Untangling the complex web of alcohol policy needs and potential solutions in Brazil: evidence from civil society and political stakeholders

Implementing evidence-based alcohol policies can reduce the negative impact of alcohol consumption on public health. However, Brazil has permissive alcohol policies and weakly adheres to World Health Organization's recommendations as the 'best buys'. To explore stakeholders' perceptions of alcohol policy needs and barriers in Brazil, we conducted semi-structured interviews with 31 stakeholders, including 15 from civil society and 16 policymakers. Civil society participants included non-governmental organization leaders addressing alcohol-related issues, while policymakers comprised civil servants and politicians experienced in alcohol-related harms. Interviews were transcribed verbatim and thematically analyzed using a deductive approach guided by research questions and an inductive approach to identify emergent themes. Most participants supported World Health Organization-recommended 'best buy' policies regulating alcohol's marketing. However, agreement on price and availability control was not unanimous. All participants acknowledged significant political barriers to adopting these policies, including intentional delays in parliamentary voting, industry lobbying, and arguments about infringing on rights such as freedom. Facing obstacles to advancing population-level policies, stakeholders often shifted their focus to individual-level interventions, such as education and treatment. While these were recognized as less effective, educational efforts were highlighted for raising public awareness of alcohol's harms and changing normative beliefs. Participants noted the lack of a formal coalition to reduce alcohol-related harm, despite its perceived necessity. Overall, stakeholders supported population-level alcohol policies but were pessimistic about their implementation due to political barriers. Many, particularly from civil society, emphasized small-scale, targeted interventions as a more feasible alternative to address alcohol-related harm in Brazil.