A dangerous cocktail of alcohol and public health
THREE WEEKS ago, an internal memo was written to the leadership of the Regional Health Authorities under my signature reminding them that the Government was involved in a process of developing an alcohol policy and that public health should not engage in any activity that would seek to undermine the proposed policy direction by associating with or using the public-health platform to promote alcohol brands.
The memo became necessary because of a number of visible promotional events linked to alcohol brands donating cash and kind to public-health institutions.
Alcohol abuse is one of the leading causes of non-communicable diseases, sickness, and death. Its promotion directly or indirectly represents a clear conflict of interest and undermines the role that public health must play in driving policies for healthier-lifestyle practices, including acceptable levels of alcohol consumption.
The memo was intended to remind public-health leaders of their duty to this cause and conflict of interest created by public endorsements of alcoholic brands.
As was perhaps to be expected, many persons objected to this memo, and it was leaked to the media. This led to a more general discussion around the appropriateness of accepting donations from alcohol brands, and in the current situation of a global pandemic where our resources are even more limited, some members of public health were also not in agreement.
RESPONSIBLE PROMOTION
Regardless of the challenges presented by the COVID-19 pandemic, sound and responsible public-health institutions should not provide a platform for the promotion of alcoholic beverages. Indeed, the pandemic context means that alcohol related-illnesses, as well as alcohol-related motor vehicle injuries, can in fact put more strain on the already overburdened publichealth system.
In Jamaica, alcohol is the most widely misused of all substances. The alcohol-attributable death rate is 6.2 and 23.7 deaths per 100,000 for Jamaican women and men, respectively. In 2014, the Government of Jamaica spent an estimated J$12.6 billion to deliver direct and indirect healthcare to persons admitted to public hospitals islandwide suffering from injuries sustained from 25,000 violencerelated incidents, 13,000 road crashes, and 500 cases of attempted suicide. Alcohol-impaired driving is one of the main factors contributing to motor vehicle accidents.
Jamaica supports the World Health Organization (WHO) and the United Nations’ call for a reduction of the harmful use of alcohol both as part of the current Global Action Plan for the Prevention and Control of Non-communicable Diseases and the Sustainable Development Goals. We also subscribe to the 2010 WHO Global Strategy to reduce the harmful use of alcohol.
A component of our subscription to these global initiatives is the formulation of national policies, including a proposed National Alcohol Policy, which focuses on reducing the harmful use of alcohol; controlling marketing of alcoholic beverages; driving policies and countermeasures; controlling drinking by youths; reducing negative consequences of drinking and intoxication; and promoting law enforcement.
Parading on hospital compounds with giant figurative cheques to show gifts in cash or kind from alcohol companies may serve the interests of the alcohol brand, and even the needs of a particular hospital deficit at a point in time, but it undermines the legitimacy of public health to champion the need for a reduction in alcohol abuse, which is a major issue in our country. With due respect to those who defend the grand public gifting, the greater principle of controlling alcohol abuse is not served, but undermined, in this instance.
AT RISK
We should remind ourselves of the impact of alcohol abuse in Jamaica. The 2016 National Drug Use Prevalence Household Survey revealed that an estimated 15 per cent of the population is at a medium to high risk of alcohol dependence. This translates to over 370,000 persons in the population being at risk. That survey also revealed that the prevalence of current use of alcohol in Jamaica was 42 per cent of the population aged 12 – 65 years. For men, the prevalence was 57 per cent, and for women, 28 per cent.
Jamaica is not an outlier. Harmful use of alcohol is a global problem responsible for three million deaths annually and five per cent of the global burden of disease. WHO statistics show that harmful use of alcohol is accountable for seven per cent and two per cent of the global burden of disease for males and females, respectively, and is the leading risk factor for premature mortality and disability among those aged 15 to 49 years, accounting for 10 per cent of all deaths in this age group.
In fact, the pandemic has seen greater levels of abuse, with many countries, including South Africa and India, responding by banning the sale of alcohol. Fewer people being admitted for alcohol-related injuries and illnesses meant more beds for COVID-19 patients. Bans were also imposed in parts of France and Mexico, and in Kenya, Greenland, Japan, and Thailand.
Jamaica has not taken such drastic measures. In this instance we are, however, taking a principled position to ensure that the public-health system does not provide a platform for advertising alcohol as we have seen by the media spotlight given to recent activities.
Given the alcohol-attributable death rate, alcohol-related illnesses, alcohol-caused motor vehicle accidents, and other social ills associated with the misuse of alcohol, public health must lead the charge in representing good health and lifestyle practices. It cannot optimise this responsibility if we are providing a platform for alcohol brands. Public health has to stand without ambiguity on this issue.