WHO AFRO RC73

The Seventy-thirs session of the WHO Regional Committee for Africa is held in hybrid format in Gaborone, Botswana, from August 29 to September 01, 2023.

During WHO AFRO RC73, health ministers and high-level delegates of the … Member States of the WHO African Region, as well as representatives of partner organizations and civil society, including Movendi International, will gather in Gaborone, Botswana, or connect virtually for the 73rd session of the WHO Regional Committee for Africa (RC73), to deliberate and decide on critical public health issues, including a new Alcohol Policy Framework for the African region.

Alcohol policy will be on the agenda of WHO AFRO RC73, after years of Movendi International advocacy to make alcohol policy the priority it should be in the African region and across countries.

Movendi International will address three agenda items

Movendi International Advocacy Priorities at WHO AFRO RC73

Movendi International is represented at WHO AFRO RC73 with International Board Members Juliet Namukasa and Labram Musah. We are engaging through bilateral and coalition-driven advocacy.

Our advocacy goals

1. To adopt the draft African framework for implementing the global alcohol action plan 2022 – 2030 in the WHO African region.
2. To ensure full resourcing of the implementation of the framework for action.
3. To support WHO AFRO and member states in adopting a stronger focus on alcohol taxation in the implementation of the framework,
4. To ensure inclusion of a solid prevention perspective,
5. To promote recognition of civil society and the community and their involvement in the implementation of the framework,
6. To support member states and WHO AFRO to replace the flawed concept of “harmful use of alcohol” and replacing it with “harm due to alcohol” or other evidence-based terminology, and to
7. To enhance recognition that action is urgently needed in countries of the WHO African region.

Adopt the alcohol policy framework

Movendi International and our members in the African region welcome the African framework for implementing the global alcohol action plan 2022 – 2030 in the WHO African region.

Movendi International welcomes the new alcohol policy framework for the WHO African region. It is high time WHO Member States in the African region accelerate alcohol policy action to protect their people from alcohol harm.

We recommend and support the adoption of the framework. But we suggest a few critical improvements on the way to the adoption of the framework and in the implementation phase.

We regret the lack of involvement of civil society in developing this framework. Civil society plays an important role to achieve full implementation of the framework.

Movendi International supports many key elements of the new framework

• The clear statements on alcohol industry interference and on the importance of protecting alcohol policy making processes from alcohol industry conflicts of interest;
• The expressed concern about children and youth and the need to protect African children and young people from alcohol industry practices;
• The objectives of the framework; and
• The priority interventions in the framework, because they reflect the SAFER alcohol policy blue print.

Movendi International welcomes the new alcohol policy framework and we support its adoption.

Movendi International is ready to support and partner with Member States and the Secretariat in developing and implementing high-impact, scientifically proven alcohol policy solutions.

Movendi International official statements

Movendi International will address the WHO AFRO RC73 three times through official statements on three different agenda items:

Our key advocacy messages

The ten years since the adoption of the WHO Global Alcohol Strategy in 2010 must be considered a lost decade for alcohol policy development – especially in the WHO African Region.

In recognising the growing alcohol burden and the lack of progress over the past decade, Member States adopted the WHO Global Alcohol Action Plan (GAAP) at the World Health Assembly in May 2022. The GAAP was also backed by an ambitious statement delivered by Kenya on behalf of all African Union member states.

Now, it is time for WHO and countries in the African Region to build on the momentum and accelerate action on alcohol in sub-Saharan Africa.

We are deeply concerned about the growing health and social inequalities affecting especially vulnerable groups: the unborn child, youth, African people currently consuming alcohol, women and others.

The practices of the alcohol industry in the African region are of major concern. In a carefully curated Alcohol Issues Special Feature Movendi International reported on Africa’s alcohol burden – providing unique resources to understand how alcohol companies fuel harm and hinder sustainable development in Africa – and what can be done about it.

• Stronger focus on alcohol taxation, 
• Inclusion of a solid prevention perspective,
• Recognition of civil society and the community and their involvement in the implementation of the framework, 
• Doing away with flawed concept of “harmful use of alcohol” and replacing it with “harm due to alcohol”, and
• Clear recognition that action is urgently needed in countries of the WHO African region.

