Civil Society Dialogues EU-USA 2011
Research and Action on Underage Drinking:
Exchange and Exploration of Issues of Mutual Concern
November 3-4, 2011, United Methodist, Washington, DC
Attendees
Abrams, Cynthia (US)
Babor, Thomas (US)
Beekman, Lauri (EU)
Bronner, Adrian (EU)
Brookes, Chris (EU)
Codenotti, Tiziana (EU)
Cushing, Judy (US)
Gillian, Evelyn (EU)
Gilmore, Ian (EU)
Jernigan, David (US)
Lincoln, Paul (EU) – via phone
Lindsey, Robert (US)
Mosher, James (US)
Ramirez, Rebecca (US)
Riibe, Diane
Riviere, Claude (EU)
Skar, Mariann (EU)
Sparks, Michael (US)
Toomey, Traci (US)
Van Dalen, Wim (EU)
Special guests
Allyn Taylor
Laurent Huber/Chris Bostic
Rosa Sandoval
Apologies
Carlsson, Sven Olav (EU)
Okulicz-Kozaryn, Katarzyna (EU)
Sharon, Nick (EU)
Initials SO??
General Board of Church and Society of the United
Methodist Church
University of Connecticut Health Center
Estonian Temperance Union, Estonia
Institute of Alcohol Studies, UK
Health Action Partnership International, UK
Eurocare, Italy
Oregon Partnership
Alcohol Focus Scotland, UK
Royal College of Physicians, UK
Johns Hopkins Bloomberg School of Public Health
National Heart Forum, UK
National Council on Alcoholism and Drug
Dependence, Inc.
Alcohol Policy Consultations
Johns Hopkins Bloomberg School of Public Health
Association Nationale de Prevention en Alcoologie et
Addictologie, France
Eurocare
Community Anti-Drug Coalitions of America
University of Minnesota
STAP, Nederlands Institut vior Alcoholbeleid, the
Netherlands
Georgetown University Law Center
Framework Convention Alliance
Pan American Health Organization
IOGT, International, Sweden
Institute of Psychiatry and Neurology, Poland
Royal College of Physicians, UK
Welcome and Introductions
CA and CB welcomed the participants briefly.
It was reiterated that the minutes of EU US Dialogue meetings are confidential, will be
distributed via email, and uploaded on the project site in the Members section.
Session 1: Review of developments and thinking about the future
Chair – Claude Riviere
Feedback from London meeting
CB briefly recapped the second meeting where goals included identifying research on
implications of underage drinking on adolescent development, identifying public health
surveillance mechanisms, and identification of how we can collectively work together.
Deliverables will be a website and four meetings. Policy recommendations are to be based
on best available evidence for what is effective in what circumstances and with which
groups. This should be discussed with policymakers from the EU and the US in order to
maximize the impact and benefits of these discussions. Dissemination must not be lost
during this process.
Donor feedback on the interim narrative report was generally positive and they would like more
visibility on the website. All documentation is currently behind password protection on the
websites. It must be agreed upon what can be made public versus what private on the website.
CR made the clarification that education is not the role of the alcohol industry- the focus of
rebutting such work should be on the conflict of interest. There is data that educational projects
with young people carried out by industry can be counterproductive. TB added that there is a
need to reframe alcohol education and to provide a more effective way to engage with the
alcohol industry. Media literacy training should be included to allow youth to be more cognizant
of industry processes.
An evaluation of 2nd dialogue continued. The group agreed that more e-communication was
desired. Sustainability of the group’s progress was discussed that would include regular
information sharing (possibly 3 month meetings?) and a chance to develop a longer-term
offering (e.g. user manual, globalink)-projects beyond the life of this particular project. It is
important to ensure focus to the project end.
The group will create agreed upon tasks, deadlines, and responsibilities that are concrete in
preparation of the next meeting in June in Brussels.
Minutes of the meeting held on June 27 and 28, 2011in London were agreed upon with minor
corrections:
Page 5 – the third to last paragraph should read ‘It was discussed’ rather than ‘It was agreed’.
Page 6 – MS corrected the entry to read ‘WHO is in the process of drafting The European Action
Plan 2012-2020…’
Updates from countries on alcohol prevention strategies, actions, and measures
RL-1. NCADD put in place a new website and the number of visitors was up 350%, 450%,
650% in the first three months. NCADD have created a platform to add new content and
information.
2. NCADD NY state affiliate-hosted the Alcohol Policy Summit with 250 attendees. Break out
sessions included suicide, FAS (foetal alcohol syndrome), child abuse, rural issues, cancer, vets,
seniors, gun violence.
3. Republished ‘Drinking too much too fast can Kill You’.
LW-1. Excise tax raises-45% in last five years-add 5% to that from Jan 1
2. Alcohol advertising issue in the Baltics-Lithuanians almost there-ban has been accepted, but it
is unclear if it will stand. There is a battle between government and local organizationsLithuanians think it will be overturned, but are glad for exposure.
