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Alcohol Consumption in Brazil: recent public health aspects

Ilana Pinsky and Ronaldo Laranjeira, Federal University of Sao Paulo

Rising alcohol consumption

According to the World Health Organization, 8-15 per cent of the burden of disease in South America is attributable to alcohol, as compared to 4 per cent worldwide (World Health Report, 2002). Brazil, the largest country in South America and the fifth biggest in the world, provides a number of epidemiological data indicating that the consumption of alcohol by its population has been growing in the last decade.

Specifically, there are several signs of this increasing consumption among the youngsters. Results from school based surveys conducted periodically from 1987 to 1997 have shown that lifetime use of alcohol is above 65 per cent for all school children, with 50 per cent of those aged 10-12 years old having already tried alcohol at least once (Galduróz et al., 1997).

Comparing the four years when the surveys were done, the frequent use of alcoholic beverages (six or more times in a month) has been increasing in six of the ten cities surveyed. In addition, heavy use (defined as use on twenty or more times in a month) grew in eight cities, which is a cause for concern. Regarding alcohol related problems, 28.9 per cent of the school students report at least one lifetime episode of alcohol intoxication. (Galduróz et al., 1997).

Other important pieces of information can be drawn from Brazil’s first household surveys, one completed in 1999 (covering 24 cities in the state of São Paulo, the most populated in Brazil) and another conducted in 2001 (covering the 107 largest cities in Brazil). Once again, alcohol stands at the top of the list of drugs used. Among 12-17 year-olds in the São Paulo survey, lifetime alcohol use was 35 per cent and 2 per cent of young people this age admitted to having problems with alcohol (Galduróz et al., 2000).

These frequencies are somewhat lower than the ones presented in the school surveys and may be due to the methodological differences in data collection. The country household survey reported a lifetime consumption of 48 per cent for 12-17 year-olds and 73 per cent for 18-25 year-olds (Carlini et al., 2002). Problems due to alcohol use were reported by 4 per cent of the 12 to 17 year-olds and 10 per cent of the 18-25 year-olds. A paper comparing the two household surveys specifically for the state of São Paulo analysed all the age groups together and concluded that alcohol lifetime use increased during these two years (Galduróz et al., 2003). The same paper suggested that this increase may be related to an aggressive alcohol advertising campaign, especially for beer.

There are other data corroborating these surveys. A study based on data from the Global Status Report on Alcohol suggests that per capita alcohol consumption in Brazil had a 74.5 per cent increase over the period between 1970 and 1996, a situation quite the opposite to many other countries worldwide (Carlini-Marlatt, 2001). In addition, the forecast by the Euromonitor, an organisation monitoring business trends, is that alcohol volume sales are expected to grow by 9 per cent in 2003, especially with the contribution of young Brazilians taken into account (Euromonitor, 2002).

Regarding the kind of alcoholic beverage sold, beer presents the highest volume by far, with an estimated 7.5 billion of litres sold in 1995. This quantity almost doubles the figure for 1985 (Carlini-Cotrim, 1999). In 2001, a representative of the Brazilian beer industry estimated the beer consumption as 8.5 billions of litres per year (SINDCERV, 2001). It is important to point out two important factors related to this increase in beer consumption in Brazil: 1) that it happens in addition to the use of other alcoholic beverages and not in substitution for them (Carlini-Marlatt, 2001) and 2) although drunk by all age groups, beer is the most frequently used alcoholic beverage among young students (Galduróz e cols., 1997).

At his point, it seems fundamental to tackle two main questions concerning this boost in alcohol consumption in Brazil: why is this happening and what is being done to address this situation?

Alcohol policy vacuum

First of all, Brazil has, in effect, few regulations concerning alcohol consumption. The small number of laws that already exists (for example, it is illegal to sell alcohol to minors, to people already visibly intoxicated, in outlets located next to roadways) is rarely enforced.

There are no regulations concerning some vital aspects of alcohol availability, such as hours and days of sale, density of alcohol outlets and specific alcohol licenses. In addition, most alcoholic beverages are extremely cheap and promotions, like “happy hours”, are frequent (“Clube das Loiras”, VEJA SP, 23/10/02). Concerning alcohol prices, a litre of cachaça (a spirit produced from sugar cane, about 40 per cent ABV) can be bought for less than one US dollar in a supermarket and a 350ml can of beer for 20 cents (as a means of comparison, a 2 litre bottle of soda costs 75 cents).

Secondly, there is an aspect that is considered by many people as intrinsically cultural to Brazil, that is, the extreme tolerance of Brazilian society regarding alcohol consumption and even alcohol abuse. Examples of this include alcohol binge behaviour by young males, even minors, often regarded positively as “macho behavior”; the general disregard for restrictive regulations; and the undisputed presence of alcoholic beverages in the majority of gatherings and festivals such as carnival, soccer games, parties, and similar events.

The lack of a consistent national policy regarding substance abuse prevention is another factor. Recently, the Anti-Drug National Secretariat was formed, and substance abuse public policies, related to both prevention and treatment started to gain some space among Brazil’s priorities, but still in a very timid and unorganised way. There are a few school prevention programmes being implemented in the country, some adapted from the US (for example, DARE) and some developed nationally, but most of them are very isolated programmes without much funding or outcome evaluation.

