Implementing effective alcohol policies: global governance to reduce alcohol-related harm Sally Casswell AP15: Policies for Reducing Problems Associated With Alcohol Availability, 2010 Washington DC

What has led towards development of global strategy? Expansion and marked consolidation of global alcohol industry in past two decades Profits used for investment and marketing in emerging markets (low and middle income countries) Rapid rise in consumption and harms in emerging markets and lack of adequate policy response Increases in unsaturated segments in mature markets Increased data availability

DALYs (000) lost in the world due to different risk factors in 2004 (WHO, 2009)

Why a Global Strategy on Alcohol? Alcohol, in striking contrast with both tobacco and illicit drugs, lacks a coherent framework for global control of alcohol- related harm Lancet Series, 2009

Global policy environment Global alcohol issues –Marketing and supply –Trade agreements –Limitations of national level response –International industry activity –Promote ineffective policy and prevention –Partnership focus

Global governance State sector – national (state and federal) governments – intergovernmental organisations NGO sector -advocacy -research TNCs – producers – front organisations

WHO Global Strategy to Reduce the Harmful Effects of Alcohol First resolution on alcohol since 1983 at WHA, 2005 Expert Committee report, 2007 Resolution, not endorsed WHA, 2007 Resolution calling for global strategy, amended and endorsed at Executive Board, Jan, 2008 Resolution calling for global strategy amended and endorsed, WHA, May, 2008 Secretariat draft Working Paper, March, 2008 Consultations –WHO conducted web based public hearing, October 2008 –Consultation with economic operators, November 2008 –Consultation with NGOs, November 2008 –Regional technical consultations with Member States in all six WHO regions, February – May 2009 Draft Global Strategy to EB, January 2010 Global Strategy endorsed by Member States, WHA, May 2010

Industry Stakeholder Marketing Recognition of need for organised efforts to avoid tobaccos fate First SAO (Portman Group, UK) established 1989 ICAP established 1995, –Statements (eg Dublin Principles), publications, conference sponsorship, research…. –Regional and national meetings in emerging markets Producers CSR –Drinking Responsibly Campaigns, disaster relief ……. GAPG established for Global Strategy Lobbying re Global Strategy –Presence in Geneva –Targeted publications eg Working Together to Reduce Harmful Drinking, ICAP –GAPG lunch briefing to show off industrys programs to reduce the harmful use of alcohol. (Oct, 2009 ) –Paid lobbyists eg Stiehle Consulting, Whittaker Group

Resolutions calling for Global Strategy Resolution calling for global strategy amended in Executive Board, Jan, 2008 –(4) to collaborate and consult with Member States as well as with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol; Resolution amended WHA, May, 2008 –4) to collaborate and consult with Member States, as well as consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators on ways they could contribute to reducing harmful use of alcohol;

Between Working Paper and EB 14. Sustained political commitment, effective coordination, sustainable funding and appropriate engagement of subnational governments as well as from civil society and economic operators are essential for success.

Between Working Paper and EB 58. Bilateral, regional and international trade agreements should consider making provision for alcohols status as a special commodity, in the light of its dependence-producing properties and the public health impact of alcohol-related harm. –Working Paper from Secretariat, March, 2008 No mention of trade –After Executive Board Meeting, Jan 2010

Between Working Paper and EB Marketing A regulatory framework, preferably with a legislative basis, with appropriate and timely sanctions is essential for the regulation of marketing and sponsorship of alcoholic beverages …… –Working Paper from Secretariat, March, 2008 For this area policy options and interventions include: (a) setting up regulatory or co-regulatory frameworks, preferably with a legislative basis, and supported when appropriate by self-regulatory measures, for alcohol marketing by … –After Executive Board Meeting, Jan 2010 Marketing changes between Working Paper and EB Trade dropped

Between Working Paper and EB Taxation –Softened: re alcohol content, –Removed: re beverages attractive to young, removal of duty free, benchmarking prices with basic commodities Supply –Softened re liability of sellers and servers

16. The policy options and interventions available for national action can be grouped into 10 recommended target areas which should be seen as supportive and complementary to each other. These 10 areas are: 1.leadership, awareness and commitment 2.health services response 3.community action 4.drink–driving policies and countermeasures 5.availability of alcohol 6.marketing of alcoholic beverages 7.pricing policies 8.Reducing the negative consequences of drinking and alcohol intoxication 9.reducing the public health impact of illicit and informally produced alcohol 10.monitoring and surveillance. WHO (2010) Global Strategy to Reduce Harmful Use of Alcohol WHO Global Strategy on Alcohol – policy options and interventions

(a) Public policies and interventions to prevent and reduce alcohol related harm should be guided and formulated by public health interests and based on clear public health goals and the best available evidence (c) All involved parties have the responsibility to act in ways that do not undermine the implementation of public policies and interventions and interventions to reduce harmful use of alcohol (d) Public health should be given proper deference in relation to competing interests and approaches that support that direction should be promoted WHO (2010) Global Strategy to Reduce Harmful Use of Alcohol WHO Global Strategy on Alcohol – principles

The strategy acknowledges the significance of different national, religious and cultural contexts for alcohol and proposes a menu of options that Member States may tailor to their cultures in order to reduce the harmful use of alcohol. The strategy also recognizes the need for the involvement of all stakeholders, including the industry, and the importance of self-regulation in helping address alcohol abuse…………………..

NGO activity Less well developed than in tobacco GAPA, APAPA, IAPA, EAAPA ……… Evidence of effective policy and implementation in different contexts Making apparent and providing critique of industry activity

Intergovernmental WHO –Research project on alcohol and development FASD; Harm to others; implementation effective policies in context of development; infectious diseases (TB, HIV) –Establishing alcohol national counterparts –Global meeting on implementation mechanisms, 8-11 February, 2011 –Report to WHA, 2013 UN – high level meeting on NCDs, 2011

In Conclusion Global Strategy achieved Process illustrates key interests and players in global governance of alcohol Not a health treaty but…………. globalised rules and principles can be of consequence even if utterly detached from enforcement mechanisms (Braithwaite and Drahos, 2000) Provides a framework for evaluation of global developments in 2013