Contributing to the WHO’s consultation on the development of a new global alcohol action plan, Movendi International proposed eleven solutions to accelerate action on alcohol harms. Movendi International also collaborated closely with a range of other civil society organizations to ensure more perspectives are considered by the WHO.
In February 2020, the WHO’s Executive Board took a unanimous decision to request the Secretariat to develop a global alcohol action plan. Member States agreed that the global alcohol burden is a “public health priority” and therefore requested “accelerated action” on alcohol harm.
Concretely, the Executive Board, in its decision, requested the WHO Director-General to:
- Develop an action plan (2022-2030) to effectively implement the WHO Global Alcohol Strategy as a public health priority, in consultation with Member States and relevant stakeholders, for consideration by the 75th World Health Assembly through the 150th session of the WHO Executive Board in 2022.
- Develop a technical report on cross-border alcohol marketing, advertising and promotion issues, including targeting of youth and adolescents, before the 150th session of the WHO Executive Board, which could contribute to the development of the action plan.
- Adequately resource the work on alcohol harm.
The importance of that decision and the renewed commitment to tackle alcohol harm as public health priority, was underlined by a landmark study, released in October 2020. The Global Burden of Disease study for 2019 found that failure in tackling preventable non-communicable diseases has made the world more vulnerable to COVID-19. The study highlighted worrying data about alcohol’s contribution to the global burden of disease.
Alcohol remains one of the leading risk factors contributing to the global burden of disease.
- Alcohol is the eight leading preventable risk factor of disease.
- The contribution of alcohol to the global disease burden has been increasing year by year from 2.6% DALYs in 1990 to 3.7% DALYs in 2019.
- In high income countries alcohol use is the second fasted growing risk factor and in LMICs it is the fourth fastest rising risk factor.
- Alcohol is the second largest risk factor for disease burden in the age group 10-24 years (GBD does not count FAS and FASD, so alcohol is not mentioned in the group 0-9 years).
- Alcohol is the largest risk factor for disease burden in the group 25-49 years.
Global action plan to improve alcohol policy development worldwide
In this context, the World Health Organization launched an extensive consultation process, lasting for more than a year, involving Member States, civil society, academia, other UN agencies, and – controversially – also the alcohol industry, despite their fundamental conflict of interest.
The first web-based consultation took place in November and December, 2020, and received more than 250 comments on the so called ‘working document’ to develop the global alcohol action plan. In 2021, WHO consulted with Member States specifically in dedicated regional meetings.
And in July of this year, the special unit task to manage the entire process, the Alcohol, other Drugs, and Addictive Behaviors unit at the WHO Secretariat in Geneva, published the first draft, announcinng:
This first draft of the action plan is based on input received thus far in the consultation process.” (PDF)
Alcohol, other Drugs, and Addictive Behaviors unit, WHO Secretariat, Geneva
Subsequently, the second round of the web-based consultation was launched, giving civil society another chance to contribute insights and expertise to help improve the draft action plan.
11 Suggestions for improving WHO’s draft alcohol action plan
Following up on the thorough analysis Movendi International made of the decade of implementation of the WHO Global Alcohol Strategy (or lack there of), and building on its comprehensive submission to the first web-based consultation, Movendi International now made eleven key suggestions to help improve the draft action plan.
The focus is on how to facilitate and improve country action to protect more people through alcohol policy solutions.
3 key suggestions
Movendi International President Kristina Sperkova commented on the latest submission to the World Health Organization:
For our members, every single suggestion matters because together they shape an ambitious action plan that has the potential to make a difference on the country and community level.
It is that dimension that needs most attention, support, investments, and protection against alcohol industry interference.”
Kristina Sperkova, International President, Movendi International
1. Do not normalize Big Alcohol
Movendi International requests significant change to the draft action plan regarding the way the alcohol industry is being addressed. The alcohol industry should not be assigned any role, action or measure in the alcohol policy response to the harm that their own products and practices are causing. Instead, Movendi International proposes for the action plan to be much clearer about spelling out the fundamental conflict of interest inherent in any involvement of the alcohol industry in public health oriented alcohol policymaking.
The alcohol industry has been identified as the biggest obstacles to country action on alcohol harms, according to the regional consultations. The action plan therefore should focus on substantial action to protect alcohol policy development from alcohol industry interference.
