Advocacy in action
Since its inception at the Global Alcohol Policy Conference in Syracuse, NY, in the summer of 2000, the Global Alcohol Policy Alliance (GAPA) has set itself the task of co-ordinating the work of advocates around the world.
One of the major issues which has emerged is the effort being made by the global alcohol industry to market its wares in developing countries. Just as the tobacco industry has aggressively promoted cigarettes in regions where restrictions on sale and advertising are either non-existent or poorly enforced, so the increasingly globalised alcohol producers have sought to increase their sales in areas where hitherto they have lacked penetration.
In many of the countries where alcohol sales have increased over recent decades, there has been little history of widespread alcohol consumption, usually for cultural or religious reasons. This tradition may linger on in older generations, but the young, often Westernised people of countries like Thailand or the Philippines have proved susceptible to the carefully targeted marketing of alcohol.
Speaking on the impact of alcohol in developing societies at GAPA's recent meeting in Bangkok, Leanne Riley, of the World Health Organization in Geneva, said that recorded per capita consumption is generally lower in developing societies but that unrecorded consumption brings the levels higher. As economic circumstances improve in a particular country, so the consumption of alcoholic beverages rises.
Ms Riley pointed out that patterns of use of alcohol were affected by the place of drinking in the particular culture, the customs among different groups, varied settings and norms. In many countries it was possible to observe old customs moving into new contexts. For example, changing gender roles had a direct influence on women's drinking. On the whole, it appeared to be the case that, in developing societies, those who drink, drink large amounts.
She reminded the meeting that of the top ten risks to health, as set out in the World Health Report, alcohol ranks fifth. This amounts to over three per cent of all deaths (1.8 million) and four per cent of all DALYs (Disability Adjusted Life Years) – that is 58.3 million. The proportion of this burden is higher in men (5.6 per cent deaths, 6.5 per cent DALYs) than in women (0.6 per cent deaths, 1.3 per cent DALYs).
Database
Nina Rehn, who is Technical Officer for the Management of Substance Dependence at the World Health Organization (WHO) outlined the work being done on the Global Alcohol Database, the world's largest single database on alcohol. The main indicators on which information has been gathered are per capita consumption, mortality/morbidity, and drinking patterns. Ms Rehn said that currently figures were available for per capita consumption in 178 countries and that there have been 670 prevalence studies in 122 countries. GAPA hopes that the data collected by WHO will form the science-based alcohol policies of the future.
Ms Rehn went on to discuss the varying attitudes to alcohol advertising in the WHO South East Asia and Western Pacific Regions:
In these WHO regions, as anywhere else, price, of course, has a dramatic effect on alcohol consumption and types of alcohol consumed, said Ms Rehn:
At the recent meeting of GAPA in Bangkok, the point was made again and again that young people of the developing world are increasingly being put at risk by the largely unfettered promotion of alcohol in their countries.
The Philippines
Joyce Valbuena, of the Health Action Network in the Philippines, stated that 60 per cent of teenagers in her country were beer drinkers, an increase of 15 per cent in the last eight years. The figures for those smoking (40 per cent) or using illicit drugs (7.2 per cent) show comparable increases. San Miguel beer is the most popular in the Philippines with a net profit for 2001 of $124 million and confidently expects its domestic beer sales volumes to have increased by at least 3 per cent in 2002.
San Miguel did not achieve this success without making an effort. In 2002 it spent $7.5 millions on an advertising campaign which exploited youth and sexual attractiveness. Pretty girls are the easiest way to catch the attention of young men but they themselves are also the target. The phenomenon of increased alcohol consumption among young women is not confined to western Europe. San Miguel's advertisements seek to associate attractive, sophisticated young Filippino women with their beer.
The many other beers available in the Philippines take much the same advertising route, with greater or lesser subtlety. Asia Breweries shamelessly play to the tradition of machismo. In one of their advertisements, typical of the genre, a sultry young woman, her ample bosom overshadowing a couple of bottles of beer, is leered at by a group of young men. The connection the advertiser wishes to make between the product and sexuality is clear.
In the Philippines, as in many in the same situation, whilst the marketers of alcohol have a relatively free hand and are taking every advantage of it, efforts to combat the problems arising from alcohol consumption on the part of governments is half-hearted. Ms Valbuena pointed out that, although there are governmental and non-governmental programmes for substance misuse, these are primarily aimed at smoking and drug addiction, against which alcohol is seen as a minor problem.
