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close this bookAlcohol-related Problems as an Obstacle to the Development of Human Capital (WB)
close this folderLevels and trends in alcohol-related mortality and morbidity
View the document(introduction...)
View the documentAlcohol-related mortality
View the documentEvidence from developing countries

(introduction...)

One useful measure, in trying to assess the impact of alcohol consumption on mortality, is to calculate the age-standardized mortality rates for alcohol-related diseases and then to compare the rates across countries. Table 2 lists the age-standardized mortality rates for the four principal alcohol-related diseases across countries. Analyzing the age-standardized mortally rates in relation to the per capita consumption of a specific country may reveal interesting trends. Using Costa Rica as an example, we compare mortality dare from table 2 and figure 7 with consumption data from Annex table A-l. The data are revealing. Agestandardized mortality data in table 2 indicates that Costa Rica experiences high mortality rates for cancer of the liver and cirrhosis, 7.47 and 11.96, respectively, while figure 7 shows that between 1983 and 1986 the number of deaths attributable to cirrhosis increased for every age group. These elevated rates may be partially explained by the consumption dare in Annex Table A-l, which indicate that between 1970 and 1989 total alcohol consumption in Costa Rica increased from 2.2 to 3.2 liters of alcohol per person (this figure is likely much higher if only the population over 15 is considered).


Figure 7: Age-specific Cirrhosis Mortality Rate Costa Rica, 1983 and 1986

TABLE 2: Age Standardized Mortality Rates for Alcohol-Related Diseases

Country

Cancer of Oesophagus

. Cancer of Liver

Alcohol Dependence Syndrome

Cirrhosis of Liver

Argentina

5.43

4.35

2.27

9.52

Canada

2.45

1.21

1.40

6.67

Chile

5.69

3.22

1.11

23.44

Costa Rica

3.12

7.47

2.19

11.96

Cuba

3.18

1.83

0.74

7 45

Mexico

1 30

1.26

4 90

33.97

Peru

0.75

1.42

1 43

11.13

U.S.A.

2.69

0.99

1.66

8.66

Venezuela

2.10

1.72

1.33

12.25

Philippines

4.43

0.00

-

-

Thailand

-

-

-

-

Czechoslovakia

2.29

3.53

1.46

17.01

Denmark

0.77

0.26

-

-

France

5.75

3.23

3.57

13.36

Germany, D.R.

2.06

1.29

6.17

13.67

Germany, F.R.

2.80

1.63

3.68

14.58

Hungary

3.60

5.17

4.83

38.01

Italy

2.38

4.21

0.35

17.37

Poland

2.45

6.10

1.6

8.19

Portugal

3.02

1.14

0.42

17.49

Spun

2.89

1.58

0.48

15.34

Sweden

1.80

1.61

3.15

4.42

Switzerland

5 360

0.09

-

_

USSR

4.63

-

-

-

U.K.

5.22

0.83

0.37

4.25

Yugoslavia

1.83

0.00

3.57

14.50

New Zealand

3.53

1.51

0 46

2.98

Source: Mortality Dab, International Classification of Disease, WHO, 1989

In comparison, during the same period in France, alcohol consumption per Capita declined from 17.3 liters per capita to 13.2 liters per capita. The consequences of this decline are shown in figure 8, which shows that cirrhosis deaths decreased for nearly every age group between 1977 and 1989.

The evidence from these two countries underscores the potential effect of changes in alcohol consumption on society. Changes in per capita consumption of alcohol can have a significant impact on mortality within a country. More importantly, household level effects of alcohol-related diseases may have an even greater effect on the poor, who are more exposed to other risk factors for chronic disease, harder to reach with IEC, and less likely to have access to appropriate medical care. The degree to which alcoholrelated diseases affect the poor in developing countries is unknown. However, it has been shown for other diseases that premature death and disability among the poor is likely to have a more significant impact on the health and economic well-being of the household. In addition, because alcohol is an addictive substance (whether it is because of genetic, behavioral. or chemical factors) and due to a lack of information on the part of consumers. households may not be maximizing their welfare in choosing to consume alcohol over other consumer goods.

Alcohol-related mortality

The consequences of excessive alcohol consumption are alarming. Of the approximately two million people who died from alcohol-related causes in 1989, 5 percent died in motor vehicle accidents, about half died from cirrhosis of the liver, another 10 percent died of alcohol dependence syndrome and 32 percent died of either cancer of the oesophagus or cancer of the liver (See Table 3).

