Alcohol, harm to others and global
governance of alcohol
Peter Anderson MD, MPH, PhD
Professor, Substance Use, Policy and Practice, Institute of
Health and Society, Newcastle University, England
Professor, Alcohol and Health, Faculty of Health, Medicine
and Life Sciences, Maastricht University, Netherlands
Helsinki 12 June 2013
1. Consider harm done by alcohol to others than
the drinker
2. Mention six reasons why we need global
governance of alcohol
3. Discuss governance options
1. Consider harm done by alcohol to others than
the drinker
i. Disability adjusted life years
ii. Estimates of personal violence
iii. Social costs
Source: Rehm et al 2012
Low birth weight
Violence
Transport injuries
Source: Rehm et al 2012
1. Consider harm done by alcohol to others than
the drinker
i. Disability adjusted life years
ii. Estimates of personal violence
iii. Social costs
In the European Union, it has been estimated that:






7% - 47% of all crimes
24% - 86% of all violent crimes
19% - 53% of all robberies
29% - 60% of all sex offences
16% - 71% of all domestic violence
40% of all homicides
are due to alcohol.
Source: Anderson & Baumberg 2006
1. Consider harm done by alcohol to others than
the drinker
i. Disability adjusted life years
ii. Estimates of personal violence
iii. Social costs
Costs of alcohol to Australian society
(Billions of dollars)
25
20
%
15
10
12.1
5
5
0
Social costs
Tangible
Intangible
Source: Laslett et al 2010
Costs of alcohol to Australian society
(Billions of dollars)
23.5
25
20
15
%
12.4
10
12.1
Plus harm to others
5
5
0
Social costs
Tangible
Intangible
Source: Laslett et al 2010
Out of pocket
Cost of time lost
19%
81%
Source: Laslett et al 2010
Stranger
Known drinker
14%
86%
Source: Laslett et al 2010
Lost productivity
47%
Other
53%
Source: Laslett et al 2010
1. Consider harm done by alcohol to others than
the drinker
2. Mention six reasons why we need global
governance of alcohol
3. Discuss governance options
Six reasons for global governance of alcohol
1.
2.
3.
4.
5.
6.
Scope of global damage
Damage substantial over most of world
Damage transcends national borders
Countries cannot manage in isolation
No legally binding agreement
Ready for movement
This does not include all:
1. alcohol use disorders
2. alcohol-related infectious diseases
3. harm to people other than the drinker
Six reasons for global governance of alcohol
1. Scope of global damage
2. Damage substantial over most of world
[Despite the fact that 3 out of 5 of the world’s
adults do not currently drink alcohol]
3. Damage transcends national borders
4. Countries cannot manage in isolation
5. No legally binding agreement
6. Ready for movement
Six reasons for global governance of alcohol
1.
2.
3.
4.
5.
6.
Scope of global damage
Damage substantial over most of world
Damage transcends national borders
Countries cannot manage in isolation
No legally binding agreement
Ready for movement
Major illegal trade routes for alcohol
as documented by alcohol industry
Major illegal trade routes for alcohol
as documented by alcohol industry
Damage transcends national borders:
It is not just the product and the damage that it
carries that crosses borders, but all the forms of
commercial communications, and, particularly,
those through electronic and social media
Damage transcends national borders:
Damage transcends national borders:
Six reasons for global governance of alcohol
1.
2.
3.
4.
5.
6.
Scope of global damage
Damage substantial over most of world
Damage transcends national borders
Countries cannot manage in isolation
No legally binding agreement
Ready for movement
Countries cannot manage in isolation:
This is not just a matter of illegal trade or
communication by digital media, but also a principle
of comity between nations, in which countries
should honour and support alcohol policies of other
countries.
1. No legally binding agreement
2. Ready for movement
Thailand case study:
On 21 January 2010, Thailand notified theWTO
Committee on Technical Barriers to Trade (‘TBT
Committee’) of its intention to introduce a new
alcohol warning law (‘Thailand’s Notification’) under
s 26(1) of its Alcohol Beverage Control Act.No legally
binding agreement
1. Ready for movement
Thailand case study:
1. It prohibits any words on alcoholic beverage packages
which would mislead the consumer into believing that (i)
alcohol can improve health or (ii) one alcoholic beverage
is less ‘toxic’ than another.
2. It requires that all alcohol beverage packages carry the
words: ‘Sale of alcohol beverages to persons under 20
years old is prohibited . . .’.
