The penultimate part of this month's management briefing focuses on the colourful relationship between the drinks industry and the World Health Organization.

The Beer, Wine and Spirits Producers' commitments and the 'Global Actions on Harmful Drinking' programme that preceded them need to be seen in the context of the World Health Organization's 'Global Strategy to Reduce the Harmful Use of Alcohol', which was launched in 2010 and runs to 2020.

While industry action on harmful drinking and responsible consumption has been a feature of its work for many years - predating the WHO Strategy in some instances by decades - the industry realised that the adoption of the WHO Global Strategy in 2010, particularly with the WHO's focus on developing economies, necessitated some specific responses.

During the lead-up to the adoption of the strategy, the degree to which industry engagement should be included was hotly debated. In the end, the involvement of companies, or "economic operators" as they are referred to, was enshrined in Paragraph 45 d/, which reads:

"Economic operators in alcohol production and trade are important players in their role as developers, producers, distributors, marketers and sellers of alcoholic beverages. They are especially encouraged to consider effective ways to prevent and reduce harmful use of alcohol within their core roles mentioned above, including self-regulatory actions and initiatives. They could also contribute by making available data on sales and consumption of alcohol beverages."

That, however, has hardly been the end of the debate. NGOs, and specifically a coalition of health NGOs called the Global Alcohol Policy Alliance (GAPA), has continued to campaign vigorously against industry involvement in the development of alcohol policy or public health and other initiatives related to harm mitigation.

GAPA maintains that Paragraph 48 i/ of the WHO strategy is far more pertinent to the issue of industry engagement. This section states that the WHO will provide support for members states by "continuing its dialogue with the private sector on how they best can contribute to the reduction of alcohol-related harm". However, it adds that "appropriate consideration will be given to the commercial interests involved and their possible conflict with public health objectives". It is the latter sentence that GAPA has highlighted.

In its Statement of Concern, discussed in the previous section of this briefing, GAPA calls on the WHO to clarify the "roles and the responsibilities" of economic operators in the implementation of the its Global Strategy.

Industry representatives, however, do not feel such clarification is necessary. "Paragraph 45 d/ defines very clearly what industry's job is and in a way it's slightly disingenuous to say WHO, you should clarify this," ICAP president Marcus Grant tells just-drinks, adding that the member states had voted unanimously to adopt the strategy with Paragraph 45 d/ included, underlining their support for industry to be involved.

Industry concern over latest WHO position

However, a recent letter from WHO director general Dr Margaret Chan responding to an article in the British Medical Journal (BMJ) appears to lend strong support to the GAPA position and impose qualifications to industry engagement that industry representatives would contend are not explicitly stated.

Picking up on a comment in the BMJ article by Marcus Grant, which states that the Beer, Wine and Spirits Producers' Commitments are responding to what WHO asks of industry in the strategy, Dr Chan writes: "Not so." Economic operators are restricted to their core roles as producers, marketers and sellers of alcohol, she adds, then goes on to say that alcohol companies should have "no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests."

Dr Chan adds that the WHO is "grateful" to researchers and civil society organisations that keep a "careful watch over the behaviour of the alcohol industry". She alludes directly here to accusations that ICAP has been involved in drafting alcohol policy on behalf of member states, something which the organisation denies.

Finally, she states that the WHO "appreciates" the concerns raised by GAPA and invites the authors of the 'Statement of Concern' to meet with senior WHO management to discuss these issues in greater detail.

While industry representatives were being diplomatic about the lack of any official response from Dr Chan during the six months since the commitments were first launched, this letter has clearly touched a nerve.

In a forcefully worded statement to just-drinks, GAPG said:

"It is disappointing that Dr Chan has reacted negatively through the BMJ to the commitments of leading beer, wine and spirits producers, which are a sincere contribution to efforts to reduce harmful use of alcohol.

"The commitments were developed as a contribution to support WHO's 'Strategy to Reduce Harmful Use of Alcohol' as WHO, and Dr Chan personally, have encouraged industry to do more in this area.

"We agree that the development of national alcohol policies is the primary responsibility of national authorities. It is also our experience that many governments do not agree with WHO's view that industry has no role in policy formulation, as industry is often invited by governments to contribute its views and expertise to the policy development process.

"We welcome constructive debate on the most effective policy options to reduce the harmful use of alcohol, and believe in the merit of including a range of stakeholders in such policy discussions. Groups such as GAPA who seek to exclude those with views different from their own do a disservice to the very serious work of addressing harmful drinking worldwide and we encourage them to adopt a more inclusive approach."

ICAP also responded directly to Dr Chan's letter, stating:

"ICAP is a think-tank dedicated to promoting understanding of the role of alcohol in society, and helping to reduce harmful drinking worldwide.

"An important part of our work is conducting research into the causes of and most effective interventions against misuse of alcohol. In disseminating the evidence-based conclusions of that research, we seek to engage and inform the full range of stakeholders involved in policy development. Policymakers sometimes request information from ICAP and may take such information into account in their work, but ICAP does not play a role in drafting national alcohol policies.

"It is our belief that effectively addressing harmful use of alcohol depends on many stakeholders - including NGOs, public health and research communities, the private sector and governments - who each have distinct roles to play."

It should be noted again here that GAPA chairman Derek Rutherford was approached by just-drinks to be interviewed for this briefing but did not respond. The views of GAPA have nevertheless been included through references and links to its Statement of Concern.

The role of member states

As mentioned previously, there is a history of acrimony between the WHO Secretariat in Geneva and the drinks industry. Industry advocates have long complained that the Secretariat has a preset position - sceptical at best and hostile at worst - on industry engagement in addressing alcohol harm. 

While some may have hoped that the adoption of  the WHO strategy, including Paragraph 45 d/, might have laid some of that to rest, most will probably conclude from recent events that little has changed.

In spite of Dr Chan's letter, and the fact that industry has been compelled to respond fairly forcefully to it, industry representatives will probably resume their attempts to foster a more positive relationship with the WHO in Geneva as both the WHO strategy and the Beer, Wine and Spirits Producers' Commitments progress.

However, at the ICAP conference in October and in conversations in the preparation of this briefing, emphasis was clearly being placed on dealing directly with member states, where responsible alcohol companies believe they will generally get a fairer hearing.

As Marcus Grant puts it: "WHO is a club of member states in the end. There may be people in the Secretariat who hold one view or another personally but in the end the WHO is not its experts and it's not its Secretariat, it's its member states. There clearly are some member states whose views would be similar to those of the 'Statement of Concern'. They may be vocal but they're very much a minority." He also stresses once more that the WHO member states voted unanimously to adopt the 'Global Strategy to Reduce the Harmful Use of Alcohol', with Paragraph 45 d/ included.

Collaboration within industry, with external stakeholders and with governments is the subject of the final article in this briefing.

For the final part of this briefing, click here.