Alcohol-free and low alcohol ("nolo") drinks have the potential to improve public health, but experts in The BMJ today call for a precautionary approach that maximises potential benefits (eg. increased substitution of alcoholic drinks with nolo alternatives) while minimising risks (eg. preventing encroachment of nolo drinks into alcohol-free spaces).
Sales of alcohol-free and low alcohol drinks have increased substantially over recent years, driven by improved manufacturing techniques and consumer demand for better and healthier alternatives to alcoholic drinks, explain John Holmes, professor of alcohol policy at the University of Sheffield, and colleagues.
In Britain, one in five adults reports consuming nolo drinks at least once a month, and nolo drinks now account for 1.4% of total alcohol sales, mainly from products that share branding with an established alcoholic drink.
Nolo drinks have obvious potential to improve public health, especially for heavier drinkers, those in lower socioeconomic groups, and people drinking in high risk circumstances, such as when pregnant, driving, or in adolescence.
However, the World Health Organization (WHO) and alcohol charities have argued that no and low alcohol drinks also pose risks to public health, such as companies using nolo drinks marketing to deter or circumvent restrictions on alcohol marketing.
In Ireland, for instance, major beer companies have responded to advertising restrictions – such as on public transport and during sports matches – by promoting alcohol-free variants which have similar branding.
Similarly, nolo drinks or related marketing may encroach on otherwise alcohol-free spaces, such as gyms and sports events or in supermarket lunchtime meal deals.
For example, the 2024 Olympics named Corona Cero (an alcohol-free variant of Corona) as its official global beer sponsor, allowing the Corona brand to appear in a wide range of sporting and media contexts that were previously unavailable to it.
To protect public health, the authors call for a precautionary approach that aims to facilitate and enhance potential benefits while also preventing or minimising any harms.
Policies that could help achieve this include encouraging companies to substitute higher alcohol products with nolo alternatives, while preventing marketing to children, protecting alcohol-free spaces, and using taxes based on alcoholic strength to incentivise consumption of alcoholic drinks that contain less alcohol.
Yet the authors warn that some policy decisions seem to be driven by the concerns of businesses, trade organisations, and self-regulatory bodies, and say public health actors must engage with nolo policy questions to ensure that their perspectives, and not just commercial priorities, shape regulation of the production, marketing, sale and use of nolo drinks, and how they are framed in public debate.
"Although we argue for a public health response to nolo drinks, we are not suggesting a reduced focus on [preventing harm from consumption of] standard alcoholic drinks. Nor are we seeking to exaggerate the degree of risk that nolo drinks present," they write. "However, as with e-cigarettes and reformulated foods, we should not take [claims about the public health benefits of] market led solutions at face value."
"Benefits may emerge from nolo drinks, but a hands-off approach could mean these are smaller and less equitable than desired. Public health actors should therefore develop a strategic and comprehensive response that balances different concerns and aspirations," they conclude.
