Cultural aspects of drinking patterns and alcohol controls in China

Ian Newman

Alcohol, 'jiu' in Mandarin, is intimately intertwined in almost every aspect of Chinese culture and has been since earliest times. China's cultural traditions, which have until now minimised the risks associated with alcohol use, will be challenged as China opens to the West. There will be a tendency for outsiders to encourage the adoption of Western-style policies to address problems from alcohol abuse. Doing so without careful consideration of the cultural role of alcohol could be counter-productive.

Legend tells that Du Kang, living in the Xia dynasty (2100 BC - 1600 BC) invented alcohol. Today some Chinese still use his name to indicate alcohol. Others attribute alcohol's origin to Yi Di, the daughter of emperor Yu, who tasted the drink and "felt cheerful" (Lee, 1987). In the agricultural communities along the Yellow River there is archaeological evidence of alcohol production 7000 years ago. In fact some archaeologists argue that the earliest crops were cultivated for the brewing of alcohol rather than for the purpose of food.

Lessons from history

The Chinese have continually regarded jiu as the representation of happiness and the embodiment of auspiciousness. At the same time, they regard it as one of the "Four Vices" or disasters. This double view of alcohol is reflected in China's history.

Early Chinese literature includes many references to alcohol. Dynasties appear to have fallen as a result of alcohol. The historical record clearly suggests that, at different times, governments have acknowledged alcohol-related problems and have used policies to prevent these problems. For example, the Emperor Yu (2205 - 2198 BC) imposed an alcohol tax to reduce consumption. During the Han Dynasty (220 - 206 BC) a variety of laws were passed to control consumption. In 206 BC a fine of four ounces of silver was imposed if three or more people were found drinking together. The idea was to curtail drinking at feasts, a practice that encouraged excessive alcohol use. In 147 BC alcohol production was totally prohibited, but in 98 BC a revision in the law specified that only government officials could manufacture and sell alcohol, thus establishing a government monopoly.

During the Wei regime (220 - 264 A D) infringement on the government's alcohol monopoly was punishable by death. At the same time as these restrictions, intended in part to prevent public health problems from alcohol use, there were actions promoting alcohol use for the public good. In 179 B. C. the social welfare legislation provided wine, corn, and meat to all old men.

With time the government alcohol monopoly gave way to the private manufacture of alcohol under licence. By the 5th century alcohol consumption again was causing problems and it is reported that the Emperor ordered all manufacturers, sellers, and consumers of alcohol beheaded. Similar penalties for alcohol production were again evident in the 11th and 12th century when the Mongol leader, Kubla Khan, is said to have banished all alcohol manufacturers from China (Cherrington, 1924).

In the same way Julia Lee (1986) in a review of Chinese poetry showed that heavy drinking and drunkenness have at times been fashionable and then fallen out of favour.

The Chinese government today has chosen not to interfere with the traditional patterns of alcohol use. There are no laws regulating the purchase, consumption, or selling of alcohol. Instead today alcohol use appears to be controlled by culture, tradition, social pressure, and the economy. The few scholars who have looked at Chinese alcohol use have concluded that Chinese may consume less alcohol than other ethnic groups for a variety of reasons.

• Chinese society is based on strong family units and people exercise considerable influence on one another. Family and community norms effectively shape behaviour (Fei Ping, 1982).

• Both Confucian and Taoist philosophies emphasise moderation, a standard widely applied to alcohol use in China today (Sue, et al., 1985).

• The Confucian ideal of "moral drinking" that emphasises alcohol's role in strengthening all that is good in a person mitigates against abuse.

• Chinese are highly "situation-centered," and therefore unlikely to exhibit reckless behaviour in a social setting (Hsu, 1981). The avoidance of embarrassment and the concept of "face" are powerful forces against drunkenness.

• Chinese traditionally drink alcohol only when eating. Drinking with food decreases the rate of alcohol absorption and may also reduce the amount consumed (Johanson & Schuster, 1981; Kalant, 1971). It is believed that alcohol should be consumed slowly to enhance its pleasure (Wang, et al., 1992).

• The ceremony associated with eating, most evident in toasts and other rituals, dictates when drinking occurs (Cherrington, 1924). The small size of the glasses or drinking cups also defines use.

• Traditionally, when drinking Chinese play games requiring cognitive and motor skills, especially at banquets. The goal of the game is not to get drunk because getting drunk is the penalty for losing (Barnett, 1955; Fei Ping, 1982; Moore, 1948). Playing games while drinking heightens sensitivity to the state of intoxication (Cicero, 1980).

