Alcohol and the global burden of disease
According to the Global status report on alcohol and health (WHO, 2014) alcohol consumption led to 3.3 million deaths in 2012. In other words 5.9% of all deaths globally resulted from using alcohol. To put that in context, alcohol led to more deaths than HIV/AIDS (2.8%), violence (0.9%) and tuberculosis (1.7%) combined.
Alcohol is also responsible for 5.1% of the global burden of disease or 139 DALY’s (disability adjusted life years) and there is evidence of strong links between alcohol use and occurrence of more than 200 diseases. This includes its role as one of the main risk factors behind the rise of non communicable diseases (NCDs) i.e. cardiovascular diseases, cancer, diabetes and chronic lung diseases.
It also includes alcohol’s role in aggravating the incidence and progression of infectious diseases such as HIV/AIDS and tuberculosis.
This makes alcohol one of the leading avoidable risk factors contributing to premature death, disability and disease worldwide. The situation is worse for developing countries since the burden of disease resulting from alcohol is heavier in poorer countries per liter of alcohol than higher-income populations and countries (Anderson et al., 2009).
In addition to its adverse impact on the health of populations, alcohol use also causes social harms and economic losses to individuals their families, communities and societies at large.
A policy approach to addressing alcohol harms
WHO has developed international policy documents such as the WHO Global strategy to reduce the harmful use of alcohol (and it’s regional adaptations) and the WHO Global action plan for the prevention and control of non communicable diseases (NCDs) 2013-2020 – to reduce the burden of disease caused by alcohol.
Due to resource constraints however, countries must choose from the raft of policy recommendation provided those best suited for their context and that deliver best value for public health. Fortunately WHO has also selected a set of policy interventions for which there is evidence of high impact in reducing alcohol use and that could be delivered cost effectively.
These proposals known as alcohol policy best buys include:
- Tax increases
- Restriction of access to retailed alcohol and
- Bans on alcohol advertising
WHO estimates that implementing Best Buys to reduce the impact of the four main NCD risk factors – tobacco use, alcohol use, unhealthy diet and physical inactivity – would cost only 1$ per capita for low income countries, 1.50$ for lower-middle income and 3$ for upper-middle income countries. This would amount to only about 4% of total health spending in lower income countries and even less for lower middle and upper-middle income countries. A very small price to pay compared to the burden of disease, loss of lives and economic losses that would be averted.
Adopting best buys as a cost effective approach to reducing alcohol harm
East African governments should embrace the great opportunities offered by the Best Buys approach to achieve the following benefits.
- Cost effectiveness: In the WHO Global status report on NCDs 2010, WHO proposes that the global NCD epidemic could be reversed with “…modest investments in interventions…” Best Buys offer a tried and tested solution in dealing with alcohol harms for East African governments due to their low implementation costs coupled with high effectiveness in reducing alcohol use.
- Securing the future: According to WHO approximately 25% of the total deaths in the age group 20-39 years are alcohol-attributable (WHO 2014). Equally, East African nations have young populations, the majority falling within this age group where alcohol is causing the most harm. Adopting Best Buys will secure the future for East Africa as its young people would be rescued from alcohol harms and hence be deployed to nation building activities.
- Protecting the emerging markets: Many African countries are now experiencing increased levels of economic growth with average rates of 6%. East African counties are registering high levels of growth as well. The result is a growing middle class which is an attractive target market for alcohol manufacturers who have saturated or mature markets in other regions of the world. As a result international brands of alcoholic beverages are steadily increasing along with intense marketing efforts to reach these new consumers. This unabated will lead to increased alcohol use and more harms in the region – especially as Western alcohol producers target African children and youth with their marketing.
- Economic Benefits: According to WHO, implementing Best Buys to prevent NCDs can prevent 3 million premature deaths per year in low and middle income countries. East African countries that adopt and implement Best Buys will avert preventable deaths and make huge savings on resources that would have been diverted to address this alcohol induced burden of disease. Such resources could then be used to finance development.
- Decongesting Health Systems: East African countries have a low patient-to-doctor ratio. Hence they are classified as Low-density-high-mortality countries by WHO for both high mortality rates and low density of health practitioners. Reducing preventable diseases, disability and premature deaths by adopting Best Buys would therefore provide much needed relief for already stretched health facilities and workers.
WHO 2004: “ Estimates of Health Personnel: Physicians, Nurses, Midwives, Dentists, Pharmacists,” Geneva
DALYs are the units of measurement used to measure the burden of disease from mortality and morbidity. They represent the years of life lost due to premature mortality and disability resulting from living with a health condition.
This policy brief was prepared by the East African Alcohol Policy Alliance, EAAPA, a regional network of national alcohol policy networks from East Africa Community (EAC) member countries. Its mission is to work towards the reduction of alcohol harms through advocacy, networking and promotion of evidence based policies among the EAC member states.