Alcohol kills more….

If you drink alcohol more.. then be aware it may lead to long-term health risks. Over time, excessive alcohol use can lead to the development of chronic diseases and other serious problems including high blood pressure, heart disease, stroke, liver disease, and digestive problems, mental health problems, including depression and anxiety…….

By Amresh K Tiwary

Alarming incidence of alcohol consumption in Indian society has wide-ranging negative effects, manifesting not only in health-related aspects but in social and economic conditions too. Curbing alcohol abuse needs to be made a priority in public health policy for achieving a healthy India

Alcohol consumption in India amounted to about 5.4 billion liters in 2016 and was estimated to reach about 6.5 billion liters by 2020. The steady increase in consuming these beverages can be attributed to multiple factors including the rising levels of disposable income and a growing urban population among others.

In India, alcohol consumption is widespread across all the states and the union territories and an estimated 160 million consume alcohol . According to National Family Health Survey-4 (NFHS-4), 29.2 men and 1.2% women consume alcohol (14).Men are almost two times more likely to binge drink than women. Approximately 22% of men report binge drinking and on average do so 5 times a month, consuming 8 drinks per binge. In 2019, 7% of men had an alcohol use disorder compared with 4% of women.

Men are almost two times more likely to binge drink than women. Approximately 22% of men report binge drinking and on average do so 5 times a month, consuming 8 drinks per binge. In 2019, 7% of men had an alcohol use disorder compared with 4% of women. Though women have had historically lower drinking rates than men, the negative effects of alcohol abuse are typically worse and more pronounced for women. The problem is exacerbated by the special dangers that alcohol poses for women. In general, alcohol affects women more strongly than men.

A global phenomenon, alcohol consumption is now getting worldwide attention due to its harmful impact on the society. Alcohol is classified as psychoactive substance which produces dependence. It has not only important implications on health but also social and economic aspect as well. There are a number of factors which determine alcohol consumption in a society.

According to Prof (Dr) Nimesh G Desai, Professor of Psychiatry and Former Director, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a large disease, social and economic burden in societies.The harmful use of alcohol can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large.

Dr Desai, said, “Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major non communicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions”.

Dr A K Agarwal, Professor of Excellence, Medical Advisor (Innovation) Appollo Hospital, New Delhi, said, “A significant proportion of the disease burden attributable to alcohol consumption arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides, and fatal alcohol-related injuries tend to occur in relatively younger age groups.”

“The latest causal relationships are those between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the incidence and course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications, added, Dr Agarwal.

Dr Suneela Garg, Director Professor, Department of Community Medicine, Maulana Azad Medical Institute, New Delhi, “Social factors like cultural practices, level of development, alcohol production, distribution and marketing strategies are important factors. In India, alcohol consumption in social gatherings and on some religious occasions is an accepted norm. Similarly, consumption of alcoholic beverages is prevalent in many tribal and village societies around the world. Individual factors also play a role in the pattern of alcohol consumption. Age group, gender, socio-economic factors, education, certain occupation, familial tendency, peer pressure etc are individual determinants of alcohol intake. Early age of initiation of alcohol intake leads to higher rates of diseases due to abuse, accidents and injuries.”

According to Prof. Ramesh K. Goyal, Vice Chancellor, Delhi Pharmaceutical Sciences & Research University. Delhi, the market forces which are promoting alcohol should be brought under legislative control. Regulating the marketing of alcohol is essential since it has important impact on younger population. Restricting the availability of alcohol can be effective. Legislations should be made and strictly enforced. Taxation policies can have huge impact on alcohol demand and supply system. Raising public awareness about the harmful effects of alcohol is essential. Innovative strategies should be used including mass media campaigns for the same. More and more counselling and rehabilitation centres should be opened for those in need, all over the country. Those who recover should be integrated within the society without stigma and discrimination. All healthcare workers, social workers should be trained in counselling alcohol users.”

Factors affecting alcohol consumption and alcohol-related harm
A variety of factors have been identified at the individual and the societal level, which affect the levels and patterns of alcohol consumption and the magnitude of alcohol-related problems in populations.

Environmental factors include economic development, culture, availability of alcohol, and the comprehensiveness and levels of implementation and enforcement of alcohol policies. For a given level or pattern of drinking, vulnerabilities within a society are likely to have similar differential effects as those between societies. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption.

