NOVEMBER 1983 - VOLUME 4 - NUMBER 11
WHO Bottles Up Alcohol Study
by Kathleen Selvaggio
In a highly unusual and controversial move, the World Health Organization secretly cancelled plans to publish a study of the global alcohol industry and ended the research project that initiated the study. The action, which is generally believed to be politically motivated, calls into question the independence of the United Nations-affiliated agency.
The news came to light recently after months of inaction by top World Health Organization (WHO) officials following their February order to halt publication of the report, which by that time was well in progress. While it is unclear exactly what prompted the agency to reverse itself, the action has puzzled and angered many involved in the research project as well as other WHO staff members. One source close to the study charges that the behavior of the WHO amounts to "what can only be called suppression" and questions whether corporate or government pressure was applied to prevent the study's publication.
The growing uproar over the study has already caused some embarrassment to the health agency, which is widely acknowledged to be the world's strongest defender of public health. Its consistent focus on primary health care, the poor and its Third-World oriented philosophy has drawn praise from all corners of the globe. And WHO itself takes pains to preserve its progressive reputation. According to present and former associates of the organization, the current WHO directorship sees itself as a very strong moral force within the international medical community and resists any suggestion that it might be open to outside pressure.
The report, "Alcohol Beverages: Dimensions of Corporate Power," by John Cavanagh and Frederick Clairmonte, was the first major investigation by either international bodies or individual governments linking alcohol abuse with the international production, marketing, and distribution of alcohol by a handful of global companies. (Excerpts from the final report appear on p.14) The study documents the changing structure of global alcohol companies, their advertising strategies, and their distribution around the world. Some of its key findings include:
The study grew out of a 1979 World Health Assembly resolution authorizing the existing alcohol program to consider, among other things, the "trade practices and agreements relating to alcohol." The resolution paved the way for 11 new research projects, one of which focused on the worldwide availability of alcohol. Cavanagh and Clairmonte completed the study under the first phase of this project.
By all accounts, the decision not to expand the alcohol program into the arena of economics and business signaled a significant departure from WHO's earlier approach to liquor-related public health problems, which had focused primarily on medical and social matters. For that reason, too, the program has stirred considerable controversy. Many industries, and some countries, most notably the United States, oppose WHO's involvement in trade matters, arguing that any such involvement is "interfering with the free market." They have argued this with considerably more force since 1981, the year WHO adapted a code recommending restrictions on the marketing of infant formula.
While the infant formula episode convinced some WHO officials of the need to concentrate more broadly on the impact of trade and marketing on public health, it apparently convinced others that such confrontations with industry and government were potentially explosive - and should be avoided. "There were those who felt that the infant formula code was a near disaster," one former WHO staff member says. He notes further how the character of WHO's pharmaceuticals division makes it extremely difficult for the agency to take an independent, critical view of the $100 billion global drug industry: several employees in the division were formerly employed by pharmaceutical companies and WHO regularly accepts money and advice from the industry with little thought to conflict of interest.
For similar reasons, there was resistance in certain quarters of the organization to examining the global liquor industry - though there had never been close ties between WHO and liquor companies.
"This sort of study is a very touchy thing for WHO to get involved in. It was skittish from the beginning," says James Mosher, secretary of the U.S.-based Council on Alcohol Policy and one of 20 outside experts who reviewed the alcohol study for WHO. Mosher believes that the study, which he calls "probably the most important study in the field," is critical to the development of national regulations on alcohol. "My past work on control policies in seven countries convinced me that this work is absolutely essential. Right now there is no thought given to the health consequences of alcohol companies' expansion into the Third World," he told Multinational Monitor.
Who dunnit - and how
Despite internal disagreements over the wisdom of pursuing such research, work on the alcohol trade project progressed for more than a year with no sign of trouble.
In June 1981, the administration of the newly expanded alcohol program, under the direction of former Swedish government official Jan Ording, decided informally that the research group on alcohol availability and trade should conduct a study of global alcohol producers and the alcohol market. Late that summer, WHO recruited Frederick Clairmonte as a consultant and John Cavanagh as a temporary staff member to carry out the study.
Expert advisors twice reviewed drafts of the study and other commissioned papers. By October 1982, they considered the study complete and recommended that it be published through a commercial publishing house. "The study [is] a pioneering work," the panel's summary report reads.
"All of us were excited about the study and felt it was critical to get it out," says James Mosher, one of the expert advisors. "We were unanimous in our decision to publish it commercially."
At the same time, the review panel prepared to launch a second phase of the project and outlined an agenda that would translate some of the finished research into action-encouraging public health awareness, promoting stricter regulation of advertising, and reviewing trade agreements involving alcohol.
During the following month, WHO's resident publications office set in motion all the steps necessary for commercial publication, first contracting a leading British psychiatrist to write a preface to the study, and then sending the manuscript to the Oxford University Press. In late January, Oxford notified WHO that, if small changes were made, it would publish the report.
But, without warning, these procedures were strangely and abruptly halted. Within two weeks of Oxford's letter, WHO requested that the study be returned on the claim that it needed substantial revision. Oxford was told that it might be contacted again, but no specific dates were mentioned. Inside sources who declined to be identified have disclosed that a handful of high level WHO officials, including Director General Halfdan Mahler, the agency's top ranking officer, had met privately in early February and decided both to recall the study and to suspend further work on the alcohol trade project.
"After the acceptance letter was received from Oxford, the report was circulated at a very high level at WHO and it's clear that some read it for the first time. It's also clear they were worried that the report could present problems for WHO with countries like the U.S.," one informed source reports.
