The confluence of legacy, corporate social responsibility, and public health: The case of Migros and alcohol-free retailing in Switzerland

BACKGROUND

Alcohol policy studies have traditionally focused on formal policymaking processes. Retail cooperatives, however, have rarely been studied as sites of public health interventions. Migros, a cooperatively owned chain of supermarkets in Switzerland, has long forbidden alcohol sales in its supermarkets. Focusing on processes of framing, this study explores a recent unsuccessful attempt to reverse the long-standing ban via membership vote in 2022.

METHODS

The study draws on a range of data sources, including company documents, a televised debate, and the results of a large online survey among the general population conducted ahead of the referendum. Using thematic analysis, it investigates various campaign-related arguments, including those made by Migros management, NGOs, and other key campaign participants.

RESULTS

Proponents and opponents used a combination of public health, economic/market-oriented, and corporate social responsibility (CSR) frames. Migros's longstanding dedication to CSR, its participatory governance structure, and the regional political dynamics in the Swiss context are essential in understanding the nature and impact of framing.

CONCLUSIONS

Alcohol-related harm arises from a complex interaction between different social, political, and economic factors. Reducing harm requires approaches that consider the range of contexts and measures that can shape alcohol availability.

Why treatment is not an option: Treatment naïve individuals, suffering from alcohol use disorders’ narratives about alcohol use and treatment seeking

Aims: To investigate the narratives of in- and outpatients at mental health and somatic hospitals, who suffer from alcohol use disorders (AUD) but have never sought AUD treatment. More specifically, to understand how the individuals view their alcohol use and explore their reasons for not seeking treatment. Methods: Individuals suffering from AUD were recruited at somatic and mental health hospitals. The study was qualitative, based on semi-structured individual interviews. A narrative analysis was performed. A total of six patients participated: three recruited at a mental health hospital, three from a somatic hospital. Results: The individuals described how heavy alcohol use had always characterised their lives; it was part of their surroundings and it added to their quality of life. Two narrative forms within the individuals’ stories were identified, in which treatment was considered either as a positive option for others but not relevant for themselves, or as representing a threat to the individuals’ autonomy. The participants expressed that they did not believe treatment was relevant for them, and if necessary, they preferred to deal with their heavy drinking themselves. Conclusions: Our findings indicate that a broad focus is needed if relatively more individuals suffering from AUD should seek treatment, since they – in spite of clearly suffering from AUD – nevertheless see themselves as heavy drinkers and have not even thought of seeking treatment. Thus, it is not (only) a question about the attractiveness of the treatment offer or due to lack of knowledge about treatment options that patients suffering from AUD do not seek treatment.

Youth's personal relationships, psychological symptoms, and the use of different substances: A population-based study

Background: Externalising symptoms and peer influence are well-established predictors of youth's substance use in general. However, there is little integrative research that compares the relative contribution of psychological and social relationship characteristics as predictors of the use of specific substances among youth in different developmental stages. Methods: A representative sample of Danish adolescents (n  =  1,168) and emerging adults (EA; n  =  1,878) reported last-month prevalence use of cigarettes, cannabis, and other illicit drugs (OID), and four indices of alcohol use. Predictor variables included internalising and externalising symptoms, and major characteristics of the youth's relationships (e.g., parental drug use, number of close friends). Results: Having a close friend who used illicit drugs, and high externalising symptoms, predicted the risk for using all substances across both age groups. Alcohol use was more consistently related to peer-related variables than to symptoms. Smoking cigarettes, cannabis use, and OIDs use were related to peer and symptom variables. Age group moderated some associations. Parental separation was related more strongly to alcohol use among adolescents than among EA, and higher internalising symptoms were more strongly related to smoking and using OIDs among adolescents than among EA. Male EAs had higher risk for using alcohol than female EAs. Conclusion: Beyond having a close friend who used illicit drugs, and externalising problems, the use of each substance was better explained by a different group of variables. There were few but important moderations by age group. The findings highlight the need for research on risk factors for substance use that is developmentally sensitive, particularly for adolescents, and for specific substances. Thus, interventions and policies should address social, developmental, and psychological factors.

An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department

Background

Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED.

Methods

An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool.

Results

150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”.

Conclusions

Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13722-021-00269-z.

