Advocacy Priorities

Helping Achieve Universal Health Coverage and Health for All through Alcohol Prevention and Control

The 2019 UN High-Level Meeting on Universal Health Coverage (UHC HLM) is an important milestone on the way to ensure health for all. It is therefore crucial that alcohol as a serious burden to and obstacle for universal health coverage is identified and that alcohol prevention and other policy solutions are addressed as critical tools to help achieve health for all.

A landmark opportunity

In September 2019, Heads of State and Government will meet for the first time to discuss universal health coverage (UHC) at the highest political level. Building on existing political commitments this UHC HLM is a landmark opportunity to galvanize political will and leadership for a one health agenda.

Health in all policies, integrated health and social services, policy coherence to promote – not undermine – health, investments in quality prevention and health promotion as well as comprehensive quality health care are within reach.

Health is a Human Right

The concept of UHC is firmly rooted in the principle that the highest attainable standard of physical and mental health is a fundamental human right. Defined as a situation where all people, everywhere, can access quality health services without incurring financial hardship, UHC is critical to sustainable development and the Agenda 2030. The right to a minimum standard of health for all was enshrined in the Universal Declaration of Human Rights, adopted in 1948.

In order to protect and promote the Human Right to health for all, quality primary health care (PHC) is essential as the foundation of sustainable and resilient health systems that are able to deliver UHC, throughout the continuum of care from prevention to palliation.

Alcohol harm: obstacle to UHC and health for all

The urgency, scale and impact pervasive alcohol harm affecting people, families, communities, societies and economies poses both serious challenges and substantial opportunities for reaching UHC.

The heavy burden of alcohol harm on societies around the world urgently require a more responsive health system that prioritizes prevention and health promotion, and that makes screening and brief interventions as well as comprehensive treatment and care packages available for all who need it. Addressing the alcohol industry as a major determinants of people’s health and well being is a formidable challenge, that goes beyond public health. Effectively tracking and monitoring alcohol as a risk factor for disease, multi-morbidity and pre-mature death is a crucial challenge for public health and its allies on the way of achieving health for all.

Major inequalities persist regarding adverse consequences of alcohol use as well as access to recovery and treatment services for all those affected by alcohol harm.

Alcohol harm is so pervasive that it poses a heavy economic burden on national budgets, and too often pushes households into vicious cycles of poverty, marginalization, and ill-health.

• Alcohol-related burdens low-, middle-, and high-income countries.
• Alcohol is a major obstacle to sustainable development, adversely affecting 13 of 17 SDGs.
• Alcohol contributed to 3 million deaths in 2016, and 5.1% of the global burden of disease.
• Alcohol is the leading risk factor for premature mortality and disability among those aged 15 to 49 years.
• The economic burden of alcohol worldwide is substantial, accounting for up to 5.44% of Growth Domestic Product in some countries.
• Alcohol use is related to more than 274 million years of healthy life lost (DALYs) in the Americas in 2012.
• In Myanmar, 27.8% of patients in hospitals had alcohol related disorders.
• In Sri Lanka, 80% of General Practitioners were frequently confronted with patients who had alcohol use disorders.
• In the Republic of South Africa the combined tangible and intangible costs of alcohol harm to the economy reached nearly 300 billion Rand or 10 to 12% of the 2009 GDP.
• In the United States, alcohol harm costs society $249 billion, every year.
• In the European Union, alcohol harm costs society €156 billion, every year.
• In 2010 in Australia, the total costs of alcohol-related problems to society were more than $14 billion. Of this $1.7 billion (11.7%) were costs to the health care system.

Call to action

The progressive realisation of UHC must ensure prioritising NCD prevention and control in UHC design and implementation. When achieved, UHC can be a powerful tool to accelerate progress on NCD outcomes, reducing inequalities, socio-economic stability and sustainable development.

Imperative for action

Movendi International is calling for a paradigm shift to achieve health and well-being for all. The paradigm shift has three elements:

1. Pivot to prevention, health promotion and a systematic strategy to curb health harmful industries.
2. Shift from expenditure to investment thinking regarding health spending.
3. Make full use of health promotion taxation

Currently, 97% of healthcare spending is for treatment and care while only 3% is spend on prevention. But evidence-based prevention is cost-effective: Every $1 invested yields a return of $10.