A crucial aspect of the increased alcohol consumption in Brazil is without doubt the high percentage of young people in its population and the fact that the country’s economic-political situation is relatively favourable. In this way, Brazil represents a very promising market as far as the alcohol industry is concerned (Euromonitor, 2002).

The industry’s interest in Brazil can be seen in their investment in marketing and advertising and by the development of new products. In 2001, $106 million were spent on alcohol advertising in Brazil, around 80 per cent specifically for beer (Pinsky, 2003). Besides, several new products, focusing specially on young consumers, have been created. Some examples are the alcopops , light beer and “caipirinha” (a mixture of cachaça and lemon juice). There has been serious investment in alcopops in Brazil. For instance, the producer of only one of these drinks spent around $5 million to promote it in the space of one year (Istoé dinheiro, 15/05/2002). The market leader, Smirnoff Ice, surpassed its expected sales by 10 million bottles and “increased by 10 per cent the vodka Smirnoff’s sales, that had been stagnating for years” (Istoé dinheiro, 15/05/2002).

What is being done?

Brazil seems to be at a pivotal moment in its acknowledgement of alcohol-related problems as a significant matter that needs to be addressed. For instance, a few Brazilian cities have experimented recently with a local regulation restricting hours for selling alcohol. In addition, the new health minister has been portraying himself as a tough opponent of the alcohol industry, and recently co-ordinated the creation of an inter-ministerial group (GTI) responsible for setting guidelines for a policy concerning alcohol related problems (Newspaper “O Estado de S.Paulo, 14/05/2003).

The GTI, that is at the moment still concluding its work, is going to offer suggestions regarding promotion, selling points, taxes and prevention. Nevertheless, there are doubts as to whether these recommendations are actually going to be put into action.

The alcohol and advertising industries, however, are not taking any chances. It is necessary to provide here a little background on other recent developments related especially to alcohol promotion. In Brazil there is a federal law, dating from 1996, that regulates alcohol advertising in Brazil, as well as tobacco and a few other products. Among other things, alcohol beverages may only advertise before 6 am and after 9pm.

However, alcohol beverages, in the definition of the 1996 law, means solely those products with an alcohol content higher than 13ABV, thus excluding beer and wine. In 2000, the former health minister banned all kinds of tobacco advertising, except within points-of-sale. Since then, more than seventy new laws were proposed suggesting further restrictions on alcohol advertising. The advertising industry, trying to anticipate and avoid further outside regulation, in September 2003 approved revisions to its self-regulation code (Brazilian self-regulated publicity code: www.conar.org.br).

Among other modifications, these restrict the use of sexual content and cartoons, both regularly employed in advertisements, to promote alcohol beverages. In addition, models featured in the advertisements should be and appear to be older than twenty-five and people should not be portrayed drinking. In this new version of the code, alcoholic beverages are actually separated into three categories: those above 13 ABV, alcohol and wine, and alcopops.

Some sections of the alcohol industry, especially those representing the beer producers, launched several campaigns intended to improve its “reputation” and avoid being included in the advertising restrictions. For instance, the biggest brewer in Brazil, AMBEV, initiated a well publicised drunk driving prevention campaign, including the donation of 38 breathalyzers to the military police and a partnership with cabs’ representatives. The industry has also been lobbying, pressuring politicians and inviting public health representatives for talks.

The newly elected Brazilian government is taking some steps towards a basic alcohol policy. It is very unlikely to succeed. If Brazil is to have some chance of a proper and sustainable policy in relation to alcohol, we need to create a strong advocacy group. The success of the country in the tobacco and HIV area supports this move.

References

Carlini EA et al. (2002) I Levantamento Domiciliar sobre o Uso de Drogas Psicotrópicas no Brasil – 2001. São Paulo, CEBRID.

Carlini-Marlatt,B. (2001). “A população é jovem e o país é quente”: estimativas de consumo de álcool e tabaco no Brasil pelos dados das indústrias produtoras. Jornal Brasileiro de Dependência Química, 2(1): 3-8.

Eutomonitor (2002). www.euromonitor.com

Galduróz JCF et al. (1997) IV Levantamento sobre o Uso de Drogas entre Estudantes de 1o. e 2o. graus em 10 Capitais Brasileiras – 1997. São Paulo, CEBRID.

Galduróz JCF et al. (2000). I Levantamento Domiciliar Nacional sobre o Uso de Drogas Psicotrópicas – Parte A: estudo envolvendo as 24 maiores cidades do estado de São Paulo.São Paulo, CEBRID.

Galduróz JCF et al. (2003) Comparações dos resultados de dois levantamentos domiciliares sobre o uso de drogas psicotrópicas no estado de São Paulo nos anos de 1999 e 2001. Jornal Brasileiro de Psiquiatria, 52(1): 43-51.

Ilana Pinsky and Ronaldo Laranjeira are researchers at UNIAD (Research Unity on Alcohol and other Drugs), Federal University of São Paulo, Brazil.
Contact: ilanapinsky@uol.com.br