3. Estonia – a proposal for an advertising ban is in parliament-usually items are rejected in the
first reading, though this made it through the first reading and will probably rejected in 2nd or 3rd.
It will be a litmus test for neighbouring countries. A recent study showed that advertising in
Estonia is going up, however people are more aware of alcohol as problem. The media in Estonia
is supporting the alcohol ad ban-opposite in Lithuania
JM-1. Working on policies surrounding ‘supersized alcopops’-24oz of 12% alcohol in single
serving container
2. Funding in jeopardy for many groups.
3. Recommended highlighting economic issues country is facing and how the industry is
exacerbating our situation. They are making money from their marketing and are slashing jobs.
They are contributing to problem.
JC-1. Addressing the first alcohol impact area in the inner city of Portland. The area has serious
problems with public drunkenness, and crime. The city has designated this as an ‘alcoholic
impact area’. The response is using research on outlet density and access to cheap, high alcohol
content alcohol. The alcohol industry wants the criteria to be a list of products that will no longer
be available. The alcohol industry want products based on alcohol content removed, and will be
testifying in front of liquor control boards.
2. Oregon is adjacent to Washington for 400 miles along border. Washington has a ballot
initiative (referendum) to privatize liquor sales. COSTCO (big box retailer) invested $20 million
in ad campaign and created a confusing media battle. Public sentiment is currently favouring
privatization. Privatisation would be disastrous both for Washington, and for Oregon, where
attempts are probably be made now to gather stakeholders support.
3. The Alcohol drug policy commission was formed in the last year. It was going to be closedchaired by AG. It is thought the commission will help set the stage for alcohol tax
DR-1. Alcopops issue. The case to designate alcopops are liquor rather than beer, was won in the
lower courts. It is in the state supreme court now.
2. Outlet density, Omaha, alcohol control organisations are working to get ordinance onto the
statutes.
3. Funding-cut for alcohol control organisations cut by nearly 60%
4. ‘Basecamp’ has been established as an online meeting group for maintaining a connection and
dialogue with other alcohol policy advocacy groups in the Omaha.
5. We will be establishing the same type of policy alliance within Nebraska.
EG-1. Alcohol minimum pricing bill published without specific price established for the
minimum price. The opposition want to know what the actual price will be, while the Scottish
government has commissioned further modeling work. The industry are concentrating their
efforts on declaring it legally incompetent and arguing that the Scottish government will need to
prove it’s a proportionate response
2. Public health levy on alcohol/tobacco retailers of certain size. Big retailers are opposing the
levy.
3. Published report ‘Rethinking Alcohol Licensing’ which has public health objectives. Licensing
authorities didn’t know how to use the public health objectives, but there are recommendations
in report
CA-1. Important to organize the faith groups around policy related to alcohol. They are hoping
the influence in US will influence international groups
2. New York state summit. CA spoke on American Indian issues (tribe in NY) on a panel on
public policy for NY American Indians. Audience of policy makers, tribe members.
3. National Recovery month-this year shifted the conversation from recovery to the issues around
alcohol control. There was good feedback on the need for a comprehensive approach.
4. Regulations in health care reform law, which include more substance abuse benefits.
MS-1. Eurocare in Parliament-3 major workshops on health warning labels, marketing, and
unborn baby. Eurocare use different parliamentarians from different committees to host events.
Good outcome and now have members who come to them to ask to host
2. Call out to all NGOs for support for a future EU-wide alcohol strategy, to follow on from the
EU alcohol strategy 2006-2012/. Support for the strategy changed with a new Health
Commissioner- who doesn’t want to promise new strategy and no member state is pushing for it.
Member states are meeting on the 17th November, gathering signatures all over EU and lobbyin
gall health ministers, requesting new strategy
DJ-1. Funding to do tax research. Looking at the impact of raising alcohol tax on jobs. How
many jobs created vs how many are lost.
2. Alcohol brand data gathered from a local emergency room for new study.
3. Alcohol brand consumption by youth project. This is a 1000 person survey, with a national
representative panel, where we will be asking about brands and looking at exposure to alcohol
advertising.
4. New action guide published. A guide has been produced on outlet density, which includes
curricular activities. Two more are coming for alcohol taxes and ‘dram shop’ liability.
5. Articles in the American Journal of Public Health will be published this month by DJ and JM.
Will be an expose on Diageo going after youth market (JM); article on ICAP (DJ).
CB-EU commission let a tender (contract) to assess markets of alcohol products of particular
appeal to minors and HAPI got it. WvD doing one of three country case studies; also doing
Smirnoff Ice and two other product case studies. The Commission wants a straightforward
report, with what policy responses might be appropriate.
RR-Cut in Enforcing Underage Drinking Laws (EUDL) funding (enforcement).
IG-1. Northern Ireland considering moving drink driving limit from .05 to .08. Working crossborder with Republic of Ireland on this.