• Chinese do not typically frequent western-style bars. Banquets and other drinking occasions are infrequent (Singer, 1972). Solitary drinking is looked down upon (Williams, 1998).

• For many Chinese, economic conditions restrict the use of alcohol to special occasions.

• Some believe the physiological flushing response-the reddening of the upper body, especially the face-restricts alcohol use. There is mixed evidence to support this conclusion (Schwitters, et al., 1982; Park, et al., 1984).

• Home production of alcohol depends upon the availability of grain, the economy, the alcohol makers' (usually the women) inclination to make the alcohol, and the auspiciousness of the occasion.

China is a large and diverse country. These different traditions will vary in importance from place to place.

As China continues to open to the West these traditional and cultural constraints against alcohol abuse will be severely tested. Already in the urban areas and in the special economic zones they are being largely discarded.

Consumption

In a country as large and as diverse as China it is difficult to estimate actual alcohol consumption. WHO estimates that 81 per cent of Chinese alcohol consumption is in the form of spirits, 18 per cent as beer and 1 per cent as wine.

Per capita alcohol consumption has increased 402 per cent between 1970 - 72 and 1994 - 1996 making it one of the fastest-growing alcohol markets worldwide.

Considering the Chinese population is 1.3 billion, a small increase in the percentage of alcohol users represents large numbers of people and significant profits for the alcohol industry. Per capita consumption however is as yet low, 5.4 litres of pure alcohol per adult 15 years and older compared to 8.9 litres in the United States, 9.4 litres in the UK and 12.5 litres in Denmark (WHO, 1999).

Making meaning from these numbers is difficult. Some 80 per cent of China's population lives in rural areas and an even larger percent could be considered poor. Their ability to purchase alcohol is limited. They are much more likely to produce their own alcohol in quantities that are unrecorded. This means the estimated consumption of 5.4 litres per person actually applies only to the more affluent Chinese, who tend to live in the urban and economic development regions of the country. China is one of the world's largest producers of alcohol: it will surpass the USA in the next couple of years to become the world's largest producer of beer. China is already the world's largest producer of spirits; however, the consumption of spirits is declining in favour of wine and beer.

In the 1970's the government built breweries in almost every province and semi-autonomous region except Tibet. The government is reported to have invested some $800 million in brewing technology. It is reported that more than 50 foreign companies have joint ventures related to alcohol production in China. No one company dominates the alcohol production market. One of the largest breweries, Tsingtao, is moving aggressively to increase its market share.

What do we know about adolescent alcohol use? Not much.

Li et al. (1996) in a study of students in grades equivalent to U.S. grades 6, 8, and 10 in Beijing reported that 70 per cent of their sample had consumed alcohol at least once and that beer was the alcohol of choice. The average age of first use was age 12.

Zhang (1997) studied alcohol use among a sample of high school students in Shanghai in grades equivalent to U.S. grades 10, 11, and 12, and found that, 77 per cent had used alcohol in the past year, 29.3 per cent had used alcohol in the past month.

Lifetime use among the Shanghai (males 91 per cent; females 89 per cent) and Beijing (78 per cent) samples, two cities with considerable western exposure, was similar to the lifetime use in the USA (80 per cent), while last-30-day-use was significantly higher in the USA (51 per cent) compared to Shanghai (males 36 per cent; females 23 per cent) and Beijing (20 per cent).

Qu, et al., (2000) reported that 59 per cent of the students in grades equivalent to U.S. grades 11 and 12 in Hohhut, Inner Mongolia, a relatively remote area with limited exposure to Western influences, had consumed alcohol in the last year - a rate similar to other areas. Use in the last 30 days was comparable to other Chinese samples (22 per cent)

As in most societies there is a relationship between parental and youth drinking and differences in male and female drinking. Adolescents' drinking patterns tend to resemble their parents' drinking patterns. Female drinking is relatively rare, at least in public. The percentage of female recent drinkers (last 30 days) is low - in the Shanghai sample 23 per cent, Beijing16 per cent.

Changing patterns

The increasing consumption of alcohol is associated with the changing political and economic conditions and the opening of China to the West. This increased contact with the West has allowed the sharing of Western images of alcohol use - images that are not always accurate and which tend to encourage risky drinking. The availability of western brands of alcohol has created a special appeal that is cosmopolitan and western, especially for young people. The development of brew pubs, usually joint ventures, has attracted young people. Increased competition has led to lower prices.

