Corporate consolidation, coupled with trade liberalization, is helping to make the alcohol industry a global business, and advocates seeking to control the proliferation of alcohol-related problems worldwide are being confronted by huge multinational corporations wielding powerful political influence and deep pockets, according to experts at the Global Alcohol Policy Advocacy Conference, held Aug. 3-5 in Syracuse, N.Y.David Jernigan, associated director of the Marin Institute for the Prevention of Alcohol and Other Drug Problems, opened the conference by pointing out that the world's 200-plus nations employ a variety of methods to control alcohol use and abuse, ranging from outright prohibition (7 nations) to state-run monopolies on alcohol sales (19 nations) to more familiar methods such as minimum drinking ages (67 nations), licensing of sales establishments (50 nations), restrictions on alcohol advertising (37 nations) and drunk-driving penalties tied to blood-alcohol level (54 nations).
Outside the developed world, however, these regulations are enforced unevenly or not at all even when they are on the books. Couple that with the desire of multinational firms like Seagram, Grand Metropolitan and Anheuser-Busch to expand into new markets, and many experts see a disaster in the making. "Alcohol's revenue-enhancing benefits are seen, but not its costs," says Jernigan, who points out that taxes and other revenues arising from alcohol sales can account for a significant percentage of the budgets of third-world governments.
Even as per-capita alcohol consumption has been declining in the United States and in Europe, people living in the developing world are drinking more, especially men, Jernigan says. "Spending on alcohol marketing has far outpaced the development of treatment and prevention" in these nations, he notes. "Policies are undercut by free-market reforms, and there is a paucity of data collection on alcohol's consequences as compared to its contributions."
Those costs include about 774,000 deaths annually worldwide, according to Shekhar Saxena, M.D., director of substance-abuse advocacy and capacity-development at the World Health Organization's (WHO's) Department of Mental Health and Substance Dependence. In addition, alcohol causes up to 10 percent of all disease-related disabilities in developing countries, which Saxena says are ill-equipped to control alcohol abuse among their populations.
In places like Eastern Europe, for instance, government officials have little experience with prevention, trade liberalization has allowed big new companies to come in and expand the alcohol market, and economic restructuring has decreased controls on marketing, production and sales. In such circumstances, "It is very hard to cope with the excessive power the alcohol industry has," Saxena says.
In Africa, where alcohol has long been used in rituals but where excessive drinking has been frowned upon, increased marketing -- especially of beer -- has led to an increase in consumption, especially among young people. Per-capita consumption remains about 1/5 of that in Western Europe but is growing, according to a presentation by Oye Gurije, M.D., a teacher and consulting psychiatrist at University College Hospital in Ibadan, Nigeria.
But as Gurije's paper demonstrates, Western-style prevention cannot simply be transplanted to Africa: Factors such as a lack of DWI laws, poor roads and inadequate emergency services and health-care facilities compound the consequences of drunk driving, for example. But it may be hard to convince people of the dangers of drinking when they are faced with more immediate problems such as hunger, communicable disease and war. "
One tactic the industry has employed to entrench itself in these new markets is to get involved in the public-health debates on alcohol, by presenting governments with advice, research and even guidelines for dealing with the harm caused by the drug. That's a role that WHO sees for itself, however: the agency's mandate includes advising member states on the problems related to use of psychoactive substances, increasing awareness of such problems, and coordinating prevention activities with other organizations.
To that end, the agency is conducting a number of research projects aimed at detailing the scope of alcohol-related problems worldwide, the link between alcohol and economic development, and the relationship between alcohol and poverty, according to Saxena.
The conference, which drew about 200 participants from around the world, was organized by the Marin Institute and the Institute of Alcohol Studies, and co-sponsored by the World Health Organization, the Center for Science in the Public Interest, IOGT International, the Robert Wood Johnson Foundation, the American Medical Association, Eurocare, FACE Michigan, and the United Methodist Church.
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