Currently, healthcare spending is considered expenditure that is often cut due to austerity programs. But investing in health promotion policy, like the alcohol policy best buys, yields significant returns on investment. A$1 investment in the alcohol policy best buys generates a return of $9.

Currently, the potential of health promotion taxation is seriously underutilized. But there is substantial benefit from health promotion taxation for domestic resource mobilization, risk factor prevention and reduction and health promotion. A 20% increase in the price of alcohol due to higher taxes could accumulate as much as 9 trillion US$ in increased revenues globally over a 50 years period

While there is unimpeachable evidence for the benefits of action, there is also urgency:

WHO data shows:

• Countries in Africa are now bearing the heaviest burden of alcohol-related disease and injury.
• Alcohol consumption will increase, not decrease, around the world by 2025.

Already vulnerable, fragile and over-burdened communities, societies and health systems are coming under ever increasing pressure due to rising alcohol use and related harm.

UHC will remain out of reach without succinct, decisive and bold action to formulate and implement alcohol prevention and control measures.

Movendi International Advocacy Priorities

To ensure the most successful UHC HLM possible, we advocate together with our members around the world for the participation of Heads of State and Government throughout the lead up and at the high-level meeting itself. And we advocate for an action oriented Outcome Document that commits to the following four priorities:

Pivot to prevention, health promotion and a systematic strategy to curb health harmful industries

Pivot to prevention of health risk factors, such as tobacco and alcohol, as well as a systematic strategy to curb health determinants, such as health harmful industries.

Rationale

Preventing health problems from occurring or expanding represents by far the best approach to reaching health for all – especially considering the increasing burden of risk factors fueling both infectious diseases and the NCDs epidemic. In the era of sustainable development a pivot to evidence-based prevention and health promotion holds four major benefits:

• Cost-effectiveness
• Sustainability
• People empowerment and community resilience
• Human Rights-based

Building societies, communities and environments that allow for and foster healthy behaviors and foster health-promoting norms is essential because treatment alone is not enough and too expensive for already fragile, vulnerable and over-burdened health systems.

Advocacy asks

1. Make disease and risk factor prevention and health promotion corner stones of the global, regional, national and local efforts to achieve UHC.
2. Adopt a strategic approach to risk factor prevention and health promotion, as critical pre-requisites for strong and resilient health systems in particular and sustainable development in general.
3. Invest in adequate support for civil society engagement and in community-based partnerships for prevention and health promotion – as essential contributions to the health systems and the SDGs in general.

Shift from expenditure to investment thinking regarding health spending

Shift to understanding health spending as investments, not expenditures.

Rationale

For example: Alcohol use is the number one risk factor for death in the age group 15 to 49 years – typically the most productive years of our lives. But this can largely be prevented. A$1 investment in the alcohol policy best buys generates a return of $9. Committing to such actions means investing in human capital and potential, community resilience, thriving economies and sustainable development.

Advocacy asks

1. Formulate and implement evidence-based alcohol policy solutions (Best Buys) to promote population health as key contribution to UHC.
2. Invest in an integrated approach to the implementation of the alcohol policy best buys as a means to boost sustainability of and investment in the UHC and PHC.
3. Make a Health in all policies approach reality and ensure policy coherence with national and international legislation on population health.

Make full use of health promotion taxation

Domestic resource mobilization through health promotion taxation holds largely untapped potential to build sustainable and resilient health systems and reach health for all. As part of a broader public health strategy to promote a life-course approach to prevention and to address commercial determinants of health, it is high time for governments to adopt sugar, tobacco, and alcohol taxes (STAX).

Rationale

Already in 2010, the World Health Report said:

Raising taxes on alcohol to 40% of the retail price could have an even bigger impact [than a 50% increase in tobacco taxation].

Estimates for 12 low-income countries show that consumption levels would fall by more than 10%, while tax revenues would more than triple to a level amounting to 38% of total health spending in those countries. “

Alcohol taxation holds significant potential for population health, for helping achieve the sustainable development goals and also for significantly contributing to financing health and development.

As such Alcohol taxation is a triple win measure:

1. It helps reduce and prevent alcohol-related harm.
2. It helps promote health and sustainable development.
3. It helps raise domestic resources for health and development.

