65th World Health Assembly: Steps taken towards reducing NCDs: but no specific alcohol target

Following on from recommendations made in the Political Declaration of the UN General Assembly on the Prevention and Control of non-communicable diseases [NCDs], representatives from 194 Member States met in May at the 65th World Health Assembly to discuss suitable proposals for measuring their prevention and control, in line with the World Health Organization’s [WHO] global comprehensive monitoring framework.

Alcohol was established as one of four major risk factors at the UN high-level meeting on NCDs in September 2011. As a result, the first draft of the WHO framework included the target of a 10% relative reduction in per capita consumption of litres of pure alcohol among persons aged 15+ years. But unlike the targets set for salt and tobacco, it was subsequently removed in the run-up to the summit in Geneva.

Under Committee A’s second report, “the Prevention and Control of NCDs”, Member States agreed to adopt the global target of a 25% reduction in premature mortality from NCDs by 2025. They also expressed strong support for additional work aimed at reaching consensus on all health targets relating to the four main risk factors by the end of 2012.

However, Member States were uncertain of reinstating the original goal of a 10% reduction in consumption relating to alcohol. The report instead requested that the Director-General of the Assembly, Dr Margaret Chan, prepare a revised discussion paper reflecting all contributions to the current debate ahead of further talks later on this year, when Member States are expected to set voluntary global targets for reducing alcohol consumption as one of the major risk factors and include a set of indicators for measuring the effectiveness of regional, national and multisectoral approaches to combat the emergence of NCDs. Member States will reconvene in October 2012 with the aim of deciding a target for alcohol reduction. The following report of Committee A was adopted by the Assembly:-

Prevention and control of noncommunicable diseases: follow-up to the High-level meeting of the United Nations General Assembly on the Prevention and Control of
Non-communicable diseases

Recalling the Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases (A/RES/66/2), in particular paragraph 62, to prepare recommendations, before the end of 2012, for a set of voluntary global targets for the prevention and control of noncommunicable diseases and the commitments made to address noncommunicable diseases, principally cardiovascular diseases, cancers, chronic respiratory diseases, diabetes, and the underlying common risk factors, namely tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol;

Reaffirming the leading role of WHO as the primary specialized agency for health, as recognized by the United Nations General Assembly in the Political Declaration of the High-level meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases and Political Declaration toward development of a comprehensive global monitoring framework, including a set of indicators, capable of application across regional and country settings, and a set of voluntary global targets for the prevention and control of noncommunicable diseases, before end 2012;

Recalling the commitment made in WHA60.23 to achieve the target of reducing death rates from noncommunicable diseases by 2% annually during the period 2006–2015,

1. DECIDED to welcome the report A65/6 on prevention and control of noncommunicable diseases and its addendum 1 and recognized the significant progress made in close collaboration with Member States pursuant to paragraphs 61 and 62 of the Political Declaration;

2. DECIDED to adopt a global target of a 25% reduction in premature mortality from noncommunicable diseases by 2025;

3. EXPRESSED strong support for additional work aimed at reaching consensus on targets relating to the four main risk factors, namely tobacco use, harmful use of alcohol, unhealthy diet, and physical inactivity;

4. DECIDED to note wide support expressed by Member States1 and other stakeholders around global voluntary targets considered so far including those relating to raised blood pressure, tobacco, salt/sodium and physical inactivity;

5. FURTHER noted that consultations to date, including discussions during the Sixty-fifth World Health Assembly, indicated support from among Member States1 and other stakeholders for the development of targets relating to obesity, fat intake, alcohol, cholesterol and health system responses such as availability of essential medicines for noncommunicable diseases;

6. NOTED that other targets or indicators may emerge in the remainder of the process established by resolution EB130.R7; 7. URGED all Member States1 to participate fully in all remaining steps of the noncommunicable diseases follow-up process described in resolution EB130.R

7 including regional and global level consultations;

8. REQUESTED the Director-General to:

undertake further technical work on targets and indicators and prepare a revised discussion paper on the comprehensive global monitoring framework which reflects all discussions and submissions to date and which takes into account measurability, feasibility, achievability and the existing WHO strategies in this area; and
consult with Member States1 including through Regional Committees, and where appropriate, regional technical/expert working groups which report to Regional Committees through the Secretariat, on this revised discussion paper
continue to consult with all relevant stakeholders in a transparent manner on this revised discussion paper;
prepare a report summarizing the results of the discussions in each of the Regional Committees and the inputs from the above-mentioned dialogues with stakeholders;

convene a formal Member States1 meeting, to be held prior to the end of October 2012, to conclude the work on the comprehensive global monitoring framework, including indicators, and a set of global voluntary targets for the prevention and control of noncommunicable diseases;

submit a substantive report on the recommendations relating to paragraphs 61 and 62 of the Political Declaration through the Executive Board at its 132nd session to the Sixty-sixth World Health Assembly.

¹ And, where applicable, regional economic integration organizations.

Globe comment

The failure of the World Health Assembly (WHA) to adopt a clear and specific target on reducing per capita alcohol consumption as part of the global effort to reduce the burden of disease caused by non-communicable diseases (NCDs) is a disappointment, and a reminder of how alcohol remains the poor sibling of the major risk factors to death and disability worldwide.

The September 11 UN High-Level Meeting on NCDs called on WHO to set targets for the reduction of death and disability due to NCDs, and the WHA responded by committing to reduce the global burden of NCDs by 25% by the year 2025. This is an ambitious goal that will require concerted efforts and action on many levels. However, it is unlikely that such a target will be achievable if it is not complemented by plans to tackle each of the major risk factors that contribute to the ever-increasing rate of NCDs in both the developed and the developing world.

A substantial body of literature has documented alcohol’s role as a major risk for chronic disease, contributing to the global burden of cancer, cirrhosis, cardiovascular disease and stroke. Alongside tobacco use, unhealthy diet and physical inactivity, the harmful use of alcohol was identifi ed as one of the top four risk factors for NCDs globally at the 2011 UN High Level Meeting on NCDs.

Numerous expert bodies have also validated the relationship between per capita consumption and alcohol-related harm. The WHA considered, but was unable to reach consensus on, adopting a modest target of a 10% reduction in per capita consumption of alcohol. Failure to include such a target in a framework that aims to reduce NCDs overall is akin to taking on an adversary without bothering to aim: there is no way to measure success (or failure), and little pressure on Member States to adopt eff ective measures to reduce consumption such as higher taxation, restrictions on physical availability, and reductions in alcohol marketing.

Many of the arguments used in opposition to the proposed target for a reduction in per capita consumption had a familiar ring to them, for they echoed the arguments being made by the alcohol producers’ industry and industry front groups such as the International Center for Alcohol Policies. Prioritizing the views and interests of economic operators over the public health research literature will threaten the success of the overall NCD prevention programme. It is essential that Member States are fully informed about the impact a weak framework for evaluation could have in the long term.

Now is the time for civil society to push for a set of targets for all four of the main risk factors for NCDs, including a 10% reduction in per capita consumption of alcohol. Unless Member States reach consensus over the coming months on a stronger framework, the action plan for NCDs is destined to fail.