Exclusion, deprivation, inequality, exploitation: Alcohol’s massive social harm
Alcohol harm is a Human Rights issue. The harms to health are only part of the total alcohol-related damage. It is especially a Women’s Rights, Child Rights and Indigenous People’s rights issue. In some parts of the world gender-based violence is alcohol-related in up to 80% of all cases. Alcohol harm exposes children to unhealthy environments, neglect and abuse, early onset of alcohol use and other detrimental factors in the socialization of children and young people.
Epidemic levels of alcohol harm all across society
Alcohol harm is of epidemic proportions worldwide. Harms from alcohol use occur not only to the consumers themselves, but also to those around them – to others in the family or household, to relatives and friends, to colleagues in the workplace and to strangers on the street.
Alcohol harms young people disproportionately. Alcohol plays a major role in perpetuating harmful gender norms, fueling the epidemic of violence against women. Alcohol frequently fuels and fortifies inequalities between and within countries. A disproportionate share of the health and economic costs of alcohol falls on poorer households.
Big Alcohol also fuels inequalities within societies. People with lower incomes are more likely to live in closer proximity to alcohol outlets, compared to those who are financially better off and living in areas that are better resourced.
Alcohol marketing violates children’s fundamental right to grow up safely, free from alcohol and other drugs.
Alcohol harm affects the poorest the most
Especially in poorer communities, in families affected by alcohol use disorder, and in Low- and Middle Income Countries (LMICs), alcohol tends to crowd out other more productive household spending, for example on education, health care and healthy food.
Both recognized and unrecognized alcohol expenditures have highly damaging effects on the most deprived families and communities. Desperately needed resources are taken away from the little available for food and other basics.
- Socio-economically exposed people are less able to avoid adverse consequences of their behavior due to a lack of resources.
- People in poor and vulnerable communities have less extensive support networks, i.e. fewer factors or persons to motivate them to address alcohol problems.
This drives social exclusion and fuels the vicious cycle of alcohol, deprivation and inequality.
Alcohol and global death, disease and disability
Alcohol causes more than 200 disease and injury conditions. Alcohol use during pregnancy risks the mother’s and the newborn’s survival and health. It also endangers the child’s health and development.
Alcohol is widely established as a structural driver of both the tuber- culosis and HIV/AIDS epidemics.
Alcohol is a major risk factor for NCDs, including mental ill-health. There is a strong link between alcohol and NCDs, particularly cancer, cardiovascular disease, digestive diseases and diabetes, as well as mental ill-health.
- Alcohol causes cancer.
- Alcohol use is overwhelmingly detrimentally related to many cardiovascular outcomes, including hypertensive heart disease, haemorrhagic stroke, ischemic heart disease, cardiomyopathy and atrial fibrillation.
- Alcohol is a major driver of mental ill-health.
- As an intoxicant, alcohol affects a wide range of structures and processes in the central nervous system.
- Alcohol is a risk factor for intentional and unintentional injuries, harms to people other than the alcohol user themselves, reduced job performance and absenteeism, alcohol poisonings, interpersonal violence, suicides, homicides, crime and injuries from driving under the influence.
- Alcohol is neurotoxic to brain development, potentially leading, in childhood and adolescence, to structural hippocampal changes, and in adulthood to reduced brain volume.
Alcohol fuels road traffic injuries and fatalities.
- Globally, alcohol causes 370 000 road injury deaths; of those, 187 000 alcohol-attributable deaths were among people other than drivers.
Alcohol is an obstacle to UHC and health for all
The health burden caused by alcohol is enormous.
Pervasive alcohol harm puts a heavy burden on health systems and poses a serious obstacle to Universal Health Coverage (UHC) and the promise of reaching health for all. The epidemic levels of alcohol harm put a heavy strain both on national budgets as well as healthcare systems.
The disease, social, and economic burden of alcoholis rising, especially in low- and middle-income countries, which already can ill afford the associated productivity losses, healthcare costs, and household impoverishment.
Globally, at least 283 million people aged 15+ years suffer from an alcohol use disorder. That equals 5.1% of all adults worldwide1. But health systems are insufficiently equipped to adequately deal with only this specific type of alcohol harm.
