Eduardo Bianco makes very important points here. ['Eduardo Bianco has noted: "It can be argued that alcohol use disorders are the single most important cause of harm to others (accidents, violence, gender-based violence)."' https://www.hifa.org/dgroups-rss/alcohol-use-disorders-12-welcome-hifa-a... ]
On the question, ‘Causes of gender based violence compared to alcohol use disorder in Nigeria’:
A systematic review and meta-analysis (DOI: 10.3390/ijerph18094407 in Int J Environ ResPublic Health ) revealed that Alcohol consumption was associated to genderbased violence in the home and society. It is pertinent to list some of the other confounding factors: low educational attainment, higher alcohol consumption, substance use, history of child and family abuse, limited decision-making skills, experiencing depression, males having multiple sexual partners, and younger age were found to be individual - and family-associated factors that increase the experiences of GBV. Other factors still include community tolerant attitudes to violence generally, women's unemployment, lower socioeconomic class, being younger, a history of child and family abuse. The authors recommend ‘the need to develop a multipronged approach of intervention, such as socio-behavioural change communication interventions at individual and community levels to eliminate all forms of alcohol misuse and violence.
On the question ‘Causes of road traffic accidents compared to alcohol use disorder in Nigeria’:
As with health data in many LLMICs, accuracy is a challenge in Nigeria but even then the magnitude and nature of the drink-drive problem in Nigeria is decreasing from 34,000 in 2007, to 9572 in 2008, according to police statistics. However, according to World Health Organization statistical modeling, this figure is likely to b emuch higher (Traffic Inj Prev . 2012;13(2):115-9.doi: 10.1080/15389588.2011.645097). Data from the police and the Federal Road Safety Commission (FRSC) are not reliable for the drink-drive problem mainly because of the lack of alcohol testing equipment, attitude of drivers of commercial vehicles (67.2 percent of drivers admitting to drinking alcohol during the working day, especially toward the end of the year when there is increased vehicular traffic due to people travelling to celebrate the Christmas and New Year holidays), poor enforcement of Laws because alcohol testing equipment is unavailable. Recommended actions to control the problem include focused and targeted publicity campaigns against drinking and driving with private sector support; leveraging on opportunities provided by supporters, such as the World Bank project supporting safe road corridor and giving priority to strengthening the road crash and injury database and drink-drive enforcement, especially for drivers of commercial vehicles.
On the questions, ‘What is the picture in different countries? What attempts (if any) are being made tomeasure harm to others? What measures can be taken at national, community and individual level to better protect people from harm’:
Excessive use of alcohol is reported in many studies to be associated with violent crimes and domestic violence across many nations. . In total harmful alcohol use is reported to account for about 5.1% of the global burden of disease, desegregated into 7.1% and 2.2% of the global burden of disease for males and females, respectively. (Harmful use of alcohol - World Health Organization (WHO) www.who.int/health-topics/alcohol). Studies from the USA reveal that adults experienced harm because of someone else's drinking such as threats or harassment, ruined property or vandalism, physical aggression, harms-related-to-driving, financial and family problems. They also report gender differences in the type of harm, women being more likely to report financial and family problems, whereas the men report ruined property, vandalism, and physical aggression. Women are afflicted by heavy drinkers in heir home/family, and the men and young people under 25 years of age harmed more by drinkers outside the home. For both sexes people who drank heavily face two to three times more risk of harassment, threats, and driving-related harm, compared with abstainers (Teetotalers). (Alcohol’s Secondhand Harms in the United States: New Data on Prevalence and Risk Factors. Journalof Studies on Alcohol and Drugs, 2019; 80 (3): 273 DOI: 10.15288/jsad.2019.80.273.)
In Nigeria, the steady rise in the consumption of alcohol (and drugs) has been linked with rising crime, violence and public disorder. The fact that Nigeria is the most populous country in Africa and home for majority of black people on the Globe makes the report of increased in excessive alcohol use worrying and concerning. (https://theconversation.com/offences-committed-under-the-influence-of-al...). The country is trying to control the situation but laws alone cannot solve the problem. Even though poverty rate is worse the farther one goes from the cities, it is interesting that reports from Nigeria reveal that harmful alcohol use was higher in rural settings (40.1%, 24.2-56.1) compared to urbans ettings (31.2%, 22.9-39.6). The number of harmful alcohol users aged ≥15 years increased from 24 to 34 million from 1995 to 2015. (Meta-Analysis. Am J DrugAlcohol Abuse . 2019;45(5):438-450. doi:10.1080/00952990.2019.1628244. Epub 2019 Jun 27).
