There is growing awareness in the global health governance arena of the extent and nature of alcohol related harm and the costs this imposes in high-income countries and in middle-income countries which are the major targets of the transnational alcohol corporations (TNAC). However, this awareness is not yet matched by global responses commensurate with the harms. In part, this can be attributed to the political economy of the past four decades during which trade and economic agreements and few regulatory constraints have allowed unprecedented development of the TNACs.
The TNACs embarked on a strategic programme of lobbying, corporate social responsibility activities, including co-opting civil society and engaging in public private partnerships in implementing ineffective personal responsibility programmes, and normalisation of alcohol via consumer marketing and this has succeeded in subverting the uptake of cost effective alcohol control policies despite evidence supporting their use. The WHO ‘best buys’ of excise taxes and restrictions on marketing and availability are strongly opposed.
The civil society voice advocating for effective policies and exposing the activities of the alcohol industry has not been commensurate with the harm causally linked to alcohol use. The lack of philanthropic support for activities aiming to effectively reduce alcohol-harm contrasts markedly with the support received by tobacco control. Recent developments in the global governance arena have emphasised the value of an earmarked tax on alcohol to fund advocacy and community action, of which Thai Health remains the most significant; this is a user pays approach to prevention work.
Positive moves in the global governance arena have been the UN focus on Non-communicable diseases, with alcohol advocates slowly ensuring more attention paid to the ‘fourth’ risk factor – alcohol – and to the importance of alcohol control policies to achieve the Sustainable Development Goals. An increased understanding of the commercial determinants of health, the need for policy coherence and collaborations to promote excise tax across tobacco, sugar and alcohol are all indicators of the changing environment. However, the alcohol industry is very present in the global governance arena reflecting a lack of awareness of the extent of the conflict of interest which defines their anti-health activity. An example is the representation of the alcohol industry at the UN during the Third High Level Meeting on NCDs in September 2018 where the world’s biggest brewing companies, ABInBev, Heineken and Molson Coors, were included in a Side Event on “Advancing the SDGs - A partners perspective” hosted by the Permanent Mission of the Dominican Republic to the UN, with the Worldwide Brewing Alliance.
Alcohol’s contribution to the health and development burden and the leverage alcohol industry is able to assert in global health governance makes alcohol an obvious candidate for an international legally binding instrument similar to the Framework Convention onTobacco Control (FCTC).
The call for an FCAC has been heard more frequently recently. The recent WHO Global status report on alcohol and health 2018 sums up the present situation:
"Given the increasing encroachment of international trade and investment on the ability of national and subnational governments to control their alcohol markets, and the increasingly consolidated global alcohol producers, a strong public health case for considering the negotiation of a Framework Convention on Alcohol Control, or alternatively for including alcohol within other international control systems (Room et al., 2008), has been repeatedly presented and discussed by public health entities, experts and advocates (The Lancet, 2007; Casswell & Thamarangsi, 2009; Baumberg 2010)."
During the same UN High Level Meeting on NCDs a side event on “Alcohol, NCDs, and Sustainable Development; Where do we stand and where do we go?” was organized by Slovenia, Sri Lanka, Thailand, Estonia, Sweden, Philippines and Suriname together with the World Health Organization and IOGT International. During the event representatives from Lithuania, Sri Lanka and Thailand specifically mentioned the need to explore a Framework Convention on Alcohol Control.
Civil society and governments can work together to bring alcohol higher on the global health and development agenda, with the particular aim to promote a Framework Convention on Alcohol control under the auspices of WHO. The PMAC side meeting provides and important setting to bring the issue forward as it aligns well with the conference theme of “The Political Economy of NCDs: A Whole of Society Approach”.
The side event is open to all participants without a conflict of interest.
Proposed program outline
Opening, welcome remarks by co-hosts
Setting the scene:
- Presentation: Framework Convention on Alcohol Control (FCAC): why and how [Professor Sally Casswell, GAPA Chair]
Present Global health landscape influencing the road map towards an FCAC:
- Threats to alcohol policy from trade/investment agreements [Sanya Reid Smith, Third World Network]
- Conflict of interest and WHO FENSA [Øystein Bakke, GAPA Secretary]
- Industry lobbying and CSR: eg from Africa [Tungamirai Zimonte, IOGT International Board Member]
- Industry lobbying and CSR: eg from Vietnam [Dr TRAN Tuan, Chairman Viet Nam Noncommunicable Diseases Prevention Alliance ]
- Member States support for an FCAC [Dr. Supreda, ThaiHealth]
Group discussion - Developing a road map towards an FCAC.
Report back from group discussion
Concluding panel comments to the group reports and plenary discussion: FCAC: Why and how?