For a growing number of American and European youth, drinking simply isn’t as cool as it once was. 

Young people — increasingly aware of the myriad physical and mental health issues linked to alcohol — are shunning drinking in favor of healthier lifestyle choices. The rise of mocktails, nonalcoholic beer and legal weed offer plenty of alternatives. 

That’s encouraging for public health experts, since alcohol is one of the world’s most significant preventable causes of death: excess drinking kills 2.6 million people each year, according to a status report the World Health Organization published in June, accounting for one in every 21 deaths worldwide. 

But the alcohol industry is doing everything it can to stay relevant. In pursuit of new profit centers, booze, beer and wine-makers are marketing to demographics they’ve historically underserved, including women, and looking to new markets in the Global South, where burgeoning economies with young populations offer growth opportunities. Conveniently, many of these same countries also place few or no limitations on how alcohol is sold and marketed. 

During an investor meeting last year, a representative from Heineken, the Dutch brewer, said the company’s fastest growing markets were in Asia Pacific and Africa. A slide deck titled “Africa drives global beer growth” showed the volume of Heineken sales on the continent had quadrupled in the last 20 years. 

“Africa is the next frontier of growth,” Roland Pirmez, president of Heineken’s Africa, Middle East and Eastern European region said in a slide deck from the presentation, citing the continent’s growing population, rapid urbanization and increasing prosperity.

Jürgen Rehm, a professor at the University of Toronto and senior scientist at the Centre for Addiction and Mental Health in Canada, said that industry marketing had led to people in Asia and Africa to begin drinking at younger ages than prior generations who had grown up with different norms and less discretionary income.

“The overall concern is that alcohol consumption is normalized globally and that a majority of the world's adults may be drinkers in 10 years from now,” Rehm wrote in an email. This result will have “serious consequences” for alcohol-related disease and economic prosperity, he said.

Heineken did not respond to questions from The Examination about these concerns.

Changing demographics 

The harms of excessive drinking have been well known for centuries, but science measuring the risks is becoming more precise. In the last decade, numerous studies have suggested that even “moderate” levels of consumption —  as little as two drinks per day for men and one for women — increases the risk of heart disease and cancer.That knowledge has begun to sink in. In the West, drinking is no longer an unquestioned rite of passage for young people: European and American adolescents are drinking less compared with a generation ago. A study of drinking habits in 28 European countries found that weekly use among adolescents peaked in 2007 and has since declined.

Boys, in particular, who historically drank more than girls, are cutting back. A recent WHO survey from Europe, Central Asia and Canada found that girls, for the first time, were more likely than boys to have tried alcohol by age 15.

Adults are also picking up the slack. In the U.S., millennials are consuming more alcohol than previous generations in their 30s and 40s. The uptick has been particularly pronounced among women, especially those with a college education.

Katherine Keyes, a professor of epidemiology at Columbia University, published a review of several studies and found binge drinking and alcohol-related hospitalizations have been rising fastest among U.S. women 26 to 35 and 45 to 64.

“What we've seen is this shift where drinking declines during adolescence but then the acceleration of drinking during the transition to adulthood is getting faster,” Keyes said.

The COVID-19 pandemic exacerbated dangerous drinking habits. Between 2020 and 2021, women aged 40 to 64 experienced significant increases in urgent complications from alcoholic liver disease, according to an analysis of insurance claims data published in the Journal of the American Medical Association.

From a man’s drink to ‘Mommy Juice’ 

This shift in drinking behavior didn’t occur by chance. Alcohol companies that once alienated women with ads suffused with sexist imagery are now marketing directly and more effectively to women, according to a 2020 report by investment research and brokerage firm Bernstein Research.

Diageo, one of the world’s largest spirit conglomerates, regularly participates in the United Nation’s annual International Women’s Day, and has wrapped itself in its messaging. Recent advertising campaigns by 20 alcohol-makers frame drinking as post-feminist — adopting language like “girl power” and “strong women” while also reinforcing gender norms by dousing their campaigns in pink — and as a way for mothers to de-stress and briefly escape the burdens of parenting. In one social media campaign by Bailey’s Nigeria, the company celebrated Mother’s Day by asking drinkers to comment on “why your mum deserves a Bailey Treat from us.”

Companies are also pivoting to products that appeal to women. Beer-makers, which historically struggled to attract female consumers, have eagerly invested in ready-to-drink beverages like hard seltzers — a product category that appeals equally to both genders. Soda companies also have leapt into the fray, producing alcoholic offerings of their own.

Lawmakers attempting to rein in excess drinking are up against a tsunami of spending. Alcohol-makers spend billions to market their products. AB InBev — which produces Budweiser and Corona among hundreds of other labels — spent U.S. $6.8 billion on advertising in 2022, according to Marketing Week.

