Movendi Analysis: First Revised Version of Political Declaration Text

Movendi International Analysis of the 1st revised version of the political declaration text shared with Member States (Rev. 1) for the 4th High-Level Meeting on NCDs and Mental Health

General Assessment

This document provides Movendi International’s analysis of the 1st revised version of the political declaration text (Rev. 1) for the Fourth UN High-Level Meeting on Noncommunicable Diseases and Mental Health (HLM4).

Rev. 1 is largely a step in the wrong direction for alcohol policy compared to the Zero Draft – particularly in how it frames alcohol harm and prioritises policy responses.

1. Movendi’s analysis shows that the Rev. 1 text of the political declaration fails to treat alcohol as a priority in the global response to NCDs and mental health.
   • It lacks clear targets, evidence-based language, and focus on the WHO-recommended alcohol policy “Quick Buys.”
2. It continues to use the flawed and misleading concept of “harmful use of alcohol,” omits safeguards against alcohol industry interference, and perpetuates tobacco exceptionalism despite alcohol’s comparable harm – especially when the alcohol burden in NCDs and mental ill-health are taken together.
3. While the inclusion of alcohol taxation is a positive step, the overall framing remains inadequate, missing a critical opportunity to advance disease prevention, health promotion, as equity, and health financing.

In this analysis, Movendi International calls for elevating alcohol policy to the same level of priority as tobacco control, emphasising evidence-based policy solutions such as taxation and the SAFER alcohol policy blue print. The analysis also highlights where in the document more robust safeguards against industry interference and a pivot toward prevention and health promotion are needed to accelerate progress on NCDs and mental health.

Key messages

The Rev. 1 document is largely a step in the wrong direction for alcohol policy compared to the Zero Draft – particularly in how it frames alcohol harm and prioritises alcohol policy responses.

1. The Rev. 1 document fails to make alcohol policy the priority it should be concerning alcohol’s contribution to the NCDs and mental ill-health burden; and
2. The time for tobacco exceptionalism is over – especially since the coronavirus pandemic. The Rev. 1 document fails to properly use the potential of the SAFER alcohol policy blue print concerning its potential for NCDs prevention, mental health promotion, and multiple benefits beyond public health.

Worsened framing:

• The flawed, outdated, and misleading term “harmful use of alcohol” is used more frequently and prominently in Rev. 1 than in the Zero Draft, despite scientific consensus that no amount of alcohol is safe – especially for cancer.
• Rev. 1 does not adopt the improved SDG 3.5.2 language (“per capita alcohol consumption”), missing an opportunity to modernise and align with global targets.

Same inadequate policy prioritisation:

• Alcohol policy is still not included in fast-track targets (unlike tobacco and hypertension), and the WHO SAFER alcohol policy blue print or alcohol policy Quick Buys are still not prioritised.
• Only one single paragraph (OP 43f) covers alcohol, while tobacco receives several paragraphs with concrete, enforceable measures.

Minor progress only in taxation:

• Alcohol taxation is now included in a target for 80% of countries to implement pro-health excise taxes by 2030, which is a positive development and should be retained and strengthened.

The Revision 1 document of political declaration marks some progress (notably on taxation and conflicts of interest language), but it remains fundamentally flawed on alcohol policy. Rev. 1 regresses on key language, fails to elevate alcohol policy, and does not reflect the urgency or evidence base. It lacks clarity, ambition, and accountability.

To make the HLM4 a true turning point, the declaration should:

• Include alcohol policy Quick Buys with fast-track targets;
• Replace misleading language and the flawed concept of “harmful use of alcohol” with “alcohol consumption” and explicitly refer to low-dose harm;
• Exclude the alcohol industry from health policymaking;
• Elevate alcohol policy to the same priority level as tobacco control; and
• Strengthen prevention framing and integrate alcohol policy into broader health systems responses.

Without these corrections, the declaration risks preserving the status quo of inadequate alcohol policy responses to the mental ill-health and NCDs crisis and thus missing the opportunity to make the Fourth High-Level Meeting on NCDs and Mental Health a turning point of alcohol policy.

Overview of How Five Key Asks Are Covered in the Rev. 1 Document

1. Prioritize Action on the Alcohol Policy Quick Buys

• Commit to make the WHO SAFER technical package the highest priority for public policy action, with emphasis on the Alcohol Policy QUICK BUYS that yield immediate health gains.

Analysis:

Revision 1 fails to prioritize or even mention the WHO-recommended Alcohol Policy Quick Buys, a set of high-impact, low-cost interventions with immediate returns for population health and sustainable financing.

