Strategy to deal with alcoholism

The World Health Organisation’s adoption this year of a Global Strategy to Reduce Harmful Use of Alcohol was historic not only for being much-needed and long-awaited, but also for being focused on what can feasibly be done, and done now. As nations around the world assess the burdens they attribute to harmful drinking and what they can do, the Alcohol Strategy provides compelling impetus and guidance for immediate action.

WHO recommends 10 target areas for action, with a helpful reframing of policy options in an arena where ‘solutions’ in the past have been few and often highly proscriptive. The Alcohol Strategy also invites a diverse array of contributors to the table — making a clean break from times when alcohol policy was typically made in forums that excluded the people who know a great deal about alcohol, the producers.

Far more significant is the fact that WHO is urging nations to address the harmful use of alcohol as part of a larger, well-reasoned ‘strategy’. Past regulatory approaches have at times profoundly lacked strategic elements. In many countries around the world, although well-intentioned, governments have often taken rather simplistic approaches to a complex matter. And in countries where resources are scarce, those resources have often been used up by measures yielding disappointing outcomes, or even unintended negative results.

Harmful drinking
In fact, WHO points out a discrepancy “between the increasing availability and affordability of alcohol beverages in many low- and middle-income countries and those countries’ capability and capacity to meet the possible additional public health burden that follows.” To be successful, approaches to reduce harmful drinking should bear in mind that the issue is not consumption of alcohol, but harmful consumption. It is not availability of alcohol per se that is problematic, but the consequences we see when people drink problematically.

For example, where taxes and prices have been raised in an attempt to restrict availability and consumption, such efforts have often led to increases in black market activity because access to legitimate alcohol has been too severely restricted. And from Eastern Europe to Africa and Asia-Pacific, we have seen far too many injuries and deaths where people turn to illicitly brewed alcohol or alcohol ‘substitutes’ not intended for human consumption.

Research has consistently shown that chronic, problem drinkers are the least likely to change their behaviour and drink less if prices increase. They may switch to less expensive drinks, they may drink at home more and go out less, but they will always find a way to drink. Even when and where alcohol has been — or is — prohibited, those determined to drink excessively do so.

Contrary to what the more vocal critics of the alcohol industry may presume, some of the people most concerned and knowledgeable about combating harmful drinking are actually the people who produce alcohol beverages. Producers have developed, supported and participated in programmes with government and law enforcement agencies, educational institutions, public health organisations and retailers to prevent drunk driving, underage consumption and other harmful alcohol use and have a good deal of knowledge to share about these programmes — and enthusiasm to share in others.

For example, there is the work of Global Actions on Harmful Drinking (www.global-actions.org), a consortium of initiatives dedicated to helping reduce the harmful use of alcohol. This work is the result of a collective commitment made by the chief executives of major international alcohol beverage producers to make a significant effort in the 2010-2012 timeframe to address harmful drinking through a combination of global and local actions. The initiatives place an emphasis on low- and middle-income countries — with a focus on drunk driving, self-regulation of alcohol marketing, and non-commercial (illicit) alcohol.

These efforts follow the same line of thinking reflected in WHO’s Alcohol Strategy: What is required is a range of options so that different countries and communities can select which combination of measures is likely to work best for them, given their drinking culture and health priorities. There is promise in such approaches that are developed enough to work in practice, not just in theory.

As alcohol producers work in concert with health professionals, governments, and civil society to reduce the harmful use of alcohol, more is now possible. With the benefit of a new sense of stakeholder partnership and guidance from WHO, there is strength in numbers and there is a feasible strategy for what can be done, and done now.

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