One of the most significant developments for alcohol control in a decade came this past February, when the World Health Organization (WHO) Executive Board decided to develop a 2022-2030 action plan to implement its 2010 Global Alcohol Strategy on the Harmful Use of Alcohol (Global Alcohol Strategy).
The executive board’s first decision on alcohol control since 2010 also requested the development of a technical report on cross-border alcohol marketing and adequate resourcing for WHO’s alcohol control work.
Consultations on the action plan, which commenced in July 2020, provide a unique opportunity to shape the future of alcohol governance. They could lead to better integration of alcohol control into broader health and development agendas, key linkages to the human rights agenda, and better implementation of alcohol control measures at the national level. To help countries and civil society navigate these processes and the possibilities they present, this blog will outline how alcohol control is currently governed at the international level, opportunities to strengthen the global health governance of alcohol over 2022-2030, and what options might exist beyond.
The global governance of alcohol control
Since 2010, the main international instrument on alcohol control has been WHO’s Global Alcohol Strategy, which includes a portfolio of recommended policy options and interventions across ten target areas. Though the strategy was endorsed by all 193 WHO Member States at the 63rd World Health Assembly (WHA), implementation has thus far been uneven across WHO regions.
The Global Action Plan on the Prevention and Control of NCDs (Global Action Plan on NCDs) includes its own voluntary target of a 10% relative reduction in the harmful use of alcohol, as appropriate in their national context. To achieve this target, the Global Action Plan on NCDs outlines three “Best Buys” for alcohol: increasing excise taxes, enacting and enforcing bans or comprehensive restrictions on alcohol advertising, and enacting and enforcing restrictions on the physical availability of retailed alcohol.
[A]lcohol has increasingly been considered as a human rights issue, most notably because of the link between alcohol and the right to health.
Alcohol control is also recognised in the 2030 Agenda for Sustainable Development (2030 Agenda) adopted by the United Nations General Assembly in 2015. The Sustainable Development Goals include a goal on health (goal 3) and specific targets on alcohol (target 3.5), as well as related targets on NCDs (target 3.4) and road safety (target 3.6).
Beyond the health and sustainable development agendas, alcohol has increasingly been considered as a human rights issue, most notably because of the link between alcohol and the right to health. While no human rights instrument explicitly refers to alcohol, it has been referenced in human rights mechanisms. General Comment number 14 on the right to health adopted by the Committee on the Economic, Social and Cultural Rights in 2000 recognises alcohol control as being relevant to the right to health. The human rights reporting mechanism has also paid increasing attention to alcohol control in recent years in both country reports and recommendations. Human rights committees have recommended states to strengthen alcohol control measures by establishing minimum ages for alcohol consumption, imposing bans on alcohol advertising, and implementing awareness raising activities. Domestically, human rights provisions included in constitutions have been relied upon to successfully defend challenges to alcohol control measures in Kenya.
Opportunities under the new proposed action plan 2022-2030
The new action plan for 2022-2030 presents unique opportunities to strengthen international governance of alcohol. It is an opportunity to update the Global Alcohol Strategy by explicitly referencing key instruments such as the Global Action Plan on NCDs (including the evidence-based “best buys”), the 2030 Agenda, and international human rights law, and incorporating commitments from those broader global governance agendas that have been agreed since 2010.
It is also an opportunity to address current gaps in implementation of the Global Alcohol Strategy. The action plan could provide clearer guidance on how member states can avoid conflicts of interest and alcohol industry interference (a key barrier to implementation), create a system for ensuring accountability for implementing measures, and include commitments to sustainable additional resourcing and political support for implementation. The action plan could also include further implementation guidance on recommended measures as well as a clear consensus statement on the public health rationale for them, both to encourage WHO member states to adopt such measures and to support them if those measures are challenged by industry.
[The new action plan is] an opportunity to address current gaps in implementation of the Global Alcohol Strategy.
Opportunities for further legal instruments post-2030
Though the 146th WHO Executive Board ultimately decided to focus on implementing existing frameworks, some WHO Member States requested WHO consider a legally binding instrument similar to the WHO FCTC for alcohol control. That question is likely to come up again in 2030, so it’s worth exploring what such a legal instrument might look like and what impact it might have.
The WHO Constitution gives the World Health Assembly to adopt three kinds of legal instruments:
- regulations, which are legally binding and automatically apply to all WHO members unless they opt out (e.g. International Health Regulations (2005) that govern the response to health emergencies such as COVID-19)
- conventions, which are legally binding treaties that countries must sign and ratify (e.g. the WHO FCTC)
- recommendations, which encompass various kinds of non-binding instruments, including codes (e.g. the WHO International Code of Marketing of Breast Milk Substitutes) and the current strategy and action plan on alcohol governance
A new legally binding instrument would have to be made under the conventions power in article 19 of the WHO Constitution. Though adoption would require a two-thirds vote of WHA members, such decisions are often made by consensus, and entry into force would require members to sign and ratify the treaty once it was adopted.
The impact of a new convention on alcohol control may be modest if the action plan 2022-2030 is strong and properly implemented. Treaties for health are an important tool for cooperation, but they have significant limitations. Even cross-border aspects of alcohol regulation will likely require significant domestic legislation to implement any international obligations, and that inherently requires political buy-in from member states, regardless of the legal status of an international instrument. And since countries must separately consent to be bound by such treaties after the text is agreed, the tension between having strong commitments and ensuring wide participation is greater than with political statements or technical programmes of work.
[T]reaties do create additional opportunities to advance policy goals – although not necessarily the ones that are most frequently cited in support of them.
Nevertheless, legally binding instruments can lead to significant impacts. In the Netherlands, for example, the WHO FCTC has allowed civil society to bring public interest litigation for more comprehensive smoke-free laws that align with obligations under the treaty. In Kenya and Sri Lanka, the fact that tobacco control laws implemented international obligations were key to findings of domestic courts that upheld those laws against legal challenges brought by the tobacco industry. Treaties often also provide an avenue for multisectoral collaboration, because they engage the parts of government responsible for implementing international obligations as well as for health. Though these kinds of impacts are specific to each country’s constitutional order and the place of international law within the domestic legal system, treaties do create additional opportunities to advance policy goals – although not necessarily the ones that are most frequently cited in support of them.
Whichever path is followed, the next two years will provide critical opportunities to build on existing international legal frameworks and advance alcohol control around the word.
Find out more about WHO’s consultation process on the action plan for the Global Alcohol Strategy.
COVID-19 has also changed the landscape for alcohol control in 2020 and beyond. Read Clare Slattery's recent blog for more on using law to shape policy around alcohol – and other NCD risk factors – during the pandemic.