A global frame is already in place


Taylor & Dhillon give a comprehensive overview of possible ways to pursue a legally binding approach to international control on alcohol [1]. In this regard it is worth noting that harmful use of alcohol has been on the agenda of the World Health Assembly in 2005, 2007, 2008 and 2010, and three resolutions and one decision have been made in the Health Assembly specifically on harmful use of alcohol in this period.

The main result of this is that currently there is a frame which the Member States of the World Health Organization (WHO) have agreed to operate under regarding harmful use of alcohol as a global health issue. On Friday 21 May the Sixty-third session of the World Health Assembly adopted by consensus resolution WHA63.13 [2], which endorses the global strategy to reduce the harmful use of alcohol [3]. Delegations from all 193 Member States of WHO reached consensus on possible ways to confront the problem at global and national levels. The global strategy was the result of a broad and inclusive consultation process, which is well documented on WHO's web page [4]. The High-level Meeting of the UN General Assembly on the Prevention and Control of Non-communicable Diseases, to which the authors refer in the paper, gave considerable support to the global strategy, promotes its implementation and calls upon WHO to intensify efforts to assist Member States in this regard [5].

Resolution WHA63.13 is not binding under international law, but it has the political authority and standing of a decision under Article 23 of the WHO Constitution [6] and thus has considerable force as an international political matter. Recommendations under Article 23 become effective immediately upon adoption by a simple majority (but in reality often a consensus) of the World Health Assembly and they raise an expectation that Member States will implement them in good faith. This in contrast to a legally binding instrument, which needs a two-thirds majority of the World Health Assembly and only comes into force for those Member States which accept to be bound to it through their domestic ratification procedures.

Thus, the global strategy is available now as a comprehensive frame for sustainable actions at all levels to reduce the harmful use of alcohol; as such, there is no need to wait for an international code or framework convention on alcohol to act. In my view the paper would have gained considerably by including in its analysis not only the negotiation process that led to the endorsement of the global strategy, documented thoroughly in the records of the World Health Assembly [7], but also an analysis of the content of the strategy, its strengths and shortcomings in obtaining the same goals as a legally binding agreement must have, i.e. considerably reduced morbidity and mortality due to harmful use of alcohol and their ensuing social consequences. Such an analysis would also have given some further insight into the preparedness of WHO Member States to embark on a road towards legally binding international alcohol control.

Successful reduction of harmful use of alcohol in a country depends largely upon having competent and capable human resources, institutional competency and capacity as well as adequate infrastructure to develop and implement a range of interventions at different levels. When it comes to the issue of national competency, it is worth keeping in mind that it is the same countries which negotiate trade treaties as negotiate in the UN General Assembly and in the World Health Assembly. Thus building national capacity and priority for health in all policies is also a must on the path that the authors suggest in their paper.

There is no need to hide that there are many implementation challenges for the global strategy, but keeping in mind the consensus-building process that led to the strategy as well as the content of the strategy itself, I am convinced that the global health community already has a tool in hand that can be used to ‘create norms that guide the behaviour of states and overcome recognized limitations of formal legalized strategies’, if that is needed.

Declarations of interest