The effect of alcohol on the constitution

Dr. Ruwantissa Abeyratne

When I was a child, every time I attended a party hosted by my relatives I wondered whether my country had been conceived under the influence of alcohol. I was not far off the mark, according to a Norwegian study conducted in 2002-2003 on poverty in Sri Lanka. It stated: The qualitative study yielded the impression that nearly every male wanted to have alcohol at weddings and celebrations and they would all protest openly about not being able to enjoy the event if there was no alcohol. But in the anonymous quantitative study just 32 percent said that the act of drinking was a pleasant experience while only 14 percent said that the experience of being drunk was pleasant.

I have begun to have my doubts about my childhood peeve. Dr. Uditha Liyanage, in an article in the ICAP Review states that religion and culture might account for the relatively high abstention rates in countries of Southern Asia, citing Sri Lanka as having an abstention rate of around 68 percent. Of course we top the batch, so to speak, with India at 79 percent, Indonesia and Pakistan at 95 percent. According to Dr. Liyanage, two thirds of the 32 percent percent of habitual drunkards in Sri Lanka are consumers of Kasippu, a primitive beverage made from sugar and yeast which is a non-commercial brand patronized mostly by the underprivileged and despondent demographic. The highest percentage of daily alcohol consumption is among persons of low education and low income.

Legislative process

In his article, Dr. Liyanage introduces an interesting fact which could well explain the social effects and consequences that the Kasippu drinker bestows to his environment and more importantly to his country. He quotes Baklien, B., & Samarasinghe, D. (2005) (Alcohol and poverty in Sri Lanka. Colombo, Sri Lanka: Forut)who say: the element of fun and sociability that generally accompanies (legal) arrack drinking occasions is not evident in the consumption of Kasippu.

A Kasippu drinker quickly gulps down the beverage and moves on, often to his home. When this practice is taken in conjunction with what would happen at home when the drunk eventually staggers there, one could draw from another study published in the European Journal of Public Health in 2005 on alcohol and intimate partner violence which stated that male alcohol consumption is one of the accepted risk factors for intimate partner violence.

Behavioural disorders

How do all these fit into the general health of the Sri Lankan constitution and the legislative process of the country? According to the figures given by Dr. Liyanage, 4.5 percent of admissions to the General Hospital are due to alcohol related problems of patients below 25 years of age. Around 13.5 percent were between 25 and 30 years. Of these 7 percent to 8 percent drank Kasippu and 9 percent drank toddy.

About 60 percent of male suicides in Sri Lanka are linked to alcohol dependence, again with Kasippu being the most prominent protagonist in the equation.

W. K. V. S. Seneviratne, in an article published in 2008 at the Post Graduate Institute of Medicine, gives the results of a pilot project carried out in Ratnapura. According to the author, Out of the sample of 398 admissions 66.58 percent were with alcohol related mental and behavioural disorders and 29.65 percent were with alcoholic liver disease. The largest group (57.54 percent ) was 31-50 years and 3.27 percent was between 12-20 age group. The highest proportion of patients was (64.03 percent) unskilled labourers.

The majority (38.27 percent) was within the family income of Rs 2,500-5,000 per month with 17.35 percent gaining less than Rs. 2,500 per month. Cost of a patient day not including amount spent for treatment costs, in the two medical wards and the psychiatric ward was Rs.572.45, 499.89 and 667.14 respectively. The highest median cost of treating a patient with alcoholic liver disease was Rs.5,076.00 (inter- quartile range 2,049.00 - 8,346.00) and out of which the major proportion of expenditure (43.55 percent) was for blood and blood products. Mean household cost due to an admission was Rs. 688.30 of which 65.05 percent was incurred as indirect costs due to lost working days.

Mean direct cost to the household was Rs 240.55 (SD=352.30) of which 64.67 percent consisted of cost of transportation. The median direct household cost was Rs 68.00 (inter quartile range = 150 - 1225). Most patients seeking in-patient services for alcohol related illnesses at the General Hospital Ratnapura were from a poor socio-economic background. The economic burden imposed by the admission to the household was mainly due to indirect costs due to lost working days. Alcohol makes poor people even poorer. Since alcohol related illnesses are preventable more priority should be given to reduce the disease burden on the health sector and the household.

Healthcare subsidiaries

If these were the figures of just one city in the country, one could well imagine that the total cost for the state in terms of medical care for the besotted would be considerable. It is here that the legislative process comes into focus, reflecting the need to curb the considerable influence exerted by the consumption of liquor on the country. The burden of costs to the country is reflected in the fact that, as reported in the Sri Lanka Pharmaceutical and Health Care Report of the second Quarter of 2011, people suffering with alcohol-related diseases in Sri Lanka are reportedly no longer entitled to healthcare subsidiaries from February 2011, despite criticisms from doctors, who claim the measures would punish the poor twice, once due to the actual addiction of a family member, and the second time by having to pay for the addiction treatment.

The National Authority on Tobacco and Alcohol Act No 27 of 2006 empowers an officer authorized by the Act to seize and detain any tobacco product which has been manufactured in contravention of the provisions of the Act. The Act inter alia provides that any authorized officer can, at any reasonable time enter any place he believes an alcoholic product is manufactured, preserved, packaged, exposed for sale or stored, and examine any such alcoholic product and take samples thereof. The Act also prohibits a person from installing or permitting to install any automatic vending machine that dispenses, or is capable of dispensing any tobacco or alcoholic products in a place accessible to the public.

Alcohol consumption

Some have suggested a three pronged policy that a state could follow to reduce alcohol related costs to a country. The first approach recommended is to adopt population based policies that would target a reduction of alcohol consumption by increased taxation, rationing, higher levies on advertising and even prohibition. These policies have been criticized by some as affecting all drinkers rather than those with an addiction to alcohol or drinking problems. The second approach, which obviates targeting the inoffensive and occasional drinker, is to come down heavy on alcohol related offences such as drunk-driving. The third approach is to introduce various intervention and prevention programmes along with educational insight that would target the population at an early age.

A fourth approach, which I might suggest, is to adopt legislation that would legally deprive the drunkard of his property. A good example is the 1887 British Colombia (Canada) Habitual Drunkards Act which permitted the wives of drunkards to obtain legal title to their husband’s property. Canada, at that time, had a state-wide drinking problem on its hands where even when the Canadian Parliament as far back as in 1792 convened at a tavern and the judiciary was composed of ruddy complexioned gentlemen which was a gentle euphemism for alcoholics. Several Canadian provinces created interdiction lists and criminalized the sale of alcohol to known and habitual drunkards. Others prohibited entertainment at taverns (such as billiard rooms and gramophones) to discourage patrons.

Although these measures might discourage the ruddy complexioned gentlemen one wonders whether the uneducated Kasippu drinker will give a hoot.