Clearly: Health promotion taxes are pro-poor, pro-sustainable development and pro-Universal Health Coverage.

Advocacy asks

1. Implement and raise excise taxes on alcoholic beverages, so as to at least double the retail price, and commit to ongoing price increases at least in line with inflation.
2. Provide technical advice and assistence on alcohol taxation to developing countries and remove subsidies for alcohol, and divest from the alcohol industry, especially in developed countries.
3. Adopt a synergistic approach to taxing sugar, tobacco and alcohol (STAX).

HELPING #BEATNCDS BY PROMOTING ALCOHOL POLICY BEST BUY SOLUTIONS

United Nations General Assembly High-Level Meeting on NCDs

The 2018 UN High-Level Meeting on NCDs (UN HLM) is a historic opportunity to mobilize political leadership, increased investments and bold new action to turn the tide on the global NCDs epidemic and the four main risk factors.

Watershed year

2018 has the potential to become a watershed year in global efforts to make alcohol policy the priority it should be.

Not one but two high-level meetings are to be held at the UN General Assembly in September to reinvigorate political commitment and spark renewed efforts by countries and the UN system to curb the epidemics of NCDs and tuberculosis – both of which alcohol is a major risk factor for.

The parallel processes of preparation for, negotiations at and follow-up on the two high-level meetings will elevate health within the context of sustainable development and hopefully lead to alcohol harm and alcohol policy solutions becoming the priority they should be on the agenda of world leaders for years to come.

The stakes have never been higher

For NCDs, this year’s HLM is the third, after 2011 and 2014. The stakes have never been higher.

• Every year 38 million people die from NCDs. That’s more deaths than all other diseases combined.
• 40% of people who die from NCDs are in their most productive years.
• Almost 2/3 of NCDs deaths are linked to the four major risk factors, including alcohol.
• NCDs burden low and middle-income countries the heaviest: 75% of all NCDs deaths occur in LMICs. In developing countries, NCDs are increasing faster, in younger people, and with worse outcomes than in wealthier countries.

Imperative for action on alcohol

Massive global burden of death and disease

• Alcohol kills 3.3 million people worldwide every year. Every 10 seconds a human being dies because of alcohol.
• Alcohol consumption is a causal factor in more than 200 disease and injury conditions.

Disproportionately harming our youth

Alcohol harm is a tremendous burden on the young people of the world:

• Alcohol consumption causes death and disability early in life – relative to other health hazards. In the age group 20 to 39 years of age about 25% of the total deaths are alcohol-attributable.

Harming economic productivity and sustainability

• The economic burden of alcohol worldwide is substantial, accounting for approximately 5.44% of Growth Domestic Product in some countries.
• Alcohol is the leading risk factor for death and disability among people aged 15 to 49 years worldwide. This is the age range in which people are typically at their most productive economically.

Alcohol as a risk factor for NCDs

Alcohol is a major obstacle to sustainable development, adversely affecting 13 of 17 SDGs. Alcohol is a major risk factor for NCDs and mental ill-health. There is a strong link between alcohol and NCDs, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes. [1]

Alcohol and cancer

A causal link has been found between alcohol and cancer of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum, and female breast. For cancer, there is no safe amount of alcohol use. The cancer risk increases steadily with greater volumes of alcohol consumption. [2]

Cardiovascular disease

Alcohol use is overwhelmingly detrimentally related to many cardiovascular outcomes, including hypertensive disease, haemorrhagic stroke, and atrial fibrillation. [1]

Liver Disease

Alcohol is strongly associated with various kinds of liver disease, with fatty liver, alcoholic hepatitis and cirrhosis being the most common. [1]

Diabetes

With regards to diabetes the situation is more complicated. Meta-analysis have confirmed that there is a U-shaped relationship between the average amount of alcohol consumed per day and the risk of type 2 diabetes. [1]

Mental ill-health

There are associations of alcohol use and alcohol use disorders with almost every mental disorder, including depression, post-traumatic stress disorder (PTSD) and suicide. [1]

Movendi International Advocacy Priorities

To ensure the most successful HLM3 on NCDs possible, we advocate together with our members around the world for the participation of Heads of State and Government throughout the UN HLM process and at the HLM3 itself. And we advocate for an action oriented Outcome Document that commits to the following four priorities:

Rationale

Alcohol taxation holds massive potential for global health, for helping achieve the sustainable development goals and also for significantly contributing to financing health and development.

