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worldHealthorganization
Global
alcohol
actionplan
2022–2030
worldHealthorganization
Globalalcoholactionplan2022–2030.
ISBN978-92-4-009010-1(electronicversion)ISBN978-92-4-009011-8(printversion)
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iii
Contents
Foreword iv
Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreduce
theharmfuluseofalcoholasapublichealthpriority 1
Background 1
Settingthescene 1
Globalstrategytoreducetheharmfuluseofalcoholanditsimplementation 2
Goaloftheactionplan 8
Operationalobjectivesoftheactionplan 8
Operationalprinciples 9
Keyareasforglobalaction 10
Actionarea1:Implementationofhigh-impactstrategiesandinterventions 11
Actionarea2:Advocacy,awarenessandcommitment 13
Actionarea3:Partnership,dialogueandcoordination 16
Actionarea4:Technicalsupportandcapacity-building 20
Actionarea5:Knowledgeproductionandinformationsystems 23
Actionarea6:Resourcemobilization 27
Indicatorsandmilestonesforachievingglobaltargets 30
iv
Foreword
Alcoholuseisassociatedwithmanyhealthrisks,duetoitsintoxicating,toxicanddependence-producingproperties.Theimpactofharmfulalcoholuseonhealthisfar-reachingandextendsbeyondthosewhodrink,affectingotherslikevictimsofdrink-drivingandinterpersonalviolence,orchildrenwithfetalalcoholspectrumdisorders.
In2010theWorldHealthAssemblyendorsedtheGlobalstrategytoreducetheharmfuluseofalcohol,butitsimplementationhasbeenuneven,andtheglobalburdenofalcohol-relateddeathsanddisabilitycontinuestobehigh.Culturaldrinkingnormsandtraditions,powerfulcommercialinterestsandofteninsufficientgovernance,fundingandinfrastructurearebarrierstoimplementationofeffectivepoliciesandinterventionsthatcouldalleviatealcohol-relatedharm.
ThisGlobalalcoholactionplan2022–2030,adoptedbythe75thWorldHealthAssembly,hasbeendevelopedtoboostimplementationoftheGlobalstrategy,bytranslatingintentionsandcommitmentsintoaction,toachievetangibleresultsacrossanarrayofmeasurabletargets.Thatwillrequireunitedeffortsonthepartofgovernments,intergovernmentalorganizations,UNentities,academia,professionalassociationsandcivilsocietyorganizations,workingtogethertowardstheactionplan’sobjectives.
WHOiscommittedtosupportingallMemberStatestoimplementtheGlobalalcoholactionplantoreducealcohol-relatedharm,asweworktogethertofulfilourfoundingvisionofthehighestattainablestandardofhealthforallpeople.
DrTedrosAdhanomGhebreyesus
Director-General
WorldHealthOrganization
1
Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcohol asapublichealthpriority1,2
Background
Settingthescene
1.Alcoholconsumptionisdeeplyembeddedinthesociallandscapeofmanysocieties.Severalmajorfactorshaveanimpactonlevelsandpatternsofalcoholconsumptioninpopulations–suchashistoricaltrendsinalcoholconsumption,theavailabilityofalcohol,culture,economicstatusandtrendsinthemarketing3ofalcoholicbeverages,aswellasimplementedalcoholcontrolmeasures.Attheindividuallevel,thepatternsandlevelsofalcoholconsumptionaredeterminedbymanydifferentfactors,includinggender,ageandindividualbiologicalandsocioeconomicvulnerabilityfactors,aswellasthepolicyenvironment.Prevailingsocialnormsthatsupportdrinkingbehaviourandmixedmessagesabouttheharmsandbenefitsofdrinkingencouragealcoholconsumptiondelayappropriatehealth-seekingbehaviourandweakencommunityaction.
