Management of Conflicts of Interest in WHO’s Consultative Processes on Global Alcohol Policy

Document Type : Original Article


SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand


The World Health Organization (WHO) has engaged in consultations with the alcohol industry in global alcohol policy development, including currently a draft action plan to strengthen implementation of the Global strategy to reduce the harmful use of alcohol. WHO’s Framework for Engagement with Non-State Actors (FENSA) is an organization-wide policy that aims to manage potential conflicts of interest in WHO’s interactions with private sector entities, non-governmental institutions, philanthropic foundations and academic institutions.
We analysed the alignment of WHO’s consultative processes with non-state actors on “the way forward” for alcohol policy and a global alcohol action plan with FENSA. We referred to publicly accessible WHO documents, including the Alcohol, Drugs and Addictive Behaviours Unit website, records of relevant meetings, and other documents relevant to FENSA. We documented submissions to two web-based consultations held in 2019 and 2020 by type of organization and links to the alcohol industry.
WHO’s processes to conduct due diligence, risk assessment and risk management as required by FENSA appeared to be inadequate. Limited information was published on non-state actors, primarily the alcohol industry, that participated in the consultations, including their potential conflicts of interest. No minutes were published for WHO’s virtual meeting with the alcohol industry, suggesting a lack of transparency. Organizations with known links to the tobacco industry participated in both web-based consultations, despite FENSA’s principle of non-engagement with tobacco industry actors.
WHO’s consultative processes have not been adequate to address conflicts of interest in relation to the alcohol industry, violating the principles of FENSA. Member states must ensure that WHO has the resources to implement and is held accountable for appropriate and consistent safeguards against industry interference in the development of global alcohol policy.


  1. Marten R, Amul GGH, Casswell S. Alcohol: global health's blind spot. Lancet Glob Health. 2020;8(3):e329-e330. doi:1016/s2214-109x(20)30008-5
  2. World Health Organization (WHO). Global Status Report on Alcohol and Health. Geneva: WHO; 2018.
  3. World Health Organization. Fifty-Eighth World Health Assembly. WHA58.26. Public-health problems caused by harmful use of alcohol. Accessed April 20, 2021.
  4. McBride R, Mosher JF. Public health implications of the international alcohol industry: issues raised by a World Health Organisation project. Br J Addict. 1985;80(2):141-147. doi:1111/j.1360-0443.1985.tb03264.x
  5. Room R. Alcohol and the World Health Organization: the ups and downs of two decades. Nordic Studies on Alcohol and Drugs. 2005;22(1 Suppl):146-162. doi:1177/145507250502201s03
  6. Casswell S, Thamarangsi T. Reducing harm from alcohol: call to action. Lancet. 2009;373(9682):2247-2257. doi:1016/s0140-6736(09)60745-5
  7. Room R. Negotiating the place of alcohol in public health: the arguments at the interface. Addiction. 2005;100(10):1396-1397. doi:1111/j.1360-0443.2005.01183.x
  8. World Health Organization. Executive Board, 115th Session. Seventh Meeting. 2005; Accessed April 20, 2021.
  9. World Health Organization. Fifty-Eighth World Health Assembly. WHA58.26. Public-health problems caused by harmful use of alcohol. Accessed April 20, 2021. Published 2005.
  10. Monteiro MG. The road to a World Health Organization global strategy for reducing the harmful use of alcohol. Alcohol Res Health. 2011;34(2):257-260.
  11. World Health Organization (WHO). Global Strategy to Reduce the Harmful Use of Alcohol. Geneva: WHO; 2010.
  12. Reducing harmful use of alcohol: beer, wine and spirits producers' commitments. Accessed April 20, 2021. Published 2012.
  13. Babor T, Brown K, Jernigan DH, et al. The international public health community responds to the global alcohol producers' attempts to implement the WHO Global Strategy on the Harmful Use of Alcohol. Global Alcohol Policy Alliance; 2013.
