IAN WEBSTER. The social harm of alcohol to communities and society

The social harm of alcohol, alcohol’s ‘harm to others’, is a re-vitalised framework for national and international policies to control the marketing of alcohol.

General Booth marched through the streets of London to save people from alcohol and poverty, ‘drunkenness … nine-tenths of our poverty, squalor, vice and crime spring from this poisonous tap root.’ The Methodists, Quakers and other protestants joined the Salvation Army, and so did Catholics through Cardinal Manning’s League of the Cross.

Recall Hogarth’s etchings of drunken men and women and neglected children. His famous print – Gin Lane – has a notice, ‘Drunk for penny; dead drunk for twopence; clean straw for nothing.’  Opium quelled the hunger of famished infants.

Poverty drove the moral approaches to alcohol in the 19th and early 20th centuries. In the extreme disparities of industrialising societies, alcohol and poverty were bedfellows, part and parcel of the lot of marginalised people.

We should remember this.

Not so dramatic, but real, are the Australians living at the margin, whose lives are impoverished by alcohol, so often linked to gambling, to homelessness, to imprisonment. Our Indigenous peoples are over-represented amongst these people. Yes, rich families spend more on alcohol, but poor families suffer the most.

A coalition of researchers in 2009, led by the Centre for Alcohol Policy Research, showed the personal, social and economic harms a drinker’s behaviour has on – families, children, workplaces, strangers and communities – alcohol’s ‘harm to others’. This was social epidemiology at its best, looking beyond medical damage to the drinker, but to the harms in the drinker’s radius – some close, in the family, and some distant, co-workers and strangers – street violence, road crashes and crimes. Most telling, most compelling, were the number of child protection cases, one in three, in which the responsible adult was intoxicated.

The old paradigm of alcohol and impoverishment is now being picked up by the World Health Organisation (WHO) and in other countries – New Zealand, US, Europe, Chile, India, Nigeria, Sri Lanka, Thailand and Vietnam. The ‘new’ version of an old paradigm – ‘harm to others’ – is a revitalised rationale for national responses to alcohol problems – beyond sickness and injury to social, community and economic harms. Aalcohol’s effects on others are more dramatic, more harmful in their consequences, than passive smoking’s ‘harms to others’ which impelled international tobacco control measures.

When the harms of drugs are fully assessed – from criminal justice, law enforcement, welfare, health and scientific perspectives – the league table of dangerous drugs is turned upside down. Alcohol wins hands-down – ahead of heroin, crack cocaine and methamphetamines; other substances, such as cannabis, are down-graded. (Lancet, 2010).

In Melbourne at the Global Alcohol Policy Conference (GAPC 2017) in October, Professor Sally Caswell, Chair of the Global Alcohol Policy Alliance, in opening the conference, noted alcohol’s link to 200 diseases and that alcohol is the seventh leading risk factor in the Global Burden of Disease (a measure of years lost from disability and death).  It is the leading global risk factor in the 15-49-year age group, and it is increasing. Alcohol is the third risk factor in the burden in Australia, second to tobacco, and is the leading risk in the 15-44-year age group. Indigenous Australians carry double the alcohol burden of non-Indigenous Australians, showing the strong nexus between alcohol, inequality and poverty.

At the GAPC conference researchers reported on the alcohol-caused hospital admissions which are 5.5 times higher in the most deprived parts of the UK than in the privileged areas, with even higher ratios in northeast England. Where there are wide area income-inequalities in Australia alcohol-related admissions and deaths are increased.

Social harms of this kind are seen in all high alcohol consuming countries – Europe, the Americas and Western Pacific (including Australia). And where alcohol consumption is increasing – in South-east Asia, central Asia and Africa – serious social and economic consequences are occurring; two thirds of Sri Lankan plantation workers’ income goes on alcohol; South African families spend disproportionately on alcohol; rural workers in Malawi drink large quantities of illicit alcohol; sex-workers have increased risk of HIV; suicides in women occur more commonly and young people are exposed to other drugs. In these countries a significant proportion of their GDP goes on alcohol.

Set this against the fact that 62 per cent of the global population are abstainers. Here’s the rub, the largely abstinent countries, including mainly Muslim countries, are subjected to the sophisticated marketing techniques of the alcohol industry honed in high income countries. Distinct groups are targeted through advertising and social media. And there are alcohol-industry-funded organisations claiming welfare objectives and benign intent – Corporate Social Responsibility (CSR) and Social Aspects and Public Relations Organisations (SAPROs), which become the stalking horses for brand identity in low-income countries, notably in Latin America.

It is hard enough to counter the industry’s power in developed countries, but with few resources and no national alcohol policies, developing and implementing sensible alcohol control policies in poor countries becomes an overwhelming task for civil society organisations.

The task is even harder, when the international bodies we look to for global and national policies on alcohol are weak. At WHO, for example, relevant staffing has progressively declined and, according to Professor Jeff Collin of Edinburgh, even the UN’s Sustainable Development Goals 2017 (SDGs) are problematic, “… the wider implications of the SDGs are also ambiguous and contentious, particularly via goal 17 which sets out mechanisms for achieving the goals as part of a revitalised ‘global partnership for development’. These mechanisms include potentially damaging commitments to further trade liberalisation and, crucially, to extensive partnerships with the private sector and to multi-sectoral approaches to policy.” In other words, opening the door for alcohol industry lobbying and involvement.

I came away from the global alcohol conference in Melbourne realising that the health/medical approach to alcohol problems in Australia and high-income countries has little traction in the developing nations. In these countries high levels of alcohol consumption have the capacity to impoverish communities and societies; these facts should galvanise the campaigns of civil society and actions by government and international bodies to reduce the damaging effects of alcohol consumption.

The social harm of alcohol, alcohol’s ‘harm to others’, is a re-vitalised framework for national and international policies to control the marketing of alcohol.

Ian Webster is Emeritus Professor of Public Health and Community Medicine, University of New South Wales

Footnote:  The Scottish parliament has, for several years, sought to require a minimum price for alcohol but the liquor industry has frustrated it.   But recent decisions by the courts have swung in the government’s favour and the legislation is set to be passed.  Alcoholic beverages were available not long ago at a lower price in Scottish supermarkets than bottled water.  This is set to change: see ScotlandAlcoholPricing

 

 

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