If you had to take a guess as to which drug
causes the most harm in our country, what would it be? This drug has toxic
effects on the user’s organs and tissues, impairs physical coordination and
cognition and affects the user’s perception and behaviour. It’s widely available,
and even sold in specialized stores. This drug is alcohol – humanity’s oldest
drug.
As a species, we’ve used alcohol since the
late Stone Age, about 12 000 years ago, and spread across the globe. In
China, evidence was found of fermented drinks appearing 9000 years ago. Wine
was first produced in Iran about 7000 years ago. In ancient Egypt and Babylon,
evidence dates alcoholic drinks back 5000 years ago, with evidence in Mexico
stretching back 4000 years ago and in Sudan 3500 years ago. Since then, it has
become part of our culture.
In ancient Greece, wine was often served at
breakfast, and it became part of the diet of most Romans. By the Middle Ages,
beer was an everyday drink for most people – even nuns had an allowance of 6
pints of ale a day! As our civilization progressed, however, attitudes started
to change. While moderate consumption was still viewed positively, the negative
effects of drunkenness was causing concern. It was not until we could start
collating large amounts of health data that we could truly start seeing the
effects of alcohol use on the population.
And so it was that we could see the cost of
alcohol. Globally, 3.3 million deaths a year occur due to harmful use of
alcohol, accounting for 5.9% of deaths worldwide. Even though women are more
vulnerable to alcohol-related harm from drinking, the harmful use of alcohol is
the leading risk factor for death for adult males. That, however, only takes
into account death – not the adverse health effects that occur due to its use.
First amongst these are neuropsychiatric
conditions. While one may be aware of alcohol-use disorders, epilepsy is also
affected by alcohol – and not only seizures induced by alcohol withdrawal.
Depression and other anxiety disorders is also associated with alcohol abuse.
Next, and as well known, is gastrointestinal diseases such as liver cirrhosis
and pancreatitis. Fewer people know about alcohol’s carcinogenic properties,
which increases the risk for cancer of the mouth, nasopharynx, other pharynx and
oropharynx, laryngeal cancer, oesophageal cancer, colon and rectum cancer,
liver cancer and female breast cancer.
By now, a few people will be thinking that
‘a glass or two of red wine is good for the heart.’ However, the beneficial
effect of that disappears with heavy drinking, and in fact increases the risk
for ischaemic heart disease and ischaemic stroke. Regardless of one’s drinking
pattern, however, alcohol has damaging effects on hypertension, atrial
fibrillation and haemorrhagic stroke. This is of particular concern for
Namibia, as in discussion with Dr Simon Beshir of the Windhoek Heart Centre, he
stated that in the majority of his heart patient referrals, alcohol consumption
could be identified as a major cause.
Furthermore, alcohol use by expectant
mothers can cause preterm birth complications, or Fetal Alcohol Syndrome. Then,
of course, there’s the additional effect of a weakened immune system, enabling
development of infections such as pneumonia and tuberculosis. And, naturally,
the injuries sustained due to alcohol’s effect on psychomotor abilities and
behaviour, resulting in unintentional injuries at best, and at worst, violence
and suicide.
How does this affect Namibia? A
surface-level analysis based on per-capita consumption shows that adult Namibians,
on average, consume 10.8 litres of pure alcohol per year – a bit above the
African average of 6. However, that does not take into account Namibia’s
abstainers. A total of 48.7% of adult Namibians are life-long abstainers, with
an additional 12.3% former drinkers now abstaining, resulting in 61% of the
adult population being abstainers. When that is taken into account, it means
that the per capita consumption of alcohol for drinkers is 27.7 litres per
year. It also reveals that 37.2% of our drinking population binge-drink at
least once a month.
It should then be no surprise to learn that
the prevalence of alcohol use disorders is 5.1% of the population, above the
regional average of 3.3%, and 2.2% of the population is dependent on alcohol,
above the regional average of 1.4%. Namibia’s death rate for liver cirrhosis is
14 people per 100 000 population per year, of which 68% can be attributed
to alcohol abuse. Even more glaringly, while Namibia used to be worst in the
world in income inequality, we’ve managed to improve on that front, only to
take on a new title – worst in the world in traffic accident deaths. Our death
rate for road traffic accidents is 35 people per 100 000 population per
year – and 66.1% can be attributed to alcohol abuse.
In total, we as a country lose 153 years of
life per 100 000 population due to alcohol use, and 180 healthy years of
per 100 000 population due to disease and disability due to alcohol. By
now, some of you are undoubtedly thinking “something should be done,” and
“there should be a law!” Unfortunately, the solution is not that easy. That
experiment has already been done. For 13 years, during 1920 to 1933, the United
States had the Prohibition. Yes, alcohol consumption dropped – but not by as
much as you’d think. At first, it dropped to about 60% of what it was
previously, but as the criminal underground started supplying demand, it crept
back to 80% of what it was. This provided a major financial boost to organized
crime, resulting in crimes increasing by 24% while the prohibition was in
effect.
In Namibia, the Self-Regulating Alcohol
Industry Forum has as its main objective promoting responsible drinking, but
ultimately, the solution cannot come from without. Alcohol use and abuse is,
after all, not done unwillingly at the start, even if it can become
uncontrollable at the end. It is we, the people and the culture, that needs to
address this cost. We need to start looking critically at ourselves, and decide
if this is a cost we want to bear, both personally, in the case of drinkers,
and socially, as a nation. When we decide that the cost is too high, that is
when we’ll start solving the problem. Not before.
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