A decision unanimously adopted at the World Health Organization’s Executive Board meeting calls the global alcohol burden a “public health priority”. In the decision, countries request “accelerated action” on alcohol harm.
After more than 12 hours of informal consultations during the entire week of the 146th session of the WHO Executive Board, a bloc of countries led by Thailand won the approval from the Board to develop a new global action plan to reduce alcohol harm.
A decision was adopted by unanimous consent that now identifies alcohol as a “public health priority”.
The decision contains four action points, requesting WHO and its Director General to:
- Develop an action plan (2022–2030) to effectively implement the WHO Global Alcohol Strategy as a public health priority;
- Develop a technical report on cross-border alcohol marketing, advertising and promotional activities, including those targeting youth and adolescents;
- Resource the work on alcohol harm and policy solutions adequately; and to
- Review the WHO Global Alcohol Strategy and report to the 166th session of the Executive Board in 2030 for further action.
The draft decision was originally proposed by Bangladesh, Bhutan, India, Indonesia, Islamic Republic of Iran, Philippines, the Russian Federation, Sierra Leone, Sri Lanka, Thailand and Viet Nam, with Norway and the European Union member states also jointly co-sponsoring the decision after compromise was reached.
The original proposal, circulated by Thailand to WHO Member States shortly before the Executive Board would convene, contained two action points, requesting the WHO Director General to:
- “Exercise global leadership as a world healthy role model by not selling and refrain from provisions of alcoholic beverages in all WHO buildings and campuses, including at all meetings and conferences organized, sponsored or co-sponsored by the World Health Organization;” and to
- “Convene a working group to review and propose the feasibility of developing an international instrument for alcohol control; and report to the 148th session of the Executive Board in 2021.”
The agreed compromise was the removal of the request to launch a working group exploring the development of an international instrument for alcohol control.
This part was completely removed as countries such as the United States, Canada, Australia, New Zealand, the UK and Haiti mounted strong opposition to this and other topics, according to sources familiar with the negotiations.
The compromise also significantly softened the request to change WHO’s internal policies on alcohol. The action request to ensure alcohol-free WHO venues and events was removed. Instead the “alcohol-free WHO request” was mentioned in the preamble part of the decision. The amended text simply acknowledges that some WHO regional offices do not offer alcohol as a practice to accelerate action.
Big interest, strong statements and some alcohol industry talking points
The WHO Executive Board session discussed alcohol policy considerations twice in the public session, aside from the informal consultations going on throughout the week. After the World Health Assembly deliberations in May 2019, the wide interest of countries in alcohol policy was apparent again.
Some countries have clearly been advancing alcohol industry positions and talking points – both in the informal consultations as well as in their public statements during the sessions. The deliberations were split into two parts as some chaos reigned – originally the meeting chair had announced the suspension of the alcohol policy discussion until the informal consultations had been concluded. But in reversal of this announcement, the agenda item was opened on Wednesday, February 5th, in the afternoon (see webcast at 19:40 minutes):
Tajikistan, as member of the Executive Board, made the first statement on the agenda item about the response to the global alcohol burden. Tajikistan highlighted the fact that alcohol per capita consumption has been rising, not declining, since the adoption of the WHO Global Alcohol Strategy in 2010, and that alcohol use and related harm are further projected to rise until 2025. Therefore, Tajikistan suggested to explore the necessity of an “international convention” similar to the one for tobacco. Tajikistan also highlighted the importance of restricting the alcohol trade and their influence on people’s alcohol use.
The United Arab Emirates then spoke on behalf of the member states of the WHO Eastern Mediterranean Region. The UAE noted that alcohol harm affected “all of us”, feeding into the NCDs epidemic and thus making national strategic plans important. The UAE also called for the creation of a network of regional experts.
Japan followed by requesting additional focus on inappropriate alcohol consumption habits; the country’s representative also requested to engage with the private sector in the implementation of the WHO Global Alcohol Strategy.
