A Framing Analysis of Consultation Submissions on the WHO Global Strategy to Reduce the Harmful Use of Alcohol: Values and Interests

Background: In response to the magnitude of harms caused by alcohol, the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (GAS) was endorsed in 2010. We analysed submissions to the 2019 WHO consultation on the implementation of the GAS to identify how different stakeholders frame alcohol use and control; and to assess how stakeholders engage with the consultation process, with possibly harmful consequences for public health policy. Methods: All submissions from WHO Member States, international organisations, non-governmental organisations (NGOs), academic institutions and private sector entities were identified and used as data for an inductive framing analysis. This involved close reading and data familiarisation, thematic coding and identifying emergent framings. Through the analysis of texts, framing analysis can give insights into the values and interests of stakeholders. Because framing influences how issues are conceptualised and addressed, framing analysis is a useful tool to study policy-making processes. Results: We identified 161 unique submissions and seven attachments. Emerging frames were grouped according to their function: defining the problem, assigning causation, proposing solutions, or justifying and persuading. Submissions varied in terms of the framing they deployed and how this was presented, eg, how the problem was defined. Proposed policy solutions also varied. Targeted solutions emphasising individual responsibility tended to be supported by industry and some Member States. Calls for universal regulation and global mobilisation often came from NGOs and academia. Stakeholders drew on evidence and specific value systems to support the adoption of certain problem and solution ideas and to oppose competing framing. Conclusion: Alcohol control is a contested policy field in which different stakeholders use framing to set the agenda and influence what policy solutions are considered legitimate. WHO should consider which interests are served by these different framings and how to weigh different stakeholders in the consultation process.

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Die Globale Strategie zur Reduktion schädlichen Alkoholkonsums:

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911.a000096 ◽

2011 ◽

Vol 57 (2) ◽

pp. 81-83 ◽

Cited By ~ 1

Author(s):

Jürgen Rehm

Keyword(s):

Global Strategy ◽

World Health ◽

Capita Consumption ◽

Member States ◽

Harmful Use ◽

Per Capita ◽

Alcohol Related Harm ◽

Harmful Use Of Alcohol ◽

Per Capita Consumption ◽

Related Harm

Global Strategy to Reduce the Harmful Use of Alcohol: First Step towards an Alcohol Framework Convention? English Summary: At the 61st World Health Assembly, the 193 member states discussed and ratified the global strategy to reduce the harmful use of alcohol. Firstly, 10 target areas have been identified within the strategy and alcohol policy should be structured according to these areas. The contribution of Anderson (2011) discusses these target areas with respect to supporting empirical evidence and policy implications. The final target area is Monitoring and Surveillance, and the other two contributions fall under this topic. Shield, Rehm, Patra & Rehm (2011) provide an overview of worldwide adult per capita consumption. Per capita consumption is associated indirectly to alcohol-related harm: as higher consumption generally leads to more harm, but the level of association varies according to economic indicators. Countries with lower GDP PPP experience more harm as they have more risks associated to alcohol such as infectious diseases like tuberculosis and/or a less developed health care system. The last contribution to this topic focuses solely on Germany and includes both health as well as social consequences ( Kraus, Piontek, Pabst & Bühringer, 2011 ). It needs to be recognized that the global strategy contains merely suggestions that are not binding to any of the member states. It is not yet shown whether this strategy is enough to combat the rising global alcohol-related harm and there have been suggestions to adopt a more binding form of international arrangement such as the Framework Convention for Tobacco Control.

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Global and Country Specific Adult per capita Consumption of Alcohol, 2008

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911.a000100 ◽

2011 ◽

Vol 57 (2) ◽

pp. 99-117 ◽

Cited By ~ 34

Author(s):

Kevin D. Shield ◽

Maximillien Rehm ◽

Jaydeep Patra ◽

Bundit Sornpaisarn ◽

Jürgen Rehm

Keyword(s):

