In a previous post, I began to look at whether alcohol control should be the subject of an international treaty similar to the Framework Convention on Tobacco Control (FCTC) – WHO’s only legally binding treaty made under Article 19 of its constitution. This post will examine the desirability of such a treaty, with a later post examining its feasibility using lessons learned from the creation and adoption of the FCTC.
A benefit of a legally binding treaty on alcohol control would be a greater acceptance of the seriousness of alcohol consumption and its associated harms. Although alcohol use is a significant risk factor contributing to the rising problem of NCDs and has health consequences affecting high- middle- and low-income countries, alcohol has not gained the same notoriety as tobacco consumption. In general, amidst other competing health interests, alcohol control may not inspire the same kind of social and political movements that was associated with, for example, HIV/AIDS or infectious diseases such as the ongoing COVID-19 outbreak. A treaty ratified by WHO Member States may be an important tool to galvanize action around this issue and may, at least, put alcohol on a similar level to tobacco use.
However, law is only one tool to govern global health, and international law may not always be the appropriate tool to reach intended health goals. First, the creation of a treaty is administratively challenging and associated with substantial time and financial commitments. The negotiations of a treaty can be lengthy and financially burdensome. The FCTC took around ten years to negotiate and draft32 and, while the FCTC could provide a useful framework, there is no indication that an alcohol control treaty would be any shorter. Additionally, once the treaty is concluded, the associated costs continue: Burci and Vignes note that the WHO does not use its treaty making powers often because of the “cost of maintaining centralized facilities for the administration of legally binding instruments”. These future costs for implementing and enforcing a treaty must be considered before embarking on the lengthy negotiation process.
Some argue that alcohol control should not be the subject of a convention because (1) it lacks a sufficient transnational dimension, (2) the expected benefits do not justify the coercive nature of a treaty, (3) there will likely not be net benefits of such a treaty, and (4) it may not be the best mechanism for addressing the challenges of alcohol consumption. The argument that alcohol consumption lacks transnational dimensions and should instead be addressed domestically could be too simplistic. First, there is a significant transnational element to alcohol control, particularly when considered globalization and how it facilitates the supply and marketing of unhealth consumer goods around the world. The manufacture, promotion, export/import and sales of alcohol has a significant transboundary element that should not be ignored simply because it does not fit traditional notions of what constitutes an international health threat. Many NCD risk factors are communicated from wealthy nations to developing nations, facilitated by global trade agreements, through the marketing and export of cigarettes, alcohol, and unhealthy processed foods. The view that alcohol consumption lacks a sufficient transnational dimension understates the power that multinational companies have over consumption of alcohol around the world.
Secondly, the idea that a problem must be purely transnational to be considered a proper subject of an international treaty disregards the influence that international laws have on domestic law. As Sridhar argues, a Framework Convention on Alcohol Control could (1) ensure that countries commit to creating national legislation, (2) require countries to report to WHO on their progress, (3) create a shared responsibility to support efforts by providing financial and technical assistance, (4) provide stronger domestic negotiating position for prioritizing alcohol regulation above economic concerns within country borders, and (5) serve as a useful tool for NGOs to pressure governments or bring the issue to court. By having an international framework, domestic legislation and regulation will be more likely implemented to address identified aspects of alcohol control.
Whether or not we think that alcohol could be subject to a convention, the question remains, however, whether this particular issue should be considered a priority for the international health community. On the one hand, the policy landscapes at the national and international levels (outlined in my previous post) show that there is some momentum that should be capitalized on to address alcohol control. On the other hand, particularly during the ongoing COVID-19 pandemic, it is questionable whether resources should be used to create an international treaty for alcohol control.