The 61st World Health Assembly published its resolution on "Strategies to reduce the harmful use of alcohol" last month. Ben Cooper examines the resolution and the response from public health agencies and industry.

The drinks industry tends to anticipate announcements from the World Health Oganization (WHO) with a degree of trepidation, but the resolution on "Strategies to reduce the harmful use of alcohol", published following the WHO's World Health Assembly (WHA) last month, was welcomed positively.

The subjects being discussed at the WHA were ones that industry representatives will rarely relish. However, engaging with NGOs, public health organisations and governments in addressing alcohol-related harm is now accepted as an important responsibility for the industry, and vitally necessary to the retention of market freedoms.

The communiqué issued by the WHO sums up the problem. "The disease burden attributable to harmful use of alcohol is significant and in many countries public health problems caused by harmful use of alcohol represent a substantial health, social and economic burden", the WHO states.

The WHO ranks the harmful use of alcohol as the fifth leading risk factor for premature death and disability in the world, and the third in developed countries, after tobacco and blood pressure. It continues: "Harmful drinking is associated with numerous social consequences, such as road traffic accidents, crimes, violence, unemployment and absenteeism. It generates health-care and societal costs. The health and social consequences tend to hurt less advantaged social groups most and contribute to disparities in health between and within countries."

The reduction of the harmful use of alcohol has become a priority at national, regional and global levels, the WHO continues, and alcohol-related harm can be reduced through the implementation of "proven alcohol strategies". To that end, on 24 May, the WHA's resolution called for the development of a "draft global strategy to reduce the harmful use of alcohol".

The draft strategy will first be presented to the WHO's Executive Board in January 2010 and then to the World Health Assembly in May 2010 for adoption. The resolution emphasises an "urgent need for action now", adding that effective strategies and interventions that target the general population, vulnerable groups, individuals and specific problems are available and should be optimally combined in order to reduce alcohol-related harm.

The WHA resolution states that the global strategy will be developed in close collaboration with Member States, but that other stakeholders, such as NGOs and the alcohol industry, will be consulted on ways that they can contribute to reduce harmful use of alcohol. However, while advocating a global strategy, the resolution acknowledged that there are "regional, national and local differences in levels, patterns and context of drinking".

Representing the industry, the Global Alcohol Producers Group (GAP Group) welcomed the resolution as "balanced and constructive", particularly as it acknowledged the importance of the different national, religious and cultural contexts, and that the global strategy would therefore consist of a set of measures that governments could tailor to their needs.

The GAP Group was formed by 16 leading companies to engage in discussions with the WHO. However, one of the sticking-points prior to the resolution being agreed was how such involvement would be represented in the strategy. At the draft stage, the term "collaborate" was used to describe the involvement of the industry, which some Member States had strongly opposed. In the final version, this has been replaced by "consultation with" commercial operators.

It appears that industry advocates were in fact not lobbying for the stronger wording, and the GAP Group's statement seems to support this. "The GAP Group companies promote partnership initiatives to curb drink driving, illegal underage and excessive drinking; the companies also promote alcohol education, conduct responsible drinking campaigns and share best practice in self-regulation of advertising. They look forward to working with WHO as it develops a global alcohol strategy over the next two years. As the resolution mandates the WHO to consult with economic operators, GAP Group companies are eager to make available their experience and insights in discussions with the WHO and are ready to discuss on ways they can contribute further to reducing harmful use of alcohol."

However, the Global Alcohol Policies Alliance (GAPA), a network of NGOs and individuals working in public health agencies, was more specific regarding the distinction between the terms "consult" and "collaborate". Its response noted that "the resolution properly distinguishes the roles of commercial and other participants in the development of the strategy and rejects WHO collaboration with the alcoholic beverage industry".

"We were opposed to collaboration with the industry," says Derek Rutherford, chairman of GAPA. "Yes the industry should be consulted but they are not the deciders of policy. Decisions must not be taken by vested interests. What the industry should be doing is looking very carefully at their marketing strategies, particularly to young people. We want to see deeds not just words."

The specifics of the global strategy will evolve over the coming 18 months, but GAP Group warned against "a singular focus on high taxes and restrictions on availability being seen as a panacea that will solve harmful drinking. 

"Such quick-fix solutions on their own are ineffective in addressing and assisting the minority who misuse alcohol," GAP Group continues, "and may result in unintended consequences such as black markets and illicit products that negatively impact public health and well-being".

This is a longstanding area of divergence between public health advocates and the industry, and it was not surprising to find Derek Rutherford in strong disagreement. "The evidence is there that price and tax does work to control consumption," he tells just-drinks. "Price does matter."

With both sides claiming there is evidence to support their respective views, Rutherford calls for policy to be decided on the weight of evidence. "What we want to see is evidence-based policies," he says, though in common with GAP Group he supports the idea of strategies taking account of different cultural contexts. "There is not an international blueprint. There will be a selection of policies and the various economic, cultural and social backgrounds of different Member States must be taken into account in the development of alcohol policies."

So it appears that the next 18 months is going to see extensive discussion at a global level of the problems created by alcohol misuse and the possible solutions. Some of this is unlikely to be comfortable for the drinks industry but the WHA resolution has at least ensured that it will continue to be involved in the process.