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A global strategy on alcohol abuse

Next week, the WHO will launch the first 'global assault on the harms associated with drinking.'

Writing in Science, David Grimm says that alcohol is about to get the sort of attention normally reserved for HIV and malaria. The World Health Organisation (WHO) has apparently tried to put an alcohol strategy in place. In 1983 the organisation called on member states to strengthen their national alcohol policies. But they fell foul of the USA, who threatened to withdraw funds from WHO if it pursued policies that were contrary to commercial interests.

But in 2002, the WHO's world health report drew on various studies, including their own Global Burden of Disease project to show that alcohol is the fifth leading cause of death and disability in the world and as dangerous as tobacco. It is also the source of 30% of various cancers and neurological disorders and leads to significant secondary dangers such as wife beating and murder.

However, what was particularly significant was the finding that in several developing countries alcohol is the top cause of illness and premature death - countries such as Brazil and Indonesia. And, as incomes improve the chances are that things are only going to get worse.

But it was a very first world country, Finland, who was the driving force behind the latest move. In 2005, after reducing alcohol taxes to bring them in line with neighbouring Estonia, Finland saw a spike in alcohol-related deaths. They grouped together with other Nordic countries to call on the WHO for a united effort to reduce alcohol-related problems. Once again, the USA was the fly in the ointment - they wanted a voluntary strategy. Thailand, on the other hand, thought that the resolution did not go far enough. Essentially the resolution died, but was brought to life again by Kenya and Rwanda, noting that alcohol causes a disproportionate amount of harm in developing countries.

The upshot is that next week member states are scheduled to vote on at the World Health Assembly and the measure is expected to pass. The resolution directs the WHO director general to formulate a global alcohol strategy within two years. But, says Grimm, it could still run into problems. Changes to the resolution, introduced recently by Mexico - and supported by Cuba and the United States - compel WHO's director general to collaborate with the alcohol industry in shaping its strategy. And that could produce a "weak and feckless policy," says Derek Rutherford, chair of the London-based Global Alcohol Policy Alliance. "The industry tries to play down evidence-based factors that reduce alcohol consumption, such as taxes and advertising bans, and instead focuses on education, even though there's no proof that education works," he says.

There is also the fear that rising alcohol taxes in poorer countries could drive people to resort to dangerous home brews, according to alcohol industry players.

Time will tell - with fears that improving economies in countries such as India could lead to alcohol becoming more of the problem than anyone has anticipated.

Source: David Grimm: Staggering towards a global strategy on alcohol abuse. Science 320:862-863

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