One continent--multiple predictions and strategies.

Abstract

This fine and timely paper by Ferreira-Borges and co-workers 1 offers further insight into an important topic and addresses the probable severe health and safety consequences of drinking that lie ahead in Africa. By reviewing research papers from the past 15 years on alcohol consumption and alcohol policy in African countries, the authors make convincing arguments for why such consequences are to be expected. Thus, we are likely to witness epidemics of alcohol-related harm in Africa if current developments in economic growth and urbanization continue, and if they combine with strong alcohol industry interests and trade agreements and with governments’ limited priorities, resources and capacity to implement and enforce effective alcohol control policies. The paper also serves as a reminder of some previous publications, and similar concerns regarding expected large increases in alcohol consumption and related harms in developing countries have been presented. For instance, several years ago Caetano & Laranja 2 noted the expected consequences of multiple factors pushing up consumption in developing countries and compared this to a ‘perfect storm’. While these concerns apply implicitly to African countries as a whole, it seems obvious nevertheless that the various emerging risk factors that are likely to push up consumption differ considerably across the 53 African countries. For instance, economic growth, both current and accumulated, differs significantly between African countries 3. Urbanization rates also vary considerably 4, as do alcohol control policies 5. This suggests that the likelihood of rapid increase in consumption and related harms may vary substantially between African countries. Consequently, there is a need also for country specific assessments of expected trends in alcohol consumption and country specific identification of feasible ways to curb consumption. Such country-specific assessments may take into consideration a much broader range of factors than those identified in the review by Ferreira-Borges and co-workers 1. A few additional factors that also vary considerably between African countries seem relevant in this respect. First, corruption level is high in many African countries, yet it varies significantly 6. Corruption in parliament and legislature affects not only economic growth 7, but probably also the alcohol industry's possibilities to influence on national control policies. Secondly, the level of conflict is high in many African countries and affects the strength of governance and state institutions and thereby the resources and capacity to develop and enforce alcohol control policies 8. It is therefore likely that the alcohol industry perceives post-conflict states as potentially lucrative markets and take advantage of weak state capacity 8. Also with respect to conflict level, there is huge variation between African countries 9. Thirdly, strict informal social control of drinking due to religious norms is associated with higher abstinence rates and lower consumption levels. In many African countries, Islam is the prevalent religion and in these countries the prevalence of drinking tends to be low 10. Possibly, this is a factor that may slow down the effects of the many emerging risk factors for increased consumption and related harms. While there is clearly a need to identify and implement effective strategies to curb the forecasted increase in alcohol-related harm, this is probably more urgent in some African countries than others. None.