Health systems are ill-equipped for massive alcohol harm.
- Ca. 1 in 5 patients in the UK hospital system use alcohol heavily, and one in 10 are alcohol-dependent.
- Only 14% of countries indicated treatment coverage of more than 40% (not even every second AUD person).
- 8% of countries have very limited or close to zero treatment coverage.
- Most countries (40%) do not even know the level of treatment coverage.
Alcohol undermines norms and conditions for academic performance
In the family and community setting, alcohol is a major risk factor for poor educational outcomes. WHO, UNODC and UNESCO list a number of risk factors on the family level:
- parental substance use,
- parental mental ill-health,
- parental abuse and neglect,
- material poverty.
WHO, UNODC and UNESCO list a number of risk factors on the community level:
- easy and wide availability of alcohol and other drugs,
- social norms permissive to substance use and detrimental to academic achievement,
- lack of positive contact with other adults.
Alcohol clearly fuels all these risk factors, contributing to:
- Parental roles are neglected and abandoned,
- Scarce resources are wasted on alcohol, instead of healthy food, leisure time activities and school material
- Resulting health issues even exacerbate the dire situation, and fuel the vicious cycle,
- Norms and conditions for academic performance are undermined and eroded.
Alcohol marketing perpetuates harmful gender norms
The alcohol industry has amassed a vast case library of alcohol ads, commercials and other alcohol brand promotions that perpetuate discriminatory images, attitudes and norms regarding women and girls and their role in society.
The portrayal of men, as well as women and girls in alcohol marketing fuels harmful masculinity, and the sexualization, objectification and de-humanization of women. It amplifies the common belief of masculine superiority over females and it justifies male demonstration of power over the other gender.
- Strong evidence of the link between alcohol use and violent behavior means that cultural and social norms around alcohol use and itsits expected effects also encourage and justify violent acts.
Alcohol fuels the epidemic of violence against women
Alcohol is seldom the sole explanation for the use of violence, but it’s often the triggering factor. Alcohol use creates a context for violent acts. It is often used as excuse for otherwise socially unacceptable behavior.
- There is a strong relationship between alcohol and domestic abuse, intimate partner violence and sexual assault. The relation between all forms of aggression and alcohol use is enormous and unequivocal.
Alcohol jeopardizes reproductive health and rights
Alcohol use has detrimental effects on the health of women and children. Alcohol consumption increases the risk of unintended pregnancies, through its contribution to unprotected sex. Alcohol use during pregnancy is also a risk factor for adverse pregnancy outcomes.
- Stillbirth, spontaneous abortion, and premature birth are some of the adverse pregnancy outcomes, due to alcohol.
- Alcohol use during pregnancy is associated with a dose-responsive increase in miscarriage risk.
Alcohol fuelled inequalities and injustices
Inequalities in alcohol-related harm exist based on factors including economic status, education, gender, ethnicity and place of residence. Harms from a given amount of alcohol consumption are higher for poorer alcohol users and their families than for richer alcohol consumers.
In general, lower socioeconomic groups consume less alcohol overall and are more likely to be abstainers, but they experience higher levels of alcohol-related harm than wealthier groups with the same level of consumption.
Big Alcohol also fuels inequalities within societies. People with lower incomes are more likely to live in closer proximity to alcohol outlets, compared to those who are financially better off and living in areas that are better resourced.
Experiencing multiple aspects of socioeconomic disadvantage amplifies inequalities in alcohol-related harm.
- In the UK, health inequalities are estimated to cost £32-33 billion per year.
- In Sweden, manual workers are 2–3 times more likely to experience alcohol-related harm than civil servants, even when alcohol consumption levels were similar.
The harms to health are only part of the total alcohol-related damage. Harms from alcohol use occur not only to the consumers themselves, but also to those around them – to others in the family or household, to relatives and friends, to colleagues in the workplace and to strangers on the street.
Negative impacts on children due to parents’ alcohol use are an example where all dimensions of alcohol’s harm to others form a “perfect storm”.
- In the United States, more than 10% of children live with a parent with alcohol problems.
