Some governments have been promoting alcohol sales through measures like allowing sale in supermarkets, allowing sale in small tetra packs, opening up shops exclusively for women, etc. The intention is to earn more revenue for government and to help farmers, factory owners, etc. who would benefit from increased sales. Also, it is argued that people will anyways drink illicit liquor otherwise which is more harmful.
This article discusses what does evidence from scientific research say about consequences of increasing the ease of availability of alcohol and answers some common questions people have regarding this issue.
A) Summary of evidence
Five policy interventions that have been found to be most cost effective in reducing alcohol related harm in research studies, have been included in WHOs SAFER strategy document. It can be found here https://www.who.int/initiatives/SAFER . Out of these five, three have been regarded to be the ‘best buys’ and one amongst them is ‘To strengthen restrictions on alcohol availability’. This can be done by decreasing number of hours of sale, restricting permitted number of shops selling it, not permitting sale below a minimum age, etc. Many other scientific reviews have also concluded that decreasing the ease of availability is one of the most effective strategies of reducing alcohol related harm in a society[i].
Findings of few research studies:
In the Brazilian city of Diadema, strict prohibition of ‘on premise consumption alcohol outlets’ after 11pm in 2002, led to a 44% decrease in murders[ii]!
A study involving 6 university campuses in New Zealand showed that the level of alcohol-related problems among students was associated with alcohol outlet density, especially ‘off premise’ outlets[iii].
In US state of New Mexico, removal of a ban on Sunday ‘off premise consumption alcohol sales’ resulted in a 29% increase in alcohol-related crashes and a 42% increase in alcohol-related crash fatalities on Sundays. In counties that reinstated the bans, alcohol related crashes again decreased to near previous values[iv].
A policy review by leading public health experts indicates that when ease of availability of alcohol increases, the total quantity of alcohol consumed in that society increases and that in-turn leads to a proportionate increase in the level of alcohol related harm in that society (proportion of people developing alcohol addiction, crimes under intoxication, accidents, etc.)[v]
Lets consider the example of Thailand. Historically, alcohol use by Thai people was low because of the influence of Buddhism. But then in 1960s, politicians made laws favouring the alcohol industry believing that it will help the economy. What was the result? In the next 40 years, around 1/3rd of their population started to drink; and 22.7% of those who drank had developed alcohol use disorders! Risk of family violence was found to be 3.84 times higher in families with alcohol use[vi].
Even people who advocate against a complete ban on alcohol sales, recommend that keeping restrictions on the sale of alcohol is the best way to keep the public health problem of alcohol addiction in check[vii].
Thus, there is extremely strong evidence now that restricting sale of alcohol through measures like restrictions on number of outlets, number of hours of alcohol sale, etc. is one of the best ways to decrease alcohol related harm in society.
B) Preventing its increasing use is essential to halt the epidemic of non-communicable diseases
To halt the epidemic of non communicable diseases like heart disease, diabetes, etc. most countries had kept the goal of decreasing harmful use of alcohol by 10% by 2025 compared to 2010. In developed countries alcohol consumption has started to decrease; but in countries of South East Asia and Africa the consumption is increasing. Strengthening the prevention and treatment of substance abuse has been chosen as Sustainable Developmental Goal target 3.5; with Alcohol per capita consumption (APC) as one of the 2 indicators to monitor this target.
However, rather than any decrease, the APC in India has actually increased by 33% in just 7 years from 2010 to 2017. If state governments continue to promote alcohol sales, alcohol related harm and non-communicable diseases in our society are bound to continue to increase.
It is important to note that many innocent members of society also have to suffer the consequences of alcohol use. For instance, as per WHO 18% murders and 18% suicides in our society are attributable to alcohol. A huge proportion of domestic violence happens under alcohol intoxication. 34% road traffic accident deaths in India are due to drunk driving.
C) Answers to some common doubts people have
Myth 1: Alcohol sales earn our government lot of revenue! Hence promoting its sale is good for our society in a way.
Ultimately what is more important: revenue generated or welfare of people?
Yes, it does earn a lot of revenue. But it also results in a lot of losses due to cost of treatment of alcohol related diseases, cost of managing its complications like accidents, crimes, etc., loss of income for family due to premature deaths, loss to economy due to work absenteeism, etc. Many analyses have shown that these losses are far greater than the amount of revenue gained. While government earns a large amount of excise revenue through alcohol, it doesn’t have to compensate for all its adverse consequences. It is the alcohol users and their families who have to bear this loss. So some governments may find this deal profitable; but society as a whole suffers.
Human resource is the most important resource of a country. What is the sense in earning revenue for the government by harming our human resource physically, mentally, financially and socially? Is this our idea of development? In his book ‘I too had a dream’ Dr. Verghese Kurien, father of India’s white revolution, says “I have often claimed that I have had but one good idea in my life: that true development is the development of women and men... I cannot help but feel some disappointment that our policy makers and implementers still believe that our nation’s women and men are means, not ends... Our greatest national resource is our people, and too often we have neglected this resource”
Let us consider the example of a liquor shop owner. He calls local youth and distributes alcohol free to them. He does this for just 2 or 3 times and he gets customers for life. He is prepared to ruin the lives of other people in his society, just so that he can earn his revenue. If a government lets its citizens become victims of alcohol & tobacco, just so that it can earn its revenue; how is it any different from that exploitative liquor shop owner? Does the government exist primarily for the welfare of people; or primarily to accumulate revenue for making regular payments to those with secure government jobs, MLAs, etc.?
The main justification for starting to imposing a heavy tax on alcohol or tobacco was not that it would earn government revenue. Main objective was to discourage people from using these addictive poisons by making them more expensive. However, with time some people have lost perspective of the situation – what was started to discourage alcohol use has now become the reason for promoting alcohol sales.
Gujrat government is widely regarded as one of the most efficiently running government and in Gujrat official sales of alcohol are banned since years. Just an example to show that it is not necessary to drug the society to earn the revenue.
Myth 2: If we restrict its legal sale, illegal alcohol will be sold anyways in equal amount.
Doing something illegally is not as easy as doing it legally. Decreasing ease of availability by strengthening restrictions decreases magnitude of alcohol related harm in a big way. As explained above, there is very strong evidence for this policy measure.
Yes, some people who are addicted will try to get it anyways; but new people will not try that desperately. Youngsters don’t start drinking in illegal alcohol shops. They start with legally available alcohol in the shop next doors; and when it ruins them then they go to the cheaper varieties of alcohol.
The most common question I am asked by youngsters is, “If alcohol is so bad, why doesn’t the government ban it?” If a substance is allowed to be legally sold and marketed using the most popular filmstars and cricketers, then our youth is bound to feel that it must be relatively safe.
If alcohol is sold in supermarkets there would be a sense of normalization of its use, its risk perception will decrease and the ease of availability will increase. Consequently, the rate of experimentation by youth and the frequency of alcohol use by drinkers will increase, with a proportionate increase in the alcohol related harm that our society has to suffer.
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