  14. Chan M. WHO's response to article on doctors and the alcohol industry. BMJ. 2013;346:f2647. doi:1136/bmj.f2647
  15. United Nations General Assembly. Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases. United Nations General Assembly; 2011.
  16. World Health Organization (WHO). Global Action Plan for the Prevention and Control of NCDs 2013-2020. Geneva: WHO; 2013.
  17. Collin J, Casswell S. Alcohol and the sustainable development goals. Lancet. 2016;387(10038):2582-2583. doi:1016/s0140-6736(16)30827-3
  18. World Health Organization. Framework of engagement with non-State actors. World Health Assembly 69.10. Agenda item 11.3.
  19. IOD PARC. Initial evaluation of the Framework of Engagement with Non-State Actors. Corporate evaluation commissioned by the WHO Evaluation Office. Geneva: World Health Organization; 2019.
  20. Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015-1035. doi:1016/s0140-6736(18)31310-2
  21. Hawkins B, McCambridge J. Can internal tobacco industry documents be useful for studying the UK alcohol industry? BMC Public Health. 2018;18(1):808. doi:1186/s12889-018-5722-0
  22. Buse K, Hawkes S. Sitting on the FENSA: WHO engagement with industry. Lancet. 2016;388(10043):446-447. doi:1016/s0140-6736(16)31141-2
  23. World Health Organization. Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues. Report by the Director-General.
  24. World Health Organization. Follow-up to the high-level meetings of the United Nations General Assembly on health-related issues. Prevention and control of noncommunicable diseases. Report by the Director-General. A72/19. Accessed April 20, 2021. Published 2019.
  25. Global Alcohol Policy Alliance. GAPA principles for advocacy 2020–2022 and key recommendations for the WHO decision to “accelerate action to reduce the harmful use of alcohol 2022-2030.” Accessed May 3, 2021. Published 2020.
  26. Torjesen I. Exclusive: partnering with alcohol industry on public health is not okay, WHO says. BMJ. 2019;365:l1666. doi:1136/bmj.l1666
  27. Manthey J, Shield KD, Rylett M, Hasan OSM, Probst C, Rehm J. Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study. Lancet. 2019;393(10190):2493-2502. doi:1016/s0140-6736(18)32744-2
  28. Jernigan DH, Trangenstein PJ. What's next for WHO's global strategy to reduce the harmful use of alcohol? Bull World Health Organ. 2020;98(3):222-223. doi:2471/blt.19.241737
  29. World Health Organization. 72nd World Health Assembly. Decision WHA72(11). Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases.
  30. World Health Organization. Web-based consultation on the implementation of the WHO global strategy to reduce the harmful use of alcohol since its endorsement, and the way forward.
  31. World Health Organization. Findings of the consultative process on implementation of the global strategy to reduce the harmful use of alcohol and the way forward. Report by the Director-General. Executive Board 146th session. Provisional agenda item 7.2.
  32. Leung JYY, Au Yeung SL, Lam TH, Casswell S. What lessons does the COVID-19 pandemic hold for global alcohol policy? BMJ Glob Health. 2021;6(7):e006875. doi:1136/bmjgh-2021-006875
  33. World Health Organization (WHO). Accelerating Action to Reduce the Harmful Use of Alcohol. Executive Board 146th Session. Agenda item 7.2. WHO; 2020.
  34. World Health Organization. Towards an action plan (2022-2030) to effectively implement the Global strategy to reduce the harmful use of alcohol. Accessed July 29, 2021.
  35. World Health Organization (WHO). Guide for Staff on Engagement with Non-State Actors. Geneva: WHO; 2018.
  36. World Health Organization (WHO). Handbook for Non-State Actors on Engagement with the World Health Organization. Geneva: WHO; 2018.
  37. World Health Organization. Management response to the Initial Evaluation of the Framework of Engagement with Non-State Actors (FENSA). Published 2020.
