"...Alcoholic beverages are global commodities and drinking is a widespread social custom, but alcohol is also a major source of health and social problems, in developing societies as elsewhere. Through controls and other prevention measures, the burden of disease and disability can be reduced. Under the auspices of the World Health Organization, an international group of scholars analyzes the many sides of the picture, with a focus on Africa, Latin America, Asia, Oceania and indigenous societies within developed countries."

The book from which the quotation is taken originated from an initiative of the World Health Organization, Geneva, an initiative which reflected the fact that WHO has responsibility for public health on a global basis. This obviously implies a special responsibility for developing societies. The question which the WHO staff found themselves facing was, what could be said in the context of developing societies about rates, patterns and trends in drinking and in alcohol-related problems, and about evidence on the effects of different alcohol policies and prevention programmes? Reflecting the available literature, the analyses and arguments in Alcohol Policy and the Public Good had been based almost entirely on material from developed societies.

The original idea of this book, then, was to prepare a volume in the tradition of Alcohol Policy and the Public Good, but drawing on material from developing societies, and directed at audiences in those societies.

The primary audience for which this book is written is those involved in dealing with alcohol problems in developing societies. This includes not only public health workers, and those involved in work in health, social work, law enforcement and public administration, but also policymakers and concerned citizens. The WHO also had in mind an audience of students and scholars in developing societies. Besides these primary audiences, it is hoped that scholars, public health workers, policymakers and others from developed societies will also find that a sustained look at alcohol issues in the context of developing societies sheds new light and opens interesting perspectives on major issues in the field.

The book brings together sections written by the foremost experts in their fields and thoroughly examines the available data on the subject. In the concluding chapter, the principal lessons to be drawn from the substantial literature available from developing societies on the different strategies for managing and reducing rates of alcohol-related problems are summarized:

• The politically easy strategies are often the least effective.

• Well-designed alcohol education is an appropriate part of the school curriculum, but is unlikely by itself to do much to reduce the rates of alcohol problems in a society.

• Likewise, a low-intensity public information and persuasion campaign may have the symbolic value of appearing to do something about problems, but will usually have little practical effect on them.

• Provision of treatment is a worthy and humane initiative in a modern society, but its primary justification is in terms of help given to drinkers and their families. In and of itself, it is unlikely to lead to a reduction in a society's rate of alcohol problems.

• Evaluation studies have demonstrated that measures that restrict and channel sales and consumption of alcohol can be effective in holding down or reducing rates of alcohol-related problems, including harm to those around the drinker.

• Effective measures include taxation to limit consumption levels, specific licensing of alcohol outlets, limits on the number of outlets and on the times and conditions of alcohol beverage sales or service, minimum-age limits, and drinking-driving counter-measures.

• Government monopolies of all or part of the retail or wholesale market have often been effective mechanisms for implementing alcohol control measures, while ensuring equitable availability.

• Limits on advertising and promotion, and requirements for warning labels or signs, are also of symbolic importance, though it is often difficult to demonstrate their short-term effectiveness in changing drinking behaviour.

The book closes with the following conclusion:

"Alcohol has been entwined with nearly all human societies throughout recorded history. In the current world its use is very broadly spread, though probably only a minority of all humans alive drink alcohol beverages at all. For many drinkers, alcoholic beverages have positive connotations and pleasant associations. Since regular drinking tends to be more common among the affluent and powerful in many societies, attitudes favouring ready availability of alcohol tend to be over-represented in policy-making circles. But the harmful consequences of alcohol use, both for the users and for others, are extraordinarily diverse and widespread. Often these consequences bear hardest on population segments with little political power.

"The harm from drinking, which includes not only adverse consequences for health but also major social problems, makes alcohol a very special commodity, not just another item of trade or commerce. [T]his is readily apparent in the context of developing societies. A global perspective on alcohol policy needs to acknowledge and take into account all the characteristics and contradictions of alcoholic beverages, and yet to focus and act on the public health policy goal: to minimize the harm from drinking.
"This goal is often stated but little acted upon by governments across the globe. In the developing world, changing patterns of alcohol production, trade and use have combined with the demands of development and urbanization to produce rates of alcohol problems that are substantial by any measure. yet often unmeasured, unmonitored, and underestimated in their impact.

"Although the pace of change in developing societies is rapid, the direction of change in levels of alcohol problems is not inexorable. Policies that effectively reduce the level of social and health harms from alcohol require preparation and planning. Developing the knowledge base is an important first step: documenting levels and trends in alcohol-related problems, reaching an understanding of how drinking levels and patterns contribute to these problems, and assessing and disseminating knowledge of strategies that are effective in reducing the rates of alcohol problems."

Alcohol in Developing Societies: A Public Health Approach
Finnish Foundation for Alcohol Studies in collaboration with the World Health Organization, 2002, 276 pages
ISBN 951-9192-63-8 is available at Swiss francs 23. -/US $20.00, (in developing countries: Sw.fr. 16.10)

Published by the World Health Organization, Geneva.