The right to tipple or smoke

THE Secretary to the Committee for Control of Tobacco and Liquor of the Sri Lanka Society of Medicine, Dr. Manoj Fernando says that 50,000 people die annually as a result of consuming liquor and smoking cigarettes.

This is much higher than the number of deaths caused by tsunami and more or less equal to number of deaths caused by war in the past 20 years.

The liquor industry in Sri Lanka has evolved into one now characterised by a few companies with high levels of horizontal and vertical integration. In addition, there is a large illegal sector, confined mainly to retail, resulting in employment of a mainly survivalist nature.

Alcohol in Sri Lanka is increasingly abused, leading to increasing levels of conflict in the family, violence, crime and alcohol related disease.

There remains a legacy of untold damage to the fabric of society, including serious health impacts on both users of alcohol and their children, domestic violence, child abuse, road accidents, crime and the associated economic costs.

But the sociologists point out that the lack of development, high levels of unemployment and isolation have contributed to particularly high levels of alcohol abuse across poorer regions and in rural areas.

Given this background, it's time the new Government initiate a new approach to liquor policy. It must seek to combine competing interests and serve the overall public good, not only that of those who produce, distribute, sell and consume liquor.

In my opinion, there are two broad concerns to be addressed: regulation of the production, distribution and sale of liquor (in part as a tool for correcting market imperfections); and controlling the economic and social costs of excessive alcohol consumption.

This would entail two key aspects: firstly, a change in legislation which will facilitate easy entry into the liquor trade; and secondly, harsh penalties for those who contravene the legislation.

Such a policy must comprise a strong regulatory regime that reverses the present approach, which has tacitly encouraged habitual liquor consumption through indiscriminate grant of licences for vendors. This must be combined with a strong public education campaign against alcohol abuse.

No sane person will advocate total prohibition, a demand which will result in a huge black market in liquor, the growth of a liquor mafia, the increase in illicit brewing, effects that will be counter-productive in fighting the social impact of alcohol abuse.

A pilot study last year says that 15-20 per cent of absenteeism, 40 per cent of accidents at work and home, and 25 per cent of road accidents are alcohol-related. Its impact is aggravated by the fact that a majority of committed drinkers are poor.

And, it is more aggravated because we live in a country where there is economic deprivation and where disease and nutritional deficiencies prevail with unsafe work and physical environments and where organised support systems such as counselling and de-addiction centres do not exist.

When we talk of cigarette consumption, the available evidence suggests that the hazards of smoking are quite well known to the general public.

The dangers of smoking are not closely guarded information available only to non smokers. Cigarettes have borne hazard warnings for decades and have been the target of a continuing informational campaign by the public health officials.

A rational man would be puzzled by the decisions of the people who choose to smoke. "Surely they must be misinformed," he might think.

"Or perhaps they were tricked into smoking when they were young and are now addicted for life". But the real truth is that they suffer what is known as 'optimism bias' and know that the risks are there, but not believe that they will be pertinent to themselves.

Government policymakers should focus on more targeted efforts to address matters that really concern smoking.

Age restrictions on smoking, the establishment of non-smoking areas and smoking lounges, and similar measures represent the kinds of interventions that are structured in a way that will generate the desired benefits without imposing costs on entire population of smokers.

Even in the absence of any additional policy interventions, smoking rates will continue to decline just as they have over the past two decades. As individual wealth rises, the value associated with health risks increases as well.

People consequently will be less willing to bear risks as they become more affluent. Market forces alone will continue to generate a decline in smoking, but they will do so in a way that is respectful to individual preferences and the choices that people make.

The tobacco and alcohol crisis cannot be unravelled by Government policy alone. There needs to be clear Government leadership and strong commitment, including organised support for research and public education and must be supplemented by public and NGO efforts.

The socio-economic costs of alcohol and cigarette production and consumption are enormous and need to be addressed as a matter of urgency.