Alcohol consumption and attributable harm in middle-income South-East Asian countries: Epidemiology and policy options
- Alcohol use levels are low in most lower-middle-income countries.
- With economic development, alcohol use and attributable harm tend to increase.
- Muslim-majority countries are a major exception to the above-noted generalizations.
- Better alcohol control policies result in decreased alcohol use and attributable harm.
- Tax policies are a key element in the design of effective alcohol control policies.
Factors and policies which potentially explain the changes in alcohol consumption and related harms from 2010 to 2017 in 11 middle-income countries in the South-East Asian region were examined. The countries are:
- Lao PDR,
- the Philippines,
- Sri Lanka,
- Timor-Leste, and
Using secondary data from UN agencies, the researchers analyzed trends in alcohol consumption, alcohol-attributable deaths and the burden of disease.
Starting from a level of consumption significantly below the global average – especially among the Muslim-majority countries (Maldives, Indonesia, and Malaysia) – the majority of the countries in this region had markedly increased their alcohol consumption along with the economic development they experienced between 2010 and 2017. In fact, five middle-income countries in this region (Vietnam, Lao PDR, Cambodia, Myanmar, and Timor-Leste) were in the top 12 countries globally based on absolute increases in adult alcohol per capita consumption (APC).
The Philippines and Malaysia were the exceptions, as they had reduced their APC over this period.
The majority of South-East Asian countries had parallel increasing trends in the age-standardized alcohol-attributable deaths and DALYs since 2010, in contrast to global trends.
While all countries put some alcohol control policies in place, there were differences in the number and strength of the policies applied, commensurate with trends in consumption. In particular, three of the countries which were most successful in reducing consumption and harm (Malaysia, Philippines, and Sri Lanka) applied more effective tax methods based on specific taxation alone or in combination with another taxation method, applying higher taxation rates and regularly increasing them over time.
To achieve the global target and the Sustainable Development Goal in reducing alcohol consumption worldwide, middle-income countries, especially lower-middle-income countries, should employ better alcohol control policies, and apply an appropriate excise tax on alcohol products with regular increases to reflect inflation.