3. It requires all alcoholic beverage packages (including
bottles, cans, boxes or wrapping) to carry one of six
graphic warnings of the harm that drinking alcohol can
do.
Thailand case study:
Argentina, Australia, Canada, Chile, Mexico, New Zealand,
Switzerland, United States and European Union have
repeatedly expressed concerns that Thailand’s warnings
labels are inconsistent with the Agreement on Technical
Barriers to Trade.
Thailand case study:
The EU, Mexico and Chile have argued that it is not drinking
per se, but excessive drinking that is the problem
Six reasons for global governance of alcohol
1.
2.
3.
4.
5.
6.
Scope of global damage
Damage substantial over most of world
Damage transcends national borders
Countries cannot manage in isolation
No legally binding agreement
Ready for movement
No legally binding agreement:
This is not because alcohol is any different from or is
a special substance compared with tobacco or the
illicit drugs. It is simply because at a global level, it
has not happened, yet.
1. Ready for movement
No legally binding agreement:
The first four reasons that I have mentioned are the
very same four reasons that are used to justify the
framework convention on tobacco.Ready for
movement
No legally binding agreement:
In addition, a psychotropic substance, as is alcohol,
may be scheduled under the 1971 drugs convention
if a WHO Expert Committee finds:
that the substance has the capacity to produce a
state of dependence and impairs central nervous
system functioning/
or produces similar abuse and ill effects as a
substance already covered by the Convention
No legally binding agreement:
and that there is sufficient evidence that the
substance is likely to be abused so as to constitute
public health and social problems warranting the
placing of the substance under international control.
No legally binding agreement:
By these criteria, it would be difficult for an expert
committee not to recommend alcohol for
scheduling under the convention.
Six reasons for global governance of alcohol
1.
2.
3.
4.
5.
6.
Scope of global damage
Damage substantial over most of world
Damage transcends national borders
Countries cannot manage in isolation
No legally binding agreement
Ready for movement
Ready for movement:
1. There is a growing backlash against the behaviour of the
alcohol industry, who are fast positioning themselves as
the next tobacco industry
2. Increasingly alcohol is recognized as a problem of the
middle aged and middle class, our problem, and we all
need help for it
3. Classified as a carcinogen by the International Agency for
Research on Cancer, it is recognized that there is no safe
level of alcohol consumption
4. Countries are getting more worried and more countries
are asking for action.
1. Consider harm done by alcohol to others than
the drinker
2. Mention six reasons why we need global
governance of alcohol
3. Discuss governance options
Maintaining the status quo:
1. Does not facilitate the institutional, political, financial, or
civil society support that have been mobilized in the
context of the framework convention on tobacco control;
2. Does not provide the needed resources available to
match the scale of the global damage;
3. Allows the alcohol industry space and time to normalize
the use of alcohol.
Maintaining the status quo:
4. terminology of the global strategy [to reduce the
harmful use of alcohol] can be counter intuitive and
confusing to those countries whose policies aim to
support non-drinkers to maintain their non-drinking
behaviour.
Harmful use implies non-harmful use, which does not
exist - being a carcinogen, any dose, and even one
molecule can cause cancer.
Schedule alcohol in the 1971 Convention on Narcotic Drugs:
1. Alcohol would need to be exempted from articles 5 and
9, which essentially state that use and possession of the
substance is to be limited to medical and scientific
purposes.
2. There may be substantial obstacles to reframing this
particular wording that would counter the scheduling of
alcohol within the 1971 Convention, but it is not
impossible.
3. Calls from parts of the Americas to open discussions of
the drug conventions may contribute to leaning in this
direction.
Framework Convention on Alcohol Control:
 Provides trade liberalization that is both sustainable in
relation to alcohol and respectful of comity of nations.
 Provides the needed global governance architecture,
resources and institutional policy support to further
policy development at the country level, particularly
in low and middle income counties
 Provides more freedom from the actions of vested
interest groups.
Framework Convention on Alcohol Control:
 Instead of routing from convention to protocol, as has
been done with tobacco, one could route protocol to
convention and start with a protocol on commercial
communications.
In conclusion
1. The scope, extent and nature of the global damage done
by alcohol, particularly harm to others, calls for effective
global architecture.
2. A legally binding agreement provides the institutional
arrangements that voluntary actions seem not to be
able to do.
3. In this sense, a global legal protocol that curbs
commercial communications could be a new step
forward.