Rehabilitation for those with acute addiction to alcohol is difficult to access, counselling programmes are not in place, and there is little or no effort made to inform the population, especially young people, about the hazards of alcohol abuse.
Malaysia
Like other developing countries, Malaysia is facing an increasing problem of alcohol abuse. The precise magnitude of the problem is difficult to ascertain because so few studies have been carried out. One indicator, of course, is the volume of alcohol sold. Available figures show that taxes on alcoholic beverages collected for the year 1996 rose to RM 817 million from 769 million in 1994. Similarly, in 1995 there were 2, 360 public premises licensed to sell alcoholic drinks. In 1996 this number increased by 50 per cent.
The National Health and Morbidity Survey of 1996, which among other aims set out to determine the prevalence of alcohol drinking among non-Muslim adults in Malaysia, showed that, of the 23 per cent of the population who drank, 32.5 per cent reported a high intake. One result of the survey was the establishment of the National Alcohol Control Programme, the aim of which is "to reduce the level of alcohol consumption to minimise problems related to alcohol abuse".
Besides creating awareness among the general public on the health and other harmful effects of alcohol abuse, the Programme aims to "review and amend legislation". There is already a body of law in Malaysia which restricts the activities of the alcohol industry. Alcohol advertising is prohibited on radio and television, although it is permitted in the print media, cinemas, and hotels' in-house TV networks.
The Road Transport Act of 1996 imposes heavy penalties on drink drivers, including fines and imprisonment and there are relatively long-standing laws aimed at the eradication of the illicit production of samsu.
Australia
An interesting comparison in the same Region, but from a developed country, was provided by Bill Stronach who gave an overview of the situation in Australia, particularly in regard to the marketing of alcohol at adolescents.
The Alcohol Beverages Advertising Code of Australia states that advertisements must "present a mature, balanced and responsible approach to the consumption alcohol beverages" and they must not "have a strong or evident appeal to children or adolescents" Furthermore, there must be no suggestion "that the consumption or presence of alcohol beverages may create or contribute to a significant change in mood or environment".
The Australian Drug Foundation conducted a survey of adolescents in the 13 to 17 age range and found that 70 per cent of them drank alcohol. The proportion of drinkers in rural areas (74 per cent) and metropolitan regions (69 per cent) were similar. 56 per cent of these young drinkers spent their own money on alcohol – at an average of $22 on the last occasion of purchase. Alcohol ranked as the fourth most common expense for young people.
37 per cent of the drinkers among young people obtained their alcohol from friends over 18 years old, 26 per cent from their parents, and 14 per cent bought the alcohol illegally themselves. 46 per cent consumed ready-to-drink products and 33 per cent had consumed spirits on the last occasion. Taste was the most common reason given for selecting the last drink consumed (58 per cent).
Among young people, the type of alcohol advertising recalled was generally associated with the alcoholic drink last consumed – for example, those who last consumed a ready-to-drink product recalled an advertisement for a ready-to-drink product. More non-drinkers (21 per cent) than drinkers (7 per cent) recalled health promotion advertisements.
Bill Stronach linked the survey of young Australian drinkers to an examination of a television soap opera directly aimed at their age group, "The Secret Life of Us".
The characters portrayed are largely young and attractive. Twenty-two episodes aired in 2001, at an average running time of 43.5 minutes, were studied. Two measures were taken: the frequency with which alcohol was shown and the screen time it occupied.
Alcohol featured in 25 per cent of scenes, ranging from 11 per cent to 45 per cent of each episode. Alcohol was visible on screen for an average of 4.54 minutes (11.5 per cent of time). The range was between 8.08 and 2.15 minutes. Of the scenes featuring alcohol, 48 per cent showed beer, 30 per cent wine, 14 per cent spirits, 5 per cent mixers, and 3 per cent champagne. The most common brands shown were Crown lager and Vic Bitter.
In the soap, 100 per cent of characters consumed alcohol. Excess consumption was shown in a number of episodes with few adverse consequences being shown. The alcohol use was shown mostly in the context of social interaction. The implication was clear that young people were being shown alcohol as a natural part of the life of their age group and an inevitable part of the relationship of attractive and enviable people.
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