Infrahealth politics: Leveraging bartenders' expertise in alcohol management - An ethnography (2025)

Background and aims: Despite WHO recommendations, the percentage of persons treated for Alcohol Use Disorder (AUD) is still low. The ever-increasing burden of alcohol intoxication cases on emergency services underscores the necessity for innovative approaches to treat individuals with AUD and to improve harm reduction strategies. Bars are often frequented by individuals with AUD who are not under observation by medical or social services. Recognizing that understanding the social contexts surrounding alcohol consumption is essential for harm reduction, this study examined the often overlooked yet important role of bartenders in implementing informal harm reduction strategies.
Methods: We conducted an ethnographic study between March and October 2023 in 33 bars in Marseille, France. Combining participant observation with semi-structured interviews, 38 bartenders (23 men and 15 women) were purposively sampled. We investigated the harm reduction strategies employed by bartenders, identified potential barriers to these professionals being able to increase harm reduction efforts, and proposed novel harm reduction strategies that these professionals and healthcare professionals could implement.
Findings: Bartenders skillfully manage situations of collective overindulgence to maintain a secure environment for customers. They mediate conflict through acts that sometimes go against the bar's financial interests, including moderating customers' alcohol consumption. Occasionally, they also provide support to patrons beyond commercial obligations (accommodation, finding work). In this multifaceted public health role, they balance hospitality with risk management.
Conclusions: Bartenders play an 'infrahealth role', reducing risks associated with alcohol consumption outside the formal framework of public health. Their harm reduction intervention ranges from adjusting beverage offerings to preventing conflicts. Acknowledging that grassroots stakeholders such as bartenders contribute to tackling AUD, and strengthening the collaboration of health professionals and local authorities with these stakeholders, could help promote safer and more responsible alcohol consumption practices. [Author's abstract]
Highlights:
Low AUD treatment rates despite WHO recommendations highlight the need for new approaches.
Bars are often frequented by alcohol consumers not monitored by medical or social services.
Bartenders engage in anticipatory harm-reduction practices.
Enhanced collaboration of bartenders with healthcare can promote responsible alcohol consumption.