Abstract
Background: In France, the evidence-based policies recommended by the World Health Organization SAFER program remain poorly implemented, despite relatively high levels of alcohol consumption and alcohol-related harms. To understand this paradox, we used Kingdon’s Multiple Streams Approach (MSA) as framework to analyze how members of the French parliament perceive alcohol and how alcohol industry and public health actors influence their decision-making.
Methods: We conducted twenty-five interviews with French deputies and senators from different political parties and regions. We built the interview guide following the three MSA streams: problem, policy, and political. We performed a thematic content analysis of the interview data using Nvivo to manage the data.
Results: The interviewed deputies and senators held ambivalent views on alcohol (problem stream): they acknowledged its health and social harms, but also emphasized its cultural and economic benefits. They supported low-evidence-based alcohol policies (e.g., education and targeted prevention) and showed limited support for Minimum Unit Pricing (MUP) policies (policy stream). Several arguments used by the alcohol industry against MUP emerged, including negative economic effects and illicit trade. The interviewed deputies and senators also reported more frequent interactions with alcohol industry actors than with public health actors (political stream).
Conclusion: In line with the MSA streams, our findings suggest that ambivalent framing of alcohol, weak support for evidence-based measures and a wine-favorable political environment may explain the weak alcohol control policies in France. Future research should include additional stakeholders to capture the full set of dynamics that contribute to policy inertia.