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15. Linkages between Poverty and Alcohol

15.1 Introduction Alcohol related issues can be considered as one of the more controversial topics in the world due to different cultural values and its often negative social and health outcomes. Given its addictive nature, alcohol is viewed as different from many other consumer products. For governments, taxes on alcohol can be an easy means of revenue generation. Nonetheless, given that excessive alcohol consumption is associated with a plethora of health, social, legal and economic issues, the costs often outweigh any positive revenue related issues. Many countries, including Sri Lanka, are increasingly looking to restrict consumption of alcohol through various measures such as prohibitive taxes, bans on alcohol related advertising, etc.

Although, some studies have shown that moderate consumption of alcohol can be good for health, many other studies suggest that alcohol consumption is harmful. On the one hand, non-health related studies have suggested that alcohol consumption is associated with celebration and pleasure, relaxation and reward. On the other hand, other non-health related studies argue that alcohol consumption is associated with health issues and criminal offences. In particular, excessive alcohol consumption has direct and indirect effects on poverty. In Sri Lanka, health activists point out that the countrys third biggest health issue is related directly to alcohol consumption. In addition, it is found to be positively correlated with crimes, domestic violence, low labour productivity, injuries and accidents. These consequences of alcohol consumption are particularly severe for the poor people in the country.

15.2 Key Issues of Poverty Poverty is clearly a complex economic, social and cultural phenomenon. It is not just an inadequacy of direct income to meet basic needs or the inability to spend. In most cases, it is associated with numerous characteristics such as lack of assets, landlessness, unemployment or underemployment, illiteracy, malnutrition, high infant mortality, large

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family size, low productivity, low position in the social hierarchy, low access to publicly provided goods and services, poor infrastructure facilities and extreme vulnerability to natural calamities, disease and social conflicts. Some of the key factors related to poverty in Sri Lanka are as follows: There is evidence to suggest that free education and efficient health care delivery have positive impacts on the population and on reducing overall poverty. To deal with high levels of inequality, of income, land and other assets, and to reduce poverty effectively, it is necessary to have sound macro-economic policies to promote growth coupled with pro-poor delivery. Poverty reduction also requires effective safety nets to mitigate the impact of personal and natural calamities like droughts, floods, landslides, etc. Inappropriate targeting of welfare benefits is also one of the major reasons for persistent high incidence of poverty in the country. Insufficient infrastructure development facilities and lack of access to services (such as proper road network, water resources and electricity) in many parts of rural Sri Lanka is one of the major issues which hamper poverty reduction.

15.3 Links between Alcohol and Poverty In addition to the above, excessive use of alcohol has also contributed to the incidence of poverty in Sri Lanka. Sri Lanka is estimated to have one of the highest per capita levels of alcohol consumption in the world. Excessive alcohol consumption has both a direct and an indirect effect on the poverty status of individuals, families, and the entire community. Excessive consumption has negative impacts on the achievement of key human development outcomes in health and education, and is a key driver for poverty in the long run. In Sri Lanka, alcohol consumption is found to be higher among poor families compared to non-poor families.1 In rural areas, people who drink do so heavily consuming locally produced alcohol for the most part. Thus, poor households tend to spend a larger percentage of their income on alcohol, while the government is providing financial support to the same target group.
1

Jayathilaka, R. (2007), Alcohol and Poverty: Are they Related? Empirical Study from Sri Lanka, Sri Lanka Economic Journal, Vol. 8, No. 1.

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Apart from the money which is spent on drink, excessive alcohol consumers often suffer many economic problems such as indebtedness, lost employment opportunities and reduced wages, increased medical expenses, and decreased eligibility for development opportunities which are available at local levels (e.g., microfinance loans, incentives, etc.). Normally, a heavy drinkers expenditure on alcohol takes up a large share of the income, implying that the household will get affected by indebtedness. This usually affects the education of the children of such households as well. When parents are addicted to alcohol, the mental and social development of children may also get affected as a result of being exposed to in-family violence, etc.

