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This article first appeared on Movendi International.

The European Parliament is on the brink of voting on a report addressing Non-Communicable Diseases and Mental Health. However, the compromised text in the report unveils a persistent lack of resolve within the Parliament in addressing the critical issue of alcohol consumption. In this opinion article, Alessandro Gallina, Policy Manager at the European Public Health Alliance (EPHA), provides insights into the current stance of the European Parliament concerning cancer prevention and the endeavor to adress one of its risk factors—alcohol use navigating the complex landscape of alcohol industry interference, emphasizing the ongoing struggle to balance public health interests against the influences of the alcohol industry.

Alcohol Policy is Back on the Agenda with the Europe’s Beating Cancer Plan and its Focus on Prevention

The launch of Europe’s Beating Cancer Plan (EBCP) in February 2021 marked a significant shift in how cancer is addressed in Europe. Over the years, the management of cancer in Europe has evolved considerably, reflecting changes in our understanding of the disease, advancements in medical technology, and important shifts in public health priorities. Historically, European initiatives primarily focused on cancer screening, treatment, and research, with national and regional policies varying in approach and reach.

The European Parliament’s Special Committee on Beating Cancer (BECA) highlighted in 2020 that these initiatives often fell short of expectations, primarily because of their narrow scope and variable effectiveness across regions, underscoring the need for a comprehensive strategy.¹ According to the World Health Organization (WHO), more than 40% of all cancer cases could be prevented by addressing common risk factors.² Therefore, the inclusion of prevention as a key pillar in EBCP was welcomed by the European Public Health Alliance (EPHA) and other public health advocates in Europe.³

The EBCP, with its substantial €4 billion budget, stands out as the most ambitious cancer initiatives in Europe, both in terms of financial commitment and its holistic approach to tackling cancer, also through prevention. The plan notably targets various known risk factors, including the established cancerogenic effects of alcohol consumption. However, in the EBCP, alcohol use is defined as “harmful consumption of alcohol”, a term that is deliberately vague and not easily quantifiable, which brings challenges in policy implementation and effectiveness measurement. This ambiguity aligns with an industry narrative that places responsibility on the individual for their consumption choices and habits, such as heavy drinking by vulnerable groups, while downplaying the need for population-level regulatory measures. Nonetheless, the plan proposes several important actions related to the commercial determinants of health of alcoholic products. These include^4 5:

• Restrictions on online advertising and promotion
• A review of EU legislation on alcohol taxation
• Introduction of mandatory ingredient and nutrient content labelling on alcoholic beverages by the end of 2022
• Introduction of health warnings on alcohol labels by the end of 2023

Challenges in Alcohol Policy Implementation and Industry Influence

This represents a significant policy shift, especially in light of the fact that the EU Alcohol Strategy, spanning from 2006 to 2012, is the one and only in the EU’s policy history, with no direct successor despite numerous stakeholder requests.⁶ Additionally, this shift is even more substantial if we take into consideration that the European Commission’s stayed inactive on alcoholic product labelling since 2017. At that time, the Commission reported a lack of “objective grounds to justify” the absence of information on alcoholic beverage labels.⁴ In response to this stance, the alcoholic beverages sector proposed a self-regulatory scheme in March 2018.⁷ This industry-led move exemplifies the complex, often bitter reality of the European health policy formulation, deeply rooted in clear conflicts of interest between private profit and public welfare.⁸ The actions listed in the EBCP aim to disrupt this paradigm by advocating for stronger, independent regulatory measures.

However, despite these ambitious goals, the implementation of these long-awaited measures outlined in the EBCP has faced delays and controversies. Preparatory work is ongoing, including an impact assessment currently in preparation, which involves a “wide-ranging evidence and data gathering exercise”,⁹ despite differing opinions among stakeholders on the desirability and feasibility of on-label listings are already known. Some prefer this information to be provided off-label through QR codes, apps, or websites, while others, including EPHA, along with our members and partners, argue that alcoholic drinks should not be treated differently from other food and drink sectors. This argument against exemption is seen by many as a mere distraction tactic, with no substantive reason to treat alcoholic beverages differently from other consumable products. The debate surrounding alcohol labelling and health warnings reflects broader tensions and challenges in public health policymaking, extending not only to the Commission but also reaching the Parliament. In 2022, the European Parliament adopted a non-binding resolution¹ on alcohol as a cancer risk factor. Initially, the resolution described consumption of alcohol as a cancer risk factor, citing the World Health Organization’s stance that there is no safe level of consumption.¹⁰ However, several lawmakers proposed amendments to rephrase it, focusing solely on “harmful consumption” and moving away from recommending health warnings on alcoholic beverage labels^11 12

Ongoing Debates and Future Directions in EU Alcohol Policy

As the impasse in the debate over alcohol labelling and health warnings persists, the issue has again emerged in European public health policy discussions, driven by the recent initiatives of the European Parliament’s newly formed Subcommittee on Health (SANT). Among the Subcommittee’s initial undertakings were a couple of own-initiative (INI) reports addressing Non-Communicable Diseases (NCDs) and mental health.¹³ These reports, which include alcohol-related harm, received favorable votes on compromise amendments from the Committee on the Environment, Public Health, and Food Safety of the European Parliament (ENVI). While the draft reports address key elements crucial for a comprehensive and effective European Strategy on NCD prevention, such as health equity, social and economic health determinants, access to care, and data quality and availability, the Parliament again showed a lack of resolve in confronting alcohol consumption. Despite directly referencing the WHO report, which states there is no safe level of alcohol consumption,¹⁰ the Parliament missed an opportunity to address it as ‘alcohol consumption’ in line with WHO’s stance. Instead, it chose the term “harmful use of alcohol’”. This was a point of contention noted by WHO Europe and IARC in their Joint Statement addressed to the European Parliament before the vote in ENVI committee on the reports last November.¹⁴

While the initiative from the SANT subcommittee is praiseworthy, it should be seen as a step towards achieving broader objectives outlined in the EBCP. EPHA’s aspiration is that this initiative will not only reinforce the implementation of extended prevention policies encompassing all preventable NCDs, but also serves as a foundation for a new European Alcohol Strategy. However, there remains a noticeable gap in effective communication regarding alcohol as a cancer risk factor, which appears to diverge from these objectives. As the draft report approaches its decisive plenary vote in December, we hope Parliament members will address this gap, sending a clear, firm message to other European Institutions, which have previously shown excessive leniency towards industries linked to health risk factors.

Public Health Advocates Calling on Commitment from the European Commission

Public health advocates, including EPHA, are calling for a renewed commitment from the European Commission. This commitment is essential for transparent, evidence-based messaging on alcohol consumption, aligning with the broader goals of the EBCP and public health initiatives across the EU. Our ongoing efforts are aimed at enhancing policy language, supported by solid scientific evidence, to underscore the importance of this issue in the broader context of fighting cancer and preventing NCDs.