By The Caribbean Voice
The Caribbean Voice is a New York-based NGO that has been involved in social activism since its launch in 1998.
Editor’s Note: In light of the recently reported statement by Minister of State, Joe Harmon, that Cabinet had not had any discussions on the question of a referendum to repeal laws criminalizing same-sex sexual activity, the column will revisit the important question of Guyana’s multiple obligations under both domestic and international law at a later date.
In a letter to the local media recently, social activist, Vidyaratha Kissoon, asked, “Will Guyana have to wait on the World Health Organisation before it admits it has a problem with alcohol consumption and do something about it?” Kissoon advocates for a ‘No Alcohol Day,’ a call supported by The Caribbean Voice, and we are certain, many other NGOs and social activists. He added that, “The legislation on tobacco control should be copied so that alcohol consumption should be banned from the same places where tobacco smoking is forbidden” and pointed out that whereas the proposed Tobacco Control Bill bans advertising and sponsorship, the alcohol industry in Guyana aggressively promotes their product ($4.8 billion spent in 2009 to ‘normalize’ drinking) which causes the highest disease burden through sports and other entertainment while Cricket Australia is reportedly now considering banning alcohol sponsorship from cricket. Incidentally, The Caribbean Voice had condemned the availability of barrels of rum on display at cricket matches at the National Stadium.
Kissoon’s points are well taken, especially given the following: on average, Guyanese consumed more than eight litres (17.5 grams daily) of pure alcohol in 2010 compared to the global figure of 6.2 litres (13.5 grams daily), according to the World Health Organisation. That is, alcohol consumption in Guyana in 2010 was equal to 8.1 litres of pure alcohol consumed per person aged 15 years or older (15+). However, the average drinker in Guyana consumed more than 3.5 gallons/13.7 litres or 29.76 grams daily.
Furthermore, one-seventh of this consumption (14%) was unrecorded, ie, homemade alcohol, illegally produced or sold outside normal Government controls. Of total recorded alcohol consumed, 77% was consumed in the form of spirits, while 23% was beer, less than 1% wine, and less than 1% other. About 15.2% of male drinkers (10% aged 15+) engage in heavy episodic drinking, that is, consumed at least 60 grams of pure alcohol at least once per month. Also, 8.6% of males and 5.9% of all Guyanese aged 15 and older are classified as having alcohol use disorder, with 3.9% and 1.9% respectively classified as alcoholics. Also in 2010, 43.6% of the overall population consumed alcohol, with significantly more male drinkers than female (73% vs. 28%). It might well be that all of these figures are much higher today.
Alcohol and the Young
60% or more of youths between the ages of 13 and 15 take a drink at some time. While adults sip/consume alcohol moderately, youths guzzle/gulp and while most adults drink at home, youths cruise around in cars and public spaces/social gatherings much more often. As well, alcohol options have changed over the years, as a wide array of new alcohol beverage products now appeal to youths. Today, the new container sizes encourage greater consumption as instead of a 12 oz, there are now 32, 40 and 60 oz containers of beers. Furthermore, communities unintentionally promote youth alcohol use by allowing alcohol sponsorship at youth-related events.
Also, data from the Guyana physical activity survey reveal that harmful drinking habits are on the rise among the youth, with 2.1% drinking regularly and 32% drinking occasionally. Seventy-nine percent of school children have their first drink before age 14.
Research shows that youths who drink before the age of 15 are four times more likely to develop alcohol dependence and two and a half times more likely to become alcohol abusers than those who wait until the age of 21. In fact, a 2009 two-day discussion on alcohol control hosted by the Health Ministry and the Pan American Health Organisation (PAHO), disclosed that alcohol is the number one drug of choice for youths.
Effects of Alcohol Use
The alcohol death rate for Guyana is 5.95 per 100,000 (globally ranked 70) according to the World Health Organization (WHO). Additionally, alcohol is a trigger for abuse, especially gender based, child and sexual abuse. Some abusers rely on substance use (and abuse) as an excuse for becoming violent – alcohol allows the abuser to justify his abusive behaviour as a result of the alcohol. In fact, research indicates that a large quantity of alcohol, or any quantity for alcoholics, can increase the user’s sense of personal power and domination over others. An increased sense of power and control can, in turn, make it more likely that an abuser will attempt to exercise that power and control over another.
Alcohol affects the user’s ability to perceive, integrate and process information. This distortion in the user’s thinking may increase the risk that the user will misinterpret his partner or another’s behaviour. As well, alcohol abuse may increase the aggressive response of individuals with low levels of the neurotransmitter serotonin and may increase the risk of violence in men who think abuse of women is appropriate and are also under socioeconomic hardship.
