Alcohol burden of disease even greater than previously believed

Infectious disease linked to alcohol

Developing countries worst affected

Alcohol’s contribution to the global burden of disease is much greater than previously suggested if infectious diseases are also taken into account.

This is one of the conclusions of an investigation into the problem commissioned by the Swedish Ministry of Health and Social Affairs and co-financed by the Norwegian Ministry of Health and Care Services.

The report of the investigation explains that alcohol consumption, in a dose-response manner, but especially heavy drinking and alcohol use disorders, increases the risk of contracting infectious diseases such as TB and pneumonia, as well as the progression of TB and HIV. Further, heavy drinking or alcohol use disorders may impair the use of preventive services for infectious diseases and treatment compliance, and may also create risk to others by those already affected. The relationship between alcohol and the risk of infectious diseases can be compounded by poverty, social exclusion, and social mixing patterns, including frequenting specific drinking establishments.

The global picture

The report concludes that globally, alcohol-attributable infectious diseases make up 13.5% of the detrimental impact of alcohol consumption on global mortality. While in absolute terms the disease burden of alcohol-attributable infectious disease is larger for men than women, the proportion of the alcohol impact is fairly similar by gender (mortality: infectious diseases make up 14.1% of the overall detrimental effect for men, and 10.5% for women).

The impact of alcohol consumption on burden of disease and injury is largest in low income countries with relatively high consumption in Saharan Africa or South America, where on average 30% of all the alcoholattributable burden is due to infectious diseases. In some countries, such as South Africa or Nigeria, infectious diseases make up about 50% of the overall alcohol-attributable disease burden.

In general, even though for lowto middle-income countries, the higher the economic development, the higher the adult per capita consumption, alcohol-attributable mortality and mortality per litre of pure alcohol per capita are highest in countries with the lowest incomes. Part of this relationship, the report suggests, can be explained by the clustering of infectious disease in poor crowded regions, often characterized by malnutrition, where alcohol’s effects on the immune system can be enhanced.

Prevention

In regard to reducing the harm from alcohol, particularly in low to middle income countries, the report says that the implementation of proven, cost-effective policy interventions will reduce the incidence and progression of alcohol-related infectious diseases as well as improving economic and social development.

Focus should be on bringing illicit markets under effective government control, managing the price of alcohol and regulating the availability of alcohol in urban environments. Both general interventions, with the aim to reduce consumption, and, in particular, heavy consumption, and joined up interventions, such as the implementation of brief interventions and other alcohol treatment options integrated within the treatment system for infectious diseases, should be included as part of an integrated alcohol policy package to minimize harm.

In many countries, there will be a need to build public health infrastructures for alcohol policy, including political will and the development of a national alcohol action plan that deals with the issues of social development and alcohol’s role in communicable and non-communicable diseases. Development agencies and philanthropic foundations should provide technical support and aid capacity building to develop, implement, and assess alcoholcontrol policies and joined up work between communicable diseases and actions on alcohol, supported by stronger international governance for alcohol control.

J. Rehm, P. Anderson, et al: Alcohol, Social Development and Infectious Disease. September 2009.

The report can be accessed at: http://www.se2009.eu/en/ meetings_news/2009/9/23/ global_expert_meeting_on_ alcohol