2. Responsibility deal-industry makes pledges and delays implementations-and is heavily
criticised by PH organisations.
3. Minimum unit price. The concept is poorly understood by public and politicians- it will hit
heavily discounted products most. Recently launched a new organization, Alcohol Research UK,
the challenge is getting a better understanding
4. Government continues to emphasize local action. It is a challenge for each community to fight
own battles and create own policy. Energy runs out.
5. Traveling internationally-would like to see better international advocacy in the alcohol policy
field. Need a forum for groups like Mike Daube’s new group in Australia and AHA to get
together
TT-1. Research-pushing papers on alcohol density-what colleges are doing in US-both in terms
of screening and enforcement
2. Surveyed state level enforcement agencies to find out what level of law enforcement is
happening on alcohol policy
3. Discussions at NABCA on the role of junk science that industry puts out. Thinking about how
to counter/punch holes in the industry junk science.
4. Initiatives looking at college drinking. Everyone wants a list of what will solve problems, but
people don’t know how to select them, put them in place, and enforce.
TC-1. Italy-situation not positive-everyone talking about economic crises. Policymakers not
willing to listen on alcohol policy. This is dangerous as it leaves room for industry initiatives.
Lots of projects from industry in schools, but the government has no money to intervene. Need a
strong strategy to counterbalance the message coming from the industry
2. Only money left is devoted to illegal drugs-based on policymakers and public opinion
3. Completed AMMIE project on how alcohol marketing is targeting young people. Will use this
report to disseminate information on alcohol marketing and young people.
AB-1. IAS concerned with policy-work with other NGOs, health groups
2. Uphill battle in England over self-regulation
3. Drink guidelines. Pressure to increase minimum standards coming from industry-not sure what
outcomes will be-avoid using terms like ‘recommended’. IAS will be putting resources towards
critically evaluating minimum drinking standards coming from the industry.
4. On-sales going down and off-sales up, based on cheap supply from supermarket.“Staying in is
the new going out”-guidelines may not matter at home
5. Digital marketing issue-potential of using digital marketing techniques within youth networks
WvD-1. New minister is a disaster-nicknamed “minister of tobacco”
2. Alcohol policy in the Netherlands is happening on the local level and is more focused on
effective policies. It is important to reach local communities and policymakers to prepare them
for how industry works.
3. Supermarket discussion of on-sale. The report found that 75% of all bars/restaurants have a
strong relationship with industry. High price of beer is political action to keep difference in price
between on and off sale. Promoting drinking at home by keeping it expensive on-sale.
4. Liquor stores. Big stores such as supermarkets and supermarket chains want to get rid of the
small stores. Most popular brands are now in big stores
5. Marketing projects-FACE, AMMIE-more scientific proof of failure of self-regulation. Need to
figure out how to use data. Normally the EU commission has several projects, but often don’t
promote the reports-up to us to use reports and have strategy
6. EUCAM-trying to coordinate all initiatives on alcohol marketing, and have trainings related to
alcohol marketing, website, etc. Next year will have training in Poland in January
(EUCAM.info)
7. Enforcement network in EU-first national enforcement conference was last week. Challenge is
to inform health people about the relevance of enforcement-many don’t know who is responsible
for enforcement.
MiS-CADCA-1. Represents voluntary members (about 3,000 local coalitions). Taking action
guides and pushing technology on how to do control strategies in local coalitions. Aim is to
move communities to think about alcohol control strategies
2. There is a growing political debate in California, parts of the northwest on availability of
marijuana which has eclipsed youth drinking. How do we keep alcohol on the agenda?
Discussion to be had on relationship between role of local action and state and national action.
TB-1. WHO organizing NGO consultation on December 12. This project should communicate
with Vladimir about itself, and perhaps send representative. Frame work of this dialogue in terms
of WHO Global Strategy Find them very compatible-WHO needs help in implementation, but no
money can be provided.
2. International Society of Addiction Journal Editors meets annually. As a spinoff, some
members of ISAJE are forming a new society-International Federation of Addiction Research
Organizations-IFARO. The first meeting was held recently-about 20-30 research oriented
professional societies met in Copenhagen. Unfortunately, many of these societies consider
advocacy limited to getting more money. Confederation designed to get these organizations
involved in real world and orient them to issues such as translating research into policies
3. New paper provided here, but not to be circulated publically – a four year project funded by
NIAAA-develop procedure for analyzing content of alcohol advertising by industry’s own self
regulation guidelines. They have developed a rating system and are reporting on findings by
brands 30-80% of ads have at least one violation.
CR-1. Parliament discussing increase taxation of spirits (340 million euros); tobacco (600
million); sugary beverages (240 billion)
2. Cost per person-300 Euros
Update:
*GAPC-350 people; 650 Thais; more than 50 countries-postponed to Feb 13-15
Report on the NCD meeting in New York
UN high-level meeting was very well attended by countries around the world (126 countries).
