Focus - Global strategy takes WHO engagement on alcohol to new level
The WHO has adopted its 'Global Strategy to Reduce the Harmful Use of Alcohol'
At the recent World Health Assembly, the World Health Organization (WHO) formally adopted a global strategy to tackle alcohol-related harm. Ben Cooper looks at stakeholder reaction to the strategy and assesses its likely impact on the development of alcohol policy across WHO member countries.
Alcohol industry representatives will know only too well that the World Health Organization (WHO) has had plenty to say about alcohol-related harm over the years, but the formal adoption of a global WHO strategy to tackle the harmful use of alcohol is nonetheless an important milestone for the Geneva-based organisation.
It is likely to have a significant influence on how alcohol policy is shaped across many countries, and is thus a critical event for the drinks industry.
At the World Health Assembly (WHA) last month, the 193 nations of the WHO reached consensus for the first time on a resolution to confront the harmful use of alcohol, and along with it adopted the WHO's first global alcohol harm strategy.
The strategy covers ten policy areas: leadership, awareness and commitment; health services' responses; community action; drink-driving policies; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of drinking and alcohol intoxication; reducing the public health impact of illicit alcohol and informally produced alcohol; and monitoring and surveillance.
It lays out a raft of policy options and interventions for consideration by WHO member states for each of the target areas, based on current scientific knowledge, available evidence on effectiveness and cost-effectiveness, experience and good practices. "The resolution and the strategy set priority areas for global action, provide guidance to countries and give a strong mandate to WHO to strengthen action at all levels on reducing harmful use of alcohol," said WHO assistant director-general Dr Ala Alwan.
The Global Alcohol Policy Alliance (GAPA), a network of academics, public health professionals and campaigners with a special interest in alcohol policy, said it believed the move by the WHO to endorse a global strategy represented an "historic decision".
GAPA said that the concerns identified included the increasing culture of binge drinking among young people worldwide, and the expanding influence of the marketing and advertising of alcoholic beverages. The strategy highlights the effectiveness of focusing on policies regarding pricing, availability and marketing of alcohol, GAPA said.
While the drinks industry has at times had a difficult relationship with the WHO, the strategy has been notable for the level of consultation with industry prior to its drafting. Major drinks companies participated in the consultation, and the Global Alcohol Producers Group (GAP Group), which represents major international drinks corporations, said the strategy was "an important and constructive step forward in helping address alcohol issues around the world".
The drinks industry appears to welcome a more conciliatory approach emanating from Geneva, and was appreciative of concessions that had been made. GAP Group said it was pleased that the strategy acknowledged the significance of different national, religious and cultural contexts for alcohol and proposed a range of alcohol policy options which member states can "tailor to their cultures" in the aim of reducing alcohol harm.
In particular, industry advocates have in the past been frustrated by a sceptical view taken in Geneva towards industry self-regulation. So, not surprisingly, GAP Group commended that the strategy, as GAP Group put it, "recognises the need for the involvement of all stakeholders, including the industry, and the importance of self-regulation in helping address alcohol abuse".
In its section on marketing, the strategy supports "setting up regulatory or co-regulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures". Interestingly, this was an area singled out for criticism by GAPA earlier this year.
But, it is an olive branch the industry will grasp with both hands. Carol Clark, a spokesperson for the GAP Group, said: "Members of GAPG plan to work constructively with the World Health Organization and Member States to help promote implementation of the strategy by supporting and contributing to feasible and effective policies that reduce harmful drinking."
As for what effect the strategy is likely to have on alcohol policy across WHO member states, it is very early to say. The adoption of the strategy at the WHA may have marked the end of a two-year process, but it is in essence just the beginning for the strategy. It should also be said that many countries are already implementing some of the policies outlined in the strategy. Indeed, it is based in part on best practice already in place in some countries.
Where it could have a pronounced and possibly speedy impact is in accelerating change in countries, notably in the developing world, which have been slower in tackling the problem, or lack the resources and experience to do so.
Given the strategy's breadth, it will be viewed selectively. Advocates of minimum pricing, for example in the UK and New Zealand, were quick to highlight its inclusion within the strategy. By the same token, industry representatives questioned the wisdom of minimum pricing while highlighting the strategy's references to tackling illegal production. What is certain is that it will become, at the very least, a reference point in policy debates across many countries for some years to come.
In a sense, it represents a formalisation and amplification of the role the WHO already plays in garnering and disseminating knowledge and expertise, but it clearly offers a substantial development of that capability with regard to alcohol. Moreover, the resolution for action agreed at the WHA gives the WHO a new mandate to involve itself in alcohol policy debates within member states.
However, another crucial facet of the strategy is that it not only seeks to make an impact on the implementation of alcohol policies within member states but also across member states.
The WHO has a transnational capability that many feel could be extremely significant in fighting alcohol-related harm going forward. The strategy states that "given the magnitude and the complexity of the problem, concerted global efforts must be in place to support Member States in the challenges they face at the national level. International coordination and collaboration create the synergies that are needed and provide increased leverage for Member States to implement evidence-based measures."
To that end, the WHO will, according to the strategy, provide leadership; strengthen advocacy; formulate evidence-based policy options; promote networking and exchange of experience among countries; strengthen partnerships and resource mobilisation, and coordinate monitoring of alcohol-related harm and the progress countries are making to address it.
GAPA chairman Derek Rutherford said: "Concerted action to reduce global alcohol problems is long overdue," adding that the decision by the World Health Assembly "goes a long way in recognising the transnational aspects of the alcohol issue".
How the alcohol debate will pan out at an international level is arguably even harder to predict than debates already being conducted in individual countries. But what public health campaigners clearly feel they have lacked is some form of international authority and legitimacy to counterbalance the global nature of the industry and the multinational corporations which dominate it. To expect the WHO alone to fulfil that function would be unrealistic, but the global alcohol strategy should certainly increase the leverage of NGOs and public health campaigners in the international arena.
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