NEWS ANALYSIS: A World Apart

The WHO has not yet determined a course of action to deal with problem drinking, but the issue is now looming large on the global health agenda, writes Ben Grant

When the World Health Organisation (WHO) held its annual assembly in Geneva last month, the issue of harmful use of alcohol emerged high up the agenda. The gathering had intended to pass a resolution outlining a future direction for tackling problem drinking, but after four days of discussion no consensus was reached. It may be years before the WHO – a body that is not exactly renowned for speedy processes – finally devises an approach which all 193 of its member states agree on. But if and when a coordinated global policy is ultimately proposed, May 2007 will go down in the annals as the time that the wheels were set in motion. Now – more than ever – it is imperative that the trade takes its commitment to responsible consumption seriously and proves to legislators that it can be a trusted partner working alongside lawmakers for a mutually agreeable resolution.

The WHO is a United Nations body charged with devising and implementing global health policy. It is headed up by director general Dr Margaret Chan (who earned the nickname Mrs Avian Flu after her role in overseeing the threat of an epidemic in her native Hong Kong). The health ministries of all 193 member states meet at the week-lokg World Health Assembly each year to discuss key issues and future strategy.

The organisation’s workload includes activities focusing on communicable and non-communicable diseases. The main thrust of the latter is tobacco, food/diet and harmful use of alcohol. The Framework Convention on Tobacco Control (FCTC) was agreed in 2005 – the document was signed and ratified and is now legally binding for the majority of WHO member states. It is notable that it took the WHO and the member states almost a decade to finally thrash out the terms of the convention – when it entered into force, however, the impact on industry was swift, comprehensive and crushing. While tobacco and alcohol are obviously two very different problems requiring very different solutions, the example of the FCTC makes abundantly clear the potential power of the WHO.

With one voice

The industry is, of course, eager that it should have some voice in policy making, and to this end the Global Alcohol Producers Group (GAP Group) was founded in 2005 to give the trade a unified global voice. Representing 17 of the leading companies in the trade, the GAP Group aims to be “a conduit for beverage alcohol producers to engage constructively with the WHO”, according to spokeswoman Abigail Jones. “We are convinced that feasible and effective solutions can only be reached with the involvement of all stakeholders and with full consideration of all the evidence.

“The trade is equally eager to take on the challenge of harmful drinking and to show what role we play alongside other stakeholders. We have valuable contributions to addressing alcohol misuse and we believe it’s important we have a seat at the table.” Jones is encouraged to note that “the early indications suggest that the new director general sees it as constructive to engage with industry.” In her opening address to the assembly, Chan said, “I am also talking with executives of multiple industries except for one – the tobacco industry.”

Industry knowledge
The vast experience that the industry has amassed over the years means that it can add valuable experience and knowledge to the decision-making process. By comparison, the WHO has only 8,000 members globally – many of these have limited knowledge of alcohol issues, and little experience of dealing with other stakeholders such as law enforcement.

Jones is quick to point out that the GAP Group will not take away responsibilities from other industry bodies such as national trade associations. In fact, she says, the GAP Group’s goal is to support national bodies in their liaison with individual health ministries.

Speaking to the drinks business on the eve of the World Health Assembly, which took place in Geneva from May 14-18, Jones expressed a hope that sufficient consensus would be reached at the meeting to give an indication of what direction the debate will move in the coming year. But she recognised that “it’s difficult to predict the dynamic of 193 countries”.

In the event, despite discussions taking place throughout the week-long assembly, and drafting groups “working until the eleventh hour”, no agreed-upon draft resolution was forthcoming. While frustrating, this outcome was always likely given the very different positions that various member states are coming from. The most notable division in Geneva came between the Swedish and Cuban delegations, which took very different positions leading the debate.

Given the Nordic tradition, it will come as little surprise to hear that Sweden stepped forward as one of the nations keen on a comprehensive and strict set of rules to govern the trade. Talking to local media after the assembly, Swedish Social Department spokeswoman Karin Nilsson-Kelly said, “We tried to compromise with the countries that protested.

But Cuba wouldn’t move an inch, they always came up with new objections.”

Cuba’s stance against restrictions was largely inspired by the importance of revenue from rum exports. Speaking on behalf of the Cuban Foreign Ministry, Oscar Léon Gonzalez expressed the sentiment that alcohol misuse is primarily an issue for first world nations; the developing world has more pressing health priorities. “Many people can’t understand why Sweden is pushing the alcohol question so hard when people are dying of Aids, tuberculosis and malaria in their countries.” With such diametrically opposed – and seemingly intractable – viewpoints, it’s easy to see why it is likely to take a significant time and plenty of diplomacy to reach a resolution. The fact that all discussions must be translated into six languages only slows down the process further.

Time to actIn terms of likely outcomes, it is probable that that WHO will ultimately take one of two paths: either a one-size-fits-all resolution, or an advisory position comprising a series of specifically targeted measures. The first of these would be similar to the FCTC, and would represent bad news for industry because many believe the issue should be addressed on a regional, culturally sensitive basis to achieve meaningful results. The latter, which has the support of GAP Group, acknowledges that the issues are not the same everywhere, so aims to offer advice and guidance on tackling the problem on a country by country basis – this would be similar to the approach that the WHO is currently taking with regard to diet and obesity.

“There’s a huge diversity of the issues that member states are keen to stress, representing the diversity of drinking patterns around the world,” Jones explained after the Assembly had concluded without resolution. Such a situation surely indicates that the most enlightened outcome would be a resolution that advises and assists each nation to deal with its specific problems, rather than a catch-all convention that may lack relevance for many countries.

It seems safe to assume that this decision-making process will run and run, and a coherent global policy on problem drinking will not emerge for some time. However the 2007 World Health Assembly catapulted the subject of alcohol misuse to the top of the priority list for international policy makers. If the industry is not seen to be taking a proactive stance to advocate responsible consumption – proving that it can be a trustworthy partner in devising a forward strategy – it could find itself locked out of the debate, and the implications for business would be dramatic.

© db June 2007