Japan is home to one of the world’s largest alcohol producers, Kirin Holdings.
The United States expressed disagreement with the call for a new international instrument, urged delegations to reaffirm the validity of the WHO Global Alcohol Strategy and to focus on its action areas. Furthermore, the U.S. encouraged taking a multi-sectoral and multi-stakeholder approach to address alcohol harm and expressed recognition for the fact that alcohol harm extended beyond the area of NCDs and that solutions could not be limited to the health sector alone.
The United States are home for a number of giant transnational alcohol corporations and are pursuing an agenda of deregulation – despite pervasive alcohol harm. The U.S. has the second largest beer market in the world.
Australia stressed their concern about the magnitude of alcohol-related disease and injury and noted the particuarly high burden in their region, the Western Pacifics; further, they underlined their voluntary commitment to reducing alcohol per capita consumption by 10% until 2025. Australia also empahsized the value of the four priority areas outlined in the WHO Global Alcohol Strategy and the need for a multi-sectoral approach to foster effective action.
The WHO Global Alcohol Strategy contains four priority areas:
- Public health advocacy, partnership and dialogue,
- Technical support and capacity-building,
- Production and dissemination of knowledge, and
- Resource mobilization.
Brazil highlighted the “domestic complexities of the issue” and expressed the wish to have been engaged earlier and on a higher level in the drafting of WHO’s report; their representative also claimed that Brazil was deeply committed to the implementation of the WHO Global Alcohol Strategy, citing the fact that alcohol consumption was a factor in 200 disease and injury conditions; further, Brazil stressed the multi-dimensional nature of alcohol issues that include economic and cultural considerations and therefore Brazil encouraged member states to engage all stakeholders in the discussions. Finally, and seemingly in contradiction to the previous point, Brazil emphasized that recommended actions to reduce alcohol harm should be evidence-based.
Also Brazil is home of powerful alcohol industry interests and has the third largest beer market by volume in the world, after China and the United States. It is currently the turf of a protracted beer war and lacks any significant, evidence-based alcohol policy regulations.
Argentina underlined that alcohol harm continued to be a major public health problem in the country. Argentina suggested to create and strengthen integrated healthcare networks and to address both the physical and mental health dimensions of alcohol harm, as well as the gender dimensions. The Argentinian representative then urged the Secretariat to help identify appropriate measures to be taken in order to protect Women’s Rights through alcohol prevention and control; they also stressed the importance of considering alcohol’s adverse impact on the social protection and safety networks in countries around the world as well as alcohol’s negative effects on youth, indigenous people, older people and other vulnerable demographic groups. Finally Argentina highlighted that there were many urgent challenges arising from alcohol harm and called for an integrated and cross-cutting approach to alcohol harm.
Sweden highlighted that alcohol prevention is an important part of a public health policy due to the heavy burden alcohol harm places on societies; the Swedish representative also emphasized that a health in all policies approach was necessary to address the health, social and economic burden of alcohol – in line, for example, with the targets of the 2030 Agenda. Sweden further stressed the clear link between alcohol use and cancer, as well as alcohol as a key factor in violence; therefore reducing alcohol availability would mean cancer prevention and reducing the levels of violence in society. Sweden further stressed that investing in alcohol prevention was beneficial even economically, as it meant reduced costs for society as a whole. Finally, the Swedish representative outlined the cross-sectoral and cross-border challenges of alcohol policy-making and welcomed more international collaboration to reduce alcohol harm.
Later in 2019, new research illustrated the costs of alcohol use in Sweden amounting to SEK 103 billion (ca. €10 billion), annually. The study showed that alcohol harm burdens the healthcare and social welfare system, the economy and productivity, the judicial system and police, as well as people’s quality of life. These costs amount to 0.2% of Swedish GDP.