It is not known, however, whether the directors had acted in response to direct pressure from governments, corporations, or other interest groups, out of fear of such pressure, or for other reasons. Persons close to the report speculate that some WHO officials were concerned that the report might have damaged Director General Mahler's prospects for reelection in May 1983. (Mahler easily won reelection.)
Neither the study's authors, John Cavanagh and Frederick Clairmonte, nor the head of the entire alcohol program, Jan Ording, were informed about the sudden change in plans.
Then, on February 15, just days after the study had been recalled, the Paris daily Le Monde published a front-page story on the global study that highlighted many of the report's findings and also suggested that publication had been stalled due to external pressure on the agency. The charge startled people inside and outside the agency and set off a wave of inquiries by the media. Some WHO officials claim that their decision to withdraw publication of the study was made in response to this leak, but its timing after WHO's decision was actually made contradicts this assertion.
By the time the health agency's governing body met in May, it became clear that WHO did not intend to continue the project. At that time, representatives from a diverse group of countries met resistance from the WHO leadership when they proposed a resolution committing WHO to continue the expanded alcohol program in some form. They succeeded in getting the resolution passed, but opponents managed to defeat a clause that specifically allowed for the continuation of the trade project.
This development did much to arouse the suspicions of the trade project participants, and the events that unfolded soon afterward wiped out any lingering doubts about the future of the project. In June, Jan Ording, director of the entire alcohol program and a strong supporter of the trade project, left the organization after his two-year contract was not renewed. Short-term contract renewals at WHO are usually a routine matter, but, some say, Ording was told rather undiplomatically that his services as program director were no longer welcome at WHO. Ording says he is not entirely sure why he was not invited to stay, but, he says, "my involvement with the trade project did not do well for me."
Meanwhile, the WHO information office, responding to an inquiry by the Washington Post (see box), stated flatly that "it was agreed that this document [the global study] would not be published examination.. .has shown that it is only partially relevant to the promotion of basic health and control of alcohol abuse."
The WHO experiment with "market interference," it seems, was over.
The reaction from project members has been anger mixed with disillusionment. "I am very upset that they canned the project, and I'm even more upset that they canned the next two phases," says James Mosher. "This project was going somewhere. It had momentum." When asked whether he believed corporations or governments had pressured WHO, Mosher replies that he "can't believe there wasn't any pressure, or at least the fear of pressure."
Jan Ording agrees. "WHO's sensitivity Lo pressure is big," he says. "Past experience on pharmaceuticals, pesticides, tobacco, and a whole range of other issues that involve industry has shown that."
WHO has never disputed the findings of the global report. When pressed, public spokespersons for WHO maintain that the decision not to publish the global study is based on top officials' judgments that the material is neither useful nor relevant to promoting public health on alcohol-related problems. The study contains good statistical information which may be useful in future WHO documents, they say, adding that WHO is under no obligation to publish every study it commissions. Nor is this the first time WHO has chosen to override the unanimous recommendations of an expert panel, they say.
While agreeing with some of these points, the study's co-author John Cavanagh argues that this case is in fact very different. "Why did WHO commission and pay for a preface to the report if it did not plan to publish it?" he asks. "And why did they then go ahead and send it to a commercial pubisher? It is highly irregular for WHO to make an about-face at that stage."
"The real question is why has this happened to this study. The report is a critique of the corporate activity of a $170 billion-a-year industry. It is a detailed investigation of that industry's marketing of a product that, it goes without saying, has an enormous impact on health."
"WHO was threatened because the study flies in the face of the economic interests of its major member states. Most other studies would not do this. These major states also happen to be WHO's largest contributors-and WHO is always careful to stay on the good side of its major contributors."
The report's present status is undetermined. One WHO director claims to have distributed copies last spring to each of the agency's six regional offices, where it is supposed to be available to the public. But someone in Geneva appears to be guarding the material closely. At the time of this writing, the WHO regional office for the Americas in Washington, D.C. had no record of receiving a copy and, after repeated inquiries by journalists, congressional staff, and university professors, the office was told by WHO headquarters that the study is available for review only in Geneva. Cavanagh and Clairmonte requested permission from WHO in September to publish the document under their own names and they have yet to receive a response.
As for the rest of the expanded alcohol program, Jan Ording says that he does not know how many of the original I l projects will survive. Several have been allowed to lapse and may never resume research, while others are floundering for lack of funding. At the moment, the overall alcohol program has no full time director and no permanent staff.
But some WHO member countries refuse to let the ailing program die quietly. Chief among the program's supporters are WHO representatives from Finland, Denmark, Sweden, Norway, and Iceland. At a WHO regional meeting of European countries held in Madrid in early October this year, the Director Generals of Health from these five Nordic countries called attention to the alcohol program during an open debate session. According to Dr. O.T. Christiansen, who attended the meeting as a member of the Norwegian delegation, Finland's health director confronted WHO director Mahler about the current status of the program and about the prospects for continued funding. The Finnish delegate stressed the importance of continuing the program, calling it one of the strongest initiatives undertaken by WHO in recent years. Mahler's cool response was to promise to step up efforts to provide funding and to say that the overall program would be reviewed in the near future.
Christiansen also said that the Nordic Health Ministers are discussing whether to challenge the suppression of the global study through direct diplomatic channels. The closed, undemocratic manner of deciding to withdraw publication disturbs them greatly, he said.
Thus the battle is not over for the alcohol program and, indeed, may just be heating up. Many people question whether the world's largest public health institution can continue to avoid the health consequences of corporate control over hazardous products like alcohol, tobacco, and pesticides and still retain credibility. "Corporate control over the production and marketing of these products has had an adverse affect on the lives of tens of millions the world over," Cavanagh warns. "It is at the core of both the problem and any real solution." To prove itself a truly moral force, he and others believe, WHO must be prepared to challenge large, powerful interests like the alcohol industry.