Foreward

Personal reflection on World Health Assembly
Derek Rutherford

WHO boldly states that its mission “shall be the attainment by all peoples of the highest possible level of health” so it was somewhat surprising to hear a delegate on leaving this year’s World Health Assembly remark “I thought I had been attending a World Trade Assembly not the World Health Assembly.” If that delegate had sat with lobbyists of the drinks industry packing the public gallery, where the committee deliberating on a need for a global strategy to reduce alcohol related harm was holding its drafting meeting, it would have confirmed the impression that one had come to a trade and not a health meeting.

Yet it may be rather unfair to damn the majority because of the actions of a minority.

After the first morning’s deliberations of the committee, the drinks industry lobbyists were expressing their dismay and concern. They had good reason to be worried since member state after member state expressed its concern over the growing problems associated with the increased use of alcohol.

From the continents of Africa and Asia came strong support for the resolution, proposed by 40 countries, to further develop a global strategy on the problems caused by the use of alcohol. Despite the heavy burden of communicable diseases faced by Africa, their delegations showed that they did not wish to have to cope with the added burden of non-communicable diseases that would result from the rising tide of alcohol consumption. They recognised the need for appropriate prevention strategies.Despite this the whole process became stalled in committee sinceWHO decisions are based on consensus. Finally what emerged was a simple resolution that ‘strategies to reduce the harmful use of alcohol’ and related documents discussed at the Assembly should be included in the agenda of the Executive Board at its 122nd session to be held in January 2008 and requested the Director General, in the interim, to continue her work on this matter.

In this edition of The Globe we publish the Secretariat’s report (page 5); the WHO Global Assessment of public health problems caused by the harmful use of alcohol for 2002 (page 8); and the WHO Expert Committee Report (page 10). This latter report had only been published on the web in English a few weeks before theAssembly. This caused some consternation for the US delegation since procedural rules had not been observed. It ought to have been circulated to all delegations in theWHO official languages. Unfortunately the proposers of the resolution had included it in their preamble. They thought it would lend added weight to their proposals. However, they should have been aware that the expert committee’s recommendations would certainly give great concern to the drinks industry and to some member states.

The reaction of Cuba to the resolution was uncompromising for reasons which are difficult to understand. Their reaction was puzzling since in the Pan American Conference on Alcohol Policy in Brasilia in 2005 the Cubans appeared very supportive of public health measures in relation to alcohol. Did national pride and trade get in the way? Prior to theWHA debate the Swedish Foreign Minister had criticised the human rights record of the Cuban Government. There were those who considered the spat to be the reason for the intransigence of the Cubans towards what they considered to be a Swedish resolution. We cannot believe that this was the motivation lying behind the Cuban position. More likely they were playing to the strong delegation of the drinks industry from their part of the world.

The issue of trade was probably the factor that dominated their actions. Previous WHO decisions on nutrition and the tobacco framework are considered by them as unhelpful to their sugar and tobacco industries. Any move on alcohol is seen as another economic threat. A Cuban foreign office official remarked “the industry is important to Cuba. It’s the fifth largest income earner after tourism and nickel.The alcohol industry gives work and contributes to economic growth.” Reporting on the debate, a Swedish newspaper described it as ending in a ‘fiasco’.

Should it be seen in that light? From the outset there could have been simply a resolution that noted the secretariat’s report and encouraged further work (which we finally landed up with). However, there was value in opening up the wider debate since vital lessons are to be learnt by the WHO secretariat, member states and nongovernmental advocacy groups.

Apart from a few member states there was overwhelming support for positive action from both developed and developing countries. It is the few that can block progress. We must recognise the power of entrenched vested interest. The powerful leverage of the drinks industry over politicians and governments particularly in their trade and finance ministries is insiduous. In her opening speech to the Assembly the Director General did with great emphasis remark that there was no place for the tobacco industry in the councils of WHO. Whilst we recognise that the drinks industry should be consulted on the implementation of policy, we must emphasise that they have no place at the decision making table. The trouble is the industry wants to have two bites of the cherry – seats not only at trade and industry but also at health. Public Health advocates at member state and international level must have confidence that the governmental health sector should not have to bow to the pressure of commercial profit in setting out and defending evidence based public health strategies to reduce the harms from the use of alcohol. It is up to member states governments to determine the balance between health and trade policies. However we would naturally proffer the advice of Disraeli, a distinguished 19th century British Prime Minister: “The first priority of any government is the health of its people.”

The WHA debate revealed the minefield there is in finding concensus. Very carefully thought out presentational skills will be needed in writing the future strategy. Member states will need to perceive and understand that they are not being given a take it or leave it ‘blue-print’ but an array of policy options from which they can adopt evidence based strategies appropriate to their particular political, social and economic cultures in order to reduce and prevent alcohol related harm.