New Zealand expressed the country was very supportive of a stronger response to alcohol harm and noted that WHO’s GPW13 provided a useful framework for the response to alcohol harm, considering which global public goods would be most useful; according to New Zealand they consider the issue of satellite and digital marketing to be sitting squarely at the global level. The country representative also noted that there was much work to build on, such as the SAFER initiative; to conclude their statement New Zealand requested further guidance from WHO regarding the role of economic operators.
Russia noted its own experience showed that only full political commitment to implementing the alcohol policy best buys, combined with international collaboration and the strengthening of state-control measures would enable countries to make the necessary progress towards bringing down levels of alcohol consumption and related harm; Russia further expressed support for WHO’s future work in order to reduce levels of alcohol harm.
As recently as October 2019, a report by WHO Europe found that alcohol consumption in Russia had fallen by 43% since 2003. This decrease has led to a historic peak in life expectancy of Russians, thanks to comprehensive implementation of WHO-recommended alcohol policy measures.
Canada noted that the WHO Global Alcohol Strategy had not been effectively implemented over the past 10 years, and that implementation of the WHO best buy alcohol policy solutions has been lacking; the country also expressed continued concern about the fact that alcohol remained a leading risk factor for NCDs.Further, Canada empahsized the importance of increased international collaboration and commitment to make progress on reducing alcohol harm; therefore Canada welcomed the additional attention by the WHO governing bodies on this issue.
Ecuador highlighted that they participated both in the regional as well as in the online consultations conducted by WHO to review the implementation of the WHO Global Alcohol Strategy; it outlined its current efforts to draw up a national strategy for the prevention and reduction of alcohol consumption and outlined several national challenges, such as the lack of a government policy regulating alcohol retail. Ecuador stressed they would like to see a strengthening of the international legal framework on alcohol and underlined its wish to see increased international cooperation in the area of alcohol control.
South Korea began its statement by citing the WHO SAFER initiaitve’s five areas of recommended action; it stated that Korea’s alcohol policies may also be considered weak, for example when compared to its anti-smoking measures. Further the Korean representative requested mutli-dimensional strategies to tackle alcohol harm comprehensively and to improve the alcohol consumption culture, to build enabling environments for alcohol policy and to strengthen public support for alcohol control measures. The country also requested WHO to play a proactive role, for example through sharing best practices and providing technical assistance; it also stressed that alcohol policy-making required whole-of-government approaches as well as the cooperation of the public and private sectors; finally, South Koera empahsized the need for national, regional and global level discussions about alcohol policy solutions.
A number of civil society organizations delivered statements, too, addressing the need to better tackle alcohol harm on all levels:
- The Union for International Cancer Control, supported by the NCD Alliance, Vital Strategies and the World Cancer Research Fund International made a powerful statement recommending to establish an expert working group through the WHO governing bodies to determine the modus operandi for delivering dramatic reductions in alcohol harm by 2030, including consideration of internationally binding instruments; to develop a Global Action Plan on Alcohol (2022-2032) through the WHO Secretariat; to increase resources for the Secretariat and the UN Inter-Agency Task Force on NCDs to oversee the aforementioned mandates and to provide technical assistance to Member States; and calling on WHO to cease bi-lateral dialogues with alcohol industry actors and call on Member States to publish public records of any engagement.
- Public Services International expressed support for a “World No Alcohol Day” and for the WHO Safer initiative. PSI also voiced concerns about WHO dialogues with the alcohol industry.
- Movendi International delivered a statement to outline four key elements of the way forward: in the face of overwhelming evidence that the alcohol industry has not acted responsibly in the last decade, as they continue to rely on heavy alcohol use for most of their profits, the following actions promise a more successful future:
- End the dialogue meetings with the alcohol industry and pave the way to a global binding treaty;
- Make alcohol control the priority it should be – through better resourcing, better mainstreaming alcohol policy across health topics, better supporting Member States with technical guidance and protection against industry interference;
- Create a sustainable global and regional infrastructure – consisting of focal point networks, best practice exchange, country missions, and high-level events;
- Promote public awareness of alcohol harm and policy solutions.
