Sri Lanka: alcohol now and then
Sri Lanka, an island just north of the equator with a population consisting of several ethnic and religious groups, became independent of British rule in 1948. If you read Sri Lankan literature of pre-colonial times, you will find hardly any references to alcohol; but watch today's popular local television soaps and you will find that nearly all include numerous gratuitous scenes of alcohol consumption, portraying it in very attractive ways. Sri Lanka has come a long way.
The path we have followed is probably similar to that taken by many other non-western cultures in which alcohol was not, a few centuries ago, a major part of the mythology (Heath 1995). In nearly all such countries including, perhaps, many that identify themselves overtly as Islamic, the experiences and customs associated with alcohol use have now become, or are gradually becoming, akin to those of the West.
When foreign meanings, rituals and experiences of alcohol are grafted onto very different cultural stock, strange things happen. The host culture, instead of simply adopting the new elements, sometimes goes overboard. Concomitants of alcohol use, in the absence of the wider tradition in which they evolved in the original settings, can take different or more extreme forms in alien territory. These modifications lead to altered profiles of alcohol-related problems in the new settings. Examples are the use of alcohol to display wealth and permission to be loutish or violent after alcohol consumption.
THE CONSUMPTION SNAPSHOT
To write of average individual consumption in a country where most of the alcohol consumed is probably illicit and unrecorded (Abeysinghe 2002; WHO 2004a) has little meaning. Official data did venture to put Sri Lanka's adult per capita consumption at just 0.21 l in 1996—a 20% or so decline from 25 years ago (WHO 1999). The extent of variation in results of the studies that are available to date (WHO 2004a) is such that they cannot provide a meaningful picture of the existing situation or of trends. Figures available at the Department of Excise which exclude the large illicit segment of the trade, show more than a threefold increase of beer production from 1995 to 2004. There has not been a large change in per capita spirit consumption and production.
The increase in beer consumption is related probably to the expansion of use among the traditionally abstinent female population (ADIC 1993), as well as vigorous marketing that has made beer more of a leisure drink than before. Most of the innovative community-orientated prevention activities in Sri Lanka have targeted licit and illicit spirit drinking and the spread of beer appears to have expanded unnoticed in the meantime. Alcohol epidemiology is not well developed in Sri Lanka. Moreover, the available official data need to be interpreted with extreme caution because of the widespread use of illicit alcohol.
Illicit alcohol is, and has been for decades, abundant. It is often alleged that these brews are adulterated with methyl alcohol and other impurities but laboratory testing has not confirmed this impression (Abeysinghe 2002). Claims, hard to verify, are made that illicit alcohol accounts for most of the alcohol consumed in Sri Lanka. The conventional wisdom is that illicit alcohol consumption and sales are impossible to control, as the enforcement agencies are corrupt and open to political interference.
The existence of a large illicit trade in alcohol complicates all measures to reduce alcohol-related harm, not least by confounding the assessment of their impact. A further problem is that legal producers of alcohol are able to forestall most regulatory measures by pointing to the presence of a large illicit trade that escapes the restraints imposed on the licit market. The legal alcohol trade argues convincingly that controls serve only to increase consumption of illicit alcohol.
Politicians generally need only the glimmer of an argument to do the bidding of charming sponsors. In the case of alcohol controls, friendly politicians have the benefit of a fairly strong argument for doing what alcohol lobbyists solicit. This applies particularly to tax increases on alcohol. Any increase of excise tax on the legal brews is likely to provide an advantage to the illicit producers who are not taxed. This is a consideration that even the impartial policy-maker has to weigh.
Licit and illicit alcohol both make significant contributions to the total consumption in most poor countries of the world. Policies in these countries have to apply to the mix and cannot simply replicate those successful where there is no sizeable illicit market. The global move must now begin to determine alcohol policies that make sense in poor countries, where the illicit market share is sizeable. Illicit production cannot remain endorsed forever as something impossible to change in today's corrupt world. Examples of its successful containment, in different parts of the world, should provide suggestions for strategies that are at least worth putting to the test.
VIOLENCE AND NASTINESS
Culture or social learning (MacAndrew & Edgerton 1969; Room 2001) is afforded less credence than alcohol chemistry, in explaining alcohol-related violence. Many westerners, including scientists, still hold mainly that alcohol differentially inhibits the more highly evolved parts of the brain, where reside socially learned controls of behaviour. An extension of this premise travels all the way to a village in Sri Lanka, in which it is used to exonerate a man who breaks his wife's jaw in a drunken assault—on the basis that he does not know what he does. This, we must remind ourselves, is in a culture where there were no reports of such occurrences before the advent of western colonizers.
Violence and nastiness when intoxicated is in Sri Lanka a thing of the present (Sonali 1990); and perhaps the most important lesson that the country has to share with the rest of the world is what can be done to reduce such behaviour.
Interventions to reduce alcohol-related violence, by continually challenging and then gradually reversing the perception that the perpetrator is not really responsible if he is drunk, have shown promising results (ADIC 2002; Samarasinghe 2005). Social permission to be nasty when intoxicated takes several months to lessen, and is achieved by the use of several inputs. One of these is to draw repeated attention to examples of how people who become boisterous when drunk are often remarkably judicious in selecting their targets. Another is to repudiate consistently any attempts to present intoxication as a mitigating factor, or indeed a cause, of nonconformity with prevailing norms of decency.