2.Alcoholisapsychoactivesubstancewithintoxicatinganddependence-producingproperties.Theaccumulatedevidenceindicatesthatalcoholconsumptionisassociatedwithinherenthealthrisks,althoughhealthconsequencesofalcoholconsumptionvarysignificantlyinmagnitudeandnatureamongdrinkers.Atthepopulationlevel,anylevelofalcoholconsumptionisassociatedwithpreventablenetharmsduetomultiplehealthconditionssuchasinjuries,alcoholusedisorders(AUDs),liverdiseases,cancersandcardiovasculardiseases,aswellasharmstopersonsotherthandrinkers.Severalaspectsofdrinkinghaveanimpactonthehealthconsequencesofalcoholconsumption,namelythevolumeofalcoholconsumedovertime;thepatternofdrinking,inparticulardrinkingtointoxication;thedrinkingcontext;andthequalityofthealcoholicbeverageoritscontaminationwithtoxicsubstancessuchasmethanol.RepeatedconsumptionofalcoholicbeveragesmayleadtothedevelopmentofAUDs,includingalcoholdependencethatischaracterizedbyimpairedregulationofalcoholconsumptionandmanifestedbyimpairedcontroloveralcoholuse,increasingprecedenceofalcoholuseoverotheraspectsoflifeandspecificphysiologicalfeatures.4
3.Thecurrentactionplanreferstothe“harmfuluseofalcohol”asdefinedintheglobalstrategytoreducetheharmfuluseofalcoholas“drinkingthatcausesdetrimentalhealthandsocialconsequencesforthedrinker,thepeoplearoundthedrinkerandsocietyatlarge,aswellaspatternsofdrinkingthatareassociatedwithincreasedriskofadversehealthoutcomes”.5Itsconceptismuchbroaderthantheclinicalconceptofdiagnosticcategoryof“harmfulpatternofuse”,whichrepresentsapartofthespectrumof“alcoholusedisorders”intheInternationalClassificationofDiseases.
1SeedecisionWHA75(11).
2PublishedseparatelyunderthetitleGlobalalcoholactionplan2022–2030.
3Inthisdocument,theterm“marketing”isusedtomeananyformofcommercialcommunicationormessagethatisdesignedtoincrease–orhastheeffectofincreasing–therecognition,appealand/orconsumptionofparticularproductsandservices.Itcomprisesanythingthatactstoadvertiseorotherwisepromoteaproductorservice.
4InternationalClassificationofDiseases,11thRevision(ICD-11).Geneva:WorldHealthOrganization;2021.
5DocumentWHA63/2010/REC/1,Annex3.
2
Globalalcoholactionplan2022–2030
4.Theimpactoftheharmfuluseofalcoholonhealthandwell-beingisnotlimitedtohealth
consequences;itincurssignificantsocialandeconomiclossesrelatingtocostsinthejusticesector,costsfromlostworkforceproductivityandunemploymentandthecostsassignedtopainandsuffering.Theharmfuluseofalcoholcanalsoresultinharmtoothers,suchasfamilymembers,friends,co-workersandstrangers.Amongthemostdramaticmanifestationsofharmtopersonsotherthandrinkersareroadtrafficinjuriesandtheconsequencesofprenatalalcoholexposure,whichmayresultinthedevelopmentoffetalalcoholspectrumdisorders(FASDs).Thereisnosafelimitestablishedforalcoholconsumptionatanystageofpregnancy.Theharmstoothersmaybeverytangible,specificandtime-bound(e.g.injuriesordamage)ormaybelesstangibleandresultfromsuffering,poorhealthandwell-beingandthesocialconsequencesofdrinking(e.g.beingharassedorinsultedorfeelingthreatened).
5.Awarenessandacceptanceoftheoverallnegativeimpactofalcoholconsumptiononapopulation’shealthandsafetyislowamongdecision-makersandthegeneralpublic.Thisisinfluencedbycommercialmessagingandpoorlyregulatedmarketingofalcoholicbeverages,whichdeprioritizeeffortstocountertheharmfuluseofalcoholinfavourofotherpublichealthissues.TheCOVID-19pandemichighlightedtheimportanceofappropriatepolicyandhealthsystemresponsestoreducetheharmfuluseofalcoholduringhealthemergencies.
