Historic moment for alcohol control
A new Alcohol Control Bill has been drafted by a small committee chaired by Betty Nambooze, a member of parliament (MP) to be presented as a private members bill. This is a truly historic and ground-breaking process in my country. Since 1962 when the first Alcohol law was drafted and passed into law as the British Colonialists were existing Uganda, nothing on this scale has been done in Uganda to control alcohol. Most actions by the government have been piecemeal work especially concerning alcohol taxation. And so obviously the impact of these measures has been very minimum in the last decades.
Uganda is a low resource developing country. It has gone through a lot of political turmoil in the last 54 years of Independence:
- We’ve had over eight Presidents.
- We’ve endured a lot of political turbulence and even wars.
- As a consequence, many children have been left orphans.
- The devastating HIV/AIDS epidemic has diminished my country to a bare minimum.
Mind you, in all these alcohol has been at the centre stage but the successive governments have taken a blind eye concerning the negative consequences of alcohol.
Alcohol a massive obstacle to development in Uganda
It has been estimated that the per capita consumption of alcohol in Uganda is 9.8 litres (WHO, 2014), but with a population of 58.7% of abstainers from alcohol use, the total per capita consumption of the alcohol users only, shows worryingly high consumption levels. Total per capita consumption of pure alcohol is at 23.7 liters in Uganda. For comparison: in Russia that number is 22.3 and in the Republic of Moldova the number is 25.4.
In March 2013, a CNN study ranked Uganda 8th in the world and first on the African continent in liquor intake.
The Daily Monitor quoted President Museveni stating that alcohol kills young people’s innovativeness. The President expressed concern over the prevalent alcohol use of young Ugandans and said that alcohol causes premature death – calling it slow suicide. Our research as UYDEL in collaboration with Georgia State University (GSU) between 2013-2015 in urban slums of Kampala, also demonstrated high levels of alcohol use among youth.
Big Alcohol targets youth aggressively
A key issue for Uganda is that the alcohol industry has targeted children and young people through the proliferation and packaging of alcohol tot packs/ sachets in lowest quantities of 30mls and cheap pricing of about Ugx 200. This distribution strategy makes alcohol very cheap, easy to conceal, and accessible to minors. Consequently, young people (10-24 years) are increasingly getting hooked on alcohol which hinders their ability to attend school and to be employed.
Additionally, massive alcohol marketing campaigns are going on – including giant billboards next to roads, near schools and kindergartens. All this comes at a price for the people in my country and our society.
As such, early onset of alcohol use by adolescents poses huge economic costs to Uganda society, especially if we also factor in alcohol-related harm such as injuries and deaths due to violence, traffic accidents, and HIV transmissions as well as deaths due to alcohol poisoning.
Unfortunately, children have been targeted by the alcohol industry through extensive marketing on television and radio programs, in magazines and newspapers and on outdoor advertising, public places such as supermarkets, markets, road side promotions with free distribution of alcohol in public places and social events, and placing alcohol billboards near schools. This calls for better regulation that protect children and youth from unethical advertising, and marketing of alcohol as well as better enforcement of the minimum legal age for alcohol use of 18 years.
Research by Professor Swahn and UYDEL in 2014 shows that only 17% of youth in the slums, ages 12 to 18, find it difficult to purchase alcohol despite the minimum legal age of 18 years. The research also shows that nearly half of the youth report seeing alcohol adverts often (44%) and that they see ads in the city, on television, on radio and in newspapers and/ or magazines. More importantly, as many as 18% report getting free alcohol as part of promotional activities and as many as 20% report having items with an alcohol brand logo on it. Also, despite the mandated alcohol warning on the advertisements, our inventory of alcohol marketing in the slums of Kampala shows that as many as 25% of the marketing materials do not have any health warning.
These findings demonstrate that youth ages 12 to 18 years are clearly targeted in marketing practices and that the alcohol industry frequently violate the regulations that are intended to protect youth. Unregulated alcohol sends the wrong message to the nation’s youth, children and fear; it will lead to serious public health and social problems. Our children will be worse with unregulated alcohol environment.
The burden of alcohol harm
Uganda needs to understand the burden of the economic costs of alcohol. When people use alcohol more it affects the economic productivity of individuals which in turn implies less productive work, fewer savings and scarcer household resources; it also means less productive workplaces with higher risk of accidents and injuries; all that means that alcohol burden communities and our country at large with social and economic harm that drain our scarce resources and lead to less investments in the country thus fueling the vicious cycle of poverty, violence, food shortage and crime.
Treatment costs rise in hospitals (as more that 200 diseases are associated with the use of alcohol) and large sums of money are spent on individuals during hospitalization, rehabilitation and treatment of people with alcohol use disorders and as well as victims of alcohol’s harm to others than the users themselves, such as road traffic fatalities, victims of violence etc. The police cost, judiciary and enforcement costs go up and money which would rather be invested in education, economy and health is taken up to police alcohol related crimes.
Weaknesses of our current legislation regulating alcohol
Most of the laws on alcohol consumption and abuse in Uganda were enacted a long time ago, in 1965. These need to be revised and consolidated for them to apply as any kind of deterrent for the many alcohol related crimes.
- Penalties provided under the current laws like the Liquor, Portable spirits and Enguli Acts are too small to have any effect on the current levels of alcohol abuse. For example the Liquor Act- cap. 93 still imposes fines of two and five hundred shillings for crimes like underage alcohol use.