That widely held alcohol-related beliefs can be changed within small communities is one important lesson from these efforts. Another is that allegedly alcohol-induced aggression declines, despite alcohol consumption remaining unchanged, when communities become less accepting of it.
The fact that intoxicated behaviour changes according to what a particular society allows or disallows is not exploited enough in interventions to reduce alcohol-related harm. This applies to Sri Lanka, but the major constraint here is the lack of resources to disseminate accurately the technical refinements and subtleties required.
Prohibitively expensive alcoholic drinks are useful symbols among the wealthy. Rich people are rarely rendered destitute through their alcohol use. However, conspicuous consumption (Veblen 1953) of alcohol, to display, pushes the lives of poor families in Sri Lanka to abjection (Baklien & Samarasinghe 2003). So does regular heavy use due usually to dependence, but this is generally recognized (Gunasekera & Perera 1997). Sri Lanka, with a per capita GNP of $1025 (Central Bank 2004), has a large poor population, so these influences matter.
A wedding or other celebration is an occasion for the poorest to demonstrate that they, too, can afford to provide guests with unlimited amounts of alcohol, and the cost of just one such celebratory event often leads to decades, sometimes a life-time, of interest payments to rapacious moneylenders (Baklien & Samarasinghe 2003).
Endeavours to reduce alcohol problems in poor countries must address this hitherto unnoticed source of significant harm: the inordinate harm to many poor families from celebratory use of alcohol. Norms and fashions related to such use can generally be modified through enlightened community action.
Money that regular, and often dependent, users spend on alcohol constitutes a major drain of resources away from essentials, amounting to between 30% and 50% of family income in the poorest families (Gunasekera & Perera 1997). This indirect harmful impact from the daily expenditures on alcohol is better recognized than the lasting damage that many poor families suffer as a result of occasional ostentatious alcohol use in festive revelry.
PROMOTION AND ADVERTISING
Beer is the starting alcohol for non-traditional segments of the market. Thus girls from a more rural background, for whom alcohol use was not culturally a norm, can be inveigled into flouting tradition with less unease through sipping a brew considered mild. Beer offers the means of escape from a traditionally imposed role without jeopardizing seriously the image of goodness.
Young women, who are influenced by television soaps, fashion magazines and other media portrayals of what the sophisticated or nonconformist female should do, are induced to flout the soft social disapproval of women consuming alcohol. Female emancipation is equated in many media portrayals with tobacco and alcohol use. That the proportion of women who publicly consume alcohol is visibly on the rise in the last 10 years is an assertion which would be confirmed by most observers, although we do not have research to underpin it.
The constant subtle devaluation of traditional cultural values contributes to alcohol's ascension. Being a ready-made symbol of progress beyond the level of ‘a villager’, it is useful for those from the villages to show that the assumed lack of sophistication does not apply to them, and the incessant portrayals of alcohol in local television soaps continue to reinforce this image.
ADDRESSING ALCOHOL PROBLEMS
Restrictions on advertising and sponsorships are only those implemented voluntarily by the alcohol trade (WHO 2004b), and there is no policy on using taxation as a means of reducing alcohol-related harm; but individuals and organisations working with communities have developed promising strategies that should be shared more widely within Sri Lanka and with other countries. Chief among them is the strategy of removing the magic and mystique built up around alcohol, in order to reduce consumption and young people's initiation.
Small-scale interventions in Sri Lanka have succeeded in reducing the attractiveness of alcohol by challenging its allegedly positive attributes and by removing the unfair privileges enjoyed by intoxicated individuals (ADIC 2002). Because community and schools’ prevention activities are generally reputed to produce poor results, this new and promising approach is worth addressing for testing more widely.
The approach used in diminishing the attractiveness of alcohol is similar to that used to reverse the social acceptance of intoxication as a justification for violence. A community that discovers how it boosts unwittingly and gratuitously the image of alcohol tends gradually to do so less. Such enterprises often lead to remarkable changes in how alcohol is seen and experienced (Samarasinghe 2005). The general principle that communities must follow is to keep challenging the unwarranted, even though seemingly self-evident, positive attributions made to alcohol. As they discover the depth of their own collective and unwitting collaboration in bolstering a highly positive image of alcohol, the constant promotion of drinking gradually declines.
Successful responses implemented by other countries, for example in Europe, sometimes but not always offer ready-made routes for Sri Lanka to follow. However, the obstacles that promoters of alcohol can create, when attempts are made to implement tested policies, are less easy to surmount in poorer nations than in the rich. Discussions on implementing effective alcohol policies should include strenuous consideration of methods to overcome impediments—especially those resulting from different forms of corruption.
The presence of a large illicit alcohol market is a genuine confounding factor when it comes to implementing known good policies and those who wish to obstruct certain policies can use it deliberately, to add confusion. The optimal mix of policies for settings with a large illicit market is not at all clear. We must address this haziness and seek remedies worth putting to the test if discussions on alcohol policy are to have relevance to poorer nations.
Sri Lanka has no large lessons to offer on how to overcome problems of the kind referred to in the preceding two paragraphs; but it can offer useful insights on what communities can do when governments are uncaring. Changing positive perceptions of alcohol, with resultant reduction in initiation, consumption and problems, constitute one kind of example. Another is the use of social disapproval to minimize the occurrence of alleged alcohol-induced aggression and violence.