On the question ‘if alcohol is indeed one of the greatest causes of harm to others, is this truly understood by the general public, by health professionals, and by policymakers?
Health practitioners know that alcohol is a psychoactive and addiction-producing substance, but they still consume it in many countries for centuries. They also know that alcohol abuse is a major cause of high burden of disease, significant social and economic consequences, and harm to other people, including family members, friends, co-workers, but they consume it. In this regard, there is much similarity in health worker attitude to the problem of smoking. It has been difficult to locate studies specifically about alcohol effect on health workers but we found some reporting from USA. In a study that asked ‘Do doctors' alcohol use affect their professional practices with their patients?, it revealed that ‘the doctors’ own personal alcohol use had a significant effect on their professional practices with their patients. However, there appeared to be no relationship between the kind of advice provided and the doctors’ alcohol use in these two studies’ (www.ncbi.nlm.nih.gov/pmc/articles/PMC3924442/)
Reports from Nigeria reveal that harmful alcohol use was higher in rural settings (40.1%, 24.2-56.1) compared to urban settings (31.2%, 22.9-39.6). The number of harmful alcohol users aged ≥15 years increased from 24 to 34 million from 1995 to 2015. (Meta-Analysis. Am J Drug Alcohol Abuse . 2019;45(5):438-450. doi:10.1080/00952990.2019.1628244. Epub 2019 Jun 27).
It may sound like a cliché but what is needed is multi-faceted, multisectoral interventions across sectors and disciplines from civil and community stakeholders, to the relevant health and social professions, to the economic and political authorities. For example, in Canada, measures include "Control policies, such as alcohol pricing, taxation, reduced availability, and restricting advertising, may be the most effective ways to reduce not only alcohol consumption but also alcohol's harm to persons other than the drinker.”(Alcohol’s Secondhand Harms in the United States: New Data on Prevalence and Risk Factors. Journal of Studies on Alcohol and Drugs, 2019; 80(3): 273 DOI: 10.15288/jsad.2019.80.273).
Joseph Ana.
Prof Joseph Ana
Lead Senior Fellow/ medicalconsultant.
Center for Clinical Governance Research &
Patient Safety (ACCGR&PS) @ HRI GLOBAL
P: +234 (0) 8063600642
E: info@hri-global.org
8 Amaku Street, State Housing, Calabar,Nigeria.
www.hri-global.org
HIFA Profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety (CCGR&PS) with Headquarters in Calabar, Nigeria, established by HRI Global (former HRIWA). He is the Country Coordinator for PACK Nigeria (Practical Approach to Care Kit) which is specifically designed to improve clinical competence (improving accuracy of diagnosis and treatment) in primary health care. He is also a Member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health (2004-2008), Joseph Ana led the introduction of the evidence based, homegrown quality tool, the 12-Pillar Clinical Governance Programme (12-PCGP) in Nigeria, which also suitable for lower-, low-, and middle income countries (LLMIC) with similar weak health sector and system. To ensure sustainability of 12-PCGP, the ‘Department of Clinical Governance, Servicom & e-health’ was established in Cross River State Ministry of Health in 2007. His main interest is in ‘Whole health sector and system strengthening in LLMICs’. He has written six books on the 12-Pillar Clinical Governance Programme, including the TOOLS manual for its Implementation, currently in its 2nd Edition. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Association’s ‘Award of Excellence’ on three consecutive occasions for the innovation of 12-PCGP in Nigeria. He served as Chairman, Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He was Member, National Tertiary Health Institutions Standards Committee (NTISC) of the Federal Ministry of Health, 2017-2022. He is the pioneer Secretary General/Trustee-Director of the Charity, NMF (Nigerian Medical Forum UK) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group; the HIFA working group on Community Health Workers, and the Working Group on HIFA-WHO Collaboration (http://www.hifa.org/support/members/joseph-0 http://www.hifa.org/people/steering-group). Email: info AT hri-global.org and jneana AT yahoo.co.uk
