A crowd gathers to watch an intoxicated youth as a police officer comes to his rescue in Nyeri town, Central Kenya. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, Mar 27 2015 (IPS)

Despite legislative attempts to curb drinking, Kenya is still facing its greatest threat from alcohol abuse. Calamities associated with excessive intoxication – dementia, seizures, liver disease and early death – have done little to deter users.

Not even confirmed reports by the Ministry of Health and government agencies such as the National Authority for Campaign against Alcohol and Drug Abuse (NACADA) that illicit brewers have been turning to lethal embalming fluid used in mortuaries have cut the rate of abuse.

“Patrons want to spend as little as possible but drink as much as they can, so they opt for cheap illicit brews, especially spirits,” says Nduta Kamau, who brews home-made alcohol in the sprawling Mathare slums in Nairobi.The [Kenyan] Alcoholic Drinks Control Act was substantially weakened in 2013 with the introduction of “devolved government”. This system of ‘home rule’ means that each county government must ratify the act – an uphill battle because some county leaders are also the owners of bars.

According to Kamau, those who brew illicit alcohol also spend as little as possible “in time and money but produce as much alcohol as they can”, while chemicals used in the mortuary speed up the production process, “so we are able to produce a lot of alcohol in a very short time.”

Kamau adds that illicit brews from dens in the slums are bottled, labelled and sold in pubs across the country. A series of police raids in these dens have found women’s underwear and dead rats in the brew.

The Alcoholic Drinks Control Act of 2010 restricts the sale of alcohol to between 5 pm and 11 pm, but drinkers are finding their way around the curfew.

Data collected by Euromonitor International, a market research firm, revealed that alcohol bought in shops or off trade beer sale during the curfew in December 2012 rose by 4.35 percent to 26.4 million litres.

“They [patrons] lock themselves up in pubs and drink during curfews or they buy the alcohol and drink in their homes exposing their children to alcohol from a very young age,” says Dave Kinyanjui, a bar owner in Nairobi’s downtown area.

The Alcoholic Drinks Control Act was substantially weakened in 2013 with the introduction of “devolved government”. This system of ‘home rule’ means that each county government must ratify the act – an uphill battle because some county leaders are also the owners of bars.

Increased drinking has meant higher profits for commercial brewers. A report last month by the East African Breweries Limited (EABL) noted an average 11 percent increase in profit from beer sales.

According to EABL, the highest growth in sales – at 67 percent – was in spirits, mainly targeting the lower income earners, who are also the target for the many brands from informal sources.

Another report released by Euromonitor International confirmed the steady growth in alcohol consumption, which could rise as the economy improves further, saying that “the alcoholic drinks market is set to expand over the forecast period as the economy is expected to grow tremendously during this time due to bright prospects of oil in Kenya and political stability.”

With the availability of non-returnable bottles and cans, it has never been easier to carry alcohol to the house.

A 2012 national survey by NACADA showed that alcohol is now the most abused substance in the country and of the different types of alcoholic drink, traditional liquor is the most easily accessible, followed by wines and spirits and last but not least Chang’aa (which literally means ‘kill me quick’).

According to an “Alcohol Situation Analysis” for 2012 by the regional office of IOGT-NTO, a global temperance movement: “out of the number of people interviewed, 63 percent had used alcohol and 30 percent had more than five alcoholic beverages per sitting, which is heavy episodic use. Teenagers between 14-17 years of age are having two alcoholic beverages per sitting.”

Government statistics also show that alcohol and drug abuse is highest among young adults aged 15 to 29 years and lowest among adults of 65 years and older.

Under-age and rural children have not been spared. According to NACADA, rural children are more likely to have consumed traditional liquor and Chang’aa than urban children.

David Ogot, national coordinator of Alcohol Awareness in Kenya and a recovered alcoholic, told IPS that “excessive drinking is often viewed as a passing problem until it really gets out of hand, at which point most families hide the issue due to shame.”

He said that there is now a great need to address “alcoholism and to stop justifying the behaviour of an alcoholic.”

Alcoholics wanting to end their addictions have little recourse, according to Dr William Sinkele, Executive Director of Support for Addictions Prevention and Treatment in Africa (SAPTA). While Kenya has over 70 in-patient treatment centres, only three are government-run, he told IPS – Mathare Hospital (with an addiction unit), Coast General Hospital and Portreitz Hospital. The rest are privately owned.

“While is it is good that we have this many treatment centres, most are concentrated around the Nairobi area.  We do not have many centres outside Nairobi.  The average Kenyan with an alcohol or drug problem cannot afford treatment,” he said.

Meanwhile, many of those fighting alcohol abuse in Kenya point an accusing finger at the global alcohol industry which has a big foothold in Kenya and has undermined proper implementation of the Alcoholic Drinks Control Act with aggressive advertising and promotion through musical and artsy events.

A press release from financial advisors KPMG, titled “Incredible Growth of Kenya’s Beer Market“ noted: “Driven by strong population growth, a growing middle class and a dynamic private sector, the beer industry in Kenya has taken off in impressive ways, and is promising of even further developments in the coming decade.” Only inflation and tax increases could diminish this rise, it said.

