On delaying a Framework Convention on Alcohol Control: Regrettably agreeing but calling for strategic action to accelerate the process


Taylor and Dhillon disparage the ‘drumbeat for codification’ for a Framework Convention on Alcohol Control (FCAC), inspired by the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC). Cogently arguing that the time is not ripe and that a ‘failed legal strategy could delay meaningful global legal action for years to come’, they urge postponement of a legally binding international treaty in favor of alternative non-binding legal strategies [1].

This commentator, a drummer for a FCAC, wishing that the conditions were prime to better address the global catastrophe of alcohol problems, reluctantly acknowledges their pragmatic arguments. But, rather than focus on the weaknesses of global alcohol control, the movement's human capital, institutional and intangible assets can/should be strategically strengthened, linked and leveraged toward implementing a FCAC sooner rather than later.

While having lesser priority than it deserves, an expanding body of research [2], the Global Alcohol Strategy (GAS) [3], the UN Special Session on Non-Communicable Disease (NCD) [4] and regional plans cite alcohol as a global health burden, a social determinant of health [5] during rapid globalization [6] and amenable to cost-effective interventions [7]. Moreover, about 30 national plans have varying degrees of implementation and the GAS outlines essential recommendations that all countries can follow.

Despite a relatively weak network of non-governmental organizations (NGOs), stakeholders are increasingly active: Global Alcohol Policy Alliance, Eurocare, medical associations [8], the Norwegian development organization FORUT, International Organization of Good Templars (IOGT), Ketil Bruun Society, professional journals [9, 10] and more groups beyond Europe. The Global Alcohol Policy Conference (GAPC) had noteworthy sponsorship and governmental and NGO presence which look forward to the imminent GAPC in 2013 [11]. Tobacco and alcohol groups increasingly recognize challenges from trade agreements. Advocates successfully excluded industry interests from their network and limited its status at the WHO. Close attention by NGOs and the WHO to the FCTC is shortening the learning curve regarding convening and implementing a global treaty. Moreover, the Gates Foundation is identifying factors that shape the effectiveness of alcohol policy networks. These activities and players bode well for a more effective global coalition supporting WHO infrastructure and comprehensive national plans, and building public awareness and political will for a formalized global framework.

Steps Forward

Building on our assets and the consensus that nothing less can address the enormous challenges [12, 13], the movement requires a dynamic process of strategic planning to raise political will and strengthen NGO involvement [14]. Following the outline and principles of the GAS and the GAPC Declaration, each nation, free of corporate influence, should develop and implement national strategies with appropriate outcome measures, as Korean advocates have urged [15]. We must assess and strengthen NGOs and domestic alcohol control plans in the context of each country's underlying political reality for change.

Alcohol control would benefit from building bridges with groups that are affected by alcohol but who have not been involved in alcohol policy. For example, potential collaborators are groups involved with youth protection; treatment and recovery communities; victims (domestic violence, sexually transmitted diseases, non-communicable disease groups); medical professionals; justice; development; tobacco; drugs; transportation; and injury. Advocacy challenges and successes might be shared and disseminated through regional cooperation. In addition, both at the regional and global level, the movement needs to closely monitor globalization and the relative decline in the practical capacity of sovereign states to unilaterally address public health challenges [16]. Similarly, special attention should be given to strategies to challenge industry manipulation of terms found in trade agreements.

Alcohol control can draw on successes and challenges of the sister issue of tobacco and the maturing FCTC. Stakeholders need to identify if, and how, legal strategies, likely to be similar to the FCTC, can contribute to international health cooperation and effective alcohol control. If, and when, there is push back for legal instruments, challenge opposing nations and corporate interests to demonstrate why a convention (or other binding option) is not needed and to propose strategies that would effectively reduce alcohol-related problems.

Pragmatically, in the near term, as Taylor and Dhillon propose, consider non-binding code approaches in critical areas with broad consensus, for example the marketing of alcohol to children, in order to affect norms and processes to impact the behavior of states and other actors. Such a non-binding code could help galvanize information, deepen public support and political will, likely demonstrate the inadequacies of non-binding measures, and create the tipping point for promulgation of a binding treaty.

To make all of this happen the movement needs secure funding from private foundations and nation states that better matches the burden created by alcohol use, not only for research but also to enhance capacity for advocacy of evidence-based measures. GAPC 2013 could provide an opportunity for re-convening stakeholders, strategic planning, and advocacy development and furthering international cooperation. This commentator perceives the glass to be more than half full.

Declaration of interests