6.Thehealth,economicandsocialburdenattributabletoalcoholconsumptionislargelypreventable.Historically,inrecognitionoftheintoxicating,toxicanddependence-producingpropertiesofalcohol,therehavealwaysbeenattemptstoregulatetheproduction,distributionandconsumptionofalcoholicbeverages.Theprotectionofthehealthofpopulationsbypreventingandreducingtheharmfuluseofalcoholisapublichealthpriorityandshouldbeafocusofalcoholpoliciesandalcoholcontrolmeasuresimplementedatdifferentlevels.
Globalstrategytoreducetheharmfuluseofalcoholanditsimplementation
Theglobalstrategy6anditsmandate
7.Theglobalstrategytoreducetheharmfuluseofalcohol,whichwasendorsedbytheSixty-thirdWorldHealthAssemblyinMay2010(resolutionWHA63.13),remainstheonlyglobalpolicyframeworkforreducingdeathsanddisabilitiesduetoalcoholconsumptionintheirentirety–frommentalhealthconditionsandnoncommunicablediseases(NCDs)toinjuriesandalcohol-attributableinfectiousdiseases.TheglobalstrategybuildsonseveralWHOglobalandregionalstrategicinitiativesandrepresentsthecommitmentofWHOMemberStatestotakesustainedactionatalllevels.Followingtheendorsementoftheglobalstrategy,regionalactionplansalignedwiththeglobalstrategyweredevelopedorrevisedandadoptedinWHO’sRegionoftheAmericas(2011)andEuropeanRegion(2012),whilearegionalstrategyforreducingtheharmfuluseofalcoholwasdevelopedandadoptedintheWHOAfricanRegion(2013).
8.Theglobalstrategywasdevelopedtopromoteandsupportlocal,regionalandglobalactionstopreventandreducetheharmfuluseofalcohol.Itoutlineskeycomponentsforglobalactionandrecommendsaportfolioofpolicyoptionsandmeasuresthatcouldbeconsideredforimplementationandadjustedasappropriateatthenationallevel.Thesepolicyoptionstakeintoaccountnationalcircumstancessuchasreligiousandculturalcontexts;nationalpublichealthpriorities;andresources,capacitiesandcapabilities.Theglobalstrategyalsocontainsasetofprinciplesthatshouldguidethedevelopmentandimplementationofpoliciesatalllevels.
6Globalstrategytoreducetheharmfuluseofalcohol.Geneva:WorldHealthOrganization;2010.
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Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcoholasapublichealthpriority
9.Sincetheendorsementoftheglobalstrategyin2010,MemberStates’commitmenttoreducingtheharmfuluseofalcoholhasbeenreinforcedbytheadoptionofthepoliticaldeclarationsemanatingfromthehigh-levelmeetingsoftheUnitedNationsGeneralAssemblyonthepreventionandcontrolofNCDs,includingthedeclarationof2011andthesubsequentadoptionandimplementationoftheWHOGlobalactionplanforthepreventionandcontrolofNCDs2013–2020(NCD-GAP).In2019,theSeventy-secondWorldHealthAssembly(inresolutionWHA72.11)extendedtheNCD-GAPto2030,ensuringitsalignmentwiththe2030AgendaforSustainableDevelopment.TheNCD-GAPliststheharmfuluseofalcoholasoneoffourkeyriskfactorsformajorNCDs.ItenablesMemberStatesandotherstakeholderstoidentifyanduseopportunitiesforsynergiestotacklemorethanoneriskfactoratthesametime;strengthencoordinationandcoherencebetweenmeasuresforreducingtheharmfuluseofalcoholandactivitiesforpreventingandcontrollingNCDs;andsetvoluntarytargetsforreducingtheharmfuluseofalcoholandotherriskfactorsforNCDs.InMay2013,theSixty-sixthWorldHealthAssemblyadoptedthecomprehensiveNCDGlobalMonitoringFramework,inwhichthevoluntaryglobaltargetfortheharmfuluseofalcoholtobeachievedby
