Taking Steps Toward Coherent Global Governance of Alcohol: The Challenge and Opportunity of Managing Conflict of Interest.

OBJECTIVE: The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) is increasingly seen as offering a template for advancing effective global health governance in other spheres, notably including alcohol. In thinking about lessons that can be transferred, there is a simplifying tendency to overstate the FCTC's transformative impacts and, more problematically, to neglect the significance of evolving policies, norms, and practices that collectively enabled its development. This can lead to underestimating the extent to which the FCTC's evolution was protracted and contested, while issues that need to be addressed as prerequisites for an international legal instrument for alcohol are viewed as only feasible after its achievement. This problem is examined here with reference to managing conflict of interest with unhealthy commodity industries. Although protection of policymaking from tobacco industry interference under FCTC Article 5.3 has been hugely significant, it was feasible because of wide-ranging developments in practices across diverse governance actors at national and international levels. This article illustrates the legitimating and enabling significance to the FCTC of measures including emergent internal practices within the WHO, the World Bank's decision to withdraw funding from tobacco projects, steps by host governments to restrict support for the overseas expansion of tobacco transnationals, and changes in civil society and researcher engagement with industry actors. Recent developments in seeking to manage conflicts of interest in nutrition policy in the WHO and at national levels highlight the scope for progress in the absence of an international legal instrument. The article concludes by considering implications of these varying innovations for the future development of effective global governance for alcohol.