World Economic Forum with WHO produced a report showing that macroeconomics is a key
driver. The cost of NCDs to the global economy is nearly $30 trillion (40% of global domestic
product in 2010) over the next ten years. These are diseases that “break the bank.”
Outcomes-final document called A Political Declaration. There are four major outcomes:
1) WHO will lead coordination of work to support countries.
2) WHO will lead monitoring including agreeing a set of indicators
3) WHO will lead preparation of recommendations for voluntary targets before end of
2012
4) UN will lead development of options facilitating multi-sectoral action before end of
2012.
There will be a comprehensive report to UN in 2014 on status of NCDs and actions that will
follow. The NCD alliance is going through major review of its strategic priorities. The Lancet
Action Group is also thinking through where to add value. Also the conflict of interest coalition
discussed a need for clear understanding of the links with private sector organizations. The
industry should not be involved in discussions on policy at all. It would be like “giving Dracula
control of blood bank security.” They will continue to meet to ensure UN organizations develop
a code.
The outcomes are weak in terms of dealing with the alcohol industry. The industry was
successful in watering down early recommendations. NHF launched PANacea, a new resource
on diet and physical activity. This could be developed for alcohol as well as food industry.
NHF is not part of the NCD alliance as funding comes from a number of places including the
pharmaceutical industry. A wider range of partners is desired.
-Outcomes: (from PowerPoint)
1-PD supported by 193 countries (120 countries spoke, 35 Heads of Gov)
2-UN co-ordination
3-WHO/UN comprehensive global monitoring framework including indicators to monitor multisectoral national plans
4-Voluntary global targets
5-UN report on effective partnerships
6-(MDG review 2013)
7-Comprehensive report to UN in 2014
GAPA sent two representatives to NCD meeting. The industry was all over this meeting.
International Center on Alcohol Policies-ICAP (the global industry’s pre-eminent health group
that is funded by the industry) was accepted as member of ECOSOC (Economic and Social
Council).
Could PANacea be used as international vehicle? There is a need to talk to GAPA before taking
that forward. They have infrastructure to take it forward. NHF is interested in implementing an
alcohol PANacea and they have some funding for it. They also already have infrastructure and
personnel.
Session 2: Working groups – Part 1: Present state of work
Chair: Robert Lindsey
Working group presentations
1. Research group
Lead: Tom Babor and Traci Toomey
Members: Adrian Bonner, Ian Gilmore, David Jernigan
TB and TT presented an overview of research/data collection/evaluation and monitoring. This
group last time came up with several areas to work in to better link research with advocacy such
as identifying gaps in research (brands, youth oriented policies, etc). The research group could
produce products such as a list of youth based policies that have efficacy, factsheets, FAQs, and
reviews of self-regulation policies to demonstrate that self-regulation is not working.
WHERE WE WERE:
The group has now compiled a list of policies. About half are from Alcohol: No Ordinary
Commodity (ANOC) overlapped with the effect on young people. The table was used as starting
point (handout) as about half are relevant to young people. The group would now like to focus
attention and it would be helpful if there were more of a mandate as to what the priorities are.
If product is users manual with accompanying workshop about implementation (for advocacy
groups), then research group could focus attention on things needed to produce those products –
e.g. summarizing literature in fact sheets or in chapter in users manual, youth drinking problems
(survey sources like ESPAD and MTF); monitoring and surveillance in various countries; and
reviewing literature on risk factors that identify young people with characteristics of risky
drinking.
Dissemination Science describes how best to disseminate the findings of research so they can be
applied to clinical research or policy. There is also research on global health policy communities.
These are groups that come together and advocate for major health problems like HIV/AIDS and
other major public health problems. This is something we could be working towards.
TT asked that out of these actions-summary of research literature, surveillance, research
questions and sources of data to guide policy selection and implementation-which is the most
important to this group? In response, the group would like the research group to make these
recommendations.
**Action – letter from Chris/David-bring into research grant on dissemination activities with
UCT
TB is considering how to get funding and who may be interested in supporting efforts to develop
user’s manual. SSA initially funded ANOC and NIAAA may also be interested.
2. Message framing
Lead: Evelyn Gillian
Members: Judy Cushing, Cynthia Abrams, Claude Riviere
EG asked-what is purpose of group? What are products? Does this group have a future in
developing an international network? You can’t talk about messaging without looking at the
context of what you are doing and your advocacy framework. What are your advocacy goals and
framework? Once you identify that, you can look at the messages. The basis of any goal must be
evidence-based approaches. We need to agree on two or three advocacy goals that we can unite a
network of advocates around. Need to be clear whether it’s research, factsheets, etc. At the same
time you must reveal conflicts of interest. Industry will push towards things that won’t work. A
strategic advocacy framework is needed (group will discuss this later).