On 1: Stronger focus on alcohol taxation

Alcohol taxation is the single most cost-effective alcohol policy solution. Countries such as Ghana and Lesotho have recently increased alcohol taxes. Botswana shows a best practice approach to raising alcohol taxes in order to reduce alcohol harm (HIV/ AIDS and road traffic crashes) and increase government revenue.

The framework addresses the importance of alcohol taxation implementation in African countries only superficially. WHO and World Bank data shows the importance of public health oriented alcohol taxes. All African countries will benefit from such alcohol taxation systems – for health and development, for equity, and for domestic resource mobilization.

On 2: Inclusion of a solid prevention perspective

Alcohol harm causes high costs and a heavy burden on African societies. The total alcohol consumption in African societies needs to be reduced as well as the initiation and onset of alcohol use among current abstainers and the young population need to be prevented.

It is essential to avoid individualizing the alcohol problem and to address its root causes through population-level measures. 

This prevention perspective at the population level is only superficially covered in the framework. All African countries will benefit from a population-level approach to the alcohol burden they are facing.

On 3: Recognition of civil society and the community and their involvement in the implementation of the framework

Movendi International regrets the lack of involvement of civil society in drafting and developing the alcohol framework. This would have mattered for the quality of the draft framework as well as for ownership to facilitate civil society support for full implementation of the framework. Civil society, NGOs, and community-based organizations play an important role in ensuring full implementation of the framework – by supporting governments and WHO country offices, by contributing strategic actions and technical expertise, by mobilizing multi-sectoral partnerships, by documenting, exposing, and neutralizing alcohol industry interference, and by ensuring accountability.

On 4: Doing away with flawed concept of “harmful use of alcohol” and replacing it with “harm due to alcohol”

Science has shown clearly and unmistakeably that there is no healthy or safe alcohol use – concerning cancer, cardiovascular disease, mental health conditions, and brain conditions.

In early 2023 WHO issued a statement in the Lancet medical journal explaining the science and doing away with the flawed concept of “harmful use of alcohol”.

In September 2022, while adopting the alcohol framework for the WHO European region, Member States agreed to do away with the flawed concept of “harmful use of alcohol”.

Movendi International support Member States in the WHO African region to follow these examples and employ evidence-based, accurate language to discuss alcohol harm and alcohol policy.

There are several reasons why “harmful use of alcohol” is a flawed concept:

• It misrepresents the current state of science of the harm and risks from low-dose alcohol use;
• It misrepresents the current state of science of the harm and risks from second-hand effects from alcohol use, including small amounts of alcohol intake;
• It frames alcohol use incorrectly as harmful and harmless; and
• It activates a dominant frame used by the alcohol industry – “responsible” alcohol use, which is problematic because this frame blames individuals for alcohol harm.

WHO and member states in the African region should stop using such a flawed concept. Instead we should all replace it with terms such as “harm due to alcohol”, harm caused by alcohol, alcohol harm, harm linked to alcohol, harm caused by the products and practices of alcohol companies, etc. Such concepts are more accurate and more understandable by people and communities.

On 5: Clear recognition that action is urgently needed in countries of the WHO African region.

The draft framework on alcohol contains many important elements (see below). Movendi International supports the framework and its strong elements.

But we are missing a clear clarion call for urgent and ambitious action on alcohol harm as a major health, development, and economic obstacle in African countries.

Alcohol affects 14 of 17 SDGs negatively. It hinders progress in all dimensions of sustainable development. Alcohol harm means African societies are losing vast resources, from human potential, health system capacity, community resilience, food and water security, to economic growth.

Action on alcohol harm means that African countries actualize the potential for progress across multiple SDGs, including poverty eradication, gender equality progress, quality education, health, safety, and economic productivity.

The heavy alcohol burden in Africa

Sub-Saharan Africa (SSA) is a region with weak alcohol policies, high proportions of abstainers and heavy episodic alcohol use (among alcohol consumers). The African region is a target for market expansion by multinational alcohol companies, trying to convert young Africans to (heavy) alcohol users. 

Nevertheless, the African region has seen a lost decade for action on alcohol, since the adoption of the regional framework. 