Nevertheless the influence of culture as a constraint against risky drinking is still apparent. Asked where they usually did their drinking the majority of students reported " at festivals and at parties," the time honoured occasions for drinking. The differences in drinking patterns among Inner Mongolian and Han students also illustrates this point.

Mongolians have a reputation for heavy drinking and consider drinking capacity a sign of status among males. Yet our survey data from Inner Mongolia suggested that Han (ethnic Chinese) students consume alcohol much more frequently than Mongolian students. However, when the quantity consumed at each drinking occasion is examined Mongolian students report drinking significantly more than Han students. The Mongolian students explained this by saying that their drinking was more likely to be restricted to special celebrations when excess use was more likely to be tolerated. Their drinking patterns appear to reflect long-standing indigenous Mongolian cultural practices. The Han, most of whom recently moved to Inner Mongolia, have tended to lose touch with their more traditional cultural practices and as a consequence appear to be more open to the acceptance of western drinking practices displayed in alcohol advertising and portrayed in movies, television, and other images from the west. Their drinking no longer relates to the traditional drinking occasions.

The complicated challenge of policy development

If the trend in per capita alcohol consumption continues, alcohol-related problems are likely to increase and gain more attention. With an increase in the number of automobiles, the effect of alcohol on drivers will become more noticeable. It is estimated that half of all traffic crashes involve drivers who have been drinking (China Daily, Feb. 4, 1996). The development of technologically sophisticated workplaces will mean the effect of alcohol on employee performance will become more evident. Similarly, contact with the west will increase the recognition of alcohol's role in social problems such as family break-ups and crime. It is estimated that one-third of serious crimes committed by adolescents involve alcohol (China Business Weekly, June 17, 1996). The tolerance for certain drinking practices will decrease. As this occurs there will be a tendency to look to the government to help reduce alcohol-related problems.

A natural tendency could be for the government to adopt alcohol control policies used in other countries, in the West for example, to address similar problems. The introduction of these policies into a very different cultural setting will need to be carefully evaluated. Policies that interfere with traditional drinking practices are likely to be openly rejected or thwarted by the public.

A careful analysis of the traditional roles that alcohol plays in Chinese society illustrates this point. Alcohol use is an integral part of religion. Alcohol in various forms is an important part of Chinese medicine. Alcohol is a critical element in hospitality. Alcohol is important in cooking and as part of the meal. Alcohol has traditionally been an important part of special celebrations and festivals. Accepting these traditional roles for alcohol illustrates how difficult it would be to adopt policies like those in the West that are reported to be effective in reducing alcohol related harm.

For example, raising the price, restricting the hours of sale, restricting home manufacture, setting a minimum age for purchase and use, and restricting the place of sale could all potentially interfere with alcohol's role in religion, medicine, hospitality, special celebrations, cooking and the rituals associated with meals. Policies that support the maintenance of traditional Chinese drinking practices will likely be well received. Policies that support traditional drinking practices, even though these carry some risks, will therefore need to be given serious consideration. The risks associated with traditional drinking appear to be significantly lower than the risks associated with western-style drinking.

If the introduction of policies to control alcohol itself carries some risks what then is the alternative? Perhaps attending to the most obvious problems associated with alcohol abuse, such as drunk driving, would be an initial approach. It's hard to say. At the very least the focus would then be on the "problem behaviour," whatever it is, and not automatically on alcohol itself.

What is important, as this brief paper has attempted to show, is that policies to prevent and reduce alcohol-related risks and harm need to be in concert with the values and the traditions of the society. In societies as different to the West as China's the challenge of policy development will depend first on a careful understanding of local traditions and culture. A first step in policy development would be to encourage traditional indigenous controls. As societies become more like those of the West, western policy options may become effective. In the meantime, and in the hope that societies can maintain something of their uniqueness, Chinese policymakers and policy advisers will need to reflect on their own cultural traditions for guidance in reducing alcohol related harm and not quickly adopt foreign strategies. And while this is a controversial point, they should also look to their traditions and cultural values for the basis of low risk patterns of alcohol use. From a policy perspective, it is significantly easier to maintain a behavioural pattern, even if it includes some risks, than to change it.

Ian Newman is Professor of Health Education at the University of Nebraska.

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