• Despite the explicit call from the Global Alcohol Action Plan (GAAP) and multiple resolutions urging accelerated action on alcohol harm, these measures are not elevated to the level of tobacco control or hypertension action in the fast-track commitments.
• Screening and brief interventions, a core Quick Buy and part of the WHO SAFER technical package, are completely absent.

Consequence:

• The declaration neglects cost-effective, equity-promoting solutions—squandering an opportunity to deliver fast, measurable progress on NCDs and mental health, especially in low-resource settings.

Proposals:

OP 40. Fast-track efforts to accelerate progress on noncommunicable diseases and mental health and well-being over the next five years, focusing on tobacco and nicotine control, alcohol policy, preventing and scaling up effective treatment of hypertension and improving mental health care, with the aim to achieve the following global targets: by 2030, 150 million less people are using tobacco, 150 million less people consume alcohol, 150 million more people have hypertension under control, and 150 million more people have access to mental health care; 

OP 43 (f) reduce harmful use of alcohol including through acceleration of the implementation of the Global Strategy to Reduce the Harmful Use of Alcohol (2010) and the Global Alcohol Action Plan 2022–2030 by prioritizing the alcohol policy quick buys: (i) Increasing excise taxes on alcoholic beverages; (ii) Enacting and enforcing bans or comprehensive restrictions on exposure to alcohol advertising (across multiple types of media); (iii) Enacting and enforcing restrictions on the physical availability of retailed alcohol (via reduced hours of sale); and (iv) Providing brief psychosocial intervention for persons with alcohol use disorder;

Note: Alternatively to the Quick Buys (see source below) include the SAFER alcohol policy blue print and list the fiveSAFER interventions.

2. Leverage the Quadruple-Win of Alcohol Taxation for NCDs Prevention

• Fully leverage the potential of alcohol taxation for NCDs prevention, health system strengthening, and domestic resource mobilization because the potential is massive, under-used, and the future of financing for health.

Analysis:

The inclusion of alcohol taxation under fiscal policies and the explicit 2030 target for 80% of countries to implement or increase taxes is a strong point and aligns with Movendi’s call to leverage the quadruple-win of alcohol taxation.

• Alcohol taxation is rightly presented as a tool for health promotion, disease prevention, and domestic resource mobilization.
• This positive development must be retained, protected, and further strengthened with accountability mechanisms.

Consequence:

Maintaining this language ensures alignment with WHO “Best Buys” and “Quick Buys” and the SDGs, and supports country-level implementation of revenue-generating public health policy.

Proposals:

OP65: Commit to mobilize, as a complement to the primary domestic resources, international support and allocate adequate, predictable and sustained resources for national responses to prevent and control noncommunicable diseases and to promote mental health and well-being, through relevant domestic, bilateral, regional and multilateral channels, including international cooperation and official development assistance, and continue exploring voluntary innovative financing mechanisms and partnerships, including with relevant parts of the private sector, and other relevant stakeholders, with due regard to preventing conflicts of interest, to advance action at all levels;

• Read more about the alcohol taxation quadruple-win.

3. Employ Evidence-Based Language

Replace the flawed term of “harmful use of alcohol” with accurate, evidence-based language on alcohol harm and policy that reflects the state of the art in scientific understanding of the NCDs risk, including from low-dose alcohol consumption.

The term “harmful use of alcohol” is repeatedly used, worsening – not improving – the language on alcohol harm and policy compared to the Zero Draft and ignoring the 2022 SDG statistical revision (3.5.2), which calls for “per capita alcohol consumption.”

• This phrase implies that some alcohol use is safe or harmless, contrary to WHO and IARC findings that no level of alcohol use is safe, especially for cancer risk.
• No mention is made of the updated evidence on low-dose alcohol harm, nor are flawed studies (e.g., those promoting alcohol’s “protective effects”) discredited.

Consequence:

The continued use of misleading terminology shields the alcohol industry and impedes public health communication and policymaking.

