• Alcohol policy;
  • framework convention;
  • international law

I have recently outlined some of the effects that I think the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) has produced, through its terms and the institutions and processes it has generated [1]. I suggested that the FCTC has:

  • raised the global profile of tobacco control;
  • strengthened governments in their fight against the tobacco industry politically and legally (in the latter case including through the automatic incorporation of the treaty's substantive obligations into law in some countries, expansion of governments' legislative powers, and strengthening of governments' hands in domestic and international legal challenges);
  • reinforced the view that tobacco products are not normal consumer products, contributing to the ongoing denormalization of the tobacco industry;
  • catalysed the formation and deepening of transnational civil society coalitions;
  • facilitated the sharing of experiences, expertise and capacity among and between governments and non-governmental organizations (NGOs); and
  • brought new resources—political, financial and human—into the field.

If this account is correct, it is little wonder that a number of alcohol control advocates [2-5] are saying ‘We'll have what they're having’.

In their thoughtful paper, Allyn Taylor & Ibadat Dhillon contend that calls for a Framework Convention on Alcohol Control (FCAC) are ‘premature’, proposing instead an ‘incremental strategy’ that ‘builds on a non-binding code approach in areas of critical concern’ [6]. Taylor & Dhillon's piece is timely not only with respect to a possible FCAC, but in advancing discussion about the optimal choice of instruments for global health governance more broadly.

It often seems that the FCTC has made treaties the Holy Grail of global health governance. Taylor & Dhillon note that a number of global health treaties are now being proposed but, as they rightly observe, it is neither possible nor desirable to have a treaty for every global health problem, and there are limits to how many treaties can be negotiated at any one time. WHO, invariably assumed to be the home of proposed global health treaties, governments (particularly of developing countries, which are usually portrayed as the primary beneficiaries of the proposed treaties) and NGOs, have capacity constraints bearing on both negotiation and implementation that cannot be imagined away.

Further, Taylor & Dhillon underline the critical point that non-binding instruments can both contribute significantly to domestic activity and facilitate international cooperation. Advocates often appear to apply their experiences at domestic level—where (binding) legislation is often essential to ensure activity—to an international context that is not analogous.

There is no magic formula for selecting the most appropriate multilateral instruments at any point in time, although it is possible to begin to identify the criteria that proposed treaties should meet. For a start, a treaty must make conceptual sense. It must be possible to identify what might be in it and how it is likely to produce its purported effects—not just what it ‘could’ conceivably do in the best imaginable world. Real-world political judgement must be brought to bear. It is easy to list all the things a treaty could do, but treaties are negotiated and implemented by hard-headed states which, as Taylor & Dhillon observe, protect their sovereignty jealously, not by high-minded NGOs or academics. The subject matter must be sufficiently confined to make both the treaty's negotiation and implementation manageable. This includes the capacity to secure the necessary engagement of relevant government departments and agencies (not just health) as well as relevant non-governmental actors. Treaties must be supported by a coherent, resourced and qualified institutional architecture that can facilitate their effective implementation. Their relationships with other international norms, bodies and processes must be considered carefully. Looking at global health governance as a whole, it is incumbent upon those of us who advocate for multilateral health treaties to consider opportunity costs. What will not be done because of the treaty we propose? How might our treaty of choice displace limited resources, political will and attention?

In my view, an effective FCAC would make an important contribution to global health; but what would constitute an ‘effective’ FCAC? As Taylor & Dhillon argue, timing is critical. They remind us that the development of norms to the standard that we might like to see reflected in treaties is not necessarily achieved most effectively through treaty negotiation, and that there are many ways of making progress in global alcohol control of which we should not lose sight—even if an FCAC is ultimately our instrument of choice.

Declarations of interest



  1. Top of page
  2. References
  • 1
    Liberman J. Four COPs and counting: achievements, underachievements and looming challenges in the early life of the WHO FCTC Conference of the Parties. Tob Control 2012; 21: 215220.
  • 2
    Lancet. A framework convention on alcohol control. Lancet 2007; 370: 1102.
  • 3
    Room R., Schmidt L., Rehm J., Makela P. International regulation of alcohol: a Framework Convention is needed, as for tobacco control. BMJ 2008; 337: 12481249.
  • 4
    Casswell S., Thamarangsi T. Reducing harm from alcohol: call to action. Lancet 2009; 373: 22472257.
  • 5
    Baumberg B. World trade law and a Framework Convention on Alcohol Control. J Epidemiol Commun Health 2010; 64: 473474.
  • 6
    Taylor A. L., Dhillon I. S. An international legal strategy for alcohol control: not a framework convention—at least not yet. Addiction 2013; 108: 450455.