CHRISTOPHER SNOWDOWN: Bottle up

Last year the World Health Organisation (WHO) launched a public consultation on its draft “Global Alcohol Strategy to Reduce the Harmful Use of Alcohol”, which included the now-infamous statement that more efforts should be made to prevent “women of childbearing age” from drinking.

The WHO has had a global alcohol strategy since 2010, but the draft of the new strategy represented a significant shift in emphasis. While the 2010 plan focused on alcohol-related harm, the working document treats mere consumption of alcohol as a problem in itself. This approach is similar to that of the SA government, which has implemented four blanket bans of alcohol sales as a response measure to Covid-19.  

After launching a public consultation on its alcohol plan, the WHO came back with a new draft last month in which the reference to women of childbearing age was, wisely, deleted. Elsewhere, however, the problems remain. The new draft is actually even worse because the authors have inserted an unjustifiable and wholly unrealistic target of reducing per capita alcohol consumption worldwide by 20% by 2030.

There was no target for per capita alcohol consumption in the 2010 plan. There was a target in the WHO’s Global Non-Communicable Disease Action Plan of 2013, but that was to reduce the “harmful use of alcohol, as appropriate, within the national context” by 10%. The new proposal of a 20% reduction in per capita alcohol consumption cannot be justified on health grounds since consumption is not a measure of health, and it is patently unachievable in such a short space of time. There is no reason to believe this target could be met even if every member state introduced the WHO’s so-called best buys (tax rises, advertising bans) tomorrow.

Where did this target come from? A clue may lie in last year’s consultation, which was inundated with submissions from temperance organisations. One of the biggest organisations in this network is Movendi International, which was, until recently, known as the International Order of Good Templars. In its submission Movendi called on the WHO to set a target of a 30% reduction in per capita consumption by 2030.

Organisations that endorse alcohol prohibition in SA and elsewhere will naturally support any measures to suppress consumption. They can be expected to propose the most extreme targets for reductions in alcohol consumption, regardless of how unrealistic they may be. But pressure groups rooted in alcohol prohibition have little public support, and it is concerning to see the preferential treatment given to them by the WHO. Movendi, for example, is listed as a “non-state actor in official relations” with the WHO. Movendi has also previously agreed to “help explore new or innovative ways and means to secure adequate funding for the implementation of the WHO global strategy to reduce the harmful use of alcohol”.

In light of the close relationship between the WHO and the global alcohol prohibition movement, it is reasonable to ask whether the WHO has simply split the difference between the 30% target for consumption proposed by groups such as Movendi and the 10% target for harmful use already in place in the action plan to arrive at a target of 20% for consumption. It is difficult to see any other logic to the decision since there is no evidence that a 20% reduction is attainable or optimal. It is a false compromise; the “golden mean fallacy” writ large.

Since there is no prospect of this target being met, the WHO is setting up member states to fail. When 2030 comes around and this arbitrary and unrealistic milestone has not been reached, we can expect the WHO and its temperance partners to demand even tougher action, perhaps including a legally binding Framework Convention on Alcohol Control (modelled on the Framework Convention on Tobacco Control) that has so far been firmly rejected by member states. 

Whatever the reasons for the sudden insertion of this target into the global action plan it is quite unacceptable. Insofar as the WHO has a mandate for getting involved in alcohol policy, it is in relation to health harms, not consumption. There is no reason to assume that a reduction in per capita consumption will necessarily lead to a reduction in alcohol-related harm. As the latest draft of the plan acknowledges, wealthier countries tend to have higher rates of consumption but do not have higher rates of heavy episodic drinking. 

The focus on alcohol consumption allows the WHO to push ahead with the kind of crude, supply-side policies popular with Western public health academics but that can only discourage the sale of legal alcohol. Meanwhile, they virtually ignore the issue of illicit alcohol, which is a bigger problem in most low and middle-income countries such as SA. Euromonitor International documented the extraordinary growth of the illicit alcohol trade in SA in 2020 as a direct consequence of the prohibition of alcohol sales. It notes that illicit alcohol trade has grown to 12% of the R177.2bn total industry market value and to 22% of the market by volume and is worth R20.5bn. Illicit alcohol trade sales by volume in SA have overtaken the entire combined wine and cider sectors (665,431 hectolitres of alcohol equivalent vs 627,758 hectolitres of alcohol equivalent).

In contrast to the WHO’s 2010 plan, the new draft says almost nothing about the social, economic and health harms of black market booze and doesn’t acknowledge the risks of increasing demand for homemade and illicit products by suppressing demand for legal products.  The tragic indirect consequence of blanket alcohol bans in SA has been the rise in illicit home-brew consumption-related deaths and increased criminal activities, which are now firmly entrenched. A new public consultation has now been launched by the WHO and will run until September 3.

No doubt the prohibition lobby will complain that the draft is still not extreme enough, but the WHO and health ministers of member states such as SA should listen to more moderate voices before embarking on a plan that is designed to fail.

• Snowdon is head of lifestyle economics at the UK-based Institute of Economic Affairs. He is the author of “The Art of Suppression”, “The Spirit Level Delusion” and “Velvet Glove; Iron Fist”.