global health diplomacy - ingrado

An example of Health Diplomacy

Benedetto Saraceno Calouste Gulbenkian Professor of Global Health

University Nova of Lisbon, Portugal

B.Saraceno, 2014

The HD PYRAMID

HD

economy

agreement

health

B.Saraceno, 2014

The Global Strategy to reduce the Harmful Use of Alcohol:

Health, Economic and Political

arguments at the crossroad

Alcohol Model

Volume Patterns Quality Intoxication

Dependence Toxicity

Alcohol-related harms

Intoxication (short term)

Risk taking behaviours, violence, injuries, accidents, acute poisoning, coma


Dependence (medium term)

Tolerance, Withdrawal, Craving for further drinking


Toxicity (long term)

Foetal Alcohol Syndrome, Brain development Liver cirrhosis, Liver Cancer, Heart attacks, Breast Cancer, Immunodeficiency, Depression,

Suicide

Dosis

• Considerable individual variations due to genetic variation in liver enzymes, rate of metabolism, pharmaco-dynamics

• Even moderate intake produces blood alcohol concentrations

• Heavy Episodic Drinking: 60 grams of alcohol

• Positive effects on heart are confined to males over 45 and females post-menopause

Adult per capita alcohol consumption

• APC: > people 15 years-old per capita amount of alcohol consumed in litres

EUR 12.18 lits 31.2 % past year abstainers

AMR 8.67 lits 41.7

WPR 6.23 lits 43.7

AFR 6.15 lits 70.8

SEAR 2.20 lits 89.3

EMR 0.65 lits 96.5

Most Consumed Beverages %

• Spirits (distilled) 45.7

• Beer (malt) 36.3

• Wine (grapes) 8.6

• Other (all fermented) 10.5

Definitions

• Member States: 194

• WHA: World Assembly of WHO, once a year during May, all MoH attending

• EB: Executive Board of WHO, twice a year during January and May, 34 people designated by Member States

B.Saraceno, 2014

Alcohol-attributable deaths (2004) • Total= 2.249.852 = 3.8% all deaths (6.2% of

men deaths) 1. Cirrhosis 2. Road accidents 3. Unintentional Injuries 4. Ca. Liver 5. Violence 6. Ca. Oesophagus 7. Hypertension 8. CV diseases 9. Suicide 17. Ca. Breast 18. Ca. Colon

1. WHA58 (May 2005): Resolution "Public health problems caused by harmful use of alcohol” requested the DG: to report to the 60th on evidence based strategies and intervention to reduce alcohol related harm…and to draw up recommendations for effective policies and interventions to reduce alcohol related harm”

2. WHO Expert Committee on Alcohol convened in 2006 (attempts to influence the 11 members?)

Process leading to the Resolution on Alcohol at the World Health Assembly 2008

a 10-steps global drama (with happy end!!)

WHO Expert Committee on Problems Related to Alcohol Consumption

- Provide technical recommendations on effective policies and interventions to reduce alcohol-related harm

• Recommendations of the committee were electronically published before the Assembly in May 2007 and considered by the Secretariat in the process of developing its report to WHA60 (2007).

• The report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the World Health Organization

Process leading to the Resolution on Alcohol at the World Health Assembly 2008

3. WHA60 (May 2007):

Report of the Secretariat on strategies to reduce

harmful use of alcohol and discussions on a

draft resolution

"Global action on the harmful use of alcohol"

sponsored by 41 Member States, followed by

several revisions were discussed (day and

night)

Diplomacy and Public Health: DISASTER

(the Cuba-Sweden controversy)

"The Sixtieth World Health Assembly decided to request that an item entitled "Strategies to reduce harmful use of alcohol" and related documents discussed at the Health Assembly should be included in the agenda of the 122nd session of the Executive Board to be held in January 2008, and asked the Director-General, in the interim, to continue her work on that question".

Decision WHA60

Global Diplomacy Starts

• 4. Informal consultation (December 2007) with Member States on strategies on reduce harmful use of alcohol – 9 policy areas for action identified

• 5. January 2008 – EB considered a report from the Secretariat and the draft resolution calling for a global strategy to reduce the harmful use of alcohol proposed by Rwanda and Kenya and recommended it for adoption at the WHA61 (May 2008)

6. Sixty-First (61) World Health Assembly (2008) resolution "Strategies to reduce the harmful use of

alcohol”

After noting that they had not reached a consensus last year, delegates adopted a resolution calling upon WHO to produce a draft global strategy to reduce the harmful use of alcohol.

