According to an editorial published on bmj.com, there is an urgent need for international regulation of alcohol akin to the 2005 framework convention on tobacco control. Professor Laura Schmidt (Philip R Lee Institute for Health Policy Studies and Department of Anthropology, History and Social Medicine, School of Medicine, University of California, San Francisco, CA) and colleagues from the USA, Canada, Finland, and Australia write that worldwide, alcohol is a significant component of disease, injury, and death, but it is the only commonly-used psychoactive substance that has yet to face international control.

International regulatory bodies have controlled tobacco since 2005, narcotic drugs since 1961, and psychoactive substances since 1971. Currently, there also exist conventions dedicated to the control of psychoactive doping substances used by athletes to enhance performance. Alcohol trade is an entrenched component of our globalized economy, and it is difficult for nations to control marketing, availability, and tax policies in order to manage alcohol related harms. Although their methods have proven only marginally effective, policymakers continue the effort to control alcohol-related harms by using public information campaigns and education programs. Schmidt and colleagues say that policymakers are ignoring the strong evidence that demonstrates the success of market interventions such as taxation and restricting availability, marketing and distribution of alcohol.

"A framework convention for alcohol control would protect public health in three ways," write the authors. It would "place restraints on the international trade in alcohol...have persuasive effects across all levels of government and society...[and would] become a base of operation for a secretariat and oversight committees charged with making the mechanisms and provisions of the convention more effective." A secretariat could, for example, maintain a clearing house of information on evidence-based approaches that countries could share.

Protection of public health requires such international agreements, argue the authors. Further, the poorest populations are disproportionately affected by the harmful health and social effects of alcohol. As developing areas in the world, such as South Asia, become wealthier, alcohol consumption and its associated harms have been on the rise. The authors point out that, "These increases foreshadow future trends in consumption and harm for other developing countries - such as those in Africa, Central America, and South America - if and when increased affluence makes them attractive untapped markets for global alcohol producers and distributors."

"The WHO commission's call to apply the model of the framework convention on tobacco control to control of alcohol is well founded and timely," conclude Schmidt and colleagues.

International regulation of alcohol
Robin Room, Laura Schmidt, Jurgen Rehm, Pia Makela
BMJ (2008). 337:a2364
doi:10.1136/bmj.a2364
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Written by: Peter M Crosta