WHO, PAHO and the alcohol industry.

Abstract

The paper by Knai et al. relates to several facets of public–private partnerships (PPP) which are often not discussed in the literature: accountability, transparency and ethics 1. By developing and applying a research methodology to assess the potential impact and relevance of such PPPs as related to alcohol, the authors provide more support to the body of evidence that these partnerships do not have a clear benefit for public health at the same time that they question how to reliably measure the impact of such actions, how to monitor implementation and how to assess the added value of such initiatives. Since the discussions over the development of a global strategy for reducing harmful use of alcohol started in the World Health Assembly, and in particular after its adoption, the alcohol industry has stepped up its activities globally, expeditiously promoting the notion that they are a ‘stakeholder’ and part of the solution. This has included direct meetings with policymakers in several countries, proposing the development of policies and interventions, funding for education and research, among other activities. Policymakers are faced with the difficult challenge of assessing whether proposals are evidence-based, have a likelihood of impact, pose a significant conflict with public health goals and can be evaluated independently. Currently, there is no accountability over actions proposed by the alcohol industry and very little on public–private partnerships with them. They are often unpublicized and nor are they ethically reviewed. Many may rely on the text of the World Health Organization (WHO) global alcohol strategy for what to do 2. In paragraph 6-d, on ‘balancing different interests’, the text is clear about the ‘right of countries to take measures to protect human health’, such as taxation, reduction of availability and banning or controlling alcohol marketing. None of these policies, however, are included in any public private partnership, for obvious reasons: they would decrease profits. Economic operators are acknowledged as ‘an important player in their role as developers, producers, distributors, marketers and sellers of alcoholic beverages (paragraph 45-d)’ and ‘encouraged to consider effective ways to prevent and reduce harmful use of alcohol within their core roles’, including ‘self-regulatory actions or making available data on sales and consumption of alcoholic beverages’. However, the wording was crafted carefully to separate them as a player that is not a ‘collaborator’ or a ‘partner’. Their role is clearly limited, and it is never linked to policymaking, education or research. The strategy recommends continuing a ‘dialogue’ with them on how they can reduce the harms from the consumption of alcoholic beverages; it is the role of governments and other stakeholders to assess whether the ways they propose have any chance of reducing the harm which, in turn, depends upon determining ways of monitoring their actions and their proposed contributions. Under ‘public health advocacy and partnership’ (paragraph 48), the WHO strategy mentions the need to ensure that the WHO Secretariat has processes in place to work with non-governmental organizations and other civil society groups, taking in consideration any conflicts of interest [italics added] that some non-governmental organizations may have; and in continuing its dialogue [italics added] with the private sector on how they can best contribute to the reduction of alcohol-related harm. Dr Margaret Chan has been clear on a few occasions about the position of WHO: in the 8th Global Conference of Health Promotion in Helsinki 3, in the Global Conference on Alcohol Policy in Turkey 4 and in a letter in reply to the British Medical Journal feature on the alcohol industry 5. In all, Dr Chan indicated that ‘the development of alcohol policies is the sole prerogative of national authorities, and the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests’. Finally, years ago the Pan American Health Organization adopted guidelines on collaboration with private enterprises 6 that textually exclude any collaboration with the alcohol industry, along with tobacco and weapons. The study by Knai et al. shows a very narrow range of activities in areas not clearly proven to lead to alcohol harm reduction and, if this is most of what can be done, it questions the need and value of a public–private partnership with the alcohol industry. Policymakers interested in reducing the harm from alcohol consumption can rely on a solid and growing body of documented evidence on what works to reduce alcohol problems at population level. None.