WHA61 Resolution "Strategies to reduce the harmful use of alcohol"

REQUESTS the Director-General: (Byzantine Language) (1) to prepare a draft global strategy to reduce harmful use of

alcohol that is based on all available evidence and existing best practices and that addresses relevant policy options, taking into account different national, religious and cultural contexts (??), including national public health problems, needs and priorities, and differences in Member States' resources, capacities and capabilities;

(2) To ensure that the draft global strategy will include a set of proposed measures recommended for States to implement at the national level, taking into account the national circumstances (??) of each country;

WHA61 Resolution "Strategies to reduce the harmful use of alcohol"

REQUESTS the Director-General: (3) To collaborate and consult with Member States, as well as

consult with intergovernmental organizations, health professionals, nongovernmental organizations and economic operators (ONE FOR THEM!!) on ways (not on everything) (ONE FOR US!!) they could contribute to reducing harmful use of alcohol;

(3) To submit to the Sixty-third World Health Assembly,

through the Executive Board, a draft global strategy to reduce harmful use of alcohol.

Process for implementing the WHA 61.4 resolution and preparing a draft global strategy

7. Stage I. Broad consultation process • Web-based consultation (WHO public hearings) with

Member States and other stakeholders (3 October 2008 - 15 November 2008)

• Round table meeting with economic operators on ways

they could contribute to reducing harmful use of alcohol (6 November 2008)

• Round table meeting with NGOs and health professionals on ways they could contribute to reducing harmful use of alcohol (24-25 November 2008)

• Consultation with Intergovernmental Organizations on

ways they could contribute to reducing harmful use of alcohol (8 September 2009)


8. Stage II. Draft strategy development • Regional technical consultations with Member

Statesrepresented by their Directors General of MoH (February – May 2009) in 6 WHO regions – Bangkok, Thailand (South-East Asia), February 2009 – Brazzaville, Congo (Africa), March 2009 – Auckland, New Zealand (Western Pacific), March

2009 – Cairo, Egypt (Eastern Mediterranean), April 2009 – Copenhagen, Denmark (Europe), April 2009 – Sao Paulo, Brazil (The Americas), May 2009


• The working document released by the WHO Secretariat for further consultation and collaboration with Member States (WHO, 2009, released in 6 languages in August 2009)

• Feedback on the working document from MS (September 2009)

• 9. Informal consultation with MS (8 October 2009) : Cuba-Sweden chairing together!!!!!!

The defeat of the Industry

9 Controversial issues 1. Harmful use of alcohol versus "responsible" use (NO) 2. Some Member States would like to see a greater

emphasis health promotion, education, family interventions even If no evidence of effectiveness was found (YES)

3. Competing interests: reference to international legal

obligations of Member States, e.g. WTO agreements (YES) 4. Add a principle on stakeholders involvement (Industry)

(NO) 5. Acknowledge the role of self-regulation (Industry) (NO)

10 Controversial issues

6. Addressing availability of alcohol (YES) 7. Suggestion to use "raising barriers (not taxes) against

alcoholic beverages that have a special appeal to adolescents (NO)

8. Reducing the alcoholic strength of different alcoholic

beverages may be in contradiction with the product regulations (YES)

9. Addressing Alcohol advertising and relevant promotional

activities (YES)

Alcohol advertising: happiness

Alcohol advertising: sport

Alcohol advertising: your hero

Alcohol advertising: sex appeal

Alcohol advertising: success

Alcohol advertising: explicit

Alcohol advertising: exclusive world

Alcohol advertising: friendly and cozy atmospheres

10. RESOLUTION APPROVED BY UNANIMOUS VOTE OF 194 MS

the world said NO to this “DREAM”

BIG PLAYERS

• Companies producing, importing, exporting, marketing and selling alcoholic beverages like beer, craft beer, draft beer, ciders, wine, rums, whiskey, liqueurs, vodka, tequila, champagnes, brandy, amaretto, ready-to-drink cocktails, malt and other spirits, mainly constitute the BIG ALCOHOL INDUSTRY

• Diageo, Bacardi, Constellation Brands and Anheuser-Busch InBev, are the key players

B.Saraceno, 2014

Distribution

• Alcoholic Beverage Market is Segmented by Product Type (Beer, Wines, Spirits and Others) and Distribution Channel (Supermarket/Hypermarket, Convenience Stores, Food Service and Others) and Geography.

B.Saraceno, 2014

The Market

• Global Alcoholic Beverage Market is forecasted to grow by 3.1% during the forecast period (2019 - 2024).

• The market is driven by the increase in global young-adult demographic, coupled with high disposable income and consumer demand for premium/super premium products.

• On a global level, Beer drives the market of alcoholic beverages.

• Asia-Pacific is expected to dominate the global market during the forecast period.

• Growth in online retailing has been observed. For instance, Drizly, an alcohol E-commerce platform has experienced growth of online alcohol delivery revenue.

B.Saraceno, 2014

Alcoholic Beverage Market Size, 2018

B.Saraceno, 2014

global health diplomacy - ingrado

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