Proposals:

OP 12. Recognize also that the main modifiable risk factors of noncommunicable diseases are tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution, which are behavioural, metabolic, and environmental in nature, and are largely preventable and require cross-sectoral actions; 

OP 45. Increase health literacy and implement science and evidence-based, sustained best practice information, and age appropriate communication programmes across the entire population and life course, to: (i) educate the public about the harms of tobacco and nicotine use, the harmful use of alcohol, and air pollution; (ii) promote healthy, well-balanced and sustainable diets such as through food and nutrition education; (iii) promote physical activity, and reduce children’s screen use, with links to school and community-based programmes; and (iv) promote healthy life skills, resilience and mental health and well-being through school-based social and emotional learning; 

OP 56. Scale up, particularly at primary health care level and within general health care services, the accessibility, availability and provision of psychosocial, psychological support and pharmacological treatment for depression, anxiety and psychosis, as well as for other related priority conditions, including childhood and youth mental health conditions, self-harm, harmful use of alcohol, other substance use, epilepsy, dementia, autism spectrum disorder and ADHD, while addressing the stigma associated with these conditions including through inclusive, accessible and equitable quality public education and the involvement of people with lived experience;

Note: these are three examples, also to illustrate the flaws and shortcomings of continued use of the flawed term of “harmful use of alcohol” and what matters is that it is replaced across the document.

4. Remove Big Alcohol from any Role in Health Policy

Refrain from assigning any role to the alcohol industry in NCD prevention and control – as was done in the 2018 HLM3 on NCDs Political Declaration – due to their inherent and well-documented conflict of interest.

The document includes improved references to preventing conflicts of interest and avoiding industry interference in tobacco policy. However, it fails to extend similar safeguards to the alcohol industry.

• Alcohol industry actors are not explicitly excluded from health policymaking, and the generic language calling on “the private sector” to contribute includes them by default.
• Unlike the tobacco industry, there is no firewall against alcohol industry influence, despite mounting evidence of policy interference.

Consequence:

The failure to implement protections equivalent to FCTC Article 5.3 creates space for Big Alcohol to influence, delay, and undermine public health responses.

Proposals:

OP83. Call upon the private sector other than health harming industries to strengthen its commitment and contribution to prevent and control noncommunicable diseases and promote mental health and well-being through the implementation of the present political declaration and the outcomes of the previous high-level meetings of the General Assembly on the prevention and control of noncommunicable diseases held in 2011, 2014, and 2018, taking into account the need to prevent conflicts of interest.

5. Pivot to Prevention and Health Promotion

• Prioritize comprehensive prevention and health promotion strategies to tackle NCDs risk factors rather than relying on industries-favored harm reduction, self-regulation, and corporate social responsibility approaches.

Analysis:

There is progress in terms of broader framing around commercial determinants of health (CDoH), environments, and upstream risk factors. However, concrete prevention strategies for alcohol remain underdeveloped.

• The promotion of mental health and reference to environmental and social determinants are welcome.
• But alcohol prevention is not integrated comprehensively into key health systems responses, nor is it prioritized in fast-track targets.

Consequence:

• The prevention pillar lacks the clarity, political urgency, and integration needed to shift from treatment-dominated to prevention-driven strategies—especially concerning alcohol.

Proposals:

• OP13. Emphasize with concern that globally there are: (i) 1.3 billion tobacco users and tobacco kills more than 8 million people each year, including an estimated 1.3 million non-smokers who are exposed to second-hand smoke; (ii) 2.6 million alcohol related deaths each year and at least 400 million people, or 7% of the world’s population aged 15 years and older, live with alcohol use disorders globally; (iii) 35 million children under 5 years of age currently overweight; (iv) 390 million children 5 – 19 years old overweight or obese, while adult obesity has more than doubled since 1990; and (v) nearly 7 million deaths each year caused by air pollution, with 99% of the population exposed to unsafe air pollution levels;

6. Tobacco Exceptionalism Persists

While tobacco control is rightly emphasized with detailed targets (e.g., 150 million fewer users by 2030), alcohol policy is not given similar treatment.

• No targets exist for alcohol use reduction, no reporting requirements are attached, and implementation of GAAP is vaguely referenced.
• Tobacco remains the only risk factor with strong, standalone, measurable political commitments, despite alcohol’s comparable harm.

Analysis:

Under OP 43 there are three sub-paragraphs focused on tobacco control. At the same time, there is only one, 43f. addressing alcohol policy needs.

Consequence:

This creates an imbalance in global risk factor governance, perpetuating tobacco exceptionalism and undermining efforts to treat alcohol as a serious, urgent public health issue.

The need for better language and more information on alcohol harm and NCDs and mental health conditions

In March 2020, the UN Statistical Commission approved a set of changes to the global indicator framework for the Sustainable Development Goals (SDGs). A positive change was the refinement of the indicator to measure progress towards SDG 3.5. 

