An alcohol perspective on Dr. Chan’s WHO speech

The world is facing a number of huge threats to health and well-being of human beings. We face a changing climate. We’re suffering an Ebola epidemic in West Africa. We can already see the emergence of anti-microbial resistance, due to, for instance, the heavy use of antibiotics in meat production. We are witnessing the ever growing burden of Non-communicable diseases, driven by the corporate consumption complex that keeps putting their own profits over and above the Human Rights of people around the world.

We are making progress concerning the HIV/ Aids epidemic but we’re still far from solving it and violence against women and girls is a public health and Human Rights issue of catastrophic proportions.

That’s a shortlist of global health and Human Rights issues of our times. And so you understand the importance of WHO and of IOGT International and our Member Organizations being involved in finding solutions. Alcohol is a factor in many of the problems mentioned.

That’s the backdrop of DG Dr. Chan’s speech at the 136th Session of the WHO Executive Board. In this context, I was glad to hear her addressing this situation with urgency and clarity, when she began her speech this way:

We are meeting at a time of profound economic, social, and demographic transitions in a world in turmoil from multiple causes. Social inequalities have increased, with more of total global wealth held by just a few rich and powerful people. Numerous conflicts, sectarian clashes, and terrorist acts show the bleak side of humanity’s inhumanity.”

Our world is indeed in turmoil, and the rise of the so called corporate consumption complex to unparalleled power and influence, is contributing to this turmoil. The corporate consumption complex, including the tobacco and alcohol industries, keeps aggressively lobbying against high-impact, evidence-based policy solutions to some of our most pressing global problems. As IOGT International we stand for a different, a better world. Our vision is a life for all human beings free to live up to their fullest potential, and free from harm caused by alcohol and other drugs. It’s a world of peace, democracy and justice where free and healthy citizens actively contribute in all levels of society.

With our work towards that vision, we are right there located within in the mission of WHO. DG Dr. Chan explained the mission in her speech this way:

The WHO Constitution refers to the ‘common danger’ of unequal development and the importance of activities that contribute to the ‘harmony of human relations.’

If public health has something to offer the world at large, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.”

And DG Dr. Chan became more specific in her speech, too. She outlined some of the threats I mentioned above and proceeded to talk about the intersection of development and health:

As the international development community transitions into the post-2015 era, we can celebrate some extremely encouraging trends and achievements. The Millennium Development Goals have been good for public health. 

Last year, especially good news came from a report showing that child mortality rates are falling faster than ever before. In 2013, 17 000 fewer children died each day than in 1990. Maternal deaths have also fallen, but not far or fast enough. While these efforts continue, WHO’s additional objectives include ending neonatal deaths and doing more to improve adolescent health.”

Alcohol plays a big role in ill-health, morbidity and pre-mature death of children, adolescents and young people. Millions of children around the world have to grow up in households with alcohol addicted parents. Many of them end up in the streets, left alone by a society that is still largely blind to the predicament of children of alcoholics.
In the low- and middle-income countries, alcohol plays a role in both depleting resources of households and economies – making health care an unaffordable fairy tale, instead of an achievable investment in the present and future of citizens and society.
We know that 5 out of 8 Millennium Development Goals are related to and negatively impacted by alcohol harm.

DG Dr. Chan continued by addressing the HIV/ Aids epidemic:

Many AIDS experts believe the epidemic reached a tipping point last year. At the end of 2013, close to 13 million people worldwide had received antiretroviral therapy, nearly 12 million of them in low- and middle-income countries. The AIDS experts will also tell you how much WHO’s public health approach to this disease and streamlined and simplified clinical guidelines contributed to this monumental achievement.”

Alcohol is a risk factor for the contraction, spread and progression of HIV/ Aids. Alcohol weakens the immune system. It is a risk factor for violent sex and for risky sexual behaviour (unprotected sex and sex with numerous partners). And alcohol also is a risk factor for poor adhesion to treatment programs. Too many people infected with the HI-Virus stop taking their medications because of alcohol use. 13 million people receive antiretroviral therapy, but too many of them fall out of treatment and/ or use their ARVs for spiking alcohol. All these links and correlations need to be addressed in the on-going work to build on the achievement so far.

HIV/ Aids is not the only infectious disease that WHO is working on. Malaria and Tuberculosis (TB) are others. And DG Dr. Chan had the following to say, concerning TB:

Building on past success, ambitions for tuberculosis rose, with WHO targeting more than 30 countries for elimination of the disease. That goal was supported by improvements in diagnosing TB’s multidrug-resistant forms. 

Like many other programmes at WHO, the ones for AIDS, TB, and malaria have been good at stimulating innovation and seizing the advantages of new technologies.”

There’s also a clear link between alcohol use and TB. And so it is crucial for WHO to address the role of alcohol harm in the context of infectious diseases, especially HIV/ Aids and TB. I would say that more innovation in finding comprehensive approaches, and cross-sectorial solutions are needed – for the most long-term, effective and sustainable outcomes for global health.

