The Commonwealth government looks set to lose its top position in preventative health measures. Despite its world-first efforts on tobacco control, when the government next steps onto the world stage, it will be not be as a leader – its position on alcohol is out of step with the World Health Organization and contrary to evidence.
It’s decision time in the global effort to prevent and control non-communicable diseases (NCDs), the leading cause of death in this country. The United Nations General Assembly reached an historic decision in September last year, when, for only the second time in its 67-year history, it met to discuss a health issue.
Member countries agreed on a 25% reduction in chronic diseases by 2025. And on 5 November, they will attend a World Health Organization (WHO) meeting to reach agreement on a global monitoring framework for these diseases.
Non-communicable or chronic diseases include cancer, diabetes, cardiovascular disease and chronic respiratory disease. They account for 60 million deaths a year worldwide, and share four main risk factors – unhealthy diet, physical inactivity, tobacco smoking and alcohol consumption.
The WHO was given the task of designing and adopting a comprehensive global monitoring framework, including indicators and a set of voluntary global targets. It has published three discussion papers on the subject this year.
The latest discussion paper proposes to identify nine outcome and exposure targets, including alcohol, fat intake, obesity and tobacco, and eleven indicators of outcomes and exposure to risk factors, including adult per capita alcohol consumption.
The WHO meeting is still a couple of weeks away but the Australian government has already indicated its position on the issue of targets and indicators around alcohol.
Its response to the WHO papers (some dating back to February, but only now made available publicly) has been to oppose the adoption of per capita consumption as an indicator and not support adopting global alcohol consumption reduction targets.
Excess alcohol consumption is one of the leading risk factors for death and disease globally and there’s a strong link between alcohol and chronic diseases. There’s also strong evidence to suggest a reduction in alcohol consumption at the population level will reduce the rates of health and social harms caused by alcohol misuse.
The government’s position is out of step with the Global Strategy to Reduce the Harmful Use of Alcohol, which emphasises that the harmful use of alcohol and related public health problems are influenced by the general level of alcohol consumption in a population, drinking patterns and local contexts.
It’s also at odds with science. Its critique of an earlier WHO discussion paper claimed that per capita consumption “does not reflect risk of NCDs”, and added that adult per capita alcohol consumption is “not a target measure that focuses on the primary area of concern with alcohol, namely, long term harm”.
The latest WHO discussion paper directly responds to this, noting “the risk of most alcohol-attributable health conditions is correlated with the overall levels of alcohol consumption…. The available data indicate that the overall levels of alcohol consumption, measured as per capita alcohol consumption, correlate with major alcohol-related health outcomes”.
It would be difficult to find an alcohol researcher in Australia who would disagree with the WHO position and agree with the government.
The failure to support what the evidence shows and what experts agree on puts Australia in a ridiculous position. And it undermines the UN initiative and risks jeopardising Australia’s international reputation.
There’s less than two weeks between now and November 5 for the government to move to a defensible and forward-looking position – a position that supports a reduction in alcohol consumption in the suggested targets and the use of adult per capita alcohol consumption as a relevant indicator for progress.
Robin Room is a technical advisor to the World Health Organization.