Alcohol has been used in many societies of the world for ages. For a long time,
however, consumption of alcohol has been strictly regulated by traditions, social
norms and natural limitations. More and more however the global alcohol market
is expanding, particularly into developing countries. The saturation of markets
for alcoholic beverages in the West combined with a higher industry concentration
and increased market power has led to the expansion of the international alcohol
industry in new markets in Africa, Asia and Latin-America. Meanwhile, in many
developing countries, alcohol is often more easily available than clean drinking
water. Today the ten biggest multinational brewers sell more than one-third
of all industrially produced beer in the world, and their share of the global
market is increasing. They make massive marketing efforts aimed particularly
at new user groups such as young people, women and ethnic groups who traditionally
did not drink. As a consequence, new drinks and drinking habits are being globalized
across different continents and sections of the population. For example, young
people in developing countries are increasingly drinking and displaying the
same harmful pattern of drinking – ‘binge drinking’ – common among young people
in developed countries.
One of the challenges is that many developing countries are highly dependent
on national revenues from alcohol. In some Indian states for example alcohol
makes up as much as 23% of the revenue. (In comparison, 2002, the European Union
drew 2.4% revenue from alcohol taxes). Of course, the state dependence on revenue
from alcohol tax is not an incentive to impose restrictions on the advertisement
and sale of alcohol and strict enforcement of such restrictions. The country
seeks to maximize income, but the social costs of alcohol are often overlooked.
These costs include the direct expenditures of treating injuries and diseases
as well as rehabilitation costs, property loss, law enforcement costs, and losses
in productivity due to absenteeism or loss of productive years of life. (1)
A vicious circle of adverse health, social and economic effects
Severe health, social and economic effects of alcohol consumption are well
documented and witnessed all over the world. Regular alcohol abuse can lead
to a multitude of chronic diseases whereas sporadic excessive drinking (binge
drinking) is hold responsible for acute adverse effects such as accidents, injuries,
violence and risk behavior. A link between alcohol and drug abuse with the spread
of Aids has been broadly documented, for example in the latest WHO resolution
of «Public health problems caused by harmful use of alcohol» of May 2005. Alcohol
consumption leads to a higher probability of unprotected sex (and therefore
to a higher risk of HIV-infection). Furthermore, a positive diagnosis for HIV
can also cause an increase in alcohol consumption which may reduce the success
of the treatment of the AIDS infection.
Most known chronic diseases attributable to alcohol are diseases of the liver
such as fatty liver (adipohepatic), cirrhosis of the liver and alcoholic hepatitis.
The risk of acquiring cirrhosis of the liver rises when an amount of 50g pure
alcohol is consumed during the period of 10 to 15 years (which is approximately
half a liter of wine or 1.2 liters of beer per day). Chronic alcohol abuse can
lead to damage of parts of the nervous system which can cause neurological and
mental illnesses. The extent of these damages depends upon the degree and severity
of the alcohol consumption, nutrition and individual disposition.
With the daily consumption of more than four glasses of alcohol, the risk for
cardiovascular diseases increases significantly. Not only chronic alcohol abuse
but also binge drinking can have a damaging effect on the cardiovascular system.
A quarter of all sudden deaths due to heart attacks among young men are a consequence
of binge drinking. The risk of a stroke is increased tenfold by this drinking
pattern. In some parts of the world where alcohol is brewed uncontrolled and
illegally at home (often by those who cannot afford to buy alcohol), ill effects
of alcohol consumption can arise from a single bout of drinking. (2)
Therefore, the World Health Organization has pointed out alcohol abuse as one
of the major causes of the global disease burden: 2002, it has been estimated
that there are about 2 billion people worldwide who consume alcoholic beverages
and among them, 76.3 million with diagnosable alcohol use disorders. In the
developing world alcohol ranks as the fourth cause of disability among men;
in the industrialized regions it even ranks first. In the European Region alone,
2002 alcohol consumption was responsible for the deaths of 63,000 young people
aged from 15 to 29! Such figures document the following statement by T. Babor:
“No other product so widely available for consumer use, not even tobacco, accounts
for so much disability as alcohol”. (3)
Destabilizing the daily hand to mouth economy
The increase in alcohol consumption in many developing nations where health
and economic systems are weakest is of particularly great concern. Poor people
around the globe are vulnerable even to small changes destabilizing their daily
hand to mouth economy. For those living under harsh circumstances, alcohol may
seem an easy way out. This is also along the lines of the image portrayed by
the alcohol producers – a taste of luxury, recreation and the world beyond everyday
worries. But the social, economic, health and other problems created by alcohol
use are severe additional burdens for poor people.