The use of mortality data (alcohol-related deaths/total deaths) presented in Table 3, underestimates the problem of alcohol abuse, since most of the costs of alcohol abuse arise from nonfatal disease and injury.2 Estimating the impact of these diseases and injuries related to alcohol abuse is complex, and requires surveillance data that are currently inadequate in both developed and developing countries, despite the large social and economic effects of these conditions. It is clear, however, that alcohol abuse creates Increased demand for services in a variety of areas, including, inter alia, direct medical treatment for conditions stemming from alcohol abuse (e.g. physician fees, medication costs, and other health care charges), alcohol-related support services which include increases in program and health insurance administration, research, and medical facilities construction and reduced productivity both in terms of short-term absenteeism and on-the-joh reductions in productivity due to alcohol abuse. The following section, reviews survey evidence on the prevalence of alcohol-related problems in several developing countries.


Figure 8: Age-specific Cirrhosis Mortality Rate France, 1983 and 1989

TABLE 3: Worldwide Deaths Attributable to Alcohol

Cause of Death

Total Deaths

% Alcohol Related

Alcohol-Related Deaths

Selected References

Motor Vehicle Accidents

214,208

50 %

107,104

1

Cancer Oesophagus

805,980

75

604,485

2

Cancer Liver

488,060

15

73,209

3

Alcohol

279,930

100

279,930

4

Dependence Syndrome





Cirrhosis

2,094,110

50

1,047,055

5

Total



2,11 1,783


Sources:
(1) Parker, 1987; (2) Rothman, 1980; (3) ibid; (4) By definition; (5) Harwood, 1984; Cruze, et al., 1981; Hyman, 1981.

Evidence from developing countries

In the last decade, the level of alcohol consumption in developing countries has increased significantly. Although the social and economic costs of the associated with excess consumption are unknown, evidence from household surveys in LAC on the prevalence of illicit substances and from the literature in other developing countries confirms that alcoholism and alcohol-related problems have emerged as priority public health concerns in several Latin American countries.

In Colombia, for example, data from a questionnaire used to evaluate alcoholism indicate that 71 percent of the male study population (56 % of total population) used alcohol in the prior year. Specific questions used to evaluate the population at risk of alcoholism indicate that 7.3 percent of the total study population was at high risk of alcohol dependence, while another 8.1 percent was classified as alcoholic. Evidence of prevalence among adolescents indicates that a large percentage of the 16-19 age group was at high risk of becoming alcoholic. Even more alarming, is evidence of the impact of alcohol abuse on morbidity from several other studies of hospital patients in Latin America and one study in Kenya.

In 1984, 21 percent of all people treated for injuries in Mexico City's emergency rooms had positive alcohol readings (more than 10 mg of alcohol per 100 ml of blood) and similar levels were found in 22 percent of the emergency room cases in Acapulco in 1987. Additional research in La Paz, Bolivia found that 26 percent of the hospitalizations, during the survey period, were for alcohol-related problems. Studies designed specifically to gauge the prevalence of alcohol-related problems among the poor (Brazil 1965 and 1974), found that in peri-urhan areas 6 percent of the persons in the survey were "pathological drinkers" and the alcoholism rate was as high as 23 percent in some of the marginal areas. A similar study at a rural district hospital in Kenya found that 54 percent of the male and 25 percent of the female outpatients met a predefined criteria for alcohol abuse and/or alcoholism.

In addition to the direct affect of alcohol on increased morbidity and mortality, alcohol also produces equally damaging secondary effects. These range from the less obvious damaging effects on the family to incarceration, suicide and even homicide. In fact, a 1985 study in Mexico found that nearly 50 percent of those convicted of homicide admitted to having consumed an excess of alcoholic beverages prior to committing the crime (Medina-Mora 1990). While it is difficult to measure the impact of these problems on society, government intervention in the form of social programs is warranted to ameliorate the burden on the families of alcoholics.

As this section and the section on the cost of alcohol-related problems show, the impact of alcoholrelated problems is not insignificant and whether the problem is cirrhosis of the liver or family abuse, alcoholrelated problems are an increasing problem for developing countries. Moreover, increasing levels of income and rapidly expanding populations, a general lack of regulations and low consumer information make the developing countries an excellent market for beverage companies. While these problems have a yet untold cost to less developed societies and economies, without changes in laws and regulations which govern advertising and taxation, alcohol-related problems will only increase in the years ahead.