Implementing effective alcohol policies: global governance to reduce alcohol-related harm

Sally Casswell

AP15: Policies for Reducing Problems Associated With Alcohol Availability, 2010

Washington DC

What has led towards development of global strategy?

• Expansion and marked consolidation of global alcohol industry in past two decades

• Profits used for investment and marketing in emerging markets (low and middle income countries)

• Rapid rise in consumption and harms in emerging markets and lack of adequate policy response

• Increases in ‘unsaturated segments’ in mature markets

• Increased data availability

DALYs (000) lost in the world due to different risk factors in 2004 (WHO, 2009)

0 10 000 20 000 30 000 40 000 50 000 60 000 70 000 80 000 90 000 100 000

Underweight

Unsafe sex

Alcohol use

Unsafe water, sanitation, hygiene

High blood pressure

Tobacco use

Sub-optimal breastfeeding

High blood glucose

Indoor smoke from solid fuels

Overweight and obesity

Why a Global Strategy on Alcohol? • “Alcohol, in striking contrast with both

tobacco and illicit drugs, lacks a coherent framework for global control of alcohol-related harm” Lancet Series, 2009

Global policy environment

• Global alcohol issues– Marketing and supply – Trade agreements – Limitations of national level response – International industry activity

– Promote ineffective policy and prevention– Partnership focus

Global governance

State sector – national (state and federal) governments – intergovernmental organisations

NGO sector-advocacy-research

TNCs– producers – front organisations

WHO Global Strategy to Reduce the Harmful Effects of Alcohol

• First resolution on alcohol since 1983 at WHA, 2005• Expert Committee report, 2007• Resolution, not endorsed WHA, 2007• Resolution calling for global strategy, amended and endorsed at Executive

Board, Jan, 2008• Resolution calling for global strategy amended and endorsed, WHA, May,

2008• Secretariat draft Working Paper, March, 2008• Consultations

– WHO conducted web based public hearing, October 2008– Consultation with economic operators, November 2008 – Consultation with NGOs, November 2008– Regional technical consultations with Member States in all six WHO regions, February –

May 2009

• Draft Global Strategy to EB, January 2010• Global Strategy endorsed by Member States, WHA, May 2010

Industry Stakeholder Marketing• Recognition of need for organised efforts to avoid tobacco’s fate • First SAO (Portman Group, UK) established 1989 • ICAP established 1995,

– Statements (eg Dublin Principles), publications, conference sponsorship, research….

– Regional and national meetings in emerging markets

• Producers CSR– Drinking Responsibly Campaigns, disaster relief …….

• GAPG established for Global Strategy • Lobbying re Global Strategy

– Presence in Geneva – Targeted publications eg “Working Together to Reduce Harmful Drinking,” ICAP– GAPG lunch briefing to show off industry’s programs to “reduce the harmful use

of alcohol.” (Oct, 2009 )– Paid lobbyists eg Stiehle Consulting, Whittaker Group

Resolutions calling for Global Strategy

• Resolution calling for global strategy amended in Executive Board, Jan, 2008– (4) to collaborate and consult with Member States as well as with

intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol;

• Resolution amended WHA, May, 2008– 4) to collaborate and consult with Member States, as well as consult with

intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol;

Between Working Paper and EB

• 14. “Sustained political commitment, effective coordination, sustainable funding and appropriate engagement of subnational governments as well as from civil society and economic operators are essential for success.”

Between Working Paper and EB

• 58. Bilateral, regional and international trade agreements should consider making provision for alcohol’s status as a special commodity, in the light of its dependence-producing properties and the public health impact of alcohol-related harm.– Working Paper from Secretariat, March, 2008

• No mention of trade– After Executive Board Meeting, Jan 2010

Between Working Paper and EB Marketing • A regulatory framework, preferably with a legislative

basis, with appropriate and timely sanctions is essential for the regulation of marketing and sponsorship of alcoholic beverages ……– Working Paper from Secretariat, March, 2008

• For this area policy options and interventions include: (a) setting up regulatory or co-regulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures, for alcohol marketing by …– After Executive Board Meeting, Jan 2010

• Marketing changes between Working Paper and EB

• Trade dropped

Between Working Paper and EB

•  Taxation – Softened: re alcohol content, – Removed: re beverages attractive to young, removal

of duty free, benchmarking prices with basic commodities

• Supply– Softened re liability of sellers and servers

“16. The policy options and interventions available for national action can be grouped into 10 recommended target areas which should be seen as supportive and complementary to each other. These 10 areas are:

1. leadership, awareness and commitment2. health services’ response3. community action4. drink–driving policies and countermeasures5. availability of alcohol6. marketing of alcoholic beverages7. pricing policies8. Reducing the negative consequences of drinking and alcohol

intoxication9. reducing the public health impact of illicit and informally produced

alcohol10.monitoring and surveillance.”

WHO (2010) Global Strategy to Reduce Harmful Use of Alcohol

WHO Global Strategy on Alcohol – policy options and interventions

(a) Public policies and interventions to prevent and reduce alcohol related harm should be guided and formulated by public health interests and based on clear public health goals and the best available evidence

(c) All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions and interventions to reduce harmful use of alcohol

(d) Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted

WHO (2010) Global Strategy to Reduce Harmful Use of Alcohol

WHO Global Strategy on Alcohol – principles

• The strategy acknowledges the significance of different national, religious and cultural contexts for alcohol and proposes a menu of options that Member States may tailor to their cultures in order to reduce the harmful use of alcohol. The strategy also recognizes the need for the involvement of all stakeholders, including the industry, and the importance of self-regulation in helping address alcohol abuse…………………..

NGO activity

• Less well developed than in tobacco • GAPA, APAPA, IAPA, EAAPA ………• Evidence of effective policy and

implementation in different contexts• Making apparent and providing critique of

industry activity

Intergovernmental

• WHO – Research project on alcohol and development

• FASD; Harm to others; implementation effective policies in context of development; infectious diseases (TB, HIV)

– Establishing alcohol national counterparts – Global meeting on implementation mechanisms, 8-11

February, 2011– Report to WHA, 2013

• UN– high level meeting on NCDs, 2011

In Conclusion

• Global Strategy achieved• Process illustrates key interests and players in

global governance of alcohol • Not a health treaty but…………. • ‘globalised rules and principles can be of

consequence even if utterly detached from enforcement mechanisms’ (Braithwaite and Drahos, 2000)

• Provides a framework for evaluation of global developments in 2013