Table 1

Characterising the alcohol environments of HICs and LMICs: similarities and differences

Dimension			HIC alcohol environments	LMIC alcohol environments
Political, economic and regulatory environment	Political		Alcohol regulation gaining priority on the political agenda.	Policymakers heistant to regulate the alcohol industry, influenced by arguments in regard to the jobs and economic benefits it provides.
	Economic		High levels of industry market concentration. Relatively strong economies mean that arguments of the economic benefits of the alcohol industry are less influential.	High levels of industry market concentration. Where LMIC economies are performing poorly, arguments for economic benefits of alcohol industry are more influential.
	Regulatory		Greater regulation, often enforced.	Less regulation, fragmented regulation and regulation often not enforced.
	Industry strategy		Diversifying products including low-alcohol options to evade regulation and maintain market share.	Particularly targeting women and young drinkers, and looking to new markets.
	Industry strategy		In both contexts, industry argues for its role in the economy through job creation. Links to political parties cemented through directorships and revolving door phenomena. Corporate social responsibility activities to create a positive view of the industry from the public and policymakers.
Alcohol supply chains	Production		Dominated by TNCs.	Dominated by TNCs, which subsume smaller local beer producers.
	Processing		In both contexts, processing largely similar for industrially processed alcohol but with informally produced alcohol more common in LMICs.
	Distribution		Fewer (and more restricted in terms of) distribution channels.	Many distribution channels and industry engagement with informal vendors with selling their products. Emphasis on entrepreneurship and sustainable livelihoods of informal vendors.
Alcohol acquisition environment	External domain	Availability	Formal market outlets – relatively stable. Little presence near schools.	Informal outlets. Diverse range of outlets. Unrecorded alcohol common. Easy availability near schools and places where youth congregate.
		Prices	Often high, with taxes applied. Relatively stable prices.	Often lower, with low/no tax applied. More variable prices, often themselves driven by marketing strategies of the alcohol industry.
		Vendor and product characteristics	Increasingly 24/7 trading. Packaging sometimes has a safety message. Cold storage.	More limited trading hours in the formal section; although often 24/7 trading in the informal sector. Packaging seldom has safety message. Variable packaging – packaging often akin to other commodities (eg, similar to milk cartons).
		Marketing and regulation	Highly regulated with strict trading laws. High level of promotion, marketing compaigns, labelling and shelf information.	Less regulated and sometimes unregulated.
	Personal domain	Accessibility	Highly accessible for most people through formal market outlets.	Highly accessible for most people through a diverse range of market outlets.
		Affordability	Many alcohol types relatively affordable for most people, although high taxes reduce consumption to some extent. Preferences highly variable by population demographic, with many niche products.	Many alcohol types relatively affordable for many people (although alcohol spending constitutes a greater share of disposable household income), particularly in middle-income countries rather than low-income countries where drinking often unaffordable for many. Preferences for cheap alcohol.
		Convenience	Variable packaging size and style and variable alcohol strengths.	Variable packaging size and style and variable alcohol strengths – although less so than in HICs.
		Desirability	Highly desirable for many people, shaped to a large extent by price and advertising of alcohol types which cater to different demographics
Alcohol consumption environment	Context of drinking		More gender equality in drinking (although still more common in men). Low levels of abstinence. Bar and pub culture, as well as people commonly drinking at home. Culture of binge drinking among students.	Large gender differences in drinking (high levels of abstinence among women). In some countries, there is a high prevalence of abstinence overall but a very heavy drinking prevalance among those who do drink. More limited bar and pub culture, and drinking in community environments more common. Binge drinking among students increasing in many countries.
Alcohol consumption environment	Perception of drinking and ’problem drinking’		Increasingly low tolerance of drink driving and drinking in pregnancy. Acceptance of public drunkenness is variable.	Higher tolerance of drink driving and drinking in pregnancy in some contexts. Acceptance of public drunkenness is variable.

HICs, high-income countries; LMICs, low-income and middle-income countries; TNCs, Transnational Corporations.