Alcohol taxation is a triple win measure:

• It helps reduce and prevent alcohol-related harm
• It helps promote health and sustainable development, and
• It helps raise domestic resources for health and development.

As part of a broader public health strategy to promote a life-course approach to prevention and to address commercial determinants of health, it is high time for governments to adopt sugar, tobacco, and alcohol taxes (STAX).

Advocacy asks

1. Implement and raise excise taxes on alcoholic beverages, so as to at least double the retail price, and commit to ongoing price increases at least in line with inflation.
2. Provide technical advice and assistance on alcohol taxation to developing countries and remove subsidies for alcohol, and divest from the alcohol industry, especially in developed countries.
3. Adopt a synergistic approach to taxing sugar, tobacco and alcohol (STAX).

Rationale

NCDs are largely preventable. Preventing problems from occurring or expanding represents by far the best approach to the NCDs tsunami – especially considering the burden of the risk factors. In the era of sustainable development a pivot to evidence-based prevention and health promotion holds four major benefits:

• Cost-effectiveness
• Sustainability
• People and community empowerment
• Human Rights-based

Building societies, communities and environments that allow for healthy lifestyles and foster health-promoting norms is essential because treatment alone is not enough to beat NCDs and prevention and health promotion are economically sound interventions generating positive outcomes beyond the realm of health. [3]

Advocacy asks

1. Make disease and risk factor prevention and health promotion corner stones of the global, regional, national and local responses to NCDs.
2. Adopt a strategic approach to disease and risk factor prevention and health promotion, as critical pre-requisites for strong and resilient health systems in particular and sustainable development in general.
3. Invest in adequate support for civil society engagement in the NCDs response and in community-based partnerships for prevention and health promotion.

Rationale

In the era of the Agenda 2030, effective partnerships across sectors are critical for sustainable progress. But not all partnerships are conducive to reaching the SDGs. Some partnerships are laden with fundamental conflicts of interest, for instance those involving the alcohol industry.

The alcohol industry has a fundamental conflict of interest with regard to the Agenda 2030 in general and SDG 3, 3.4 and 3.5 (to name a few) specifically. [4] Therefore, partnerships with the alcohol industry to help beat NCDs are incompatible.

Advocacy asks

1. Safeguard the NCDs response on all levels against conflicts of interest, avoid undue influence of the alcohol industry and refrain from incompatible partnerships.
2. Identify and regulate the alcohol industry as a vector in the NCDs epidemic and a commercial determinant of health and development.
3. Put the public interest and Human Rights, including the Convention on the Rights of the Child, at the center of all efforts to prevent and control NCDs and their risk factors.

Rationale

The three alcohol policy best buys hold considerable and largely untapped potential to help beat NCDs and promote health and development. [4]

Part of the potential of an integrated approach to implementing the alcohol policy best buy measures lies in increasing financial resources for and scaling up of investment in efforts to end control and prevent NCDs. The 5 major NCDs (cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental illness). could contribute a cumulative output loss of US$ 47 trillion until 2030, representing a loss of 75% of global GDP in 2010 (US$ 63 trillion). [6]

Scientific evidence clearly shows that the alcohol policy best buys provide an excellent option for increas- ing financial resources to boost investments in the NCDs response. Investing in the alcohol policy best buys is proven to be very cost-effective and high-impact. A $1 investment in the alcohol policy best buy measures generates a return of $9 dollars. [7]

Advocacy asks

1. Invest in an integrated approach to the implementation of the alcohol policy best buys as a means to mobilize additional resources to boost investment in the NCDs response.
2. Increase and meet the financing needs of the global NCDs response from all sources, including domestic, bilateral, multilateral and innovative financing by 2030.

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From Burden to Solution – Ending TB by tackling alcohol as a major risk factor

UN High-Level Meeting on Tuberculosis

The 2018 first ever UN High-Level Meeting on Tuberculosis (UN HLM TB) is a historic opportunity to mobilize political leadership, increased investments and bold new action to turn end the epidemic of TB.

