Editorial: WHO fires first shots in the war on alcohol
HUMANITY鈥檚 relationship with alcohol has never been easy. Now it is about to undergo as great a change as our attitude to tobacco, which has seen smoking plummet from the height of cool to the lowest of unpleasant habits.
Advertisement
That at least is the hope of the World 91色情片 Organization, which, between now and January, will be honing its draft of the first , the fifth leading cause of premature death and disability worldwide.
Unveiled last week in Geneva, Switzerland, the document is the culmination of talks between representatives from the WHO鈥檚 193 member states. 鈥淚t is a landmark document,鈥� says Peter Anderson, a health consultant and adviser on alcohol to the WHO and the European Union.
Member states will be invited to ratify the finalised version of the document at the in May, but the document will not be legally binding. Its purpose instead is to raise awareness among governments about the importance of reducing alcohol abuse and to provide data that will persuade electorates that new laws are required 鈥� thereby emboldening governments to take action. The document will also present a menu of legal and governmental strategies that have been shown to work. 鈥淚t will provide knowledge and awareness about the size of the problem, and advice about the most cost-effective policies,鈥� says Anderson.
The impetus for action is founded on the growing realisation that alcohol doesn鈥檛 just harm those who drink, combined with a better knowledge of intervention strategies. For example, in March the UK government鈥檚 chief medical officer, Liam Donaldson, to 鈥減assive drinking鈥�, the damage that heavy drinkers wreak on others. To illustrate the extent of the problem in the UK, he reported that in 2008, there were 125,000 鈥渁lcohol-related instances of domestic violence鈥�, that an estimated 6000 babies are born annually with fetal alcohol syndrome and that in 2006, 7000 people were injured and 560 killed as a result of drink-driving, not including the drivers.
Interactive graphic: Explore alcohol鈥檚 toll on our health (requires Google Earth)
Sally Casswell of Massey University in Auckland, New Zealand, who helped produce the WHO document, says a focus on passive drinking is key to winning public acceptance for more stringent alcohol legislation. 鈥淚t challenges the neoliberal ideology which promotes the drinker鈥檚 freedom to choose his or her own behaviour,鈥� she says.
Persuading governments and citizens of the problem is just the first step, though. What, if anything, can be done to stop people drinking to excess?
To some extent, strategies will depend on location. In rich countries, for example, the focus is likely to be on stopping young people from binge drinking, whereas introducing drink-driving laws may be a priority in rapidly developing countries, where newly acquired wealth is increasing ownership of cars and access to alcohol.
Generally, however, the WHO says the most effective measures are to raise prices through heavy taxation based on alcohol content, and to reduce the availability of alcohol through strict licensing schemes limiting opening times and the number of outlets.
鈥淭he WHO says the most effective way to reduce alcohol consumption is to raise prices鈥�
Such strategies may smack of overactive government, but recent findings suggest these measures work. of the University of Florida, Gainesville, and colleagues reviewed 112 studies examining the effects of price and tax on alcohol consumption and found that, on average, a 10 per cent increase in the price of beer reduced consumption by 5 per cent, of wine by 7 per cent and spirits by 8 per cent (Addiction, ).
From another study, in which Wagenaar鈥檚 team surveyed 800 students leaving a campus bar over four nights, and took breath alcohol readings, the researchers calculated that each 10-cent increase in the cost of a drink, per gram of ethanol, was associated with a 30 per cent decrease in the chance that students would leave the bar drunk (Alcoholism: Clinical and Experimental Research, ).
Meanwhile, at the behest of the Scottish government, Petra Meier of the University of Sheffield, UK, used Scottish data on levels of alcohol consumption and the prices paid by different people for different types of drink to calculate the social effects of l.
She estimates that setting the minimum price at 40 pence per unit of alcohol (a small glass of wine or half a pint of beer), which is still at least twice as expensive as the cheapest alcohol available in Scotland, could save the nation 拢950 million in healthcare and policing costs over 10 years, and avoid 3600 hospital admissions and 1100 criminal offences each year.
As for light drinkers who complain they would be unfairly set back by price increases, Meier claims that a 40p minimum would hit heaviest drinkers hardest, as they often drink the cheapest booze, costing them 拢137 extra per year compared with just 拢11 extra for a moderate drinker.
Of course, taxing booze and restricting its availability are not new ideas and such strategies are already deployed to some extent in most developed countries. But the WHO document argues that many countries do not implement them effectively.
In the US and the UK, despite taxes that are heavier than on many other products, alcoholic drinks are still cheaper relative to income, and more widely available today than ever before. This is likely due to government fears of a consumer backlash, huge tax revenues from alcohol, and pressure from the industry to avoid anti-drinking legislation. Meanwhile, poorer countries often don鈥檛 have any regulations at all.
Predictably, the alcohol industry is not happy with the WHO鈥檚 focus on reducing consumption through pricing, availability and marketing. It also argues that government intervention isn鈥檛 the only way to solve the problem. 鈥淥ther parties, including industry, can play a role,鈥� says Marcus Grant of the , a think tank funded by the alcohol industry, in Washington DC.
He cites a collaboration in Kenya to overcome poisoning caused by cheap bootleg beer in which an African brewery produced a safer rival, and the Kenyan government agreed to lift tax on it. The ICAP is publishing a book called Working Together to Reduce Harmful Drinking in November, co-edited by Grant, that includes a pledge to 鈥渢ake into account鈥� the potential health impacts of products such as alcopops, which appeal to the young, and promotions such as happy hours. Another is to adhere to responsible marketing policies that are monitored by independent consultants.
Others are sceptical of the industry鈥檚 contribution to the debate. of the University of Melbourne, Australia, who studies the legislation on recreational drugs, fears that some parts of the WHO document may already have been watered down to appease the industry, especially those seeking to restrict marketing.
Anderson warns against this: 鈥淧rice and availability are still the most effective strategies to reduce consumption, but the other thing is marketing, creating a social climate around drinking through sports sponsorship and movies. That has a powerful impact.鈥�
鈥淐reating a social climate around drinking through sports and movies has a powerful impact鈥�
Anderson is still optimistic, though. 鈥淚 don鈥檛 think alcohol will ever become as socially unacceptable as tobacco use, but societies may adopt a more cautious approach to its supply and marketing, resulting in less harm.鈥�
Interactive graphic: Explore alcohol鈥檚 toll on our health (requires Google Earth)
Editorial: WHO fires first shots in the war on alcohol
