The excessive consumption of alcohol is a problem that alarms many policy makers in the public health arena. In the last decade, the problems related to alcohol abuse increased dramatically in many societies, both developed and developing. In many countries, one in ten individuals are clinically diagnosed as alcoholic at some point during their lives. This growth in alcohol-related problems is manifest in an increasing number of alcohol-related deaths, diseases such as cancer of the liver, and lost productivity due to alcohol dependence. While the impact on morbidity and hence productivity is difficult to measure, according to WHO mortality data, alcohol-related diseases accounted for 2 million deaths worldwide in 1989. The impact of alcohol abuse, however, extends beyond premature mortality, to include a myriad of secondary problems, ranging from child abuse to reduced worker productivity. Although the net impact of these problems is unknown, many countries have acknowledged the significant health, social, and economic costs they impose on developed and developing countries. As levels of GNP per capita rise, third world populations age, and alcoholic beverages are more widely marketed and distributed in developing countries, the number of alcoholrelated problems can only be expected to increase.
In spite of the apparently negative impact of alcohol on society, alcohol has been an important element in many cultures. From anesthesia in the civil war to fuel in many parts of the world, the production and consumption of alcohol has been am integral part of social, religious and medical life in societies all over the world. In fact, it is only recently, that the benefits of moderate alcohol consumption have been held in contrast with evidence of the deleterious effects of over-consumption. In response to a growing number of alcohol-related problems, many countries are now examining domestic policies related to alcohol consumption.
Over time, developed countries have experimented with a range of policy options, from prohibition to bans on advertising, drinking age laws and health promotion campaigns. While these policies have been effective in developed countries, resulting in stable or declining per capita consumption, they have also stimulated beverage companies to pursue new markets in less developed countries. As a result, alcohol problems have risen rapidly in developing countries.
The increasing number of health and social problems related to excess alcohol consumption, such as traffic accidents, spousal and child abuse, and diminished worker productivity impose an increasingly heavy burden on the developing countries. At a time when many countries are placing emphasis on the development of human capital, alcohol-related problems may be an obstacle to continued development. Furthermore, the economic costs associated with excessive alcohol consumption may be imimical to overall goals of national economic development.
This paper is an initial attempt to review the range and impact of alcohol-related problems and to promote the debate on the appropriate role of government in regulating alcohol consumption. Given the alcohol related problems are well documented in developed countries, this paper will draw on lessons learned in the industrialized countries and present only a cursory view of the problems in developing countries. Section II provides a review of the problems related to the consumption of alcoholic beverages. Section III will examine global trends in alcohol production and consumption. Section IV then follows with a discussion of trends in alcohol-related mortality and morbidity. Section V of the paper examines the various means of analyzing, within an economic framework, the cost of alcohol related problems. Section Vl provides a brief discussion of the cost-effectiveness of different interventions and then discusses the role of government in the prevention and control of alcohol related problems vis a vis the various policy options. And Section Vll concludes with some final remarks and a call for additional research.
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