Commitment to tackling alcohol misuse is missing from UN summit declaration, experts say

BMJ 2011; 343 doi: (Published 13 September 2011) Cite this as: BMJ 2011;343:d5836
  1. Deborah Cohen
  1. 1BMJ

After months of negotiations and lobbying by industry groups, non-governmental organisations, and public health experts, national governments have finally agreed the political declaration that will form the spine of the UN summit on non-communicable diseases later this month.

Representatives of the 193 United Nations member states will meet in New York on 19 and 20 September to commit to the declaration, which details how they should tackle rising rates of non-communicable diseases—notably cardiovascular and respiratory disease, cancer, and diabetes—in low and middle income countries.

Draft documents have been circulating for several months, and the BMJ reported last month how some governments were trying to water down commitments to measures controlling alcohol, tobacco, and unhealthy food (BMJ 2011;343:d5328, doi:10.1136/bmj.d5328).

The NCD (non-communicable disease) Alliance, a global network of organisations representing the four main non-communicable disease groups, is broadly supportive of the “strongly worded” document and says that “agreement was reached on several issues of contention during hard-fought negotiations.”

In earlier drafts of the political declaration, some Western countries—with policies already protecting their own citizens—were lobbying against imposing fiscal measures on tobacco. However, the final declaration says specifically that “price and tax measures are an effective and important means of reducing tobacco consumption.”

The declaration also makes specific reference to the elimination of “industrially produced trans fats in foods.” And it states that a comprehensive review of the declaration will be held in 2014, which the European Union had fought against.

However, the NCD Alliance concedes that the declaration “falls short in several key areas.” It has few specific targets. The deletion of the target limit on consumption of salt of 5 mg per person per day that was in earlier drafts remains. In its place is the promotion, “as appropriate, of cost-effective interventions to reduce salt, sugar and saturated fats.”

Of particular disappointment to public health advocates are the measures on alcohol control. Alcohol industry representatives have been out in force visiting the country missions in the UN headquarters in New York.

“The language on curbing the harmful use of alcohol is particularly weak, with no reference at all to essential measures on the price and availability of alcohol,” the NCD Alliance said.

It added, “Regrettably, member states have ignored calls from the NCD Alliance to agree measures to protect children from the marketing of alcohol but have committed to implement WHO recommendations to restrict the marketing to children of foods high in fats, sugar and salt; and to reverse the rising trends of obesity in children, youth and adults.”

Other than for tobacco, nowhere is it recognised that involving the industry in the making of health policy is an inherent conflict of interest. Public health advocates have pointed out that although the private sector can implement interventions, policy development should be protected against any potential conflicts of interest. They have called for an ethical code of conduct to guide governments, non-government organisations, and private sector partners.


Cite this as: BMJ 2011;343:d5836

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