Are perceptions of social norms regarding peer alcohol and other drug use associated with personal use in Danish adolescents?

Aims: This study aims to describe norm perceptions among Danish pupils aged 13–17 years related to the prevalence of personal lifetime use of alcohol and other drugs (AODs). Further we examined if norm perceptions were associated with personal lifetime AOD use. Method: The data were collected as baseline data in the trial The GOOD Life. A total of 2601 pupils from 42 public schools in the Region of Southern Denmark completed an online questionnaire measuring personal lifetime AOD use and personal approval of use. Additionally the perceived frequency of AOD use and approval of use among peers of their own grade were measured. Lifetime AOD outcome variables were alcohol consumption (at least one drink, being drunk and had five or more drinks on one occasion), smoking, and cannabis use. Results: Pupils’ perceptions of peer approval were significantly higher than pupils’ personal approval of AOD use among adolescents for all outcomes. With the exception of cannabis use the estimated AOD prevalence among peers (median) were higher than the actual prevalence of personal lifetime use. Multilevel logistic regression models showed a significantly increased risk of personal AOD use for pupils that overestimated their peers’ AOD use and also for pupils that perceived peers to approve of AOD use. Conclusions: The findings highlight that pupils’ exaggerated perceptions regarding their peers’ use and approval of AOD use are related to personal experience with AODs.

What happens to drinking when alcohol policy changes? A review of five natural experiments for alcohol taxes, prices, and availability

Natural experiments are an important alternative to observational and econometric studies. This paper provides a review of results from empirical studies of alcohol policy interventions in five countries: Denmark, Finland, Hong Kong, Sweden, and Switzerland. Major policy changes were removal of quotas on travelers' tax-free imports and reductions in alcohol taxes. A total of 29 primary articles are reviewed, which contain 35 sets of results for alcohol consumption by various subpopulations and time periods. For each country, the review summarizes and examines: (1) history of tax/quota policy interventions and price changes; (2) graphical trends for alcohol consumption and liver disease mortality; and (3) empirical results for policy effects on alcohol consumption and drinking patterns. We also compare cross-country results for three select outcomes-binge drinking, alcohol consumption by youth and young adults, and heavy consumption by older adults. Overall, we find a lack of consistent results for consumption both within- and across-countries, with a general finding that alcohol tax interventions had selective, rather than broad, impacts on subpopulations and drinking patterns. Policy implications of these findings are discussed.

New hypotheses regarding the Danish health puzzle

AIMS

Nordic welfare states have achieved admirable population health profiles as a result of public policies that provide economic and social security across the life course. Denmark has been an exception to this rule, as its life expectancies and infant mortality rates since the mid-1970s have lagged behind the other Nordic nations and, in the case of life expectancy, behind most Organisation for Economic Co-operation and Development nations.

METHODS

In this review paper, we identify a number of new hypotheses for why this may be the case.

RESULTS

These hypotheses concern the health effects of neo-liberal restructuring of the economy and its institutions, the institution of flexi-security in Denmark's labour market and the influence of Denmark's tobacco and alcohol industries. Also of note is that Denmark experienced higher unemployment rates during its initial period of health stagnation, as well as its treatment of non-Western immigrants and high wealth inequality and, until recently, the fact that Denmark did not systematically address the issue of health inequalities.

CONCLUSIONS

These hypotheses may serve as covering explanations for the usually provided accounts of elevated behavioural risks and psychosocial stress as being responsible for Denmark's health profile.

Alcohol and Alcohol Effects: Constituting Causality in Alcohol Epidemiology

Taking cues from Science and Technology Studies, we examine how one type of alcohol epidemiology constitutes the causality of alcohol health effects, and how three realities are made along the way: (1) alcohol is a stable agent that acts consistently to produce quantifiable effects; (2) these effects may be amplified or diminished by social or other factors but not mediated in other ways; and (3) alcohol effects observable at the population level are priorities for public health. We describe how these propositions are predicated upon several simplifications and that these simplifications have political implications, including the attribution of responsibility for health effects to a pharmacological substance; the deletion of other agentic forces that might share responsibility; and a prioritization of simple effects over complex effects. We argue that epidemiological research on alcohol might expand its range of ontological, epistemological and methodological practices to identify new ways of understanding and addressing health effects.