We need taxation as one of the strategies to tackle alcohol abuse, gov’t has to take action on this serious problem
Dear Editor, Even as the World Health Organization (WHO) reports that in 2016 alone, more than 3.3M people died around the world because of alcohol-use, the Ministry of Public Health in Guyana appears to have no strategy to deal with the rising alcohol-use problem in Guyana. Not only is there little or no focus on prevention of alcohol-related problems, but the Ministry appears to have abandoned all the education, awareness and treatment initiatives that were in place to deal with alcohol abuse. The WHO reports that about 6% of the population of Guyana suffers from an alcohol-use disorder. The WHO also reports that on an average, the per capita consumption of pure alcohol in Guyana amounts to about 8 liters per year (about 160 bottles of beer or about 20 bottles of rum).
Because science has shown, unequivocally, that no amount of alcohol use is safe, I have long insisted that certain strategies are required for the control of alcohol use. Besides education and awareness and prevention strategies, we need alcohol taxation, similar to tobacco taxation, as one of the strategies to reduce alcohol use. I am hopeful, just as I was decades ago, that Guyana will summon the strength and moral courage to increase alcohol taxation and introduce strict age limits for the purchase and use of alcohol as part of a comprehensive strategy to control the use of alcohol. We need a robust public education and awareness programme, alcohol and substance abuse counseling programmes etc., but these initiatives must be anchored by an aggressive taxation and licensing legal framework for alcohol-use.
While I have major disagreements with President Granger and his APNU+AFC government, I fully and unconditionally support the President when he said recently that Guyana will embark on a path to control the use of alcohol. During my time as Minister of Health, I often urged that we do more to control the use of alcohol and to stop alcohol abuse. We developed a number of initiatives to tackle alcohol abuse and introduced prevention and treatment strategies. But some of the initiatives, like increased taxation, did not find favour in our government, in parliament and in the public. Big alcohol, represented in Guyana by Banks DIH and DDL and other private sector entities, was opposed to some of the prevention strategies, not unlike big tobacco that did succeed in delaying action against tobacco. Just as I did with tobacco, so I am today giving unreserved support to the President and the government for action that control alcohol use in Guyana. He needs to start by demanding more action from his ministry of public health. It is late already, but it is never too late.
Guyana abrogates our responsibility for the welfare of our people if we do not take comprehensive and aggressive action to minimize the ill-effects of alcohol, including, but not limited to heavy taxation policies. A number of initiatives in public education and awareness, substance abuse counseling and treatment etc. that were introduced when I was Minister of Health have been thrown by the wayside. I urge the President, if he is serious, to investigate why these initiatives are no longer in place. The initiatives that I started are not enough, but are a good place for us to start if we are serious in controlling the use of alcohol in our country. It took us almost 15 years, but we succeeded last year in finally introducing tobacco control laws. We must do so now for alcohol. I expect push-back from big alcohol, just as we encountered with big tobacco.
Big alcohol has promoted studies that show benefits in the use of small amounts of alcohol. This particular commentary, therefore, is a spoiler alert drinking any amount of alcohol, small or large amounts, is not good for your health. Even the studies that show certain benefits in alcohol consumption point out that the negative impacts outweigh the benefits. A study published in the respected medical journal, The Lancet, by the Global Burden of Diseases, Injuries and Risk Factors (GBD) group, examined the global burden of alcohol health effects for 195 countries and territories from 1990-2016. The conclusion is unequivocal - no amount of alcohol is safe, any amount of alcohol negatively impacts health. The study examined 23 health outcomes, including:
● Cardiovascular diseases: atrial fibrillation and flutter, haemorrhagic stroke, ischemic stroke, hypertensive heart disease, ischemic heart disease, and alcoholic cardiomyopathy;
● Cancers: breast, colorectal, liver, esophageal, larynx, lip and oral cavity, and nasal;
● Other non-communicable diseases: cirrhosis of the liver due to alcohol use, diabetes, epilepsy, pancreatitis, and alcohol use disorders;
● Communicable diseases: lower respiratory infections and tuberculosis;
● Intentional injuries: interpersonal violence and selfharm;
● Unintentional injuries: exposure to mechanical forces; poisonings; fire, heat, and hot substances; drowning; and other unintentional injuries; and Transportationrelated injuries.
The plain truth is that the risk of mortality far outweighed any potential benefits of alcohol use. In 2016, alcohol-use caused at least 3.3M deaths globally, about 5% of all deaths. The study showed that alcohol use is the 7th leading risk factor for deaths across the world. It accounted for 2.2% of all female deaths and 6.8% of all male deaths. Alcohol was linked to 12.2% of deaths in males and 3.8% of deaths in females, between the ages of 15 and 49.
While no study is available in Guyana, I had done an estimate sometime in 2008, just before I became the President of the World Health Assembly, that alcohol directly accounted for about 700 deaths annually in Guyana. Alcohol plays an ugly role in deaths caused by suicide, motor vehicle accidents, other accidents, violence, HIV, TB etc. These are outside of deaths because of the potentiating role of alcohol in the non-communicable diseases, such as cancers, diabetes, hypertension, hepatitis etc. Note also that alcohol is a major contributor in the transmission of HIV in Guyana and around the world.
According to the study, the main causes of alcoholrelated deaths globally in the 15-to-49 age group were tuberculosis, road injuries, and suicide. For those older than 50, the leading alcohol-related cause of death was cancer. Alcohol use can cause at least 7 types of cancer: those of the mouth, gullet (oesophagus), throat (pharynx and larynx), liver, large bowel (colon and rectum) and breast. The more alcohol one consumes, the greater the risk for these cancers. The only way to reduce your risk for cancers is to avoid the use of alcohol, period.
Eight of the top 10 countries with lowest death rates attributable to alcohol use among 15- to 49-year-olds were Muslim countries in the Middle East: Kuwait, Iran, Palestine, Libya, Saudi Arabia, Yemen, Jordan, and Syria. These countries are majority Muslim, which generally bans the use of alcohol. Conversely, 7 of the top 10 countries with highest death rates were in the Baltic, Eastern European, or Central Asian regions, specifically Russia, Ukraine, Lithuania, Belarus, Mongolia, Latvia, and Kazakhstan.
The researchers found that no amount of alcohol provided any health benefit, evidence that supersedes what has been claimed in previous years. The widely held view that small amounts of alcohol have health benefits needs reviewing because whatever benefits alcohol use may have is far outweighed by the negative effects. This study makes it clear that the safest level of drinking is none. The lead author of the study, Dr. Emmanuela Gakidou of the Institute for Health Metrics and Evaluation, stated: “The health risks associated with alcohol are massive. Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss”. No wonder the Chief Medical Officer of the UK agrees.
Yours faithfully, Dr Leslie Ramsammy