Elsevier

The Lancet

Volume 373, Issue 9682, 27 June–3 July 2009, Pages 2247-2257
The Lancet

Series
Reducing harm from alcohol: call to action

https://doi.org/10.1016/S0140-6736(09)60745-5Get rights and content

Summary

Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.

Section snippets

Alcohol: a global priority for action

The first report in this Series showed that consumption of alcohol contributes greatly to the burden of disease. Alcohol has an important effect on mental health and injury, overall accounting for 4·6% of the global burden of disease and injury in 2004.1

Present estimates of health effects probably underestimate the harm caused by alcohol, because the full range of social costs are under-researched.2 Estimates of economic costs associated with alcohol, which include measures of lost productivity

A global marketplace

Global, regional, and national policies to accelerate free trade in goods, services, and financial investments are enabling the expansion of alcohol corporations in emerging markets, contributing to increased availability, affordability, and marketing of alcohol.13 Trade agreements, structural adjustment programmes, and World Trade Organization (WTO) dispute settlements have often failed to recognise alcohol as a health-damaging commodity. The effects of trade agreements are felt nationally and

Alcohol producers

Alcohol producers are well organised and effective lobbyists for industry-friendly policies both internationally and nationally. Representatives of the global alcohol industry, especially the distilled spirits sector, were strong supporters of trade treaties that expanded their access to rapidly emerging markets.40 The World Spirits Alliance lobbied for the General Agreement on Trade in Services (GATS), seeking liberalisation or elimination of barriers to tariffs and non-tariffs, including all

Non-governmental organisation response

A major scaling up of activity both nationally and internationally will need increased resources to enable advocacy from well informed voices that are independent of commercial interests. The tobacco experience shows that investment in the non-governmental organisation (NGO) sector can catalyse and support national action.70 Development of the FCTC was supported by, and also supportive of, the development of a global network incorporating more than 200 NGOs.71, 72 However, in the alcohol policy

WHO

WHO is the policy holder for alcohol within the UN system. However, neither WHO nor other UN agencies with potential interests have paid much attention to alcohol.65 The financial and human resources allocated to international alcohol-related activities remain very small. For some years, WHO has received funding earmarked for alcohol (and other drug activities) from only two countries—Norway and New Zealand.

However, awareness of the role of alcohol in the global burden of disease has improved

Readiness for action

This Series has shown that the preconditions that facilitated development of a strong global and national response to the tobacco epidemic are also present for alcohol. These preconditions include: evidence for the extent of alcohol-related harm, evidence of cost-effective interventions and countries' experience in implementation; understanding of strategies and tactics used by the industry; and pressure for change from NGOs.70

Furthermore, this Series has provided data for the costs associated

Strengthening of national action

Countries vary in the extent to which they implement cost-effective strategies. A WHO global survey of alcohol policy, done in 2002, showed that some of the effective policies—eg, restrictions on place and time of alcohol sale, and age—are in place in most countries that responded.83 However, in many countries not all key effective policies are in place, and policies with reduced effectiveness (such as classroom education and mass-media campaigns) are more popular than are those policies shown

Strengthening of global action

An international refocus is urgently needed, particularly within WHO.81 Positive signs exist, both in the 2008 call from WHO member states for the development of a global alcohol strategy and in the regional activities. Signs of change in other international agencies are also present. The World Bank—which once facilitated the establishment of breweries as part of economic development—now takes public health issues and social policy concerns into account when considering investments in

A Framework Convention for Alcohol Control: a matter of time

In view of the comparability between tobacco and alcohol, plus the precedent established by the FCTC, calls for a Framework Convention on Alcohol Control (FCAC) are not surprising. These calls come from a range of sectors, including professional,77, 78 academic,65, 93, 94 and NGO sectors.95 Furthermore, this call appears in WHO publications, with a recommendation by the 2006 Expert Committee on Problems Related to Alcohol Consumption that WHO should analyse the feasibility of “international

Conclusion

Strong evidence exists for the need for an effective response to prevent alcohol-related harm. Rates of alcohol-related harm and potential increases in use (particularly in low-income and middle-income countries), the availability but little uptake of cost-effective, affordable interventions, and the dangers posed from aspects of globalisation all show the need for a strengthened response both nationally and globally. To enable this response we need: an active process of negotiation in which

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