Recommendations: The advocacy and framing group could come together and agree on a broad
framework and audiences. Develop a model of change that is supplemented with case studies.
Tobacco benefitted from having clear consensus in the goals, etc. There are differences with
alcohol, but it is still a hazardous substance that benefits from regulation and control.
TB-(related to the handout/paper) This could go into the user’s manual. It is clear, a good start,
and suggests practical materials that could be used in a workshop to train people.
3. Organizing and advocacy
Lead: Jim Mosher, Robert Lindsey
Members: Tiziana Codenotti, Michael Sparks, Wim van Dalen
JM would like to review the minutes and try to look at key topics. What is the role of the alcohol
industry, the role of alcohol control lobbying? What advocacy skills would be needed for an
effective campaign? Three documents come out of this: (1)-WvD-7 key actions of NGOs-there
are key principles in terms of advocacy (‘grasstops’). (2)-MiS-Two page model for community
organizing in the US. This looks at skills needed to get the grassroots level engaged. (3)-TCPrinciples of advocacy from the EU base. This group is again asking what are particular goals.
This guides what level of government we aim for, etc.
*There are three advocacy goals from EG’s paper. They address price, advertising, and physical
availability. ICAP does not include these.
4. Implementation and enforcement
Lead: Rebecca Ramirez, Mariann Skar
Members: Chris Brookes, Lauri Beekman
They were going to do a draft survey, but who are we going to send it to? What are we going to
do with it? Now going to meet to decide if it is feasible. They will also look at case studies and
follow up after small group discussion today.
DJ emphasized the importance of this group. Other groups could do good work, but it won’t
matter. You must also address implementation issues. DR adds that it is important to look at
monitoring and evaluation, too.
Session 3: Feedback from group discussions
Chair: Tiziana Codenotti
Products from the four groups-DJ
In the small groups, think down one track with an ancillary track. Consider a single product (user
manual) with a wide array of supporting materials that could be produced (case studies,
factsheets). What would we need to get support for publication? We will create “small chunks”
from each group that could go into a three-page synopsis describing what a manual would cover.
Think of other things that might be useful. Within your section decide what are the discrete
pieces that individual people could write between now and the next meeting.
EG-What about a companion to ANOC? Many were excited about this possibility. It would be a
practical resource that could be shared with public health advocates. Not a book, but something
linked to interactive websites. Do we still think this will come out of this group? It is not possible
by June so what is the timeline?
DJ-Need a plan in place to produce such a document to shop for funders. Lay out the pieces of
what your group will do. We need a set of shared lessons by end of this meeting.
TB-Develop an outline of products and develop outline/abstract both of user’s manual and of
workshop in ways that could be used to get funding to continue the work. From this we can draft
an application to funding agencies. We should also do more than just develop outline-develop
representative chapters or PPT slides.
CB-There is a caveat; by June we need to have something that is the result of our discussions
(such as a user manual), but we need factsheets or something else as well.
After a discussion TB suggests that groups can develop documents of processes and possibly
create a toolkit? If everyone contributes a small piece that is organized around an outline it could
be put together in a few months. This could form the basis of a user’s manual. An Editorial group
could be created to maintain communication during the upcoming months.
Session 4: Working groups - Part 2: Future of the Work
Groups broke out into individual rooms for the afternoon.
Session 5: Feedback from group discussion and close
No additional discussion took place and the group adjourned.
DAY 2
CB welcomed the group and reviewed Eurocare and the National Heart Forum website briefly.
Session 5: Exploring the development of a ‘Framework Convention on Alcohol Control’
Chair: Rebecca Ramirez
Panel discussion from experts on the FCTC
Professor Allyn Taylor-former senior legal advisor at WHO; has worked on design and
development of international legal strategies for 2 decades.
The time is right for some sort of legal alcohol control strategy, but a conceptual conversation is
needed first to develop a Framework Convention (FC). An FC is useful for tobacco, but is not
always appropriate for all public health challenges.
Key strategic questions:
1) What is the purpose of international law-making for alcohol control? How can an
international legal instrument contribute? Problem is focusing on the form without
looking at purpose.
2) Political feasibility of international legal action? Before undertaking, activists and
negotiators need to ask what nations are likely to commit to? FCTC or narrower
approach?
3) What should be form of international legal instrument? Assumption is that treaties are
the only way to go – not true. Use of hard laws does not guarantee action. By removing
concern about legal obligations, non-binding agreements may actually be more effective.
The political feasibility issue is key. There is historical resistance of lawmaking by WHO and by
the international lawmaking community. Hurdles include a lack of experience, processes that are
cumbersome and slow, and developing country representatives who had never negotiated treaties
before. It may be far more difficult to negotiate for alcohol control than tobacco. Initially the
tobacco opposition did not work against efforts. The alcohol industry is very opposed, but a nonbinding global code on marketing to children may be potent and politically achievable.