“To expand its customer base, “the company has accordingly invested in marketing and sales capabilities in this area.”

Meanwhile, in a blog on the IOGT International temperance website,  Brenda Mkwesha wrote: “The odds seem to be against us, but we have heart-driven teams who aren’t willing to stand by while we flush our lives down the toilet. Here’s to a Life Set Free!”

Edited by Lisa Vives/Phil Harris   

By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America. Credit: Bigstock

By Laurent Huber
GENEVA, Jul 7 2014 (IPS)

Undeniably, the Millennium Development Goals (MDGs) helped lift specific health concerns onto the global agenda.

For example, maternal mortality, which is addressed in MDG 5, declined 45 percent from 1990 to 2013, while deaths of children under five (MDG 4) dropped from 12.4 million to 6.6 million worldwide from 1990 to 2012, (both statistics from the World Health Organisation).If trends do not change, by 2030 NCDs will be the leading global cause of disability.

Despite those impressive advances, the world is facing new development challenges. For this reason, the Sustainable Development Goals (SDGs) that will replace the MDGs in 2015 must expand the list of health goals to include non-communicable diseases (NCDs) – the world’s #1 killer.

NCDs account for 60 percent (35 million) of all deaths. They include cancers, cardiovascular and lung disease, and diabetes, but they are not – as many people believe – ‘lifestyle’ diseases afflicting old people in rich countries. The largest burden – 80 percent, or 28 million deaths – occurs in low-middle-income countries (LMICs), making NCDs a major cause of poverty and an urgent development issue.

If trends do not change, by 2030 NCDs will be the leading global cause of disability. In addition, between 2011 and 2031 the diseases would have cost the world economy 30 trillion dollars, the equivalent of 98,400 dollars for every person in the United States.

Tobacco is the leading risk factor for NCDs. One hundred million people died from tobacco-related disease in the 20th century, and unless the global community acts decisively, one billion people will die in the 21st century. By 2030, 80 percent of deaths from tobacco will be in the poorest countries in Asia, Africa and South America.

In 2011, world leaders assembled for the first time at the United Nations to discuss the growing NCDs epidemic. The Political Declaration they issued concluded that the burden of NCDs “undermines social and economic development throughout the world”.

It noted that NCDs strike people in LMICs during their prime working years, and that close to half of all NCD deaths in these countries occur below the age of 70, and nearly 30 percent under age 60. As well, most NCDs deaths are preceded by long periods of ill health.

These illnesses, and early deaths of families’ main income earners, result in loss of productivity, which drags down economic growth and development.

Social determinants, such as education and income, influence people’s vulnerability to NCDs and exposure to risk factors. Individuals of lower education and economic status are increasingly exposed to NCDs risks and are disproportionately affected by them. For example, in countries such as Bangladesh, India and the Philippines, tobacco use is highest among the least educated and poorest segments of the populations.

At the same time, having an NCD may also contribute to social inequalities. The financial burden associated with these diseases increases the risk that families will be unable to send children to school and, under-educated, the risk grows that those children will live in poverty for the rest of their lives.

What can be done? There are four modifiable risk factors for the main NCDs: unhealthy diets, physical inactivity, harmful use of alcohol and tobacco use. While work continues to adopt global tools to tackle the first three factors, there is consensus on how to fight the tobacco epidemic.

In 2003, the world’s governments adopted the WHO Framework Convention on Tobacco Control, the first modern-day public health treaty. It contains a number of measures that Parties commit to implement, including: smoke-free public spaces, pictorial health warnings on packages, price and tax measures to increase the price of tobacco – which discourages consumption – and complete bans on tobacco advertising.

Today the FCTC has 178 Parties, representing nearly 90 percent of the world’s population. In the battle against NCDs, “There is no other ‘best buy’ for the money on offer”, said WHO Director-General Margaret Chan in 2011.

Recognising the potential of global tobacco control, the Political Declaration of the 2011 NCD Summit:

• Urged greater efforts from countries to implement the FCTC;
• Called on countries that are not Parties to the FCTC to accede to the Convention;
• Noted the importance of tobacco taxation as a strategy at the national level;
• Recognised the irreconcilable differences between the tobacco industry and public health policy.

Building on the Declaration, in May 2013 the World Health Assembly endorsed the Global Action Plan for the Prevention and Control of NCDs, 2013-2020. It includes a target for cutting tobacco use: a 30 percent relative reduction in smoking prevalence by the year 2025.

A stand-alone goal, Attain healthy lives for all, has been proposed for the SDGs. Its sub-goals include: “By 2030 reduce substantially morbidity and mortality from non-communicable diseases (NCDs) through prevention and treatment…” and “Strengthen implementation of the Framework Convention on Tobacco Control in all countries who have ratified the Convention and urge countries that have not ratified it to ratify and implement it”.

Including NCDs and the FCTC in the development goals that will be announced by the UN General Assembly in 2015 will also ensure that battling the tobacco epidemic becomes a national priority, and prevent millions of premature deaths.

Laurent Huber is Director of the Framework Convention Alliance.

In Russia, vodka is a killer. Credit: Pavol Stracansky/IPS.