Alcohol Consumption ◽

Burden Of Disease ◽

Eastern Mediterranean Region ◽

Global Strategy ◽

World Health ◽

Capita Consumption ◽

Harmful Use ◽

Per Capita ◽

Harmful Use Of Alcohol ◽

Per Capita Consumption

Aims: Alcohol is a substantial risk factor for mortality and the burden of disease globally. In accordance with the World Health Organization’s (WHO) global strategy to reduce the harmful use of alcohol, we estimated recorded, unrecorded, tourist, and total adult per capita consumption by country and WHO sub-region for 2008, and characterized the association between per capita consumption of alcohol and gross domestic product (GDP-PPP) per capita. Methods: Using data from the Global Information System on Alcohol and Health database ( World Health Organization, 2010 a) and the 2005 Global Burden of Disease study ( Institute for Health Metrics and Evaluation, 2010 ) on adult per capita consumption of alcohol, we estimated recorded adult per capita consumption for 2008 through time series analyses for 189 countries within WHO sub-regions, and then from these estimates calculated recorded adult per capita consumption estimates for each of the WHO sub-regions. Estimates for populations were obtained for 2008 from the United Nations Populations Division. 2008 GDP-PPP data by country (N = 178) were obtained from the International Monetary Fund. Results: Adult per capita consumption of alcohol in 2008 is estimated to have been 6.04 litres (95 % CI: 4.43 to 7.65). This can be broken down into 4.39 l (95 % CI: 3.72 to 4.86) of recorded per capita consumption of alcohol, 1.75 l (95 %CI: 0.25 to 3.25) of unrecorded per capita consumption of alcohol, and 0.00 l (95 %CI: 0.00 to 0.129) per capita consumption of alcohol consumed by tourists. Adult per capita consumption was highest for the European regions and lowest for the Eastern Mediterranean region. Total adult per capita consumption of alcohol showed an increase as GDP-PPP increased until approximately 15,000 international dollars of GDP-PPP per capita. Recorded consumption showed a general increase with GDP-PPP. Unrecorded consumption showed a U-shaped association with GDP-PPP per capita, with countries with the lowest and highest GDP-PPPs per capita having the lowest unrecorded adult per capita consumption of alcohol. Conclusions: In accordance with the WHO’s global strategy to reduce the harmful use of alcohol, we present estimates of the recorded, unrecorded, tourist, and total adult per capita alcohol consumption for 189 countries and the 14 WHO sub-regions. Accurate and up-to-date estimates of alcohol consumption are imperative for monitoring and developing effective strategies to control the large and increasing global alcohol-attributable burden of disease and injury.

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Missing in Action: The Global Strategy to Reduce the Harmful Use of Alcohol and the WTO

European Journal of Risk Regulation ◽

10.1017/err.2020.67 ◽

2020 ◽

pp. 1-22 ◽

Cited By ~ 1

Author(s):

Paula O’BRIEN

Keyword(s):

Legal Status ◽

Global Strategy ◽

World Health ◽

The World ◽

Different Types ◽

Regulatory Instruments ◽

Harmful Use ◽

Missing In Action ◽

Health Organization ◽

Harmful Use Of Alcohol

This article addresses the question of how the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol (Global Strategy) and its Framework Convention on Tobacco Control (FCTC) have been used in the context of discussions about alcohol and tobacco measures, respectively, in the World Trade Organization (WTO) Committee on Technical Barriers to Trade. The article finds considerable differences not only in the extent to which the FCTC is used compared to the Global Strategy , but also in the ways in which the two global health instruments have been used in the WTO context. The article proffers three key reasons for these differences: the legal status of the instrument; the content of the instrument in terms of whether it contains guidance as to the use of detailed, evidence-based measures; and the role and legitimacy that the instrument accords to the relevant industry interests. The article considers how the insights from the research can inform the developments in global governance of alcohol that are underway in WHO policy. It also positions its findings in terms of the wider international law debates about hard law versus soft law, and whether different types of international regulatory instruments and the legal status of these instruments impact their effectiveness in supporting domestic public health measures.

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City-based action to reduce harmful alcohol use: review of reviews

F1000Research ◽

10.12688/f1000research.13783.1 ◽

2018 ◽

Vol 7 ◽

pp. 120 ◽

Cited By ~ 2

Author(s):

Peter Anderson ◽

Eva Jané-Llopis ◽

Omer Syed Muhammad Hasan ◽

Jürgen Rehm

Keyword(s):

Controlled Trial ◽

Review Literature ◽

Convincing Evidence ◽

Global Strategy ◽

World Health ◽

Community Based Interventions ◽

Review Of Reviews ◽

Harmful Use ◽

The Impact ◽

Harmful Use Of Alcohol

Background: The World Health Organization global strategy on alcohol called for municipal policies to reduce the harmful use of alcohol. Yet, there is limited evidence that documents the impact of city-level alcohol policies. Methods: Review of reviews for all years to July 2017. Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register, and Epub Ahead of Print databases. All reviews that address adults, without language or date restrictions resulting from combining the terms (“review” or “literature review” or “review literature” or “data pooling” or “comparative study” or “systematic review” or “meta-analysis” or “pooled analysis”), and “alcohol”, and “intervention” and (“municipal” or “city” or “community”). Results: Five relevant reviews were identified. Studies in the reviews were all from high income countries and focussed on the acute consequences of drinking, usually with one target intervention, commonly bars, media, or drink-driving. No studies in the reviews reported the impact of comprehensive city-based action. One community cluster randomized controlled trial in Australia, published after the reviews, failed to find convincing evidence of an impact of community-based interventions in reducing adult harmful use of alcohol. Conclusions: To date, with one exception, the impact of adult-oriented comprehensive community and municipal action to reduce the harmful use of alcohol has not been studied. The one exception failed to find a convincing effect. We conclude with recommendations for closing this evidence gap.