Laurent Hubert-Framework Convention Alliance
In the early stages there was no one voice of civil society. What would success look like? The
same thing was seen with the NCD summit. They could not define policy objectives. It is known
these things can work from examples like the Framework Convention on Climate change. The
difference here is that NGOs were not allowed anywhere near the negotiations. FCTC was able
to be an integrated process.
How did the alliance develop? Civil society coalesced around the treaty and formed a coalition.
They joined policy positions and included as many people as possible from as many countries as
possible A flat governing structure was set up to allow as many participants as possible. They
wanted to avoid having those with more money/power from having more voice. You do need
resources-the people joining must commit resources without having to control the whole thing.
Rosa Sandoval-PAHO-plays a role within UN and within the Americas
There are 35 member states-29 are partners and the US is not one of them.
What has been impact of FCTC in this region? Having a legally binding instrument helps. They
have had the treaty since 2003. In 2006 they went smoke free and as of now 10 Latin American
and two Caribbean countries have followed and gone smoke free. Fourteen countries have
approved warnings with strong images on packs. These are things where progress has been seen
and it has been easier for countries to approve the laws because of the treaty.
Article 13 banning tobacco advertisement promotion and sponsorship has seen less progress, but
this is common through the world. What is the role of treaty in having laws approved?
1-There is one text (government, civil society, etc) that all may use which eliminates the chance
of loopholes. However, the text is not as strong in some cases. You must consider how much
governments are willing to draft. For example, there is no language on smoke free workplaces.
2-Helps within the government. The language helps to start a conversation with other sectors
outside of the minister of health.
3-Treaty has a clear position on what the role of the tobacco industry is-that it is a conflict of
interest to have them at the table.
What does the treaty do?
1-Having a treaty doesn’t mean that we have a law. It takes a long time and negotiations to get
laws. Even with deadlines-for example, tobacco health warnings are still not present in a lot of
countries.
2-Even with treaty you still need a minister of health and civil society to fight for it and track
what’s happening with it.
What are challenges with treaty?
1-Progress is not uniform. Some countries will have comprehensive laws versus very minimal
action. Panama, Columbia, and Uruguay are very progressive while others are not.
2-Some policies are easier to approve than other. There is heavy tobacco industry influence in
this. There has been a change in the modality of industry influence from the early 2000s when
treaty was being ratified it was more about misinformation and lies. Recently in last 3 years it’s
more about lawsuits directly by the industry (class action lawsuits).
Questions from the group:
-What are options besides a FC? There is a global strategy now. What else is out there?
AT-There are no rules in a design. You could divide the world into binding and non-binding
agreements. Example-Law of the Sea Convention-took 10 years and didn’t happen and it was a
single instrument. Another challenge of an FC is that it can be very slow. An FC provides
mechanisms and systems for governments and over time states accept commitments. It is a two
step process to get binding substantive commitments. There are also non-binding instruments
where standards are developed. These can be political resolutions adopted by governing body
including guidelines, codes, standards of practice, etc.
LH-The treaty process is under-resourced. The treaty process legitimizes the issue more,
however. It puts it on the table for more discussion. Not much money has been put towards
implementation of the treaty-depends on philanthropy too much.
AT-There is interest out there for a binding legal treaty, but there is more desire for faster less
expensive instruments. A lot of effectiveness of FCTC has been through the non-binding
standards. There is interest from the Bloomberg group in getting into the discussion on obesity
and alcohol.
AT-There is evidence that binding and non-binding instruments can be helpful for smaller or
developing countries to stand up to powerful industries. FCTC is one of most widely ratified
treaties, but part of reason for this is it is weak. Lawmaking is dynamic and incremental – nonbinding instruments are often the first step.
MS-Why hasn’t US ratified?
AT-The US generally doesn’t ratify international treaties. It is less important to ratify treaties
than to implement the provisions. For example, price provisions are strong, but opposed by
many. Now the US is most vocal on using tax policies on tobacco control.
JM-Alcohol industry and public health groups often trying to figure out what happened with
tobacco and how they did it. The alcohol industry changed the rules in response to the tobacco
industry experience. What are barriers? Where is the most likelihood for success? Industry is
literally writing policy for these countries.
LH-During conversations the tobacco industry was not invited to table. Alcohol and sugar
industries present themselves as part of the solution.
AT- Industries put a lot of pressure on WHO and on governments. It is good to find partner
governments who can move this along. Focus on incremental strategies. You may or may not
include the industry during hearings instead of inviting to table.
BL-Still dependent upon philanthropy?
LH-There is not enough funding for development of treaty from many countries and there is less
for implementation. Countries should develop independent policies that will bring in revenue and
ideally then would dedicate a portion of that to implementation of a treaty.
LR-From a human rights perspective (experience with land mines), a treaty that is law makes a
difference. Getting there much harder, much riskier, but the idea of progressive strategy is ideal.
-How much will it help as an organizing tool? People get more excited about a law than a code.
