Grieshaber-Otto J, Sinclair S, Schacter N
Cedar Isle Research, 3270 Chaplin Road, Agassiz, British Columbia, Canada V0M 1A2.
Addiction. 2000 Dec;95 Suppl 4:S491-504. doi: 10.1080/09652140020013737.
There is an underlying incompatibility between government efforts to minimize the harm associated with alcohol, particularly by regulating its supply, and international commercial treaties that promote the freer flow of goods, services and investment. These treaties have already forced changes to many government measures affecting alcohol availability and control, primarily by constraining the activities of government alcohol monopolies and by altering taxation regimes. The North American Free Trade Agreement and the World Trade Organization agreements open new avenues for challenges against alcohol control measures. Some of these agreements extend beyond trade, border measures and differential taxation and allow challenges that intrude into areas of non-discriminatory domestic regulation affecting market access, intellectual property, investment and services. Effective protection from these agreements for vital public health measures has rarely been obtained, although it is increasingly essential. The WTO "services" agreement, basically unknown to the public, is currently being re-negotiated and poses the gravest new challenge to policies designed to influence patterns of alcohol use and minimize alcohol-related harm. In future, these international agreements will probably affect adversely those alcohol approaches considered to be the most effective or promising. These include: maintaining effective state monopolies, restricting the number and locations of retail outlets, taxing and regulating beverages according to alcohol strength, restricting commercial advertising, and maintaining and enhancing public alcohol education and treatment programs. These effects can, in turn, be expected to increase the availability and access to alcohol, to lower alcohol taxes, and to increase advertising and promotion, resulting in increased alcohol consumption and associated health problems. Until more balanced international rules are developed, the challenge facing alcohol policy researchers is to defend national and local alcohol measures from further erosion. This will require greater coordination with researchers in other affected sectors, intervention with government representatives in health and related areas and the promotion of alternative approaches to current international commercial agreements.
政府为尽量减少与酒精相关的危害所做的努力，尤其是通过监管酒精供应来实现这一目标，与促进商品、服务和投资更自由流动的国际商业条约之间存在潜在的不相容性。这些条约已经迫使许多影响酒精供应和管控的政府措施发生了变化，主要是通过限制政府酒精专卖机构的活动以及改变税收制度来实现的。《北美自由贸易协定》和世界贸易组织的各项协定为挑战酒精管控措施开辟了新途径。其中一些协定的影响超出了贸易、边境措施和差别税收的范畴，允许对影响市场准入、知识产权、投资和服务的非歧视性国内监管领域进行挑战。尽管至关重要，但很少能从这些协定中获得对重要公共卫生措施的有效保护。基本上不为公众所知的世贸组织“服务”协定目前正在重新谈判，这对旨在影响酒精使用模式并尽量减少与酒精相关危害的政策构成了最严峻的新挑战。未来，这些国际协定可能会对那些被认为最有效或最有前景的酒精管控方法产生不利影响。这些方法包括：维持有效的国家专卖制度、限制零售店的数量和位置、根据酒精含量对饮料征税和监管、限制商业广告以及维持和加强公众酒精教育及治疗项目。反过来，这些影响预计会增加酒精的可得性和可获取性、降低酒精税、增加广告和促销活动，从而导致酒精消费增加以及相关健康问题增多。在制定出更加平衡的国际规则之前，酒精政策研究人员面临的挑战是捍卫国家和地方的酒精管控措施，使其免受进一步侵蚀。这将需要与其他受影响部门的研究人员加强协调，与卫生及相关领域的政府代表进行干预，并推动对当前国际商业协定采取替代方法。