The agenda item was then taken up again on Friday, February 7th, to adopt the draft decision, when additional countries made their statements.
A number of remarkable statements were delivered by a broad range of countries (see WHO recording, above, from 1:37:50 hours).
For example, the EU and its members states expressed serious concern about the slow progress in implementing the WHO Global Alcohol Strategy. Germany, making the statement on behalf of the EU member states, highlighted that in 2016 more than 290,000 people died due to alcohol in the European Union; Germany also stressed the link between alcohol and cancer.
We have to do better,” said the joint statement of EU member states.
The statement further underlined the sense of urgency and the need for international coordination and cross-border collaboration to address alcohol harm comprehensively, citing digital marketing as likely the most striking example.
Bangladesh further noted the grave concern that no progress had been achieved so far in reducing total per capita alcohol consumption globally, since the adoption of the WHO Global Alcohol Strategy in 2010. Further Bangladesh noted the fact that alcohol advertising, promotions and sponsorship leads to earlier initiation and higher amounts of alcohol use among children and youth.
Norway further elaborated the need for urgent and accelerated action by emphasizing evidence that shows that global targets, including those of the SDGs, are not likely to be achieved due to lack of progress on reducing alcohol consumption and related harm.
In late 2019, Norway launched a new and ground-breaking international development strategy “Better Health, Better Lives” to tackle NCDs and the risk factors – including alcohol – as part of its international development assistance.
In a second statement, Thailand addressed the lack of resources and leadership invested into the work on alcohol policy at the WHO.
Moving forward: need for bolder targets and action to curb alcohol harm
Civil society has been advocating whole-heartedly for the adoption of this decision, which was hard won against the aggressive Big Alcohol lobby.
The revised text also retained a reference to alcohol’s carcinogenic properties, which had been opposed initially by the United States and others.
Movendi International called the adoption of the decision “historic”.
In a statement live from the World Health Organization Executive Board room, Movendi International said:
This is a historic day for global alcohol control.
While the decision does not contain everything that communities around the world had hoped for, this decision today is a significant improvement.
It strengthens the global infrastructure for alcohol prevention and control. And it puts focus on the need for accelerating action.”Movendi International
The NCD Alliance also lauded the action taken by member states and added several key messages:
- The need for the EU cancer plan – which currently overlooks alcohol as a key risk factor for premature death – to tackle alcohol as a carcinogen.
- The potential of the action plan to provide a stronger whole-of-government and inter-agency framework for accelerated action, accountability and impact and for addressing barriers towards progress.
- The importance of addressing alcohol industry interference through the action plan.
…it has been acutely apparent that throughout recent months and days, the alcohol industry were actively lobbying Member States in efforts to dilute existing evidence-based policies which are known to reduce alcohol harm, as well as undermining efforts by Member States to secure a stronger global response to alcohol,” said the NCD Alliance, in their statement, as per Health Policy Watch.
Movendi International stressed the need for bold targets and action and the need for a global binding treaty on alcohol.
It has taken ten years for a substantive discussion of the global alcohol burden and the necessary policy response at the WHO governing bodies. Thanks to today’s decision, this will change: the issue will be on the agenda more often and more regularly,” said Maik Dünnbier, Director of Strategy and Advocacy at Movendi International, as per, Health Policy Watch.
But what this week of debating the response to alcohol harm has shown is: while we are not where we need to be yet, the awareness is rising of the heavy burden that alcohol harm places on a broad range of health and development goals; and the commitment to much bolder actions is clearly increasing – as evidenced by the broad support for the decision.
It is also clear that more must be done: The action plan needs to be filled with bold targets and actions to turn the tide on alcohol harm. The overarching need is still a global binding treaty on alcohol to effectively protect the human right to health.”Maik Dünnbier, Director of Strategy and Advocacy, Movendi International