2025isdefinedasatleast10%relativereduction,asappropriate,withinthenationalcontext,andmeasuredbyindicatorsacrossthreedomains,includingtotalalcoholpercapitaconsumptionwithinacalendaryearinlitresofpurealcohol,age-standardizedprevalenceofheavyepisodicdrinking,andalcohol-relatedmorbidityandmortality.7
10.Theinternationalmandatetoreducetheharmfuluseofalcoholwasfurtherstrengthenedwiththeadoptionofthe2030AgendaandtheSustainableDevelopmentGoals2030(SDG2030).Reducingtheharmfuluseofalcoholwillcontributetoprogresstowardstheattainmentofthemultiplegoalsandtargetsofthe2030AgendaandtheSDGs,includingSDGgoal1onendingpoverty;SDGgoal4onensuringaqualityeducation;SDGgoal5onachievinggenderequality;SDGgoal
8onpromotingdecentworkandeconomicgrowth;SDGgoal10onreducinginequalitieswithinandamongcountries;andSDGgoal16onpromotingpeaceandprovidingjusticeandstronginstitutions.Inviewofthenegativeimpactoftheharmfuluseofalcoholonthedevelopmentandoutcomesofmanydiseasesandhealthconditions,includingmajorNCDsandinjuries,theeffectivereductionoftheharmfuluseofalcoholwillmakeasubstantialcontributiontowardstheattainmentofSDGgoal3(Ensurehealthylivesandpromotewell-beingforall),inparticularSDGtarget3.5(Strengthenthepreventionandtreatmentofsubstanceabuse,includingnarcoticdrugabuseandharmfuluseofalcohol).ThisreflectsthebroaderimpactoftheharmfuluseofalcoholonhealthinareasbeyondNCDsandmentalhealth(SDGtarget3.4),suchasroadtrafficaccidents(SDGtarget3.6),reproductivehealth(SDGtarget3.7),universalhealthcoverage(SDGtarget3.8)andinfectiousdiseases(SDGtarget3.3).
11.Oneoftheguidingprinciplesoftheglobalstrategystatesthatpublicpoliciesandinterventionstopreventandreducealcohol-relatedharmshouldbeguidedandformulatedbypublichealthinterestsandbasedonclearpublichealthgoalsandthebestavailableevidence.Evidenceofthecost-effectivenessofalcoholpolicyoptionsandinterventionswasupdatedinarevisionofAppendix3totheNCD-GAP,whichwasendorsedbytheHealthAssemblyinresolutionWHA70.11.Thisresultedinanewsetofenablingandrecommendedactionstoreducetheharmfuluseofalcohol.Themostcost-effectiveactionsorbestbuysincludeincreasingtaxesonalcoholicbeverages;enactingandenforcingbansorcomprehensiverestrictionsonexposuretoalcoholadvertisingacrossmultipletypesofmedia;andenactingandenforcingrestrictionsonthephysicalavailabilityofretailedalcohol.Byprioritizingthemostcost-effectivepolicymeasures,theWHOSecretariatandpartnerslaunchedtheSAFERinitiative,withtheprimaryobjectiveofsupportingWHOMemberStatesinreducingtheharmfuluseofalcoholbyenhancingtheongoingimplementationoftheglobalstrategyandotherWHOandUnitedNationsstrategies.TheWHO-led
7DocumentWHA66/2013/REC/1,Annex4,Appendix2..
4
Globalalcoholactionplan2022–2030
SAFERinitiativefocusesonthesupportforimplementationofcost-effectivepolicyoptionsandinterventions.Italsoaimstoprotectpublichealth-orientedpolicy-makingagainstinterferencefromcommercialinterestsandestablishstrongmonitoringsystemstoensureaccountabilityandtrackprogressintheimplementationofSAFERpolicyoptionsandinterventions.
