Rohan Maharaj | Alcohol and the commercial determinants of health

‘He’s a real rum head, he doesn’t know when to stop.’

All too often, we blame others for their lack of self-control – for not stopping after “just one” alcoholic drink. Our medical models reinforce this thinking, focusing heavily on individual behaviour change and placing the responsibility for addiction squarely on the shoulders of sufferers. Our legal models also place emphasis on enforcing the law around drink driving and legislation to try and curb the individual’s misuse of alcohol.

There is another side to the equation – much of our exposure to alcohol, and the health risks that follow, are not simply the result of personal choice. They are shaped by the commercial environment in which we live and work. This is what public health experts describe as the commercial determinants of health: the strategies used by corporations, in the pursuit of profit, to promote products that harm health. The alcohol industry deploys these strategies aggressively, particularly in small island developing states and low- and middle-income countries, where regulatory systems are often weaker and social norms favour acceptance.

The rise of globalisation and the multinational corporations, combined with the power of the World Trade Organization (WTO) make the international drivers of the commercial determinants even more potent. With the rules of the WTO, alcohol is treated as an ordinary commodity – traded like rice or flour. But alcohol is not an ordinary commodity. The science is clear now that there is no safe level of consumption of alcohol. Alcohol consumption contributes to more than 200 diseases and injuries, including addiction, cancers, liver damage, non-communicable diseases, road traffic injuries, violence, and widening social inequality.

The alcohol industry actively shapes consumption by controlling availability, pricing, and marketing. They sponsor sports and cultural events, embed alcohol into festivals such as carnival and competitions like the Caribbean Premier League (CPL), and frame drinking as culture, celebration, and identity. Already historically etched with the ‘DNA’ of rum, alcohol becomes further woven into our everyday Caribbean lives.

BURDEN OF HARM SHIFTED

The alcohol industry works actively to create ‘life-worlds’ – our shared, taken-for-granted experience of what it means to socialise, to belong, to celebrate. We see this influence clearly on social media, where liking a brand, a logo, or a sponsored team creates a sense of belonging. Industry practices such as premiumisation – appealing to status and aspiration through “premium” branding – sweetened ready-to-drink products targeting youth and women, and the creation of new drinking occasions are all deliberate strategies. International Beer Day, Beer Weekend Festivals, and even St Patrick’s Day celebrations in countries with no historical connection to Ireland do not arise by accident.

Industry lobbying further shapes the policy environment. Through “corporate citizenship” and behind-the-scenes influence, public health conversations are reframed away from population protection and alcohol regulation and toward voluntary actions, individual rights to happiness, pleasure, and conviviality. The burden of harm is shifted onto personal responsibility, while the commercial environment – and corporate profit – remain untouched. This same pattern is evident across the Caribbean in resistance to efforts to reduce salt, sugar, and fat content in foods, even as nearly 70 per cent of deaths in the region are linked to diet and consumption patterns. The pushback faced by governments and civil society is not coincidental; it is structural and well-resourced.

TRUE ECONOMIC COST

Our governments already possess the legal authority to act. National constitutions, international conventions, and regional declarations provide the mandate to protect populations from public health harm. What is needed now is the political will to use these powers – to regulate advertising and sponsorship, limit corporate influence on policymaking, and place public health above private profit.

Many argue that the alcohol trade brings important economic benefits. However, when these gains are weighed against the costs to healthcare and criminal justice systems, premature deaths and injury, absenteeism and presenteeism, the erosion of family life and harm to children and relationships, and the often-uncounted burden of foetal alcohol syndrome, it becomes clear that the true economic cost of alcohol far exceeds its financial returns.

Without decisive action, Caribbean countries will continue to lose human potential to preventable alcohol-related harm. This is not a failure of willpower among individuals. It is a failure to confront the systems that quietly but powerfully shape our choices and our lives.

Dr Rohan Maharaj is a senior lecturer in family medicine and a fellow of the Caribbean College of Family Physicians. He is the alcohol policy advisor, The Healthy Caribbean Coalition. Send feedback to columns@gleanerjm.com