  38. World Health Organization. WHO 2021 dialogue (virtual) with representatives of economic operators in alcohol production and trade. Accessed July 29, 2021.
  39. Atlas Network. About Atlas Network. Accessed April 15, 2021.
  40. World Health Organization. WHO Register of non-State actors. Published 2021.
  41. World Health Organization. Developing a Global action plan to reduce the harmful use of alcohol - 2020 Web based consultation on a working document.
  42. World Health Organization. 2019 WHO Forum on alcohol, drugs and addictive behaviours. Accessed April 19, 2021.
  43. World Health Organization. Third WHO Forum on Alcohol, Drugs and Addictive Behaviours (FADAB). Accessed July 29, 2021. Published 2021.
  44. Corporate governance. Shareholder structure. Accessed July 29, 2021.
  45. Atlas Network. 2019 Annual Report. Accessed April 15, 2021.
  46. Smith J, Thompson S, Lee K. The atlas network: a "strategic ally" of the tobacco industry. Int J Health Plann Manage. 2017;32(4):433-448. doi:1002/hpm.2351
  47. Tobacco Tactics. Atlas Network. Accessed September 23, 2021.
  48. McCambridge J, Mialon M, Hawkins B. Alcohol industry involvement in policymaking: a systematic review. Addiction. 2018;113(9):1571-1584. doi:1111/add.14216
  49. World Health Organization. Online consultation on the Global alcohol action plan, first draft. Accessed July 29, 2021. Published 2021.
  50. Parker LA, Zaragoza GA, Hernández-Aguado I. Promoting population health with public-private partnerships: where's the evidence? BMC Public Health. 2019;19(1):1438. doi:1186/s12889-019-7765-2
  51. Lincoln P, Rundall P, Jeffery B, et al. Conflicts of interest and the UN high-level meeting on non-communicable diseases. Lancet. 2011;378(9804):e6. doi:1016/s0140-6736(11)61463-3
  52. Tangcharoensathien V, Chandrasiri O, Kunpeuk W, Markchang K, Pangkariya N. Addressing NCDs: challenges from industry market promotion and interferences. Int J Health Policy Manag. 2019;8(5):256-260. doi:15171/ijhpm.2019.02
  53. Casswell S. Vested interests in addiction research and policy. Why do we not see the corporate interests of the alcohol industry as clearly as we see those of the tobacco industry? Addiction. 2013;108(4):680-685. doi:1111/add.12011
  54. Hawkins B, Holden C, Eckhardt J, Lee K. Reassessing policy paradigms: a comparison of the global tobacco and alcohol industries. Glob Public Health. 2018;13(1):1-19. doi:1080/17441692.2016.1161815
  55. World Health Organization (WHO). Guidelines for Implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control on the Protection of Public Health Policies with Respect to Tobacco Control from Commercial and Other Vested Interests of the Tobacco Industry. Geneva: WHO; 2008.
  56. World Health Organization. Report of the Indepedent Expert Oversight Advisory Committee. Programme, Budget and Administration Committee of the Executive Board. EBPBAC31/2.
  57. Viet Cuong P, Casswell S, Parker K, et al. Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control Study. Drug Alcohol Rev. 2018;37 Suppl 2:S45-S52. doi:1111/dar.12665
  58. Babor TF, Robaina K, Brown K, et al. Is the alcohol industry doing well by 'doing good'? findings from a content analysis of the alcohol industry's actions to reduce harmful drinking. BMJ Open. 2018;8(10):e024325. doi:1136/bmjopen-2018-024325
  59. Mialon M, McCambridge J. Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review. Eur J Public Health. 2018;28(4):664-673. doi:1093/eurpub/cky065
Volume 11, Issue 10
October 2022
Pages 2219-2227
  • Receive Date: 06 May 2021
  • Revise Date: 24 September 2021
  • Accept Date: 02 October 2021
  • First Publish Date: 03 October 2021