Call time on soft approach to Big Alcohol
Location: The World
Topic: Alcohol, WHO
Call time on soft approach to Big Alcohol
March 25 2015
Ten years ago the World Health Organisation’s Framework Convention on Tobacco Control (FCTC) came into force. It was not the first international health treaty negotiated by the WHO, but in many ways it was the most remarkable. Achieving global consensus around any kind of public health treaty is quite a feat. So achieving a consensus when the main target of the treaty was, in effect, that most slippery and dangerous of customers – Big Tobacco – was close to miraculous.
Within a year, 168 states had signed the treaty and many more are now parties to the convention. As the WHO loudly (and rightly) trumpets, this makes it “one of the most rapidly and widely embraced treaties in the history of the United Nations”.
In the decade that has passed since the FCTC earthquake shook the international health law landscape, the global public health community has increasingly turned its attention to another industry: Big Alcohol. So far the WHO has stopped short of using its authority to create a Framework Convention on Alcohol Control (FCAC).
Instead it has opted for a more softly-softly approach. This has primarily taken the form of aglobal strategy to reduce the harmful use of alcohol which was endorsed by the 63rd World Health Assembly in 2010. This strategy is designed to tackle the growing impact of alcohol on individuals and society. However, as a “portfolio of policy options and measures that could be considered for implementation and adjusted as appropriate at the national level” it growls more than it bites.
The calls for FCAC
The unwillingness of the WHO to grasp the framework nettle has annoyed many a medical expert. The World Medical Association, the American Public Health Association and the American Society of Addiction Medicine have issued policy statements calling for an international convention to control alcohol and many leading medical journals such as The Lancet have published supportive editorials.
The underlying reason for these calls relates to the fact alcohol is beginning to rival tobacco in the deadly harvest that it reaps. Tobacco still rules the roost in terms of the global impact on health; around half of the billion-strong smokers living today will probably die of tobacco-related diseases. However, the global burden of disease attributable to alcohol is very similar to the burden attributable to tobacco and in certain groups, especially the young, alcohol may already cause more havoc.
Harm caused by alcohol
In 2012, 5.9% of all global deaths and 5.1% of the global burden of disease and injury were attributable to drinking alcohol. This translates into 3.3m souls succumbing to the allure of beer, wine and spirits. The problem is especially acute in countries like Russia. But the UK is badly affected too.
Alcohol, like tobacco, can also affect third parties. Adults and children who cultivate tobacco are exposed to a number of hazards and may develop conditions like acute nicotine sickness. Passive smokers are also at risk. However, alcohol has much more wide-ranging impacts on third parties. Road traffic incidents and domestic violence are prime examples.
Alcohol also downs a lot of resources. The NHS forks out 3.5 billion annually to treat the consequences of alcohol misuse. This is a bit more than the cost to the NHS of treating diseases caused by smoking. When other costs, such as policing and lost productivity are added, the total bill for England alone is about 21 billion per annum. This dwarfs the UK-wide tax receipts generated from alcohol duties which amounted to 10 billion in 2013-2014.
Tobacco but not alcohol?
Given the similarities between alcohol and tobacco it may seem odd that there is a legal framework for tobacco but not for alcohol.
Two simple explanations for the difference in approach can be dismissed quite quickly. The first is that tobacco, unlike alcohol, is always dangerous. The second is that alcohol, unlike tobacco, has health benefits. The first claim is strained. If your total tobacco consumption amounts to smoking one – and only one – cigar on your birthday the extra risk to your health is either non-existent or infinitesimally small.
Red wine debate still bubbling away. Derek Gavey, CC BY
The second claim has more force, especially (perhaps) when the alcohol consumed takes the form of red wine. However, the health benefits of alcohol are increasingly contested and according to some experts may evaporate entirely when the evidence is properly scrutinised.
What other reason could there be for the different approach to alcohol? One procedural explanation is that international legal treaties take a lot of time and effort to negotiate – the FCTC took ten years and cost in excess of US$34m. Having expended so much effort on the FCTC is it possible that framework-fatigue has already kicked in?
A more cynical explanation is that Big Alcohol has lobbied the WHO more effectively than Big Tobacco ever managed to do. The recent debacle in England regarding a minimum price for a unit of alcohol certainly suggests that policymakers can be under the influence.
Even the most ardent supporter of tobacco and alcohol – and I speak as a never smokerbut a regular drinker – must admit that these products are causing an immense amount of ill-health to users around the world, and significant harm to children and third-parties. As such, a firm legislative and global response is needed.
This is not some kind of paean to prohibition. Aside from the fact that criminalising consumption or sale of alcohol or tobacco does not work, competent adults have the right to take risks with their own health.
Instead, this is a call for legally binding international conventions to help defend tobacco and alcohol control policies in trade courts and help countries deal with issues, such as web advertising, that can leak across national borders. It is also a call for global conventions that would enable ministries of health to implement strong domestic regulation and would empower non-governmental organisations to bring legal and social pressure to bear on corporations and corrupt legislators.
Thanks to the WHO we already live in a world governed by such a convention relating to tobacco. We should now call time on the soft approach to Big Alcohol by implementing some hard law.