• 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.
• Africa already has highest the aged-standardized alcohol burden compared to all other WHO regions. This is due to the large burden of attributable disease caused by tuberculosis, cardiovascular diseases, digestive diseases and injuries.

Scientific analysis illustrates the case for urgent and ambitious alcohol policy action:

• 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.
• Modelling forecasts that global targets to reduce alcohol use and harm will not be met.
• Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. 

The African Region has a high level of lifetime alcohol abstainers (57.5%). But Member States are not doing enough to protect the African people from alcohol initiation.

How alcohol companies fuel harm and hinder sustainable development in Africa

Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa.

• People who consume alcohol use high volumes. This has serious negative effects to the users themselves and it creates massive second-hand harm to families, communities and overall society. 
• The adult per capita alcohol use decreased by 24% from 6.3 litres in 2016 to 4.8 litres in 2019. But alarmingly, alcohol consumption among users increased from 17.2 L in 2010 to 18.4 L in 2016. This is because of the overall lack of implementation of comprehensive alcohol policy solutions, especially concerning the lack of implementation of the alcohol policy best buys in Africa.

Movendi International welcomes the decline in alcohol use but cautions that this has not been driven by alcohol policy implementation but by other factors. The figures about rising  alcohol use among alcohol users are alarming.

These are some of the latest examples:

Need for comprehensive, ambitious, and evidence-based alcohol policy action in African countries

In high income countries alcohol use is the second fasted growing risk factor and in LMICs alcohol is the fourth fastest rising risk factor for the global disease burden.

Alcohol is the largest risk factor for disease burden in the group 25-49 years.

Africa is the region with the youngest population in the world. WHO Member States are not doing enough to protect young people from alcohol harm fueled by alcohol companies. 

• Almost a quarter of young Africans between the ages of 15 and 19 consume alcohol. This early initiation spells serious risk of health, social, and economic harm and costs for African societies.
• More than half of all young alcohol users engage in heavy episodic (or binge) alcohol consumption. This is alarming because consequences such as injury, trauma, violence, road traffic crashes, and others are harming overall development.
• It is estimated that 10% of women of reproductive age – 15 to 49 years – in the African Region drink alcohol and 3% are heavy episodic alcohol users. The prevalence of foetal alcohol syndrome in the African Region is 14.8 per 10,000 population.

Most African countries have implemented alcohol tax policies, but they have seldom adopted other World Health Organization ‘best buys’ for cost-effective alcohol policy solutions. 

Many countries in the WHO African region have minimal alcohol policy solutions in place.

Some, such as Botswana, Ghana, or Lesotho, have successfully implemented stringent tax policies to address alcohol harm. 

All this shows that progress has been insufficient! 

We remain alarmed by the slow pace of implementation of the WHO Global Alcohol Strategy by Member States.

The region is facing the results of a lost decade for action on alcohol – since the adoption of the regional framework in 2010. Therefore, more ambitious, urgent action is needed, tackling concrete challenges in the region.

The three biggest challenges for protecting Africans from alcohol harm

1. Alcohol industry practices that undermine governments’ tax revenue and extract resources from African countries while leaving them with high costs and without adequate funding to deal with the harm caused by alcohol companies
2. Alcohol industry practices that increase alcohol availability, especially online retail and on-demand delivery of alcohol
3. Alcohol industry that promote the acceptability of alcohol, especially through aggressive marketing that exposes children and youth to alcohol promotions, that targets women, and that seeks to convert alcohol abstainers to alcohol users

Movendi International supports

• The clear statements on alcohol industry interference and on protecting alcohol policy making processes from alcohol industry interference
• We also agree with the concern about children and youth and the need to protect them from alcohol industry practices
• The vision, if “harmful use of alcohol” is changed
• The objectives
• The targets, but note that they are modest and do not reflect the urgency with which action is needed
• Guiding principles, but we suggest critical improvements
• Priority interventions, as the reflect the SAFER alcohol policy blue print

We suggest to improve

• The vision of the framework.
• Focus on DUI and SBIT overshadows the need to advance the three alcohol policy best buys, and especially alcohol taxation. This matters for making progress quickly and setting African countries on track towards the targets.