surprise, but there has been little previous research on the subject, and the study has been described as an initial step, providing 'some much-needed evidence in an ideological discussion'2. The study received extensive media coverage in Australia, New Zealand and the United Kingdom, drawing attention to this widespread practice. The findings were juxtaposed with accounts of professional footballers' all too common violent or loutish behaviour while drinking 3. Several commentators, including former sporting icons, drew parallels with tobacco industry sponsorship and argued that similar restrictions should apply to the alcohol industry 4. The alcohol and sponsorship industries' response in the United Kingdom was true to form. In a manner reminiscent of the tobacco industry's public relations efforts, the Portman Group (a public relations body set up by the alcohol industry) and the European Sponsorship Association (ESA), whose members include leading alcohol producers (i.e. Anheuser-Busch InBev, Carlsberg, SABMiller), dismissed the results 5 despite the ESA having criticized an earlier European Union report for not providing evidence of a link between sponsorship and hazardous drinking. The Alcohol in Europe report 6 had recommended the abolition of alcohol industry sponsorship of sport. The refrain from the ESA was: 'There is absolutely no link between sponsorships and alcohol misuse'5, and that a causal relationship had not been established. A similar position was held until well into the 1990s by the tobacco industry about the link between smoking and lung cancer 7, despite extensive evidence from case control and cohort studies over several decades 8. The alcohol industry response in Australia and New Zealand was muted. Notably, in January 2009, representatives from six major sporting bodies accepted that they have a role to play in dealing with unhealthy alcohol use among sportspeople and they signed up to a government-led, voluntary, unmonitored code of conduct 9, with the goal of not allowing 'sportspeople or officials to participate in sport while consuming or under the influence of alcohol'. That such behaviour had hitherto not been formally prohibited is indicative of the unhealthy culture that has developed, and it reveals how far some sporting bodies have to go in meeting their responsibilities to players, supporters and the general public. A single study showing a cross-sectional association between the receipt of sponsorship and drinking behaviour should not be the basis of a causal inference, even when it is consistent with a plausible hypothesis. What kind of study would produce robust evidence of causation? A randomized controlled trial would be ideal, but it would probably be unethical and impractical to assign people randomly to various levels of alcohol industry sponsorship. A large cohort study, with prospective objective measurement of exposures and outcomes, would have some theoretical advantages over a cross-sectional study but, like non-randomized studies of the use of medicines, it would be confounded by all the factors that predict the exposure of interest 10. From the point of initiating such a study, which would cost millions of dollars, useful findings might be a decade or more away. Even if it could be conducted, those with a vested interest in continuing the practice of sponsorship would still have open to them what might be called 'the Phillip Morris defence', i.e. obdurate denial of a causal relation in the absence of randomized data 7. Eventually, perhaps, enough good-quality observational studies might accumulate such that even hardened sceptics might accede. It would be unwise, however, for us to accept such a great burden of proof and, notably, this standard of evidence had not been met when governments banned tobacco industry sponsorship. Unhealthy alcohol use, and in particular youth binge drinking, is described as a significant, persistent problem in many countries. In the face of such problems we should consider the full range of possible countermeasures, primarily those underpinned by strong research evidence, but also those which are yet to be subject to extensive study. With regard to the latter, we agree with Babor et al.11 that where evidence is lacking, policy makers should adopt the precautionary principle which recommends, among other things, taking preventive action in the face of uncertainty and shifting the burden of proof to the proponents of the activity. For alcohol, as for tobacco, sponsorship of sport enables companies to promote their products to vast audiences of all ages, with few if any substantial constraints and all the benefits of association with healthy activities and sporting heroes. It should not be left to the public to demonstrate that alcohol industry sponsorship is harmful but, rather, it should be up to the proponents of the activity, i.e. the alcohol industry, to show that the practice is harmless. In the meantime, government should prohibit the practice in the interest of reducing unhealthy alcohol use. The alcohol industry and some sporting bodies will no doubt argue that sport will suffer without industry money. Similar arguments were made in the 1980s and 1990s about tobacco industry funding of sport 12. As the experience with tobacco funding shows, there are effective strategies available for addressing this concern. In Australia, VicHealth was established by the Victorian Tobacco Act 1987. Its role is 'promoting good health and preventing ill-health'13. Revenue from tobacco taxes is used to fund its activities which include sponsoring sport. It would be similarly possible to hypothecate an alcohol tax for the specific purpose of funding sporting activity. An added advantage is that this approach takes decision making about which sports to fund and the level of funding away from commercial interests and into the remit of an organization whose board is ultimately accountable to the public. Whether sport and alcohol remain so tightly linked is principally up to legislators and policy makers. In the interest of preventing harm, action should be taken now to restrict or, better, eliminate alcohol industry sponsorship of sporting bodies and sportspeople. Taxing alcohol in order to sponsor sport via an independent body would provide for sporting activity more equitably than the current arrangement. In addition, as researchers and advocates we should take every opportunity to draw attention to relevant research findings by way of mobilizing public opinion and pressuring government to ban alcohol industry sponsorship. The authors have never received alcohol or tobacco industry funding.