Alcohol addiction in adults can also affect the education of children as well as the nutritional status of the entire family. One of the reasons for poor families to be persistently poor is due to such reasons.

15.4 Availability of Alcohol There are two types of easily identifiable alcohol sectors in Sri Lanka, namely, the legal and illegal (kasippu)2 sectors. Home based brewing of alcohol in Sri Lanka is illegal. However, this illegal brewing is a lucrative business in most parts of the island. After any increase in taxes on alcohol, alcohol prices rise and products of the illegal industry become more and more attractive to consumers. Illegal alcohol is more harmful to consumers. Anecdotal evidence suggests that many people have faced severe health problems loss of eyesight, brain damage, paralysis, etc. due to the consumption of kasippu. Thus, free availability of cheap alcohol aggravated by unemployment and underemployment is a major reason for addiction to alcohol, particularly in the rural sector. In the plantation sector, women also consume large quantities of alcohol due to the harsh nature of the work, climatic conditions, as well as due to cultural factors. All these contribute to aggravating poverty conditions in these vulnerable sectors and segments of society.
2

This is the most common and accepted name of illicit brewing in Sri Lanka.

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A study by the World Health Organization (WHO) highlights that kasippu makes up 92 per cent of total alcohol consumption in Sri Lanka, amounting to 625 million litres, while legal alcohol consumption amounts to only 55 million litres.3 Thus, per capita consumption of hard liquor is about 36 litres and this is considered a high level of consumption. According to industry sources, in the last five years, the legal alcohol sector has grown by 10-12 per cent while the illegal liquor sector has also been growing at a much faster pace. Nevertheless, soft liquor consumption in Sri Lanka has been declining over the last five years while hard liquor consumption has been increasing. Therefore, in Sri Lanka, hard liquor contributes more towards alcohol consumption at an increasing rate. This is exactly the opposite trend to movements in world wide alcohol consumption.

In recognition of the growing problem of alcohol consumption in Sri Lanka, the government has recently initiated certain measures to regulate the industry.4 Two Bills related to control of sales of alcohol for young adults, banning of advertisement, and 1 km alcohol-free distance from religious places were passed in Parliament in 2006. The expected positive impact of these approved two Bills still remains to be seen.

The existing uniform taxation of soft and hard alcohol in Sri Lanka also has some serious shortcomings that impact adversely on high risk sub-sets of the population who are mainly in the poorer groups. The overall level of alcohol taxation, and hence price, is likely to be one factor underlining the increasing consumption of illicit alcohol, and the related adverse effects.

However, there is no unique solution to the kasippu threat in Sri Lanka. Whilst it is recognized that kasippu dealers and supporters of kasippu sellers are engaged in illegal activities, enforcing the laws has been difficult, and often ineffective. In many instances, there is collusion among kasippu dealers, the law enforcing authorities and some

3 4

WHO (2004), Global Status Report on Alcohol, World Health Organization, Geneva. The government has spelt out its policy towards alcohol under the Mathata Thitha programme.

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politicians. Such an undesirable situation needs to be changed to control the kasippu threat effectively in Sri Lanka given the significant downside effects on health, particularly on the vulnerable poor in the country.

15.5 Health Issues Alcohol has been identified as one of the most harmful products to human health. Studies have found that around 4 per cent of the burden of disease worldwide is due to alcohol.5 In addition, alcohol consumption is estimated to contribute to more than 60 health related problems. These include chronic diseases such as cirrhosis of the liver and certain cancers, as well as poor health resulting from trauma, violence, and accidental injuries. Therefore, most governments try to control the consumption of alcohol through laws, although very few countries ban alcohol entirely. On the other hand, the World Health Organization (WHO) has recommended that its member countries should develop national control policies to prevent excessive alcohol use. Nonetheless, there are significant variations to be found between national alcohol policies.