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City-based action to reduce harmful alcohol use: review of reviews

F1000Research ◽

10.12688/f1000research.13783.2 ◽

2018 ◽

Vol 7 ◽

pp. 120 ◽

Cited By ~ 1

Author(s):

Peter Anderson ◽

Eva Jané-Llopis ◽

Omer Syed Muhammad Hasan ◽

Jürgen Rehm

Keyword(s):

Controlled Trial ◽

Review Literature ◽

Convincing Evidence ◽

Global Strategy ◽

World Health ◽

Community Based Interventions ◽

Review Of Reviews ◽

Harmful Use ◽

The Impact ◽

Harmful Use Of Alcohol

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Meeting the Global NCD Target of at Least 10% Relative Reduction in the Harmful Use of Alcohol: Is the WHO European Region on Track?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103423 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3423 ◽

Cited By ~ 3

Author(s):

Charlotte Probst ◽

Jakob Manthey ◽

Maria Neufeld ◽

Jürgen Rehm ◽

João Breda ◽

...

Keyword(s):

Action Plan ◽

Alcohol Exposure ◽

Heavy Episodic Drinking ◽

World Health ◽

European Region ◽

Noncommunicable Diseases ◽

Relative Reduction ◽

Harmful Use ◽

Health Organization ◽

Harmful Use Of Alcohol

Background: The Global Action Plan for the Prevention and Control of Noncommunicable Diseases set the target of an “at least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context”. This study investigated progress in the World Health Organization (WHO) European Region towards this target based on two indicators: (a) alcohol per capita consumption (APC) and (b) the age-standardized prevalence of heavy episodic drinking (HED). Methods: Alcohol exposure data for the years 2010–2017 were based on country-validated data and statistical models. Results: Between 2010 and 2017, the reduction target for APC has been met with a decline by −12.4% (95% confidence interval (CI) −17.2, −7.0%) in the region. This progress differed greatly across the region with no decline for the EU-28 grouping (−2.4%; 95% CI −12.0, 7.8%) but large declines for the Eastern WHO EUR grouping (−26.2%; 95% CI −42.2, −8.1%). Little to no progress was made concerning HED, with an overall change of −1.7% (−13.7% to 10.2%) in the WHO European Region. Conclusions: The findings indicate a divergence in alcohol consumption reduction in Europe, with substantial progress in the Eastern part of the region and very modest or no progress in EU countries.

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WHO Global Strategy to Reduce the Harmful Use of Alcohol (2010)

Alcoholism Treatment Quarterly ◽

10.1080/07347324.2011.562795 ◽

2011 ◽

Vol 29 (2) ◽

pp. 170-175

Author(s):

Thomas F. McGovern ◽

Stephen Manning ◽

Terry McMahon

Keyword(s):

Global Strategy ◽

Harmful Use ◽

Harmful Use Of Alcohol

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Policy Implications of the WHO Strategy to Reduce the Harmful Use of Alcohol

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911.a000099 ◽

2011 ◽

Vol 57 (2) ◽

pp. 85-98 ◽

Cited By ~ 4

Author(s):

Peter Anderson

Keyword(s):

Health Impact ◽

Community Action ◽

Policy Implications ◽

Alcoholic Beverages ◽

World Health ◽

Supporting Evidence ◽

Negative Consequences ◽

Minimum Age ◽

Harmful Use ◽

Harmful Use Of Alcohol

Aims: To describe the supporting evidence and policy implications of the 10 target areas of the WHO strategy to reduce the harmful use of alcohol. Methods: Based on published systematic reviews of the literature and publications of the World Health Organization, the supporting evidence and policy implications of the 10 target areas are described. Findings: There is evidence to support action in each of the 10 target areas: leadership, awareness and commitment; health services’ response; community action; drink-driving policies; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of intoxication; reducing the public health impact of illegal and informal alcohol; and monitoring and surveillance. Conclusions: The following policy measures have the strongest evidence: increasing alcohol taxes; government monopolies for the retail sale of alcohol; restricting the density of outlets and the days and hours of sale; increasing the minimum age of purchase; lowering the legal BAC levels for driving; introducing random breath-testing for driving; implementing widespread brief advice for hazardous and harmful alcohol consumption; and ensuring treatment for alcohol use disorders. There is reasonable evidence to support the introduction of a minimum price per gram of alcohol; restricting the volume of commercial communications; and enforcing the restrictions of sales to intoxicated and under-age people.

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