By Pavol Stracansky
MOSCOW, Feb 15 2014 (IPS)

Sitting in the dining room of a Moscow hotel, manager Yulia Golovanova explains why she always likes to see Russians, rather than foreigners, bring guests in.

“Just watch them,” she says as eight well-dressed men sit down at a table and immediately order vodka. “They come in, order round after round of vodka and keep on drinking. When there’s a big group of them they can spend huge amounts on alcohol alone,” she tells IPS.A quarter of Russian men die before they are 55, with most deaths down to alcohol consumption.

Less than an hour later the men have each consumed at least a quarter of a litre of vodka as well as glasses of beer and wine and show no signs of stopping.

The scene – a group of men drinking large quantities of hard spirits – is far from uncommon in a country with one of the highest per capita alcohol consumption rates in the world and where alcoholic overindulgence is ingrained in the culture.

But drinking in Russia has, over the years, taken a massive toll on the country, and, left unchecked could have disastrous consequences, experts say.

Tatiana Mironova, director of the Moscow-based National Centre for Public Health Monitoring, which works to reduce alcohol abuse, tells IPS: “If nothing changes or if alcohol consumption gets worse, the negative effects of drinking, in terms of the health burden and associated social problems such as domestic violence and others, will only get worse.”

Data on drinking in Russia paints a grim picture. The Russian Health Ministry says alcohol consumption per capita is 13.5 litres – twice the global average and well above the nine-litre mark which the World Health Organisation considers dangerous.

A study by the Lancet medical magazine published last month showed that a quarter of Russian men die before they are 55, with most deaths down to alcohol consumption. In comparison, the figure in the United Kingdom is seven percent and in the United States just one percent.

Experts say that what makes Russia’s problem unique is the way people drink with a prevalence of binge drinking and a preference for spirits.

While its alcohol consumption rate is actually lower than some European states, the main drink of choice in Russia, especially among men, is vodka. And it is often drunk in binges.

The effects of the country’s problem with alcohol abuse are stark. Apart from the fact that the premature death rates contribute to Russia’s already shrinking population, the Russian government estimates that the economy loses up to 100 billion dollars per year to drinking.

Other studies have suggested that as many as three-quarters of murders are committed, and almost half of suicides occur, under the influence of alcohol. Drink also plays a role in an overwhelming number of deaths from drowning, fires and falls. Law enforcement bodies say it plays a significant role in high rates of criminality, domestic violence, sexual assault and child abuse.

“Both government and wider society are aware of the direct relationship between alcohol consumption and social problems,” says Mironova.

Sociologists often cite Russians’ propensity for heavy drinking to a need – dating back throughout the nation’s history – for people to escape from widespread poverty and repressive regimes. Its historically low price and ubiquity has also meant it has always been easily accessible to the wider population. Vodka now costs just 4.50 dollars for half a litre and that price has only recently been raised.

Heavy drinking and rampant alcoholism across the country have been well documented from tsarist times right through the communist era to today’s capitalist society.

Authorities have attempted to deal with them. As far back as 1985, then general secretary of the Soviet Union’s Communist Party Mikhail Gorbachev introduced a series of measures cutting alcohol production, restricting sales and hiking prices.

While enormously unpopular with the public, the restrictions had an immediate impact on national health. Alcohol intake in the country fell by 25 percent, as did the premature death rate.

Following the lifting of those restrictions and the break-up of the Soviet Union, drinking soared once more, and with it premature death rates.

In recent years the Kremlin has looked to cut dangerous alcohol consumption once more, and a series of laws restricting sale, pricing and advertising of alcohol have been brought in.

The restrictions appear to be having some success. The Lancet study shows that while the premature death rate remained very high – more than four times the Western European average – it dropped one-third since 2006 when restrictions on alcohol were first introduced. Consumption of spirits fell by the same amount in the same time.

Professor Sir Richard Peto, an epidemiologist at Oxford University in the UK and co-author of the study, tells IPS: “This illustrates that the changes introduced since 2005 have had an effect and that, with more effort, the premature death rate [from alcohol] can be reduced further. It is not impossible.”

Experts agree that raising prices is crucial to any further success while controls on advertising and sales need to be strictly maintained or tightened even further.

But that alone will not be enough, they say.

“What is needed is not only measures to limit the marketing and sale of alcoholic products, but also active efforts to reduce the demand for alcoholic products. There need to be preventive and educational measures among people as well as prevention of alcohol abuse in the workplace and in primary health care,” Mironova says.

The government seems committed to improving the health of the nation. Besides the vodka restrictions it has recently banned smoking in public places and put restrictions on tobacco advertising and sales.

Health ministry plans envisage further rises in vodka prices up until at least next year. The ministry says it wants to see annual consumption of spirits reduced to eight litres per person.

How successful that will be in a country where many locals readily admit that massive consumption of spirits is an integral part of their culture is hard to predict.

At her restaurant, Golovanova quietly watches the businessmen order more shots of vodka. “Drinking causes so many problems in Russia, but many Russians just don’t see drinking heavily as a problem,” she tells IPS. “They see it as something completely normal.”