Many studies in Sri Lanka have documented that alcohol is an important factor in the persistence of poverty in the country.6 Many families are found to be unable to escape from poverty because of the alcohol and tobacco use of one or more of their members. Once influenced by alcohol use, poverty itself may be exacerbated by absenteeism, lack of motivation, ill-health and lack of a family unity.7 It is a leading risk contributor to the burden of disease and a key cause of disability, especially among men. Thus, excessive alcohol consumption generates a wide range of interrelated negative effects and outcomes, some primary and others secondary. Most common primary consequences are domestic violence, violence against women, injuries and accidents, petty crime, violence, and declines in labour productivity.
5

See Rodgers A., et. al. (2004), Distribution of Major Health Risks: Findings from the Global Burden of Disease; Room, R., et. al. (2005), Alcohol and Public Health, Lancet, 365: 51930. Room, R. et al. (2002), Alcohol in Developing Societies: A Public Health Approach, Finnish Foundation for Alcohol Studies in collaboration with the World Health Organization. Baklien, B. and D. Samarasinghe (2003), Alcohol and Poverty in Sri Lanka, FORUT, Norway.

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From a health activists point of view, alcohol consumption has resulted in serious health and safety issues that adversely affect society. The WHO (2004) highlights that the effect of alcohol consumption on the health of the population is the third biggest issue in Sri Lanka, followed by premature death caused by tobacco, and high blood pressure. While there is no guarantee that abstaining from alcohol consumption will reduce poverty levels it will certainly help to reduce the health hazards, violence, and indebtedness of individuals and households indirectly helping to sustain income levels of affected households.

15.6 Community Level Intervention Alcohol and related problems especially among the rural population is a community based activity which is perhaps best tackled at the community level. Generally, a community is guided by leaders of religious places, respected elders of the community, government servants, law enforcement authorities, etc. Such community leaders are in a position to guide the community more effectively and, therefore, their contribution at the community level to eradicate the menace of alcohol abuse will be more productive.

Community level programmes focus on changing the environment in which a person consumes alcohol, rather than the behaviour of the individual drinker. There are several community activities which can be adopted to discourage alcohol consumption. First, the use of media to target policy makers, as opposed to the general public, in support of programme goals. Secondly, building an environment to focus on mobilizing the community to make structural and system changes, rather than on persuading individuals to change their behaviour. Finally, community and environment activities can generally target the supply of alcohol through social and market systems as opposed to the demand for alcohol by individuals. Such environmentally based community prevention programmes represent an important and promising approach to the reduction of alcohol problems.

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In the current environment of reduced state involvement in social and economic activities, the community emerges as the natural vehicle for taking action against alcohol related problems as long as the freedom of the community to act is not constrained or diluted by political regimes. Communities need to be supported in this task and lasting change is most likely when the people who are affected are part of the change process. The complexity of how a community functions also has to be taken into consideration and harnessed. The most positive change is likely to be achieved by operating at the level of the overall community system so that the structure and operation of the whole community are geared to ways that support safer drinking, avoiding illicit brew.8 This can best be implemented only when community intervention is free of politics.

15.7 Conclusion Sri Lankas alcohol policy has to take into consideration issues of illegal alcohol, legal alcohol, pricing and quantities as determining factors when formulating policy within the context of cultural and religious values. However, effective alcohol policies are those that control access to alcohol, determine how alcohol is being distributed and influence various high-risk activities. An effective approach may include efforts to implement multiple policies, including policies aimed discouraging illicit and illegal alcohol. Availability of cheap illicit alcohol is a society-wide problem which has to be tackled at both the national and grass root levels. Other measures include ensuring that there is no police/political interference in the enforcement of laws and regulations. Educating the younger generation in society about the harmful effects of excessive alcohol consumption could also be a major component in an effective alcohol policy. The problem of alcohol consumption should be tackled through a well coordinated education programme at the national level through the school education system.

IPS (2007), A Framework for Formulation of a National Alcohol Policy: Background Paper and Analysis to Guide Government Policy on Alcohol, unpublished document.

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