Achieving consensus on a tricky liquid

The recent publication of the World Health Organization’s Global Status Report on Alcohol and Health marked a “further milestone in WHO’s efforts to monitor the situation with alcohol consumption, alcohol-related harm and policy responses worldwide” – as the report itself notes. It provides a comprehensive summary of current information about alcohol use and misuse around the world and its release resulted in considerable media interest, including in New Zealand.

For those of you who looked (very!) closely at the report, you might have noticed that New Zealand was one of four countries that financially supported the production of the report, including the collection and analysis of the report’s data. This is significant, as despite the acknowledgement of the public health burden from harmful use of alcohol, and now international agreement on a global strategy to reduce harmful use of alcohol, it is still a low priority for donor funding to support WHO’s work in the area.

New Zealand has also contributed to other recent milestones in WHO’s work to strengthen the global response to harmful use of alcohol. The process that eventually led to agreement on a global strategy was kick-started at the World Health Assembly in May 2005, with agreement on the first resolution in over a decade on harmful use of alcohol. The term ‘harmful use of alcohol’ was carefully constructed to accommodate varying views on what might this might constitute. The complexity of the negotiations at that meeting were a harbinger of what was to come in following years: at one point the delegate from Iceland, who was reporting progress on the delicate negotiations, described alcohol as a ‘tricky liquid’, much to the amusement of those gathered. The term still seems highly appropriate!

In September 2006, New Zealand hosted the annual WHO Western Pacific Regional Meeting in Auckland, where a regional strategy to reduce alcohol related harm was considered and endorsed by the region’s countries. The regional strategy was designed as a menu of best practices to reduce alcohol-related harm and facilitate policy development and implementation at the country level.

Two years later, the issue was back on the World Health Assembly (Assembly) agenda, with a group of countries seeking a mandate for WHO to develop a global strategy to reduce harmful use of alcohol. Some countries and parties, such as the alcohol industry, questioned the need for a global strategy per se. Arguments in response focused on the global aspects of the production, marketing, and trade in alcohol, which thus required a global response to at least some aspects of the public health problems caused by harmful use of alcohol. I was personally involved as chair of a ‘drafting group’, but after three days of intense effort we were unable to agree the text. I found out only later that the blocking tactics employed by one country were only partly about the issue at hand – the chief motivation was a political tit-for-tat on a completely unrelated issue!

But the following year, the Assembly did agree a resolution mandating the development of a global strategy, and again New Zealand played a key role in solving a very minor wording problem that threatened to derail the whole process. There was a palpable sense of relief – and achievement – when the resolution was adopted ‘with acclamation’. At the same meeting, the Assembly also endorsed the 2008-2013 Action Plan for the global strategy for the prevention and control of noncommunicable diseases, which identified harmful use of alcohol – along with tobacco use, unhealthy diet and physical inactivity – as one of the four common risk factors for the main noncommunicable diseases. This was another important ‘breakthrough’, greatly increasing the visibility of both the burden of disease by caused harmful use of alcohol and its preventability.

Following the Assembly, New Zealand’s advice was sought by the WHO secretariat on the next steps, and we unanimously agreed that getting widespread buy-in to the Strategy was key: as then New Zealand Director-General of Health Stephen McKernan noted in the meeting “You can’t overdo the process.”

WHO subsequently embarked on a widely consultative process to develop the Strategy during 2008 and 2009, with New Zealand again playing a role by hosting the WHO Western Pacific  Region Consultation in Auckland in March 2009, one of six such regional meeting held. Other consultation meetings were held by WHO with civil society organisations as well as the private sector.

The Global Strategy to Reduce Harmful Use of Alcohol was endorsed by the World Health Assembly in May 2008, a significant achievement, but one that really only signals the ‘end of the  beginning’. Action by countries, both individually and collectively, will determine the value and success of the Strategy.

There are significant opportunities this year, with the United Nations General Assembly convening a two-day ‘high-level meeting’ on noncommunicable diseases in September in New York. With  harmful use of alcohol clearly featured among the four ‘common risk factors’, global attention to this important public health problem can only increase – as, hopefully, will global action.