Implementationoftheglobalstrategysinceitsendorsement8
12.Sincetheendorsementoftheglobalstrategy,itsimplementationhasbeenunevenacrossWHOregionsaswellaswithinregionsandcountries.Thenumberofcountrieswithawrittennationalalcoholpolicyhassteadilyincreasedandmanycountrieshaverevisedtheirexistingalcoholpolicies.However,thepresenceofwrittennationalalcoholpoliciescontinuestobemostcommoninhigh-incomecountriesandleastcommonamonglow-incomecountries,withwrittennationalalcoholpoliciesmissingfrommostcountriesintheAfricanRegionandtheRegionoftheAmericas.Thedisproportionateprevalenceofeffectivealcoholcontrolmeasuresinhigher-incomecountriesraisesquestionsaboutglobalhealthequity.Specifically,itunderscorestheneedformoreresourcesandgreaterprioritytobeallocatedtosupportthedevelopmentandimplementationofeffectivepoliciesandactionsinlow-andmiddle-incomecountries.
Challengesinimplementationoftheglobalstrategy
13.Considerablechallengesremainforthedevelopmentandimplementationofeffectivealcoholpolicies.Thesechallengesrelatetothecomplexityoftheproblem;differencesinculturalnormsandcontexts;theintersectoralnatureofcost-effectivesolutions,includingpricingstrategies,andassociatedlimitedlevelsofpoliticalwillandleadershipatthehighestlevelsofgovernment;andtheinfluenceofpowerfulcommercialinterestsinpolicy-makingandimplementation.Thesechallengesoperateagainstabackgroundofcompetinginternationaleconomiccommitments.Thelimitedavailabilityofcomprehensiveandreliabledataonalcoholconsumptionandrelatedharm,generatedatthenationallevel,presentsadditionalchallengesfortheevaluationoftheimpactofimplementednationalpolicyresponsesinmanycountries.Coordinationandcooperationatalllevelsfordealingwiththesechallengesisfurthercomplicatedbycontextsinwhichtheresponsibilityforactionstoreducetheharmfuluseofalcoholisdispersedbetweendifferententities–includinggovernmentdepartments,differentprofessionsandtechnicalareas.
14.Theproductionofalcoholicbeverageshasbecomeincreasinglyconcentratedandglobalizedinrecentdecades,particularlyinthebeerandspiritssectors.AsignificantproportionofalcoholicbeveragesisconsumedatheavydrinkingeventsassociatedwithsignificanthealthrisksandheavydrinkingisoftenassociatedwiththepresenceofAUDs.Thishighlightstheinherentcontradictionbetweentheinterestsofalcoholproducersandpublichealth.Atthesametime,thereismountingevidencethatanylevelofalcoholconsumptionisassociatedwithhealthrisks.Somecountriesexperiencesubstantialchallengesinprotectingalcoholpolicydevelopmentfromcommercialinterests,whiletheissueofsafeguardingalcoholpolicydevelopmentatalllevelsfromalcoholindustryinterferenceisconsistentlypresentedasamajorchallengeininternationalpolicydialogues.Stronginternationalleadershipisneededtocounterinterferencefromcommercialinterestsinalcoholpolicydevelopmentandimplementationinordertoprioritizethepublichealthagendaforalcoholinthefaceofthestrongcommercialinterestsassociatedwithalcoholbeverageproductionandtrade.Competinginterestsacrossthewholeofgovernmentatthecountrylevel,includinginterestsrelatedtotheproductionandtradeofalcoholandgovernmentrevenuesfromalcoholtaxationandsales,oftenresultinpolicyincoherenceandtheweakeningofalcoholcontrolefforts.Thesituationvariesatnationalandsubnationallevelsandisheavilyinfluencedbythecommercialinterestsofalcoholproducersanddistributors,religiousbeliefs
8SeedocumentEB146/7/Add.1.
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Actionplan(2022–2030)toeffectivelyimplementtheglobalstrategytoreducetheharmfuluseofalcoholasapublichealthpriority
andspiritualandculturalnorms.Generaltrendstowardsderegulationinrecentdecadeshaveoftenresultedintheweakeningofalcoholcontrols,tothebenefitofeconomicinterestsandattheexpenseofpublichealthandwell-being.