Introduction

2018 may be remembered as a watershed year in global health. Not one but two high-level meetings are to be held at the UN General Assembly in September to reinvigorate political commitment and spark renewed efforts by countries and the UN system to tackle tuberculosis and NCDs. The parallel processes of preparation for and follow-up on both high-level meetings will elevate health and make it the priority it should be on the agenda of world leaders for years to come.

For tuberculosis, this is the first ever UNGA High-Level Meeting on the fight against TB. TB is responsible for more deaths than HIV and malaria, but has not received the same attention and political commitment. The first WHO Global Ministerial Conference on Ending TB, held in Moscow in November 2017, was a first step and the UN HLM on TB will be critical to drive efforts to end this top infectious killer. It provides a crucial opportunity to mobilize political leadership and new resources and action to improve the lives of people affected by TB worldwide.

Alcohol as a risk factor for TB

Evidence shows that alcohol use, alcohol dosage and alcohol-related problems are all associated with an increased risk of tuberculosis. In fact, alcohol use increases the risk of TB threefold, and is also a strong risk factor for poor TB treatment adherence. That simply means Alcohol is an important population level risk factor for TB, and it often is a common co-morbidity among TB patients.

#1 Advocacy Priority

BOOST TB INVESTMENT BY MAKING FULL USE OF THE ALCOHOL POLICY BEST BUYS

Rationale

The three alcohol policy best buys hold considerable and largely untapped potential to help increasing financial resources for and scaling up investment in efforts to end TB.

TB cannot be eliminated with existing resources in TB care and R&D. Without significant investment in the efforts to end TB, the disease is estimated to cost the global economy nearly $1 trillion by 2030.Scientific evidence clearly shows that the alcohol policy best buys provide an excellent option for increasing financial resources to help end TB. Especially alcohol taxation is a powerful tool for resource mobilization. And investments in the alcohol policy best buys are show to be very cost-effective and high- impact.

A $1 investment in the alcohol policy best buy measures generates a return of $9 dollars.

Advocacy asks

1. Increase and meet the financing needs of the global efforts to en TB from all sources, including domestic, bilateral, multilateral and innovative financing by 2030.
2. Enact and increase alcohol taxation as a proven best buy measure to raise domestic resources, reduce alcohol harm and in doing so reduce the TB burden.
3. Implement the three alcohol policy best buys to address alcohol as a major TB risk factor and as long-term, sustainable, cost-effective investment in TB reduction and health promotion.

#2 Advocacy Priority

CLOSE THE TB TREATMENT GAP BY ADDRESSING ALCOHOL AS TB RISK FACTOR

Rationale

Alcohol use increases the TB risk threefold, is a strong risk factor for poor TB treatment adherence and is a severe driver of co-morbidities, such as in persons with TB and an alcohol use disorder.

40% of people with TB go undiagnosed or unreported every year, Between 2018 and 2022, 40 million people will need quality care – including people with alcohol use disorders.

To effectively close existing gaps in TB diagnosis, treatment, care, and prevention it is imperative to improve screening and brief interventions for alcohol use disorders among TB patients; and to better identify TB in person with alcohol use disorders.

Advocacy asks

1. Coherently address alcohol as major risk factor for tuberculosis.
2. Increase the provision of screening and brief interventions for alcohol use disorders and co-morbidities.
3. Invest in the provision of comprehensive care packages through systematically identifying co-morbidities and providing effective help and care.

#3 Advocacy Priority

PROTECT EFFORTS TO END TB FROM INCOMPATIBLE PARTNERSHIPS AND SAFEGUARD AGAINST CONFLICTS OF INTEREST

Rationale

In the era of the Agenda 2030, effective partnerships across sectors are critical for sustainable progress. But not all partnerships are conducive to reaching the SDGs. Some partnerships are laden with conflicts of interest, like the case of the Global Fund partnering with the world’s second largest beer producer Heineken exposed.

The alcohol industry has a fundamental conflict of interest with regard to SDG 3 in general and SDG 3.8 specifically. Therefor, partnerships with the alcohol industry to help end TB are incompatible.

Advocacy asks

1. Put affected people and communities at the center of all efforts, be rights-based, and enable a model of person-centered care and prevention.
2. Safeguard the TB response against conflicts of interest, avoid undue influence of the alcohol industry and refrain from incompatible partnerships.
3. Identify the alcohol industry as a commercial determinant of the tuberculosis epidemic.