Stakeholders’ power and interests in alcohol, tobacco, and nicotine policy in 7 European countries

Abstract Background The different interests of public sector, civil society, and commercial sector have strong influence on alcohol, tobacco, and nicotine policies. As part of JAPreventNCD project, a stakeholder analysis was conducted in seven European countries to study the interests and influences of the key players in these policies. Methods Organizations in BE, BG, EE, FI, IS, SI, and UA participated in an online stakeholder-analysis survey in November-December 2024. The average power to influence these policies (scale: 0, none to 3, strong) and support for selected policy measures (6-point Likert scale from 1, strongly oppose to 6, strongly support) of the three stakeholder groups were assessed. Differences were analyzed using ANOVA. Results Altogether 34% of the 662 invited stakeholders responded (n = 223): 47% from the public sector, 34% from civil society, and 19% from the commercial sector. In preliminary analyses, the commercial sector had more power to influence alcohol (mean score:1.4±0.7) than tobacco (1.1±0.6) or nicotine (1.0±0.7) policies. Its interest in influencing tobacco (1.1±1.2) and nicotine (1.3±1.2) policies was significantly lower than that of the public sector (for both policies, 2.3±1.0) and civil society (2.0±1.1) (p < 0.001). Among stakeholders, influencing availability measures was the top priority. Both civil society and public sector support measures to reduce the availability or lower the affordability of these products (4.5±0.9 to 5.1±0.7), whereas the commercial sector's views significantly differ (p < 0.001). The commercial sector opposes more strongly especially availability measures for alcohol (2.7±1.0) and nicotine (2.8±1.3). Conclusions While civil society and public sector support measures to reduce the availability of harmful products, the commercial sector opposes to these measures, more strongly for alcohol. Commercial determinants of health have strong impact on the implementation of evidence-based health policies. Key messages • There is an imbalance between different stakeholders in power and interest in influencing health policies. • Policies that put public health ahead of commercial interests are necessary.