Other substantial costs to society include property damage, job loss and health service costs. Alcohol abuse has many potential consequences including accidental falls, burns, drowning, brain damage, impaired driving resulting in accidents, deaths and injuries, poor school performance, work productivity loss, sexual assault, truancy, violence, vandalism, homicides, suicides, lower inhibitions, increased impulsivity, risky sexual behaviour, early initiation of sexual behaviour, multiple sexual partners, pregnancy and STDs.
Alcoholism is associated with about 60 health related issues, some of which can be fatal. These include cirrhosis of the liver, cancer, heart attacks, high blood pressure and stroke, (which are among the leading causes of death in Guyana). The risk for a stroke is significantly increased in hypertensive sufferers who consume alcohol. High blood pressure and alcohol abuse are a deadly duo.
The 2009 two-day discussion on alcohol control hosted by the Health Ministry and PAHO, disclosed that alcohol was one of the primary causes for underdevelopment in Guyana. As well, between 8-10% of the national health care budget is spent on accident victims and treating injuries caused by persons who are hooked on some form of substance.
Redress
As TCV’s Training Director, Leslyn Holder, pointed out at the Health Sector Consultation meeting for the region of the Americas in 2016, “The increase in the consumption of alcohol (and illicit drugs) has resulted in a rise in health problems associated with consumption across the nation. This phenomenon which contributes to disability, diminished quality of life and reduced productivity has become a public health concern”. Added Ms. Holder, “Guyana has seen the need to treat this phenomenon with a public health approach and as such has been focusing on the initiation of strategic plans for prevention, early intervention, treatment, rehabilitation and social reintegration”. Among the recommendations made at various fora and/or by different stakeholders are to:
Review and update the National Drug Strategies and implement early intervention and prevent/reduce alcohol abuse and its concomitants.
Improve planning skills, for developing programmes and interventions, with special focus on financial and administrative issues.
Develop the regulation framework for service providers (prevention and treatment) to enhance public and private sector partnerships and provide support as much as possible.
Strengthen/improve data collection and evidence generation and encourage international/local cooperation to share evidence-based practices.
Stringently enforce the laws, especially as they relate to the minimum age alcohol purchase, drinking and driving, opening and closing times of rum shops and beer gardens, setting up of bottom house ‘rum shops’ to accommodate social events such as weddings or in areas where rum shops and beer gardens are not easily available.
Implement an ongoing, multi media, campaign to sensitise the public about the dangers of alcohol use and abuse with messages aimed at encouraging reduction and tackling stigmas, myths and misinformation. Also approach the media to provide free space for public service messages and information to help bring about awareness and redress.
Establish a programme to develop gatekeeper awareness and skills training for community facilitators, such as police officers, social workers, teachers, priests and the like. This can be combined with similar gatekeepers;’ awareness and skills training for suicide prevention and anti-abuse, both of which are related to substance use/abuse.
Establish a system of monitoring and intervention in clusters.
Increase taxes on all alcohol- based products (except for medicinal purposes). In the United Kingdom empirical evidence demonstrated that increased taxes has helped to reduce consumption.
Legislate, as in the cigarette industry, for warnings to be prominently placed on alcoholic products about dangers to health.
Put in place laws to prevent the advertising or selling of alcoholic beverages during school activities and youth activities where minors predominate.
Restrict granting of new licences to persons desirous of selling alcohol.
Include anti-alcoholism in the Health and Family Life Curriculum in schools to combat drinking by minors and teens.
Legislate for manufacturers and distributors of alcohol to contribute a minimum – maybe 2 % – of their sales to fund anti-alcoholism campaigns and rehabilitation programmes.
As with various other social issues, government must strengthen the inter-institutional coordination and collaboration between the Ministry of Health and other government agencies, as well as with various stakeholders including NGOs, FBOs, CBOs and must also allocate adequate resources and finances to increase capacity building within the health and other relevant sectors to address alcohol use/abuse, related disorders and consequential rehabilitation.
The Ministry of Health has two out-patient treatment centres for persons who are misusing alcohol and drugs. These are the Georgetown Public Hospital Corporation (GPHC) Treatment Centre and the National Psychiatric Hospital Treatment Centre. More such centres need to be set up in public health institutions across Guyana. Furthermore SRP (structure relapse prevention) counseling should be part of all treatment everywhere. SRP puts the client at the centre of treatment and imbues him/her with capacity to eventually take charge of his/her rehabilitation. Thus the government needs to ensure that the capacity to offer SRP is available at all public health care institutions as it moves forward with its plans to integrate mental health care within the current physical health care system and to tackle substance abuse.
On a final note, anti-alcoholism is one of the pillars of The Caribbean Voice’s (TCV) platform and perhaps the only non-alcoholic reception in Guyana is the one held at the Annual El Dorado Awards which is set December this year in Georgetown. TCV can be contacted via email at caribvoice@aol.com or phone at 644 1152, 646 4669.