The 2019 UN High-Level Meeting on Universal Health Coverage (HLM UHC) 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.
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.
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.
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.
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.
Movendi International is calling for a paradigm shift to achieve health and well-being for all. The paradigm shift has three elements:
- Pivot to prevention, health promotion and a systematic strategy to curb health harmful industries.
- Shift from expenditure to investment thinking regarding health spending.
- 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.
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 of health risk factors, such as tobacco and alcohol, as well as a systematic strategy to curb health determinants, such as health harmful industries.
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:
- 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.
- Make disease and risk factor prevention and health promotion corner stones of the global, regional, national and local efforts to achieve UHC.
- 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.
- 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 to understanding health spending as investments, not expenditures.
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.
- Formulate and implement evidence-based alcohol policy solutions (Best Buys) to promote population health as key contribution to UHC.
- 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.
- Make a Health in all policies approach reality and ensure policy coherence with national and international legislation on population health.
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).
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:
- It helps reduce and prevent alcohol-related harm.
- It helps promote health and sustainable development.
- It helps raise domestic resources for health and development.
Clearly: Health promotion taxes are pro-poor, pro-sustainable development and pro-Universal Health Coverage.
- 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.
- 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.
- Adopt a synergistic approach to taxing sugar, tobacco and alcohol (STAX).