In the coming year, the World Health Organization will develop an action plan to implement the global strategy to reduce the harmful use of alcohol, a document produced in 2010. In more ways than one, this strategy will be a guideline for policy changes and governmental orientations for how to have a more healthy attitude towards alcohol. This article reviews the document to understand the message the organisation wants to convey to the international community and why.
In a matter of health and wellbeing, the consequences of the use and overuse of alcohol seems logical. The debate regarding the physical and mental consequences is one which ought to be discussed among the professionals within the field. However, on another level, the impact on society and the community by the strategy itself is easily forgotten, which is why this text will try to shed light on the issue.
There are several ways of analyzing a strategic document. However, since this is neither a dissertation nor a consultational response, the analysis will be brief and a basis for discussion. For that, the article will focus on a few aspects which have been seen as important issues lately, namely equality and non discrimination.
The WHO global alcohol strategy
In summary, the strategy aims to reduce the harmful use of alcohol and its consequences, in various situations, by certain people and all over the world. It also puts emphasis on restricting alcohol use for a few groups of people who are supposedly more vulnerable than others, without further explaining the logic and reasoning of why and how this is the conclusion and focus.
There are a few eye-catching aspects in the strategy, such as delimiting the access to alcohol and regulating the marketing of alcoholic beverages where the document addresses the marketing and pricing (p.94-97). These both take a step away from the idea of the free market and the will of the individual, which has been a common thread in society as it has developed in the last decades.
However, there are aspects which might be less of a concern of the market and more towards the individual, namely the consumers. The WHO is suggesting how to change certain aspects of national policies and regulations throughout the document.
One could argue that these small changes are nothing but related to improving the health of the population. On the other hand, while suggesting adjustments to the way regulations and norms function on a state-level, it also implies a will to change how the countries are run. A wish for an ideological change towards how the organization wants the world to be. In the small question of improving the individual’s health and diminishing the risk for negative side effects, one might only see the benefits. However, when suggestions are made to limit the access to alcohol, for what marketing should be allowed and regarding the pricing policy, the unanimity might not be as strong.
The ideological implications are far from the only noteworthy aspects of this document. The document targets several groups, based on sex, wealth and geography, characteristics with which one is born and for a large part does not have much possibility or willingness to change.
The report states, on page 87, that ”Population-wide rates of drinking of alcoholic beverages are markedly lower in poorer societies than in wealthier ones. However, for a given amount of consumption, poorer populations may experience disproportionately higher levels of alcohol-attributable harm. There is a great need to develop and implement effective policies and programmes that reduce such social disparities both inside a country and between countries.” In this, the WHO does not explain why and how this is the logical conclusion, nor why it is important that this issue lies within the people with a worse financial situation.
They continue stating “Policies are also needed in order to generate and disseminate new knowledge about the complex relationship between harmful consumption of alcohol and social and health inequity, particularly among indigenous populations, minority or marginalized groups and in developing countries.” Neither here is it explained or referred to any information as to why these people should be the focus of the situation.
The act of selecting a few groups as more vulnerable without any reason can lead to creating or increasing a potentially existing stigma, or in other ways harm the group that was pointed out to be special, in some way.
More than that, the report also states that “Special attention needs to be given to reducing harm to people other than the drinker and to populations that are at particular risk from harmful use of alcohol, such as children, adolescents, women of child-bearing age, pregnant and breastfeeding women, indigenous peoples and other minority groups or groups with low socioeconomic status”. Since this sentence points out several groups and the report does not follow up with more explanations, a few more questions arise, more than the initial queries of this article relating to equality and non-discrimination.
The harmful effects of alcohol on children, adolescents, pregnant and breastfeeding women are well known, and not something that needs further discussion here. However, when it comes to a statement such as “women of child-bearing age”, the question of what age that is remains unanswered.
As it states today, and by that what the strategy aims to do, the WHO proposes that any woman, almost of any age and stage of life, should abstain or at least diminish their consumption of alcohol. Making such a large claim of a huge part of the world wide population, without any reservations or differentiations between groups, is highly problematic. It suggests that there is one way that every woman in a certain age is, and that she needs to change, regardless of her situation. More than that, some of these groups blend into another, a woman can be child-bearing as an adolescent, but questions such as when it ends or why is this an issue remains unanswered.
As it is, and by that as the WHO strategy is, every woman in childbearing age should want to reproduce and thus should diminish her intake. That is quite a bold statement to make. Does the organization thereby claim that every woman can, want and should become pregnant? If she does not, what would that mean? Is this aspect only connected to child bearing? If so, how should women relate to alcohol if they are unable or unwilling to become pregnant? As it stands, this last group is ignored by the document and this is a very important distinction by itself. In relation to alcohol and their health, these women are irrelevant.
By contrast, the World Health Organization writes on their website “Reproductive health […] implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do it. […] Implicit in this … [is] the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant”. The difference is clear, with the freedom to decide if reproduction is relevant on the one hand while on the other the need to “give special attention” to women in child-bearing age. The same goes for focusing on the couple or shifts towards the woman. Since it doesn’t elaborate why, more questions appear relating to the role of the woman in the eyes of the organization. It seems that pregnancy is a natural thing that every woman in her lifetime wants to or even can do, and is something which is expected of women.
All in all, if the sentiment of this part of the alcohol strategy is to answer yes to these questions, there is one important part missing in the equation – the man. As is stated by several researchers, but clearly summarized by Mary Ann and Nicholas Emanuele, “Alcohol can have profound deleterious effects at all levels of the male reproductive system”. The use of alcohol can affect the production and quality of the sperm, which in itself has natural consequences on the reproduction. This is not mentioned in any way in the strategy nor is any other situation related to men, if not “domestic violence against women and children” is to be understood as a male issue.
If this report will be the foundation of the action plan which aims to spread to every country, it is of vital importance that it lies on factual grounds and does not arbitrarily point out groups without explaining why. In the same manner, the aforementioned aspects, among others, can be connected to other organs within the WHO and UN but this connection is absent in the document.
Before this report becomes the guideline for global change, it ought to be discussed and the questions answered. If not, these changes towards arbitrarily selecting people without evidence and blatant accusations without evidence may lead toward a situation which goes against what the United Nations stand for. As the United nations charter states, “The people of the United Nations determined [..] to reaffirm faith in fundamental human rights, in the dignity and worth of the human person, in the equal rights of men and women and of nations large and small, and to establish conditions under which justice and respect for the obligations arising from treaties and other sources of international law can be maintained, and to promote social progress and better standards of life in larger freedom”.
It is interesting that this document focuses on these certain topics and sees them as the critical points relating to alcohol while neither backing it up with facts nor discussing other potential aspects. The return to a post-covid discussion is vital, but so are the topics and the data upon which it is based. In order to move forward with the work on physical and mental health, one needs to ask the right questions and be able to answer them. If this document will be the basis for the future work on alcohol policies in Sweden, further questions must be asked and several issues addressed.
Robin Moraes Holst
Robin Moraes Holst got a Master of Science with a major in Global Studies from the University of Gothenburg