Convention needed to regulate alcohol
7th November 2008
Experts on bmj.com have said that an international agreement, similar to the 2005 framework convention on tobacco control, is urgently needed.
The authors believe that such a convention would place restraints on the international trade in alcohol, and help legislators and governments learn about, and implement, effective evidence based policies on alcohol control.
Policymakers, they say, continue to use public information campaigns and education programmes to control alcohol related harms despite evidence that they are only marginally effective. Yet there is strong evidence that taxation and restricting availability, marketing and distribution of alcohol are what works, writes Laura Schmidt, and colleagues from Australia, Canada, Finland and the US.
They point out that the health and social harms caused by alcohol disproportionately effect the poorest populations of the world and that it is timely to apply the framework convention model to alcohol in developing countries such as Africa and South America.
Tobacco is controlled by the 2005 framework convention, narcotic drugs by the 1961 convention and psychoative substances by the 1971 convention.
The Fair Pint Campaign
Supporting tied landlords and consumers
24,000 of Britain’s pubs are tied to PubCos. Even though tied landlords can buy cheaper beer – they are tied to the PubCos for their supply.
• Tied pub landlords must buy all of their beer and some other supplies from the PubCo.
• Consequently the consumer is usually paying a significanly inflated price for a pint of beer, and tied pub landlords are being forced to sell beer at a loss.
• Around 27 pubs a week – just under four a day – are closing.
It’s time to break the tie and call for a fair pint.
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Visit our news page for the latest developments, and see how the Fair Pint? Campaign is raising the profile of this important issue.
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Women targeted in drink campaign
By Toby Helm, Public Policy Editor and Rebecca Smith, Medical Editor
Middle-aged women will be targeted in a hard-hitting anti-alcohol campaign after research found that just one large glass of wine per night could increase the risk of breast cancer by 60 per cent.
Up to 2,000 women every year die from breast cancer linked to drinking, with a growing number also suffering other cancers, liver damage and fertility problems.
Rising levels of alcohol consumption, particularly among the middle classes, have been blamed in part on an increase in the strength of many wines and a fashion for larger glasses, leading to confusion over how many units of alcohol each glass contains.
The Government has responded with a 10 million advertising campaign that aims to educate women about the health risks of drinking and the need to be aware of how much alcohol they are consuming.
The drive has been spurred by a Department of Health report that has not yet been published but details of which have been obtained by The Daily Telegraph.
It found that women who consumed more than the recommended level of 14 units of alcohol per week were at least 60 per cent more likely to suffer breast cancer than those who stayed below the limit.
With one large glass of wine now estimated to be worth the equivalent of three units, just one per night would add up to more than 20 units a week.
The campaign amounts to a partial admission by ministers that they have focused too much on teenage “binge drinking” – to the exclusion of other age groups who are at the greatest risk of damaging their health. It will also signal a move towards emphasising the health impact of drinking instead of focusing almost exclusively on its links to crime and anti-social behaviour.
One arresting image that will be used will show two wine glasses without stems, resembling a woman’s breasts. The campaign will feature on television and in cinemas, and on posters in pubs, clubs, GP surgeries and hospitals.
Dawn Primarolo, the public health minister, said the campaign would leave women in no doubt that their health would be seriously at risk if they carried on drinking too much. “This group of middle-aged women is under everybody’s radar,” she told The Telegraph. “There is a great deal of harm being caused to them.
“People need to be reminded of the health consequences. It is not only the issues around breast cancer but also, increasingly, liver disease, unplanned pregnancies and ruptured bladders. This is dreadful stuff.”
Ministers have been alarmed by data showing a sharp rise in hospital admissions of women whose conditions turn out to be linked to alcohol.
Another aspect of the campaign will be to ensure that people know how much alcohol they are drinking.
“People go out and think they have drunk one glass of red wine and that was one unit – but the glass was so large it was in fact three and a half units,” Ms Primarolo said.
Ignorance was particularly common among women, many of them middle class and who tended to drink at home. “There is a group of middle-aged women who have been consistently drinking above the recommended level without realising it,” she said.
Admitting that the campaign would be controversial, Ms Primarolo added: “There has to be a bit of a shock element. I am not talking about things that will be ghoulish but the imagery will be unmistakable.”
Official guidelines say women should drink no more than 14 units of alcohol a week, and men no more than 21. However, many do not know what constitutes a unit.
Half a pint of beer or lager of 3.5 per cent strength is one unit but this can be misleading because many lagers are around five per cent. Similarly, one small glass (125ml) of wine of eight per cent alcohol is one unit but most wines are now between 11 and 13 per cent, and few pubs use small glasses. With a large glass often measuring 250ml, it can contain one day’s alcohol quota for a woman.
Doctors have been calling for a shift in Government policy for several years as the health impact of excessive drinking increases. Deaths attributed to alcohol have doubled in 10 years and there is particular concern at the growing number of women with liver damage, pancreatitis and cirrhosis.
According to Government figures, 20 per cent of women (4.9 million) are classed as hazardous drinkers because they are consuming between 14 and 35 units at week.
Women in higher managerial jobs are likely to drink the most.
But critics will be disappointed that the Government is again turning to an awareness campaign. The Alcohol Health Alliance, which is made up of medical groups, wants a rise in tax on alcohol, a ban on advertising and restrictions on sales.