Men traditionally drink more frequently and more heavily than women. However,
the patterns of drinking for men and women are beginning to converge. While
men still experience more direct drinking-related harm than women, women as
well as children are often the victims of the harmful use of alcohol by men:
Domestic violence, broken families, neglected children, a husband failing to
bring income to the family in addition to the money spent on alcohol – all this
put an extremely heavy burden for poor families.
A recent paper in the National Medical Journal of India points out: “Although
it is important to recognise that alcohol consumption typically increases with
affluence, it should be kept in mind that some of the adverse effects related
to drinking are aggravated by poverty. For example malnutrition and infections
common among the poor interact with alcohol in the development of liver disease.
As a result, alcohol related mortality is often highest among the poor in a
society.” (4)
The approach of the International Federation of Blue Cross
Rapid socio-cultural change and increasing cultural globalization in many parts
of the world leading to significant growth in the use of drugs and alcohol ask
for the implementation of effective counter-measures. The International Federation
of the Blue Cross (IFBC) is one of the few international organizations in the
field of prevention, treatment and after-care of alcohol abuse and its related
problems.
The IFBC is a politically and denominationally independent umbrella organization
consisting of about 40 national member organizations, predominantly in Africa,
Europe, Brazil and India. As a global network community the federation supports
its member organizations in building up their competence in the field of alcohol-
and substance abuse related problems. In collaboration with our partners, we
promote the exchange of knowledge and create opportunities for our members to
share their experience by developing multi-national projects, transfer of knowhow
and project-based partnerships.
Based on christian values, the members of the IFBC are engaged in the prevention
and treatment of alcohol and other drug related problems. One of the specific
assets is the extensive expertise in the area of self-help work. Furthermore,
they commit themselves for comprehensive alcohol-political measures. Particularly
our members in the south work under difficult social and political conditions
in countries where alcohol dependent people not only look for help in vain,
but are also often excluded from communities, stigmatized as being „useless
drunkards” (as it has been the case in Europe in the 19th century, before alcoholism
was recognized as an illness). Prevention activities of our member organizations
in Africa, India and Brazil integrate services for children and youth at risk
through counseling, skills development and creation of employment. Furthermore,
awareness for alcohol and drug related issues are created through educational
programs in schools, communities and slums. In addition medical and therapeutic
help is provided to alcohol dependent people and their families, in close collaboration
with churches, self-help groups and other NGOs.
Based on the strong evidence of the link between alcohol, Aids and poverty
we are convinced that if our members succeed in implementing effective alcohol
prevention, this will also be a contribution to the prevention of poverty and
AIDS. Our goal is not that Blue Cross Organizations start developing AIDS Prevention
Programs; however, we aim at integrating the substance abuse issue in existing
Aids and poverty programs of other NGOs. In addition, we put a strong focus
on a holistic approach in the projects and services of our member organizations:
This requires the consequent inclusion of women and children, a target group
that is often strongly directly and indirectly affected by the effects of alcoholism
as mentioned above.
The south empowers the south!
Based on the motto „The south empowers the south“, the IFBC develops resource
centers on the aspect of substance abuse and related health risks such as poverty
and HIV/AIDS. One of the main aims of these centers is to mobilize resources
and key people within and outside of the Blue Cross, in order to make it possible
to train people on the field so they are qualified to develop sustainable and
culture specific projects.
As a project example we like to refer to a community based project lead by
the resource centre in Lesotho: In a participative assessment in a local rural
community near Maseru, people of the village described unemployment, poverty,
boredom and lack of self esteem as causes behind alcohol and drug related problems.
Based on this situational analysis, an income generating project has been developed
together with the local community and the Blue Cross partners. In this project
example, alternative livelihood has been generated through planting and selling
trees to the government. The target group of the project addresses young unemployed
people at risk as well as those engaged in home brew production of alcohol.
(This kind of illegal alcohol production without any legislation or restriction
leads to a high availability in rural of alcohol as well as often to severe
alcohol dependency of the brewers).
Encouraged by the positive experiences of our first resource centre in Lesotho,
the IFBC plans to initiate further centers in Africa, India and Brazil so that
increased capacity and networking within the issues of prevention, treatment
and advocacy of alcohol and drug related issues will be possible!
*Irene Abderhalden is Co-General Secretary of the International Federation
of the Blue Cross in Bern, Switzerland. Contact: i.abderhalden@ifbc.info,
www.ifbc.info
References
- www.add-resources.org
- Overview of the Health Issues to Alcohol Consumption. Brussels: International
Life Sciences Institute; 1999.
- Babor T. Alcohol: No Ordinary Commodity - Research and Public Policy. Oxford:
Oxford University Press; 2003.
- Subir, Kumar Das; V Balarishnan, D M Vasudevan: Alcohol: Its Health and
Social Impact in India. National Medical Journal of India Vol. 19, No. 2,
2006.
