Global Governance on Alcohol

NGO Movement in Global Governance. Global governance, as a response to the global nature of the markets and communication networks, requires not just intergovernmental responses, such as those carried out by the UN system (see the section titled ‘the UN system’ below), but also response from NGOs and volun­tary organizations operating at a regional and inter­national level.

In response to growing awareness of the contribution alcohol is making to the global burden of disease, a number of NGOs focused on alcohol policy have emerged and a number of health NGOs have demonstrated concern for alcohol policy development.

For example, in 2005 the World Medical Association passed a Statement on Reducing the Global Impact of Alcohol on Health and Society, which urged consider­ation of a Framework Convention on Alcohol Control similar to that of the WHO Framework Convention on Tobacco Control. This was followed in 2006 by a state­ment from the American Public Health Association, which also urged the adoption by the World Health Orga­nization of a binding international treaty, modeled after the Framework Convention on Tobacco Control.

The World Bank, which in 2000 issued a Note calling for caution in relation to funding of alcohol beverage projects as part of development aid, has more recently in its World Development Report for 2007, Development and the Next Generation, emphasized the dangers of alcohol (and tobacco) use by the world’s cohort of younger people and called for action via raising taxation, comprehensive bans on advertising and product promotions, age restric­tions on sales, and prominent health warnings.

Newly emerging global and regional networks on alco­hol policy are monitoring and advocating for action within the U.N. system as well as by national governments. These include the Global Alcohol Policy Alliance, Eurocare, the Asia Pacific Alcohol Policy Alliance, and the Indian Alcohol Policy Alliance.

The UN System. A regional approach to alcohol policy was initially mapped out by Health Ministers in Europe, in consulta­tion with nongovernment organizations. In 1995, a WHO European Charter on Alcohol was adopted, with ten stra­tegies for action. This was followed by an Action Plan, later revised for 2000-07. In 2001, the Health Ministers of WHO Europe countries issued a Declaration on Young People and Alcohol, with policy targets to 2006.

The European Commission also reviewed the policies of its member countries in 1998 and in October 2006 released a European Union Alcohol Harm Reduction Strategy. This strategy had had considerable input from industry representatives and, upon its release, received a more favorable response from industry interests than the NGO sector. Its focus on education as the strategy of choice reflected the lobbying on the part of the industry interests who were pleased to see no specific plan with regard to taxation or product labeling (Anonymous, 2006).

In 2006, following concern raised by public health agencies and community organizations in the Western Pacific Region, the World Health Organization’s Western Pacific Regional Office drafted and consulted on a Regional Strategy to Reduce Alcohol-Related Harm that reflects current evidence on effective policy.

The Strategy notes that effectiveness will depend on member countries combining as many as possible of the recommended measures, which included: public awareness and health promotion; building capacity among health workers, sup­port for advocacy and community action; regulation of advertising and sponsorship enforced by a government agency; drunk-driving laws with a low blood alcohol concentration (BAC) and frequent random enforcement; collaboration between health and law enforcement on alcohol-related crime and public safety; regulating alco­hol sales through a minimum age, restrictions on avail­ability and a licensing system; appropriate enforcement of the above alcohol laws, using taxation based on alcohol content to reduce harmful use, and giving consideration to alcohol harm reduction when participating in trade negotiations.

The Western Pacific Regional Strategy was adopted by the region’s Heath Ministers in October 2006. The same month, Health Ministers of WHO’s South-East Asian Region adopted a short Resolution endorsing a report on Policy Options for Alcohol Consumption Control as a guide and minimal framework for member states.

The report noted research on effective and cost-effective inter­vention, and its options included taxation and other price controls, regulating alcohol availability, drunk-driving mea­sures, regulation of production and distribution, restrictions on advertising, and community action. It noted the expense and limited effectiveness of mass media moderation cam­paigns countered by industry advertising.

The report also commented on the role of key players, noting that local communities and groups were crucial for effective action and monitoring practices and policies, and there was a more limited role for the industry in ensuring high standards and compliance with regulations (World Health Organization Regional Office for South-East Asia, 2006).

Following evidence of the large contribution that alco­hol makes to the burden of injury and disease in all regions of the world, the World Health Organization reviewed current alcohol policies in WHO member countries (World Health Organization, 2004) and sponsored a proj­ect to evaluate the most effective and cost-effective alcohol policies to reduce alcohol-related harm (Chisholm et al, 2004, 2006). In 2005, Health Ministers gathered at the 58th World Health Assembly adopted a report on ‘Public health problems caused by harmful use of alcohol’ (World Health Organization, 2005).

It noted the policy strategies most likely to be effective or ineffective in reducing alcohol- related harm and mandated further work by WHO in this area. In the following year, a resolution supported by more than 40 countries calling for work toward a global strategy on alcohol failed to achieve a consensus and was referred back to the Executive Board for further work.

In addition to the partial progress made to date on regional and global strategy, there have been, as described earlier, calls from NGOs and also in the scientific litera­ture for action more in line with that taken with regard to tobacco, in the form of a binding international agreement - a Framework on Alcohol Control Policy (Room, 2005).

There are differences between tobacco and alcohol that militate against such an agreement, the most important of which is probably the much shorter time of widespread use of the two drugs. Whereas tobacco has been widely used only in the last 100 years, alcohol has a much longer history. However, the new situation brought about by vastly increased globalization, resulting in much faster spread of commercial alcohol in contexts without traditional social controls constraining harm, and the size and vulnerability of the world’s youth cohort, are factors that are as relevant for alcohol as for tobacco.

There is good evidence of effective policies to reduce alcohol-related harm that may be implemented at the national and local level. An international infrastructure is needed to ensure the appropriate dissemination and adoption of these effective strategies, but such a frame­work is currently lacking.

Citations:
Anonymous (2006) EU Alcohol Strategy - Is the glass half full or half empty? The Globe, Issue 3.
Babor T, Caetano R, Casswell S, et al. (2003) Alcohol: No Ordinary Commodity - Research and Public Policy. Oxford, UK: Oxford University Press.

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Chisholm D, Rehm J, van Ommeren M, and Monteiro M (2004)
Reducing the global burden of hazardous alcohol use: A comparative cost-effectiveness analysis. Journal of Studies on Alcohol 65: 782-793.

Chisholm D, Doran C, Shibuya K, and Rehm J (2006) Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug and Alcohol Review 25: 553-565.

Foxcroft D (2006) Alcohol education: Absence of evidence or evidence of absence. Addiction 101: 1057-1058.
Gould E (2005) Trade treaties and alcohol advertising policy. Journal of Public Health Policy 26: 359-376.

Gual A and Colom J (1997) Why has alcohol consumption declined in countries of southern Europe. Addiction 92(supplement 1): S21-S32.
International Center for Alcohol Policies (2002) Self-Regulation and Alcohol: A Toolkit for Emerging Markets and the Developing World. Washington, DC: International Center for Alcohol Policies.