2. Ensure bolder targets and bigger ambition
The last decade has been a lost decade for alcohol policy action to protect more people and communities from the harms caused by the products and practices of the alcohol industry. To bring about transformative change, the new action plan needs to contain ambitious targets and bold actions. And Member States have called for an action plan that has the potential to accelerate action on alcohol as public health priority.
- Ensure bolder targets and bigger ambition,
- Craft stronger conclusions evaluating the decade of WHO GAS implementation,
- Better consider the needs of the most vulnerable and devise stronger actions to protect those at risk of being left behind,
- Improve and enhance the structure and apply best practices from other WHO action plans,
- Ensure greater focus on the SAFER strategies,
- Facilitate country action,
- Don’t normalize Big Alcohol through the global alcohol action plan,
- Ensure greater focus on governance and infrastructure improvements,
- Improve resourcing as well as reporting and review of implementation,
- Update nomenclature in line with state-of-the-art evidence, and
- Convening an Expert Committee.
Movendi International proposes an ambitious target to reduce overall alcohol use in countries by 30% until 2030.
Movendi International also suggests an ambitious target to protect alcohol abstainers from pressures to start consuming alcohol – as is enshrined in the WHO Global Alcohol Strategy, but where no action has been developed so far. The target should be to at least maintain current levels of people living free from alcohol, including children, youth, and adults.
And Movendi International requests even more ambitious focus on and investment in advancing the three alcohol policy best buys to improve countries’ alcohol policy action.
3. Build a better, more sustainable alcohol policy infrastructure
In other areas of global health, such as tobacco control or the work against anti-microbial resistance, there is a robust, developed and functional infrastructure to govern and advance policy solutions in the respective area. There are international collaboration platforms, global ministerial meetings, networks of national experts. On national level, there are mechanisms for governments and civil society to meet and cooperate.
These infrastructure elements are critically important but have so far been missing in the area of alcohol policy development.
Therefore, Movendi International is proposing to build better, more sustainable alcohol policy infrastructure on all levels, through the new action plan. This is needed for countries to learn from each other, support one another, exchange best practices and collaborate across borders – to tackle the alcohol burden.
This infrastructure improvement should include a global initiative to support countries in advancing alcohol taxation. It should also create the first global ministerial conference on alcohol policy.
Why this matters: Lack of progress and failure to implement high-impact alcohol policy solutions
Evidence shows that alcohol policy development has been ineffective over the past decade of the WHO Global Alcohol Strategy (WHO GAS). Technical support to governments has been inadequate, for example concrete technical tools have still not been developed, and the WHO Secretariat has not allocated adequate resources to the work on alcohol harm. Efforts to protect country initiatives for alcohol policy have also been inadequate in the last decade, so that the alcohol industry could interfere, delay and derail such initiatives.
Overall, trends in alcohol consumption, alcohol’s contribution to the global burden of disease, and progress towards global targets are all pointing the wrong direction.
- Progress in the formulation and implementation of national and local alcohol policy solutions has been insufficient.
- Most countries, especially low- and middle-income countries (LMICs), have NOT implemented a comprehensive set of alcohol policies.
- No low-income country has reported increasing resources for implementing alcohol policy in the last decade.
- Many countries are failing to implement the alcohol policy best buy solutions, with LMICs more likely to have fewer evidence-based and cost-effective policies.
- Modelling forecasts that global targets to reduce alcohol use and harm will not be met.
- Without action, Africa could see an increase in both the absolute number and proportion of people consuming alcohol, the amount consumed per capita and heavy episodic alcohol use.
- South East Asia has seen a 29% increase in per capita alcohol use since 2010.
Alcohol affordability
95% of reporting countries implement alcohol excise taxes.
Few use such taxes as a public health policy to reduce consumption.
Less than half use price strategies such as adjusting taxes to keep up with inflation and income levels, imposing minimum pricing policies, or banning selling below cost or volume discounts.
Alcohol availability
Less than one-third of countries have regulations on outlet density and days of alcohol sale.
Some countries, mainly LMICs in Africa, still have no legal minimum purchase age.
Alcohol marketing
Most countries have some policies on alcohol advertising.
Alcohol marketing regulation continues to lag behind technological innovations and e-commerce, including rapidly developing new delivery systems.
Most of the countries that reported no restrictions across all media types were located in the African or Americas regions.
Alcohol remains one of the leading risk factors contributing to the global burden of disease.
- Alcohol is the eighth leading preventable risk factor for disease.