The UN Statistical Commission thus rebuked alcohol industry lobbying to undermine scientific consensus and derail the response to alcohol as obstacle to development.

The refined inidcator SDG 3.5.2: Alcohol per capita consumption (aged 15 years and older) within a calendar year in litres of pure alcohol”

The APC indicator is well-established practice by the World Health Organization and its Member States to measure annual total per capita alcohol consumption. And the WHO NCDs Global Action includes a voluntary target agreed by Member States about reducing per capita alcohol use.

Source: “UN Statistical Commission Refines SDG Alcohol Indicator“

• Globally, at least 400 million people, or 7% of the world’s population aged 15 years and older, live with alcohol use disorders.
• Heaviest burden shifting: The highest alcohol-attributable mortality and disease burden per liter consumed is now in low- and lower-middle-income countries, where health systems are least equipped to manage it.
• Cancer deaths due to alcohol are increasing.
  • Since 2006, the total number of healthy life years lost due to alcohol-related cancer in the world has increased by 11%.
• Alcohol remains the leading risk factor for death and disease among 15- to 49-year-olds globally.
• Most countries reported no progress on the “best buys” in alcohol policy since 2010, signaling the urgent need for action. 

The WHO warns that without major policy changes, the global target of a 10% reduction in population-level alcohol use by 2030 will not be met – and consumption is projected to rise instead.

Why Alcohol Taxation Matters: The Quadruple Win of Alcohol Taxation

Alcohol taxation is more than a fiscal policy – it’s a powerful, proven tool for transforming societies. While often framed as a win-win or triple win, the full potential of raising alcohol excise taxation is best captured in its quadruple win:

1. Prevent and reduce harm: Raising alcohol taxes is the single most cost-effective alcohol policy solution to directly lower population-level alcohol consumption and the wide range of harms and costs it causes – violence, injuries, cancer, liver and heart disease, mental ill-health, and premature deaths. It prevents suffering, saves lives, and protects families and communities.
2. Generate revenue: Alcohol taxation is a cost-effective measure for governments to increase domestic revenues. The potential of alcohol taxation to bring in reliable and substantial funds often exceeds those from tobacco or sugar-sweetened beverage taxes.
3. Finance health and development priorities: The revenues raised can be (soft) earmarked or strategically allocated to finance health systems, prevention and health promotion programs, education, or other vital public services, such as better enforcement and scientific evaluation of alcohol policies. This way alcohol taxation helps fund public goods and human development.
4. Advance health equity and social justice: Alcohol harm disproportionately affects people in vulnerable and marginalized communities with low socio-economic status. Preventing and reducing alcohol harm benefits them the most and redirecting revenues toward public goods contributes to reducing health inequalities. Alcohol taxation is a rights-based, pro-equity policy that promotes social justice and strengthens the social contract by prioritizing people’s welfare over alcohol industry profit interests.

The WHO SAFER Alcohol Policy Blue Print

Strengthen restrictions on alcohol availability

Enacting and enforcing restrictions on commercial or public availability of alcohol through laws, policies, and programmes are important ways to reduce use of alcohol. Such strategies provide essential measures to prevent easy access to alcohol by young people and other vulnerable and high-risk groups.

Advance and enforce alcohol impaired driving counter measures

Road users who are impaired by alcohol have a significantly higher risk of being involved in a crash. Enacting and enforcing strong alcohol impaire driving laws and low blood alcohol concentration limits via sobriety checkpoints and random breath testing will help to turn the tide.

Facilitate access to screening, brief interventions and treatment

Health professionals have an important role in helping people to reduce or stop their alcohol use to reduce health risks, and health services have to provide effective interventions for those in need of help and their families.

Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion

Bans and comprehensive restrictions on alcohol advertising, sponsorship and promotion are impactful and cost-effective measures. Enacting and enforcing bans or comprehensive restrictions on exposure to them in the digital world will bring public health benefits and help protect children, adolescents and abstainers from the pressure to start consuming alcohol.

Raise prices on alcohol through excise taxes and pricing policies

Alcohol taxation and pricing policies are among the most effective and cost-effective alcohol control measures. An increase in excise taxes on alcoholic beverages is a proven measure to reduce the use of alcohol and it provides governments revenue to offset the economic costs of alcohol harm.

For more reading

“From 2018 to 2025 and Beyond: Why Upcoming High-Level Meeting on NCDs Matters So Much For Alcohol Policy Progress”

Kristina Sperkova’s Blog Post:

Source Website: Movendi International Advocacy Priorities for the HLM4 on NCDs and Mental Health