NCD Alcohol Target Dropped to
Placate Drinks Industry

In the monitoring framework for the prevention and control of non-communicable diseases, the World Health Organization has removed the target to reduce per capita alcohol consumption. The first draft of the framework included a target to achieve a 10% relative reduction in per capita consumption of litres of pure alcohol among persons aged 15+ years. Compared with the 25% per capita consumption reduction in the Health For All target of a generation ago, the suggested target was more realistically achievable and should have been acceptable to Member States, who had previously agreed to the WHO Global Alcohol Strategy.

The exclusion of an alcohol target in the revised framework paper is both puzzling and a cause for concern. In the WHO’s Feedback from the first draft targets it is reported that “some Member States expressed concern about the implicit difficulties in working with the alcohol industry towards a goal that is counter to their best interests.” Collaborating with the drinks industry will hinder effective strategies to reduce alcoholrelated harm.

Until now, alcohol has maintained its position within WHO as one of the major risk factors for NCDs, following recommendations made at the UN high-level meeting on NCDs in September 2011. Suggested exposure targets for the prevention of NCDs included reductions in the consumption of alcohol, salt and tobacco. Whilst targets remain in the WHO framework for salt and tobacco, alcohol has been removed. The removal of the per capita alcohol consumption target is also due to concerns from Member States that it is not a valid proxy of harmful alcohol consumption. This goes contrary to strong evidence of the well accepted “total consumption model”: When total alcohol consumption increases in a society, there tends to be an increase in the prevalence of heavy drinkers. Because heavy drinkers account for a significant proportion of total alcohol consumption, it would be difficult for the total consumption level to increase without an increase in their drinking.

The amount of alcohol-related harm in any society tends to rise and fall in line with changes in the total or average level of consumption. The more alcohol is consumed by a society, the higher its level of alcohol-related harm is likely to be. The lower its level of consumption, the lower its level of harm.

Another concern was raised about the difficulty of obtaining an accurate measure of per capita consumption, which could be hindered by the supply of unrecorded, informal alcohol. This appears a weak argument given the work conducted by WHO in tracking per capita alcohol consumption, resulting in three Global Status Reports (1999, 2004 and 2010). The last report, Global status report on alcohol and health, is a comprehensive knowledge base on the status of alcohol consumption. WHO has been actively involved in documenting and reporting in this field since 1974 and from 1996 data was collected in the Global Alcohol Database, which was further developed and transformed into the Global Information System on Alcohol and Health in 2008.

The Global Strategy points to effective, evidence-based public health interventions. Including a target on per capita alcohol consumption would be in accordance with the Global Strategy to reduce the harmful use of alcohol. To exclude the target of reducing alcohol consumption from the NCD monitoring framework is ill advised. It is imperative that WHO continues to adopt a public health approach to tackle the growing burden of alcohol harm. Now is the time to move forwards not backwards.