Conceptual causal model of alcohol consumption and health outcomes
The impact of alcohol consumption on chronic and acute health outcomes in populations is largely determined by 2 separate but related dimensions of drinking:
• the total volume of alcohol consumed, and
• the pattern of drinking.

The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication, and, on rare occasions, also the quality of alcohol consumed. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes in individuals.There are gender differences in alcohol-related mortality and morbidity, as well as levels and patterns of alcohol consumption.

Ways to reduce the burden from harmful use of alcohol
The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.

Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost-effectiveness of the following strategies:

Regulating the marketing of alcoholic beverages (in particular to younger people);
Regulating and restricting the availability of alcohol;
Enacting appropriate drink-driving policies;
Reducing demand through taxation and pricing mechanisms;
Raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies;
Providing accessible and affordable treatment for people with alcohol-use disorders; and
Implementing screening and brief interventions programmes for hazardous and harmful drinking in health services.

WHO Response
The harmful use of alcohol is one of the leading risk factors for population health worldwide and has a direct impact on many health-related targets of the Sustainable Development Goals (SDGs), including those for maternal and child health, infectious diseases (HIV, viral hepatitis, tuberculosis), non communicable diseases and mental health, injuries and poisonings. Alcohol is specifically mentioned under health target 3.5: “Strengthen the prevention and treatment of substance use, including narcotic drug abuse and harmful use of alcohol” .

WHO aims to reduce the health burden caused by the harmful use of alcohol and, thereby, to save lives, prevent injuries and diseases and improve the well-being of individuals, communities and society at large.

WHO emphasizes the development, implementation and evaluation of cost-effective interventions for harmful use of alcohol as well as creating, compiling and disseminating scientific information on alcohol use and dependence, and related health and social consequences.

The “Global strategy to reduce the harmful use of alcohol”, negotiated and agreed by WHO Member States in 2010, represents international consensus that reducing the harmful use of alcohol and its associated health and social burden is a public health priority. The strategy provides guidance for action at all levels, including 10 recommended target areas for policy options and interventions for national action to reduce the harmful use of alcohol and the main components for global action to support and complement activities at country level.

The update of the evidence on cost-effectiveness of policy options and interventions undertaken in the context of an update of Appendix 3 of the Global Action Plan for the Prevention and Control of n Non communicable Diseases 2013-2020 resulted in a new set of enabling and focused recommended actions to reduce the harmful use of alcohol. The most cost-effective actions, or “best buys”, include increasing taxes on alcoholic beverages, enacting and enforcing bans or comprehensive restrictions on exposure to alcohol advertising across multiple types of media, and enacting and enforcing restrictions on the physical availability of retailed alcohol.

With growing awareness of the impact of alcohol consumption on global health and an increase in international frameworks for action, the demand for global information on alcohol consumption and alcohol-attributable and alcohol-related harm, as well as related policy responses, has increased significantly. The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels.

Achieving reduction in the harmful use of alcohol in line with the targets included in the SDG 2030 agenda and the WHO Global Monitoring Framework for Non communicable Diseases requires concerted action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.

How much alcohol are people drinking?
The average daily consumption of people who drink alcohol is 33 grams of pure alcohol a day, roughly equivalent to 2 glasses (each of 150 ml) of wine, a large (750 ml) bottle of beer or two shots (each of 40 ml) of spirits. Worldwide, more than quarters (27%) of all 15–19-year-olds are current drinkers. Rates of current drinking are highest among 15–19-year-olds in Europe (44%), followed by the Americas (38%) and the Western Pacific (38%). School surveys indicate that, in many countries, alcohol use starts before the age of 15 with very small differences between boys and girls.

Worldwide, 45% of total recorded alcohol is consumed in the form of spirits. Beer is the second alcoholic beverage in terms of pure alcohol consumed (34%) followed by wine (12%). Worldwide there have been only minor changes in preferences of alcoholic beverages since 2010. The largest changes took place in Europe, where consumption of spirits decreased by 3% whereas that of wine and beer increased.

In contrast, more than half (57%, or 3.1 billion people) of the global population aged 15 years and over had abstained from drinking alcohol in the previous 12 months.

Almost all (95%) countries have alcohol excise taxes, but fewer than half of them use other price strategies such as banning below-cost selling or volume discounts. The majority of countries have some type of restriction on beer advertising, with total bans most common for television and radio but less common for the internet and social media.