- Alcohol taxes under the laws are generally high on imported alcohol but low on locally manufactured alcohol which makes it much cheaper and also means the levels of consumption are high due to accessibility.
Under the Liquor Act- cap. 93 Children are allowed to purchase alcohol for consumption by another person (adult) and are also allowed certain types of alcohol at meals. This fails to serve the original agenda of the Act as it exposes children to alcohol abuse.
Furthermore these laws are poorly enforced as enforcers lack the capacity and resources required in alcohol investigation and prosecution procedures such as forensics. The UNBS Act which enforces standards for commodities sold in Uganda does not have any noted standards for native liquor like enguli, yet its consumption is very fatal to human health.
There are also many types of alcohol on the market not covered under any laws because they weren’t in circulations when these laws were enacted, they include local brews like Kasese, Lira lira, Ajono etc.
There is a serious need to review the laws and institutions which regulate alcohol to address the changing social and economic patterns, and government policies. These laws also need to be consolidated into one for ease of reference.
The new law needs to be pragmatic about the proposed areas for regulation and enforcement of alcohol production, sale and consumption in Uganda.
The new alcohol control bill
The new bill looks at eliminating small packaging, banning alcohol advertising, regulating the time for alcohol consumption but considers only very minimally the production process.
I think that specifically the following areas need to be strengthened:
- Regulate alcohol packaged in sachets
Sachets (produced domestically or elsewhere) should be banned immediately and alcohol should instead be packaged in bottles with a minimum of 250ml.
Sachets are cheap, available, and easy to conceal by children and as such are partly responsible for increased alcohol use and related harm. Research by Professor Swahn of GSU shows that many (26%) of the youth in the slums ages 12 to 18 prefer consuming alcohol in the sachets and the number is likely higher among youth who have more resources.
Countries such as Malawi, Zambia and Kenya have all banned alcohol packed in sachets because of their specific harm among youth. In these countries, local leaders, enforcement agencies, faith based organizations and civil society have supported the ban and successfully enforced it.
- Regulate alcohol marketing
The Liquor Act, Cap. 93 prohibits all forms of alcohol advertising, promotion and sponsorship through means that are false, misleading or deceptive or likely to create an erroneous impression about characteristics, health effects, or hazards of alcohol. Enforcement is needed to ensure appropriate health warnings accompany all alcohol advertising. The new law has agreed the we need to eliminate alcohol advertising.
- Decrease availability
Prohibition of public sales should be implemented and advertising in form of road side promotions and free distribution of alcohol to minors needs to end. The time of advertising should be from 10pm to 6am when children are less likely to be listening to radio or watching television. All alcohol marketing and sales must be located at least a 300 meters away from primary and secondary schools to protect youth.
- Regulating time of sale of alcohol
During week days (Monday to Friday) bars should open earliest at 4pm and close at 10 pm and on weekends (Saturday and Sunday) bars should open at 2pm to 11pm.
Often heads of households are selling all their food to get money and end up using it to buy alcohol. Often large parts of their productive time is spent consuming alcohol and later nursing hangovers. Bars and places start selling alcohol as early as 8am, yet this early morning time could be translated into food production time.
- Licensing alcohol selling places
The Liquor Act, Cap. 93 prohibits the selling of alcohol anywhere in Uganda without a license. All alcohol selling places should have a special license allowing them the sale of alcohol and their trading licenses shall be revoked once they do not abide by set the standards and guidelines.
There is an urgent need to ban all places unlicensed like markets, or roadside selling of alcohol. To reduce the density of outlets and thereby regulating distribution of alcohol selling places.
This will help get rid of people who make alcohol so widely and easily available in Uganda through selling it in markets, on streets, on road sides, in taxi parks etc. The issuance of licenses will also increase the revenue for local governments, urban councils and municipalities accruing from alcohol selling places.
- Minimum legal age at 21 years
No person under the age of 18 is allowed to consume alcohol, or purchase alcohol: The Liquor Act, Cap. 93 Section 19 places a restriction upon the license not to allow persons under the apparent age of 18 to be in a bar or licensed premises during the period of sale and consumption of alcohol. Our research demonstrates that only 17% of youth ages 12 to 18 report having difficulty purchasing alcohol because of their age. This means that over 80% of youth find it easy to purchase alcohol despite the minimum legal drinking age of 18 years.
With the new national identification cards, it is very feasible for retailers to verify age at time of purchase, as the law intends and the age needs to be raised to 21 years as many countries have developed this international standard.
- Endowment fund of 5% tax
The new law should be elaborate and ensure that my country establishes a multi-sectoral ministerial National Alcohol Board with funding, through an established endowment fund-5% tax from alcohol beverages sold to benefit prevention, rehabilitation, research, education and enforce regulations.
The Ministry of Trade, Industry and Cooperatives should fast track the development of the alcohol policy in cooperation with the Ministry of Health and other relevant sectors. The policy should consider the WHO Global Alcohol Strategy.
The impact of these policy changes and enforcement of existing laws will have a profound impact on the health and well-being of our children and youth and ensure economic viability of future generations. The bill should not criminalize alcohol use but guide the population and protect minors from alcohol.
I’m looking forward to debating the new bill and its content, without emotional overtones but instead examining the costs of alcohol harm to individuals, families, communities and our society at large.