As I’ve mentioned above, in addition to the infectious diseases the world now also has to deal with the rising burden of Non-communicable, chronic diseases (NCDs). DG Dr. Chan tied together the development agenda with the rise of NCDs and thus pointed out a crucial issue: NCDs, often called lifestyle diseases manufactured by the corporate consumption complex, are not only a global health threat, but a burden to economic development and sustainability, to social cohesion and progress and to people living a happy and fulfilled life.

The health challenges we will face in the post-2015 era are considerable. With the rise of chronic noncommunicable diseases, the sharp divide between health problems in wealthy and developing countries is dissolving.

Health everywhere is being shaped by universal pressures, like the globalized marketing of unhealthy products, population ageing, and rapid urbanization. These forces have created multiple health burdens that need to be addressed at the same time, but with different strategies. 

The ancient burden of deaths from infectious diseases has been joined by a newer burden of even more deaths from NCDs. Rapid unplanned urbanization has added a third burden: deaths from road traffic crashes and the mental disorders, substance abuse, and violence that thrive in impoverished urban settings. 

The report on adolescent health gives a good indication about how these burdens vary from one WHO region to another.”

This is the only section where DG Dr. Chan addressed alcohol directly, in mentioning “substance abuse” – but we know that alcohol use is one of the major risk factor for road traffic accidents, for violence and for mental ill-health. Alcohol is one of the four major risk factors for the global NCDs epidemic that is claiming millions of lives every year.

I think it was important that Dr. Chan addressed the marketing practices of the corporate consumption complex in this context, through the example of the food industry. We know today that the industries that belong to the corporate consumption complex are interlinked and are learning from each other’s methods. The alcohol industry and tobacco industries are best buddies, for example and together they entertain ties to the food and beverage industry. These industries need to be curbed, their practices denounced and their influence on public health policy-making needs to be eliminated, for the world to stand a chance of building a better, healthier, happier future.

Dr. Chan took up a few concrete examples:

In the Americas, interpersonal violence is responsible for 1 in every 3 deaths among adolescent males in low- and middle-income countries. In wealthy countries, most adolescent deaths follow traffic injuries. […] For girls in South-East Asia, it is suicide. In sub-Saharan Africa, it is HIV/AIDS.”

I’ve already mentioned the links between alcohol and HIV/ Aids, the correlations between alcohol use and violence and between alcohol and road traffic fatalities.
We also have ample evidence for the links between suicide and alcohol. It’s an important issue to address and our Members in the South-East Asian region are working on gender issue, on the empowerment of women and girls. A huge obstacle is the aggressive and unethical marketing of alcohol, that often depicts women in a de-humanized, sexualised and objectified way.

Alcohol is a major obstacle to development, global health, democracy and the enjoyment of Human Rights because it cuts across so many issues, as you can see. One more issue was also addressed by DG Dr. Chan:

… international systems, such as those that govern trade, have a major, sometimes detrimental impact on health. 

Such non-health drivers of disease underscore the need for governments to establish coherent policies that avoid a situation where strategies that are good for one sector have costly adverse consequences for health.”

I was happy to hear that part of her speech because it speaks to one fundamental challenge of the 21st century: Health is a Human Right. Trade is not. Trade is a tool for human beings to have a better life and often trade is important. But it is obvious by now that trade all too often comes at the cost of human well-being and social development. The challenge is to reverse this and to get our priorities right.

In this context I’d like to finish this blog entry with one final quote form DG Dr. Chan:

The challenges ahead are more complex than they were at the start of this century. For many of them, delivering medical commodities will not be enough, as reducing several major health threats requires action from multiple non-health sectors. 

It also requires behavioural change. This includes changes in human behaviours, one of the hardest jobs in public health, but also changes in the behaviours of powerful economic operators. 

Public health, with its emphasis on population-wide prevention and fairness in access to health-promoting and life-saving interventions, increasingly operates in a world fraught with dangers around every corner. Many arise from human mismanagement of our crowded planet’s environment, systems for food production, and resources, including fragile antimicrobial medicines.”

For a better future, the corporate consumption complex, including tobacco, alcohol, food, pharmaceutical industries, needs to be addressed and any conflict of interest at play must be eliminated.
In IOGT International we are experts in how to work with an Alcohol in All Policies-approach (AiAP) – something that is crucial for solving the complex and interdependent challenges of the world of the 21st century. We know how to empower people to change their behaviour – by changing the environments and the culture around them. Simply put: it’s easier to change a large group of people, than to change the behaviour of one individual.

I’m glad that DG Dr. Chan emphasised the need for population-wide measures, especially mentioning prevention. Evidence-based and high-impact alcohol policy measures are powerful tools for prevention.

Looking at DG Dr. Chan’s speech in the way I just did, we can see how much alcohol is actually present. Like that, we get a feeling for the gains that can be made if alcohol would be addressed across the different sectors – such an approach would truly change history, save lives and improve the present and future for all. We call it: Life set free.

This post originally appeared on Maik Dünnbier’s IGOT International blog, live from the 136th Session of the Executive Board of the World Health Organization on 28 January 2015.

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Maik Dunnbier

Maik is a Policy and Communications Officer for IOGT International and writes a blog on his life with IOGT. He is also a student at Stockholm University, studying Political Science, Philosophy and History of Ideas.

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