By Isidore Obot
Alcoholic drinks are all around us. They come in various forms and prices – from expensive foreign wines and liquor to the more affordable palm wine and locally distilled beverages. Drinking at home or in a communal setting is a popular activity among old and young in Nigeria as it is in many parts of the world. More than half (53 per cent) of Nigerians aged 15 years and above are alcohol consumers; 47 per cent are abstainers, a category that includes people who have never had any alcoholic drink and those who used to drink but stopped for religious, health or cultural reasons. More females (62 per cent) than males (33 per cent) fall under the category of abstainers. This distribution is similar to what obtains in most low-income countries but different from the situation in western countries where higher proportions of adults are alcohol drinkers.
A dangerous pattern of drinking. What is striking about the Nigerian situation and a source of concern in public health circles is the way people drink or the pattern of drinking in the country, i.e., the typical quantity and frequency of alcohol consumed by a drinker. The total alcohol per capita consumption in the general population globally is about 6.4 litres of pure alcohol (ethanol) and about 6.2 litres in the African region. In Nigeria it is more than double that number (13.4 litres). The calculated total alcohol per capita for drinkers only is 15 litres globally and 18.4 litres for Africa. In Nigeria the figure is 25.5 litres.
What this means is that a typical drinker in Nigeria consumes more alcohol over a period of time than a similar drinker in the African region. Nigeria clearly leads the way in per capita consumption. More distressing is the extent of heavy episodic or “binge” drinking, a pattern of consumption that involves taking 60 grams or more of pure alcohol (up to six drinks) on at least one occasion in the past month. A drink is that quantity of beverage (a glass of beer or wine, a shot of liquor) that contains about 10grams of ethanol). Fifty five per cent (55 per cent) of drinkers in Nigeria, especially male and young drinkers, engage in binge drinking. This pattern of drinking to intoxication is harmful consumption; it is strongly associated with intentional/unintentional injuries and interpersonal violence.
Harmful consumption of alcohol is linked to many other health and social problems. As a leading cause of disease, death and disability globally, it is associated with more than 200 disorders, including infectious diseases (tuberculosis and HIV/AIDS), and non-communicable conditions (liver cirrhosis, different types of cancer, alcohol addiction, gender-based violence, etc). According to the World Health Organisation (WHO), alcohol is responsible for three million deaths each year globally, and accounts for more than five per cent of global burden of disease as measured by disability adjusted life years (DALYs), a health metric that combines healthy years of life lost due to mortality and disability.
Alcohol is not an ordinary commodity. The psychoactive ingredient in beer, wine, whiskey and a host of other commercial drinks is an intoxicating and addictive substance known as ethanol. Ethanol works in the brain to produce the happy feelings and excitement associated with drinking. Unfortunately the fun derived from drinking and the economic benefits that accrue to government coffers are outweighed by the social and health harms linked to the substance.
Urgent need for a national alcohol policy. Alcohol-related problems are preventable and evidenced-based strategies have been developed by WHO to reduce different types of harm. The SAFER initiative is highly recommended for adoption and implementation by policy makers in a whole-of-society response to harmful use of alcohol. The strategy involves the following actions: strengthening restrictions on alcohol availability (S); advancing and enforcing drink driving countermeasures (A); facilitating access to screening and brief interventions (F); enforcing bans on advertising, sponsorship and promotion (E); and raising prices of alcohol (R). These actions, especially the three ‘best buys’ – increasing tax, restricting marketing, regulating physical availability – have proven effective and cost-effective and should be the basis of a national alcohol control policy.
Unlike countries in the western world and in a growing number of low and middle-income countries, Nigeria does not have a national alcohol policy that aims to control the production, distribution and consumption of alcohol. This is attributable to several reasons. One is that alcohol occupies a “respectable” position in traditional society as a cultural item that is consumed as part of celebrations of various kinds. A more concerning reason is that the alcohol industry, in a bid to protect its commercial interests, interferes with efforts by health experts to develop and implement alcohol control policies to protect public health and promote social welfare. It is important to recognise that alcohol producers and distributors are in business to make a profit, which depends on the volume sold to consumers, and cannot be expected to do what might hinder the growth of the drinking population. The role of government on the other hand is to protect lives and promote social welfare by implementing effective alcohol control policies, which often mean reduced availability of and restricted access to alcohol.
About five years ago the Federal Ministry of Health embarked on an initiative to develop a national policy on alcohol and much work has gone into it. But progress has been stymied due in large part to interference by the alcohol industry. What is happening in Nigeria comes right out of the playbook of the industry, which has been accused of hijacking the policy development process in several low-income countries. Producers of alcoholic beverages do not usually support the implementation of effective strategies; they rather call for “responsible drinking” and ignore strategies that have been proven to reduce harms. They argue that they do not target heavy drinkers or young people but in reality the alcohol business does not depend on light/occasional drinkers but on heavy consumers for sales. Research has shown that 70 per cent of sales in developing countries take place during heavy drinking occasions. The alcohol industry cannot be trusted to defend public health; its involvement in the development of alcohol policy is a serious conflict of interest.
Is drinking good for your health? There is a long-standing belief in the general population that alcohol has health benefits, that drinking has cardio-protective effects – a “little wine is good for the heart”. The growing consensus among experts today is that “any alcohol use is associated with some amount of risk”. In other words there is no level of drinking that is safe for everybody. However, harm can be minimised with a pattern of drinking that does not exceed two drinks a day for male drinkers (about one bottle of beer) and one drink for female drinkers. A practical advice on drinking is this: if you are a drinker, aim to drink less; if you are not a drinker, don’t start drinking in the hope of deriving any health benefit.
With many years of accumulated research evidence, it is well established that alcohol is a cause of many health and social problems. This is the case in Nigeria as in many other countries around the world. Hence, drinking, especially harmful consumption, should be discouraged as a public health measure. Concerted actions by government and civil society are urgently needed to reduce population per capita consumption, and young people and abstainers need to be protected with appropriate policy against the commercial activities of alcohol producers and vested organisations.
Professor Obot is the Executive Director, Centre for Research and Information on Substance Abuse (CRISA), Uyo; Vice-President, Global Alcohol Policy Alliance (GAPA) and Member, WHO Advisory Committee on Alcohol, Drugs and Addictive Behaviours, Geneva.