15.Alcoholremainstheonlypsychoactiveanddependence-producingsubstancethatexertsasignificantimpactonglobalpopulationhealththatisnotcontrolledattheinternationallevelbylegallybindingregulatoryinstruments.Thisabsencelimitstheabilityofnationalandsubnationalgovernmentstoregulatethedistribution,saleandmarketingofalcoholwithinthecontextofinternational,regionalandbilateraltradenegotiations.Italsohamperseffortsastoprotectthedevelopmentofalcoholpoliciesfrominterferencebytransnationalcorporationsandcommercialinterests.Thishaspromptedcallsforaglobalnormativelawonalcoholattheintergovernmentallevel,modelledontheWHOFrameworkConventiononTobaccoControl.9DiscussionsaboutthefeasibilityandnecessityofsuchalegallybindinginternationalinstrumentindicatedalackofconsensusamongMemberStatesonthisissue.
16.Informallyandillegallyproducedalcoholaccountsforanestimated25%oftotalalcoholconsumptionpercapitaworldwideandinsomejurisdictionsexceedshalfofallthealcoholconsumedbythepopulation.Informalandillegalproductionandtradearedifferentinnatureandrequiredifferentpolicyandprogrammeresponses.Informalproductionanddistributionofalcoholareoftenembeddedinculturaltraditionsandthesocioeconomicfabricsofcommunities.Illicitalcoholproductionisassociatedwithsignificanthealthrisksandchallengesforregulatoryandlawenforcementsectorsofgovernments.Thecapacitytodealwithinformalorillicitproduction,distributionandconsumptionofalcohol,includingsafetyissues,islimitedorinadequate,particularlyinjurisdictionswhereunrecordedalcoholmakesupasignificantproportionofallthealcoholconsumed.
17.Satelliteanddigitalmarketingpresentagrowingchallengefortheeffectivecontrolofalcoholmarketingandadvertising.Alcoholproducersanddistributorshaveincreasinglymovedtowardsinvestingindigitalmarketingandusingsocialmediaplatforms,whichareprofit-makingbusinesseswithaninfrastructuredesignedtoallow“programmaticnativeadvertising”thatisdata-drivenandparticipatory.Internetmarketingcrossesborderswithevengreatereasethansatellitetelevisionandisnoteasilysubjectedtonational-levelcontrol.Inparallelwiththegreateropportunityformarketingandsellingalcoholthroughonlineplatforms,deliverysystemsarerapidlyevolving,imposingconsiderablechallengesontheabilityofgovernmentstocontrolalcoholsales.Fromapublichealthperspective,recentdevelopmentsinmarketing,advertisingandpromotionalactivitiesrelatedtoalcoholicbeveragesareofdeepconcern,includingthoseimplementedthroughcross-bordermarketingandthosetargetingorreachingouttochildren,adolescentsandyoungpeople.
18.Limitedtechnicalcapacity,humanresourcesandfundinghindereffortstodevelop,implement,enforceandmonitoreffectivealcoholcontrolinterventionsatalllevels.Technicalexpertiseinalcoholcontrolmeasuresisofteninsufficientatnationalandsubnationallevels,asaretheavailablehumanandfinancialresourcesatalllevelsofWHOfortheprovisionofrequiredtechnicalassistanceandthecompilation,disseminationandapplicationoftechnicalknowledgeinpractice.Fewcivilsocietyorganizationsprioritizealcoholasahealthriskormotivategovernmentstotakeactioncomparedtothenumberoforganizationsthatsupporttobaccocontrol.IntheabsenceofphilanthropicfundingandwithlimitedresourcesinWHOandotherintergovernmentalorganizations,therehasbeenlittleinvestmentincapacity-buildinginlow-andmiddle-incomecountries.
9AuYeungSL,LamTH.UniteforaFrameworkConventionforAlcoholControl.Lancet.2019;393(10183):1778–1779.doi:10.1016/S0140-6736(18)32214-1.
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Globalalcoholactionplan2022–2030
19.Thelackofsufficientlydevelopednationalsystemsformonitoringalcoholconsumptionandthei
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