India is one of the largest producers of alcohol in the world and contributes to 65% of production in the South East Asia Region and nearly 7% of imports into the Region. The precise estimate in unrecorded alcohol production is not clearly known.
The alcohol beverage industry contributed an estimated Rs 216 billion in 2003 – 04 to the State exchequer and constituted nearly 90% of the State excise duties. This revenue generation is one of the important sources of revenue for the states.
Alcohol policies promoted to date have been primarily with a view to increasing taxes and not from a public health point of view. The public health importance of alcohol control has been totally neglected in formulating policies and programmes.
Consumption Patterns
35% of adult men and 5% of women consume alcohol - 70 million alcohol users, 12 million of whom are alcohol dependent. More than 50% of regular users fall into the category of hazardous drinking.
Alcohol use is high in poor communities, contributing to increasing expenditure on alcohol and increasing resources spent on managing alcohol related problems.
The average age of starting alcohol use has reduced from 28 years during the 1980s to 17 years in 2007.
Health Consequences
Despite the use of alcohol over centuries, the health consequences of alcohol have not been comprehensively documented in India due to absence of good reporting systems and surveillance procedures. Based on the available data, it can be estimated that alcohol contributes to a substantial proportion of mortality - approximately 20% of premature mortality in men. Alcohol users have a higher incidence of mortality, hospitalization and disabilities due to injuries. Nearly one third of night-time road traffic injuries and deaths can be attributed to alcohol use. 25% of suicides have been linked to alcohol consumption. Around one fourth of violence and abuse against women and children has been linked to chronic alcohol use.
Among hospitalised stroke subjects, long-term alcohol use has been recorded in 25% of total subjects. Linkages of alcohol use to specific types of cancer in the Indian region have been well established. A significant relationship has been established between alcohol use, risky sexual behavior and increased risk of HIV-AIDS and other sexually transmitted diseases in the Indian region, as sex associated with alcohol is more often associated with no protection and multiple sex partners. Alcohol dependents constitute a major burden in the majority of health care settings at secondary and tertiary levels.
The social consequences of alcohol use have largely had an effect on personal life, workrelated areas and on family relationships. Out of 9,938 women surveyed in rural, urban and urban slum areas across 7 cities in India, 26% reported experiencing spousal physical violence during their marital physical life. Women whose husbands regularly consumed alcohol were 6 times more likely to suffer violence. A five state study for the Planning Commission of India, in 2004, found that deaths attributable to alcohol-related domestic violence ranged between 12 and 33%.
Social Costs of Alcohol Use
The report recognizes that the direct and indirect impact of alcohol on the economics of society has been difficult to gauge with the available data. It was observed that the social costs of alcoholism far exceeded the revenues generated from alcohol. Based on a small sample of alcohol dependents it was estimated that the losses were to the tune of Rs 18.39 billion compared with the revenue of Rs 8.46 billion.
In a recent study it has been estimated that Indians might be losing an estimated Rs 244 billion due to different impacts of alcohol, while the revenue generated by the government is approximately Rs 216 billion. The report raises the question ‘are we losing more than we are gaining?’'
The Response
Efforts to address the growing problem of alcohol have been extremely limited in the Indian region due to several reasons: greater attention to the revenues generated from alcohol, increasing publicity favouring consumption of alcohol, penetration of alcohol into semi-urban, rural and transitional towns and cities, changing lifestyles and liberalized values among youth. In addition, the non-availability of good quality data, lack of a central coordinating agency, and nonrecognition of health, social and economic consequences of consumption, compounded by the publicity given to the health benefits of alcohol, due to J-shaped association of alcohol and cardiovascular health and the impact of globalization, have all contributed to the problem. Consequently, initiatives, including policies required for addressing alcohol control, have been relegated to the periphery and even those implemented have not been systematically evaluated.
Some specific responses to this complex problem include the following: establishment of de-addiction centres under the Ministry of Health and counseling centres under the Ministry of Social Justice and Empowerment, greater emphasis on management and rehabilitation of alcohol dependents, increasing resources towards management of crime and stepped-up judicial efforts, health education programmes across the country, especially for drinking and driving, limited community-based interventions and increasing outreach activities by non-governmental organizations.
On the policy front, a few attempts have been made in the past but no systematic evaluation has been done to identify the effectiveness of the following initiatives: prohibition, tax increases over a period of time on almost all types of alcoholic beverages, control of illicit production of alcohol, programmes to check drinking and driving to reduce road traffic injuries, prescription of legal ages for drinking (which vary across different states), fixing of timing of sales in alcohol selling outlets, packaging changes (smaller sachets, labeling etc), a ban on advertising and encouragement for the manufacture of low alcohol drinks.