-Need a champion state that will lead from the start.
AT-International law is rarely enforced. Whether it’s non-binding or binding, we ‘encourage’
implementation.
RS-Countries often ask, “Is it binding legally?” “Yes” “What are the consequences?” “Nothing.”
Countries that have ratified treaty can be used as examples to ones that have not.
Bernard Merkel-In charge of bi-lateral arrangements between US and EU on health, safety,
consumer affairs.
Feels this is the right time to be approaching this. There is an NCD agreement. It doesn’t say
much, but it does mention alcohol. There is a process going on. The EU is discussing a whole
new alcohol strategy. It would be a huge mistake to do something that looks like a
comprehensive anti-alcohol initiative. Focus on marketing to children, advertising, labeling, and
drunk-driving. There will be no support for anything that looks like prohibition.
Session 6: Next steps
Chair: Wim van Dalen
Preparation for 4th dialogue in Europe and discussion on project continuance
DJ-Does this group want to make any consensus statement/declaration? It may be useful to have
something-SEE DOCUMENT- This will be put up on the discussion forum for comments
including whether we should have something like this or not.
TB offers to develop wiki which will be posted on the discussion section of website.
JM-Continuation of discussion on advocacy/framing group recommendations. The money for
our group should be reserved for the editorial committee and our liaison (Michael Sparks). We
will provide a draft to the editorial committee and a detailed outline by the end of January
including drafts of the case studies and the three core products.
WvD-The next meeting is in Brussels. On the agenda will be the draft statement from DJ. We
will be close to a final draft on the user’s manual and ancillary products. The meeting needs to be
structured so all pieces may be reviewed.
TB-There are two channels being pursued for funding. Neither is very large and suggestions are
welcome.
1st source-Renewal application for the alcohol research center. This would provide support for
his participation with EG to edit the manual. Also to conduct two workshops that would test out
use of the manual with a particular constituency. He would suggest trying an advocacy workshop
format with alcohol research scientists and develop it further to apply to other stakeholders. They
could budget to bring together 4-5 members of this group to run such a workshop.
2nd funding source-Center of the Study of Addiction-apply for funding to hold additional meeting
for the people involved in writing sections of manual and helping to find a publisher.
Timeline-SSA-will know by June-NIAAA-probably wouldn’t know by June
WvD-Do we need a meeting before Brussels?
The discussion focused on the sustainability of this project. Do we proceed with two years at a
time as we’ve done before or find targeted funding for specific projects. There may be funding
opportunities in the faith community. Any additional funding from current funding stream is
unlikely as they generally don’t fund the same thing again. We need to keep the vision of
creating an international network
JM-The agenda has been laid out-is this the group to put it forth? We’re seeing the same agenda
being put forth by GAPA and others.
DJ-We’re being opportunistic and taking whatever opportunities come along.
CB-Will post a topic on future working in an on-line discussion forum. Perhaps we need to have
2.5 full days at the next meeting as the agenda is very dense, especially including meetings with
policymakers.
DJ-In regards to PANacea-should we send a message to the Heart Forum expressing appreciation
for their willingness to do this? *An email from the US would be welcome*
Contact with policymakers:
MS-There are many different ways to do this.
1-Internally-invite a few from the commission and hope they come
2-Go to Parliament-this is MS’s proposal-have a debate within the Parliament. Get the
commissioner and other Director Generals together and focus on marketing ban since there are
so many experts in this group.
Should we make the draft statement part of the package? What is the specific goal? EU is
discussing strategy on alcohol now.
DJ is sympathetic to the advertising issue, but that doesn’t seem to be message from this group.
We don’t have trained informed advocates who can carry out the message. We need a stronger
focus on training the population.
MS-Training is not necessarily a political issue within the Parliament
TB-The framework on alcohol is too broad, but what about a conceptual Framework Convention
on underage drinking; not as a proposal to the UN, but as a way to organize our activities. This
could bring together knowledge and activities for a public health problem. By June we should
come up with a document stating what countries and states should be doing to promote a
comprehensive group of policies against underage drinking. It probably should be more hard
hitting than the WHO global strategy.
EG-We could frame it by talking about protecting young people from alcohol harm, not just from
underage drinking. We need to get away from that type of thinking. It gives more scope, but also
is specific enough to talk to policymakers.
TC mentions that the wording in the EU strategy is protecting children and unborn child.
DJ-What is the definition of young people? 24?
WvD-Do we need another document/introduction to send to policymakers before?
DJ-Need to decide if we draft the beginnings of policies/principles that would be in a framework
convention? Add to editorial group’s responsibilities.
TB suggests that it be a symbolic document, not a legally binding one.
EG-We should put some thought into format for dialogue. Instead of a panel or just a speaker.
Do a round table?
