Alcohol, a Huge Obstacle to Sustainable Development

The products and practices of the alcohol industry cause an unprecedented global disease and development burden

Alcohol availability

Incidents of sexual and other assaults, domestic violence, child abuse, youth violence, homicides, alcohol-related motor vehicle crashes, and drunk driving have all been shown to increase when the availability of alcohol increases – Photo by Paolo Bendandi on Unsplash

By Kristina Sperkova, President of MOVENDI International – Since the adoption and subsequent implementation of the WHO Global Alcohol Strategy, there has been no significant reduction in the number of alcohol-related deaths, illnesses and social and economic harm.

Globally, levels of alcohol consumption and alcohol-attributable harm remain unacceptably high. And the products and practices of the alcohol industry adversely affect 14 of 17 Sustainable Development Goals.

Implementation of the WHO Global Alcohol Strategy is inadequate

The implementation of the WHO alcohol policy best buys (increasing taxes on alcoholic beverages, enforcing restrictions on exposure to alcohol advertising, and restrictions on the physical availability of retailed alcohol) has been inadequate in the last ten years and needs to be accelerated.

Alcohol Affordability

95% of reporting countries implement alcohol excise taxes but only a  few use such taxes to reduce alcohol use and achieve public health goals. In addition, less than half use price strategies such as adjusting taxes to keep up with inflation and income levels, imposing minimum pricing policies, or banning selling below cost or volume discounts.

Alcohol Availability

  • Less than one-third of countries have regulations on outlet density and days of alcohol sale.
  • Some countries, mainly low and medium income countries in Africa, still have no legal minimum purchase age.

Alcohol marketing

  • Alcohol marketing regulation continues to lag behind technological innovations and e-commerce, including rapidly developing new delivery systems.
  • Most of the countries that reported no restrictions across all media types were located in the African or Americas regions.

Alcohol remains one of the leading risk factors contributing to the global burden of disease. The contribution of alcohol to the global disease burden has been increasing from 2.6% of DALYs in 1990 to 3.7% of DALYs in 2019.

The alcohol industry remains to be the biggest obstacle to evidence-base public health action on alcohol. And the absence of robust infrastructure on all levels undermines sustained action, leadership, exchange, and accountability.

Growing awareness of the heavy burden alcohol harm causes

It had taken ten years for a substantive discussion of the global alcohol burden and the necessary policy response at the WHO governing bodies. The Executive Board’s decision by unanimous consent in February 2020 (EB146) finally changed this and identified alcohol as a “public health priority”.

EB146 decision also illustrated growing awareness of the heavy burden that alcohol harm places on a broad range of health and development goals. The decision also underlined the growing commitment to take much more ambitious actions to protect people from harms due to alcohol.

The decision contained four action points, requesting WHO and its Director General to:

  • Develop an action plan (2022–2030) to effectively implement the WHO Global Alcohol Strategy as a public health priority;
  • Develop a technical report on cross-border alcohol marketing, advertising and promotional activities, including those targeting youth and adolescents;
  • Resource the work on alcohol harm and policy solutions adequately; and to
  • Review the WHO Global Alcohol Strategy and report to the 166th session of the Executive Board in 2030 for further action.

Two years of making alcohol policy a priority

Since then, alcohol policy has been on the agenda over the last two years – and it is crucial that alcohol policy remains a regular agenda item in the coming years. WHO has conducted an extensive consultation process lasting two years, to develop the global alcohol action plan to accelerate alcohol policy development and implementation as public health priority – an urgent need according to WHO Member States. The consultation process included global and regional engagements with Member States, one informal meeting and web-based consultation with civil society and academia, and – controversially – also the alcohol industry, despite their fundamental conflict of interest.

After two years of consultation and negotiation of the draft action plan, the WHO Secretariat’s proposal for a global alcohol action plan won the unanimous approval from the Board. In the decision, members of the WHO Executive Board recommend to the 75th World Health Assembly (WHA75) in May 2022 to adopt the draft global alcohol action plan.

Flaws and positive elements of the proposed global alcohol action plan

The proposed Global Alcohol Action Plan has several flaws such as it normalizes the role of alcohol industry, it maintains WHOs dialogue with the alcohol industry, it keeps the concept of harmful use of alcohol that is very misleading as evidence shows there is no positive effect of alcohol use.

Positive elements of the proposed action include increased ambition and commitment, better alcohol policy infrastructure, re-convening of an expert committee on problems related to alcohol consumption.

Overall, five key themes emerged from all statements representing national priorities, concerns, and contexts:

  • Broad and strong support for an ambitious action, including ambitious goals and targets such as 20% alcohol use reduction per capita.
  • Priority attention to the most cost-effective, evidence-based alcohol policy solutions, the best buys and the SAFER technical package.
  • Unequivocal calls for WHO investment in technical support and capacity building for Member States to facilitate greater country impact.
  • Emphasis of the importance of governance and infrastructure improvements for alcohol policy on all levels.
  • Serious concerns about alcohol industry interference, and the need to develop technical guidance for Member States on how to avoid, or safeguard against potential conflicts of interest and industry interference in public health alcohol policy making.