Barriers of Effective Alcohol Control Policies
Apart from the influences of rapid globalization, industrialization, urbanization and media influences at macro and micro levels, several other barriers that have contributed to the failure of policy include: conflicts between the Centre and the State on issues with regard to production, distribution, taxation and sales, emphasis on the revenue gains and promotional aspects of alcohol use, increasing emphasis on other addictive drugs, nonrecognition of alcohol and its effects on major public health problems, non-recognition of alcohol as a major risk factor for non-communicable diseases and injuries and greater importance given to tertiary prevention as compared to primary and secondary prevention efforts. Other factors include: the absence of a rational and scientific alcohol control policy based on a public health approach; inadequate training of health professionals to recognise early alcohol-related health problems and timely and effective interventions for cessation of use; stigma associated with chronic alcohol use; non-recognition of the economic impact of alcohol-related problems; absence of an inter-sectoral approach; selective attention to doubtful and marginal health benefits; non-availability of good quality population-based data through well-designed studies at national and local levels and the emergence of social drinking in a major way.
Towards Solutions
The report recommends that policy should focus on both supply and demand reduction as well as on the development of a rational and scientific alcohol control policy specifically outlining what is to be done and by whom. A rational taxation policy needs to be evolved without compromising the public health aspects of alcohol control. Uniform excise policies that discourage smuggling, adulteration and undocumented consumption needs to be promoted across states. Appropriate media-related policies with regard to promotion and advertising should be developed in a systematic way. Human resource development and capacity strengthening across the sectors of health, police, law, welfare, excise, transport and several other sectors should be undertaken for policy formulation, programme development and implementation along with evaluation. Most importantly, a public health approach of identifying the problem, understanding the determinants, implementing interventions and evaluating what works should be the focus of future programmes at all levels.
The legal age of drinking should be specified in a uniform manner across all the States of India. This should not be less than 21 years. A consensus has to be evolved with regard to location and timings of alcohol sales and vending in all the states and has to be implemented in totality by the enforcing agencies. Screening for alcohol should be introduced in all emergency room departments of government hospitals, medical colleges and apex institutions. Prevention of drinking and driving should be given high priority and necessary capacity strengthening of police and health functionaries along with infrastructure supply should be given importance.
Early detection of alcohol-related problems should be given high importance and necessary capacity strengthening of doctors and NGOs should be undertaken. Early interventions for vulnerable populations like children, women and disadvantaged communities should be encouraged. Health promotion efforts (not health education alone) should be given importance in control of alcohol problems. Life skills training across educational institutions especially in 8 - 12 grades of education should be introduced in a systematic manner covering alcohol and other risk factors for emerging non-communicable diseases and injuries. Targeted and focused education programmes with clear information on reducing consumption of alcohol, along with the dangers of increasing alcohol use, should be introduced. Community empowerment programmes to understand, identify and recognize alcoholrelated problems through local civil society agencies should be strengthened. Research and surveillance should be strengthened across medical colleges and apex institutions along with developing a research agenda for the future.
Alcohol causes one in 20 deaths globally every year, according to the World Health Organisation
Alcohol kills 3.3 million people worldwide each year, more than AIDS, tuberculosis and violence combined, the World Health Organisation said on Monday, warning that booze consumption was on the rise.
Including drink driving, alcohol-induced violence and abuse, and a multitude of diseases and disorders, alcohol causes one in 20 deaths globally every year.
This actually translates into one death every 10 seconds.
Alcohol caused some 3.3 million deaths in 2012, WHO said, equivalent to 5.9 per cent of global deaths (7.6 per cent for men and 4.0 per cent for women).
In comparison, HIV/AIDS is responsible for 2.8 per cent, tuberculosis causes 1.7 per cent of deaths and violence is responsible for just 0.9 per cent.
More people in countries where alcohol consumption has traditionally been low, like China and India, are also increasingly taking up the habit as their wealth increases.
"More needs to be done to protect populations from the negative health consequences of alcohol consumption.
Drinking is linked to more than 200 health conditions, including liver cirrhosis and some cancers. Alcohol abuse also makes people more susceptible to infectious diseases like tuberculosis, HIV and pneumonia.
Most deaths attributed to alcohol, around a third, are caused by associated cardiovascular diseases and diabetes.
Alcohol-related accidents, such as car crashes, were the second-highest killer, accounting for around 17.1 per cent of all alcohol-related deaths.
China, India drinking more
Binge drinking is especially damaging to health, the WHO pointed out, estimating that 16 per cent of the world's drinkers abuse alcohol to excess.
While people in the world's wealthiest nations, in Europe and the Americas especially, are boozier than people in poorer countries, rising wealth in emerging economies is also driving up alcohol consumption.
Drinking in populous China and India is rising particularly fast as people earn more money, the WHO said, warning that the average annual intake in China was likely to swell by 1.5 litres of pure alcohol by 2025.
Still, Eastern Europe and Russia are home to the world's biggest drinkers.
Russian men who drink consumed an average of 32 litres of pure alcohol a year, according to 2010 statistics, followed by other Western countries including Europe, Canada, the United States, Australia and South Africa.
On average, every person above the age of 15 worldwide drinks 6.2 litres of pure alcohol in a year, according to the report.
Counting only those who drink though, that rises to 17 litres of pure alcohol each year.
But far from everyone indulges. Nearly half of all adults worldwide have never touched alcohol, and nearly 62 per cent say they have not touched a drink in the past year.
Abstinence especially among women, is most common in low-income countries, while religious belief and social norms mean many Muslim countries are virtually alcohol free.
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