CB has had discussions on a meeting in the US with some people from EU. There is a small
amount of funding to bring people across. 1-For what purpose/what audience? 2-Who would be
right people from EU? 3-When? (Before Aug 10-funding over) It is generally thought that the
approach to alcohol policy is different between the US-EU, but could bring some people over to
show that there are similarities.
DJ-Need to figure out the audience first. The US side should discuss this and report back.
TB-Once he has developed funding applications, the message could be circulated so others could
see if they fit any other funding (faith communities, NGOs, etc).
CB-wrap up
We are missing previous work from Don Zeigler, but it may fit into FCAC agenda. We also need
to make sure we actually use the websites as effectively as possible.
There are two weeks to get papers to TB.
DJ-We will hold virtual meetings monthly. If you must miss, designate someone to take your
place. Hopkins will organize these meetings.
Civil Society Dialogues EU-USA 2011
Research and Action on Underage Drinking:
Exchange and Exploration of Issues of Mutual Concern
November 3-4, 2011, United Methodist, Washington, DC
SMALL GROUP RESULTS/DISCUSSIONS (presented afternoon of Nov 3)
1. Research Group
-List of key policies – reduce list even further from TB’s list
-Research arguments for effective policies
-Industry arguments against effective policies
-Research-based responses to industry
-Research base on policy selection
-What does NOT work (brief)?
-Role of education/awareness
-School/family-based information
-Mass media campaigns
-Education of policy maker and public re policies which work
-Media literacy
-Opposition research
-Self-regulation literature
-Exposure, content compliance
-Public opinion polling
-Message framing research
-Exposing junk science and industry paid research
-Minimum information to get policy issue on the table
Research on Implementing Effective Health Research
-Use research to guide:
1. Effective coalitions/advocacy campaigns
2. Enforcement…
3. How to train…
*What research tells us on how to most effectively adopt and implement policies
We aim to highlight:
1-How to better identify collect and use info that can support advocacy
2-The research evidence behind effective and ineffective policies
3-The tactics of poor industry funded research and how to counteract
4-What research tells us about the adoption and implementation of effective policies
Products produced or identifies
1-Key info needed
-List available national survey-limitation of each
-Other sources of data (FARS, etc.)
-Basics on how to collect (WHO)
-Case study of how to use data (nat’l, local example)
2-User friendly summary of alcohol policy research
Tool/fact sheets on 3-4 top policies
Tool/fact sheets on ineffective political approaches (ICAP?)
3-How to identify junk science-conflict of interest, how data are manipulated
-Where to get help/how to respond and whether to respond
4-Sumary of research showing that advocacy and policy change can work (e.g. CMCA)
-Use as intro to the rest of manual
2. Advocacy Group
Major documents:
1. Principles of Advocacy (Tiziana, Michael)
-Persistence
-Personal/emotional
2. Principles of Framing (Evelyn, Judy)
3. Advocacy steps (Michael, Evelyn)
-reference particular case studies
Case Studies:
Part A – International/Regional/Local-How do you make it happen?
1. Identify policy goal
-Level of government involved
2. Framing the issue
3. Power analysis
4. Identify industry/opposition
Part B – Build power
4. Identify stakeholders
5. Build grassroots support
6. Influence policy makers
7. Control advocacy policy
8. Incorporate enforcement
9. Evaluation
10. Role of personal stories
Industry:
Framing/counter-framing
-7 Industry messages
*Ban of TV advertising (Wim)*
Political strategies
-Lobbying
-Media
-Donations, etc
*Have success stories and stories of defeat*
Other case studies (no more than 2-3 pages, can use pictures, etc):
1. Oregon-alcohol apparel in kid’s department (Judy)
2. Alcohol outlet density (Diane? Describe part “A”)
3. Loi Evin – campaign to save – example of reactive advocacy (Claude)
4. Scotland – Price campaign (Evelyn-Part “A”)
5. Faith community – what works as bringing faith community in as a stakeholder (Cynthia)
6. Industry – Holland – in context of a campaign (Wim)
-International (? ask David)
-Local level, Omaha (Jim, Bob)
-Poland (Katarzina?)
6. Role of personal stories (Bob)
7. Privatization (Judy)
3. Enforcement Group
Preamble
-Describe systems/theories
-Deterrence theory
-Implementation factors
-Processes – who can enforce and monitor the law
-Lesson on enforcement and implementation
-Cautionary tales
-Need for evaluation
-Industry involvement
-Need for complimentary policies
Case Study Topics
1. Taxes in Estonia
-How taxes are collected and why is that process successful
2. Loi Evin
-How ANPAA and others monitor compliance with law and what they do when there are
violations
3. Age 21 minimum purchase age
-After laws passed, how did support for law enforcement actions increase
-Research base
-National programs
-New enforcement strategies and new collaborations
4. Nebraska alcopops
-Struggle/process for existing policy to be implemented
Consider adding:
-How enforcement changes with privatization
-Sweden experience-reference somewhere
-Discussion on internal vs. external enforcement
-Deterrence theory