Unlike tobacco companies, which since the 1998 Tobacco Master Settlement Agreement have been prohibited from exempting the money they spend on advertising from their U.S. taxes, the alcohol industry is under no such restrictions. That meant the 10 largest alcohol producers could write off taxes on $1.5 billion in advertising expenses in 2017, according to the public health advocacy organization Vital Strategies.Whereas the majority of developed countries restrict beer advertising on television and radio, most of the countries with no advertising restrictions are in Africa and Central and South America, according to WHO. A third of countries have a total or partial ban on beer company sponsorships at sporting events, but in many developing economies there are no restrictions.

Raising taxes

Economists and scientists say one of the most effective ways to curb excess drinking is to raise taxes on alcohol. Taxes are “best buy” interventions for reducing non-communicable diseases, according to WHO, as they are highly cost effective and relatively easy to implement.

Taxes have been crucial to curbing drinking rates in Eastern Europe —  a region once home to some of the world’s heaviest drinkers. Since 2002, former Soviet states Estonia, Latvia and Lithuania have raised taxes on alcohol and seen alcohol-attributable deaths fall. Lithuania later implemented additional excise tax increases and saw an additional 3% decline in mortality by any cause.

Countries have experimented with other pricing policies, too. In Russia, after the government set a minimum price per unit for spirits, alcohol consumption per capita fell by 26% from 2010 to 2016. A similar policy In Scotland reduced alcohol sales by 3% and cut hospital admissions and deaths from chronic diseases, according to an independent review.

Although global alcohol companies like Diageo preach “the importance of moderation,” this shifts the responsibility for excess alcohol use onto the drinker. Meanwhile, companies fiercely oppose measures shown to reduce excess drinking, such as raising alcohol taxes. Diageo has lobbied to cut taxes on its products in Mexico; Anheuser-Busch and other alcohol businesses have largely funded efforts to kill alcohol tax bills in New Mexico and Oregon.

Politicians have listened. In the U.S., state alcohol taxes have fallen more than 30% in real terms since 1990. In 2020, a bipartisan group of federal lawmakers awarded permanent tax cuts to many alcohol sellers. As of Aug. 1, the alcohol industry had 280 registered lobbyists in Washington, D.C. 

Asked for comment, a Diageo spokesperson responded, “We are committed to changing the way people drink for the better,” citing the company’s educational website DrinkIQ and its growing portfolio of nonalcoholic beverages. “The right information empowers consumers to make the right choices.” 

Global health policymakers have not made combatting excessive drinking a priority. Governments and philanthropic organizations spend $4.17 on alcohol policy for each death due to excessive drinking, compared with $11,000 for each death caused by HIV/AIDS, according to a recent analysis.

WHO has set an ambitious goal to cut drinking by 20% by 2030, but member states have done little to further it. Its recent status report found that nearly half of reporting countries have no alcohol policies in place.

Warning labels add cancer to the list of risks

Where governments have hesitated to limit alcohol sales practices by other means, health advocates have turned to a new weapon: information. A growing number of countries are requiring labels warning drinkers about alcohol’s potential health impacts, which a recent systematic review in The Lancet shows have the potential to raise awareness and reshape behaviors. And alcohol-makers are struggling to argue why consumers shouldn’t be fully informed about the products they are buying. 

The efforts are a patchwork so far but could be gaining steam. Last fall, Australia and New Zealand began enforcing a requirement for stronger pregnancy warning labels on alcoholic beverages. Ireland went a step further, mandating that in 2026 beverages carry labels informing drinkers that alcohol causes cancer. And this spring in Alaska, lawmakers passed a new requirement that bars post a sign warning patrons about the link between alcohol and cancer. The fight can still be an uphill battle. In 2015, after Thailand proposed adding stronger warning labels to alcohol products, other countries with large alcohol export industries disputed the measure in the World Trade Organization, and Thailand ultimately withdrew it. (The government recently rebooted the effort but is again facing fierce opposition from businesses.)

Setting global standards to rein in alcohol-makers 

Some have called for a global treaty to protect people from alcohol-related harms, modeled after WHO’s Framework Convention on Tobacco Control. The 20-year-old treaty signed by countries covering 90% of the world’s population has helped curb smoking rates in many places. It includes many of the same strategies public health experts recommend for regulating alcohol such as raising taxes and regulating marketing.

One of the most striking parts of the FCTC is that it explicitly excludes tobacco companies from policy negotiations, said Ben Hawkins, a researcher at the University of Cambridge. In contrast, the alcohol industry often has a seat at the table during policy negotiations.

Maristela Monteiro, a retired senior adviser on alcohol at the Pan American Health Organization, said alcohol companies are in dire need of regulating.

“They're stronger than the tobacco corporations.” she said. “They learn from the tobacco case and they know that they need to be ahead of the game.”