Alcohol causes 3 million deaths each year. Eliminating conflicts of interest is vital to bringing this number down

Alcohol causes three million deaths each year, including 13.5% of deaths amongst those aged 20-39 years.

The personal and economic costs of alcohol-related harm are not met by the alcohol industry, which (like tobacco) is increasingly dominated by large multinational companies.

At the global level, there have been many calls for a binding international legal instrument on alcohol control; for example: here, here, and here.

Yet global health scholars warn that a framework convention on alcohol control would be premature at this point. Even if politically feasible, it might “bake in” weak norms that may do little to accelerate the implementation of priority policies for alcohol control. 

You’ll find interesting discussion about this issue here, here, here, and here.

Alcohol industry influence

The WHO’s Global Strategy for Prevention and Control of Noncommunicable Diseases, adopted in 2000, didn’t even mention alcohol as a risk factor.  This was apparently due to effective lobbying by the industry.

The Global Strategy to Reduce the Harmful Use of Alcohol was adopted by the World Health Assembly in 2010, yet WHO Member States have made little progress in adopting effective measures to reduce alcohol-related harm since that time, and global per capita alcohol consumption is expected to increase by 2025 (see here, para 13).

WHO documents have referred to the alcohol industry as “economic operators” and framed them as global stakeholders in reducing alcohol-related harm, encouraging them to implement “self-regulatory initiatives”: see, eg, here (para 45), and here (p 135).

Contrast this with the realisation in the case of tobacco that there is a ‘fundamental and irreconcilable conflict of interest’ between the tobacco industry and public health interests (see Guiding Principle 1 here).

The extent of WHO’s engagement with the alcohol industry is summarised in the Global Status Report on Alcohol and Health, published in 2018.

Acknowledging the significant influence of the alcohol industry at global and national levels, including efforts to influence policy and bias research, this report states:

‘Despite this a dialogue has continued with economic operators in alcohol production and trade at the international level seeking ways they can contribute to reducing the harmful use of alcohol in their roles as developers, producers, marketers and sellers of alcoholic beverages’ (p 130).

‘The main areas for the dialogue include self-regulation of marketing within coregulatory frameworks, labelling and consumer information, alcohol content in alcoholic beverages as well as provision of data useful for improving estimates of alcohol consumption in populations. In this context it has to be underlined that regulatory controls on the market must be decided and enforced by governments, with public health interests as the primary goals. Such regulations and their enforcement need to be protected from industry interference.’ (p 135)

The global alcohol industry has effectively exploited the prevailing conceptual approach to addressing NCDs – which emphasises public-private partnerships and a multisectoral, all-of-society approach.

(See, for example, paras 43-44 of the Political Declaration of the 3rd High-Level Meeting of the UN General Assembly on NCDs (2018), or do a word search for “partnership” in the WHO’s Global Action Plan for Prevention and Control of NCDs).

However, engaging with the alcohol industry has failed to reduce alcohol-related harm.

In reality, it has probably been counter-productive. Scholars have pointed out that it has created a welcome environment for influence by the alcohol industry.

WHO itself points out that alcohol industry lobbying is a key reason for countries’ lack of progress in implementing measures to reduce harm (eg here, para 67).

Alcohol and global health: a clear conflict of interest

WHO does not partner with the alcohol industry.

Yet it relies heavily on industry estimates of levels of alcohol consumption (see eg here, pp 398, 407).

And it apparently continues to consult with the industry about how “economic operators” might contribute to:

-the Global Strategy to Reduce Harmful Use of Alcohol (2010);

-the Action Plan (2022-2030) to Effectively Implement the Global Strategy to Reduce the Harmful Use of Alcohol [adopted by the World Health Assembly on 28 May 2022]; and to

-implementing the commitments made at High-level Meetings of the UN General Assembly on NCDs. For examples, see here, (p 3/31; 2019), here (2020), and here (2021).

The Action Plan (2022-2030) to Effectively Implement the Global Strategy was developed precisely because progress in global alcohol control has stalled.

The Action Plan highlights the ‘inherent contradiction between the interests of alcohol producers and public health’ (see para 14).

Yet according to the Foundation for Alcohol Research and Education (FARE), even this document was weakened during the consultation process: see Analysis of Changes to the World Health Organization Global Alcohol Action Plan 2022-2030.

It is mistaken to assume that just because opportunities exist to reduce the harm from promotion and sale of alcohol, that engaging or partnering with the industry will benefit public health.

This important lesson also applies to vaping regulation: see here.

If alcohol-related harm were diving sharply, then those who advocate for dialogue and direct engagement might have a point.  But it isn’t.

An OECD report states that Covid-19 may have intensified the problem of harmful alcohol consumption by those who drink to excess. 

Australian evidence suggests that alcohol brands have exploited people’s sense of isolation during Covid-19, and need for support, to push brand awareness: see here, and here.

At the global level, another recent report illustrates that the primary purpose of alcohol industry submissions to the Action Plan (2022-2030) to Effectively Implement the Global Strategy was to:

-challenge concerns about conflicts of interest

-promote collaboration and partnership between government and the alcohol industry; and

-keep the focus of policy efforts directed towards reducing harm from alcohol rather than reducing global consumption overall. See Alcohol Industry Submissions to the WHO 2020 Consultation on the Development of an Alcohol Action Plan: A Content and Thematic Analysis.

So long as they’re part of the conversation, whether at global or national level, the alcohol industry will use their access to policy-makers to advance their economic interests.

Those economic interests, unsurprisingly, involve growing markets for alcohol consumption, strengthening brands, and encouraging consumption.