- The contribution of alcohol to the global disease burden has been increasing year by year from 2.6% of DALYs* in 1990 to 3.7% of DALYs in 2019.
- In high income countries, alcohol use is the second fastest growing risk factor and in LMICs it is the fourth fastest rising risk factor.
- Alcohol is the second largest risk factor for disease burden in the age group 10-24 years.
- Alcohol is the largest risk factor for disease burden in the group 25-49 years.
Supporting advocacy from the NCDs prevention and control community
Movendi International also worked closely with partners from the NCDs prevention and control community to develop a distinct response to the WHO consultation.
Together, 12 expert organizations from global, regional and national levels came together to craft another comprehensive submission, incorporating the specific perspectives and expertise.
Many organizations also submitted individual comments, such as EPHA and the WCRFI.
The group welcomed several elements of the first draft and requested the removal of others.
Together, they request WHO to reassess the role assigned to the alcohol industry in the action plan. The abundance of activities assigned to the alcohol industry across the action areas was riddled by conflicts of interest and legitimized industry involvement.
- American Institute for Cancer Research,
- CLAS Coalition for Americas’ Health / Coalición América Saludable,
- European Public Health Alliance (EPHA),
- Movendi International,
- NCD Alliance,
- Norwegian Cancer Society (Kreftforeningen),
- Union for International Cancer Control,
- Vietnam NCD Alliance,
- Vital Strategies,
- World Cancer Research Fund International (WCRFI),
- World Heart Federation, and
- World Obesity Federation.
They also request:
WHO should desist with dialogues with the alcohol industry whose interests conflict with those of public health. In the same manner that WHO does not engage with the tobacco industry and abides by the International Code of Marketing of Breast-milk Substitutes, WHO should cease this harmful practice that does not serve public and global health, but instead can be seen to legitimize or further the interests of the alcohol industry.”
NCDs control civil society groups
The group also took issue with the concept of “harmful use of alcohol” that is being used in the draft action plan. This concept was not compatible with evidence that has developed since the publication of the WHO GAS in 2010. The Global Burden of Disease study 2018 showed that there is no safe level of alcohol consumption. Therefore, in the submission, the group requested the draft global action to apply the latest scientific evidence and the term “harmful use” be updated to “alcohol use” and/or “alcohol harms”.
Moreover, the group made seven constructive suggestions to further improve the draft action plan. A focus is, among others, better facilitation of alcohol policy country action through a set of mechanisms that the action plan should outline and support.
Bringing together the alcohol prevention community
Working cloesly together with a set of national alcohol policy advocacy organizations and other partners, Movendi International also brought together the wider alcohol policy community to develop and submit a joint contribution to the consultation.
Through the Alcohol Policy Futures platform, a coalition of 25 civil society organizations from more than 20 countries addressed five priority areas to help improve the draft action plan:
- Further strengthen the focus on the alcohol policy best buy solutions, including better/ more specific targets and indicators,
- Review the role assigned to the alcohol industry in the document, and better cover conflict of interest concerns,
- Improve and develop the terminology, especially concerning the concept of “harmful use of alcohol”, and the definition of “economic operators”,
- Review and improve the structure, logic, and coherence of the action plan, and
- Strengthen review of and reporting on progress (or lack thereof) on a regular basis, including capacity building to do so, as well as resourcing.
Kristina Sperkova, International President of Movendi International commented on the importance of these efforts of collaboration:
We are thankful for the outstanding collaboration with so many partners. It shows that people around the world deeply care about how the WHO and our countries respond to alcohol harm. This level of engagement from the NCDs control and the wider alcohol prevention community is unprecedented.
Working together in this way really allows us to speak with one voice, to amplify one another and to counter the attempts of Big Alcohol to undermine the process.
Working together also allows us to really learn from each other and to ensure that valuable lessons and unique expertise is brought to bear on the development of this new alcohol action plan.”
Kristina Sperkova, International President, Movendi International
Find all three consultation submissions
Movendi International, submission to the second web-based consultation on the development of the WHO global alcohol action plan: “11 SUGGESTIONS FOR IMPROVEMENTS”
Alcohol Policy Futures submission: “First draft of the global action plan for improving WHO GAS implementation”
Joint submission by NCDs prevention and control expert organizations: “WHO Web-Based Consultation on the first draft of the global action plan to improve the implementation of the WHO Global Alcohol Strategy”