- In the EU, 9 million children grow up with parents who have alcohol problems.
Alcohol violence makes neighborhoods, public space and cities unsafe and unfree.
- Globally, 90 000 deaths due to interpersonal violence are attributable to alcohol
- Philadelphia, U.S.: Study shows, the more alcohol outlets a neighborhood has, the higher is the number of violence cases in the neighborhood.
- Cali, Colombia: Closing alcohol outlets two hours earlier reduced homicides by 25%.
- 45% of Irish people say they decided to walk a different way due to fear of people who had used alcohol, or of places where alcohol use is very common.
Evidence shows that alcohol-related exclusion from public space puts a heavy burden on adolescent’s health and well- being.
- 55% of adolescents in Sweden say that they stay away from public space because of alcohol.
- Sweden: 87% of adolescents agree/ partly agree that alcohol makes public space unsafe.
Alcohol violence impacts physical, mental and sexual health. It considerably burdens the public health system and other public sectors, making it a major sustainable development issue.
Globally, across all age groups, alcohol is estimated to be responsible for 26% and 16% of years of life lost through homicide by males and females respectively.
- Norway: 53% of assault victims presenting at an emergency department reported the perpetrator had used alcohol prior to the attack.
Children, adolescents and youth bear a disproportionate burden of alcohol’s harm to others: they suffer alcohol violence perpetrated by adults, often parents.
- USA: 13% of child abusers are under the influence of alcohol,
- Europe: 16% of all cases of child abuse and neglect are alcohol-related,
- Alcohol fuels and exacerbates child maltreatment, and physical and sexual abuse.
Development for women
Alcohol: Massive obstacle to gender equality and women empowerment
Societal norms, gender-based violence and sexual reproductive health and rights are major components of achieving full gender equality and complete empowerment of women and girls. Alcohol is a key driver of harmful societal norms; a major risk factor for violence against women and girls; and a substantial hinder to sexual reproductive health and rights for women and girls.
Gender equality is fundamental to delivering on the promise of the 2030 Agenda. As long as women are […] disempowered […] we will not succeed in ending poverty,” wrote Antonio Guterres, Secretary-General of the United Nations, in his forword of UN Women’s 2018 flagship report on gender equality in the 2030 Agenda.
The creation of inclusive and peaceful societies will also remain out of reach until women and girls are safe from all forms of violence and can shape the decisions that affect their lives. […]
Gender equality is a goal in its own right and a powerful force for upholding the main promise of the 2030 Agenda: to leave no one behind.”
Alcohol marketing perpetuates harmful norms
The portrayal of men, as well as women and girls in alcohol marketing fuels harmful masculinity and the sexualization, objectification and de-humanization of women.
Alcohol advertising, promotions and other marketing activities amplify the common belief of masculine superiority over females and thus justify male demonstration of power over the other gender.
- Presence of sexually violent advertising within alcohol licensed spaces undermines considerably the call to end gendered violence.
- Strong evidence of the link between alcohol use and violent behavior means that cultural and social norms around alcohol use and its expected effects also encourage and justify violent acts.
- Alcohol violence is more likely in cultures where many believe alcohol plays a positive role by ”allowing” people to transgress boundaries of normal social conduct.
Alcohol fuels epidemic of violence against women and girls
There is a strong relationship between alcohol and domestic abuse, intimate partner violence and sexual assault. The relation between all forms of aggression and alcohol use is enormous and unequivocal, according to the World Health Organization.
Alcohol is seldom the sole explanation for the use of violence, but it is often the triggering factor. Alcohol use creates a context for violent acts and is often used as excuse for otherwise socially unacceptable behavior.
For instance, safe and healthy public space is a Women’s Rights issue. However, evidence shows that alcohol threatens women’s safety and freedom in public space, as well as at home and in intimate relations.
- 65% of women experiencing intimate partner violence in India, Vietnam, Uganda, Zimbabwe, and South Africa reported the perpetrator had used alcohol.
- Focus groups in rural Rwanda show that women who are victims of domestic violence rank alcohol as number one factor.
- Australia: 40% of all cases of physical and/ or sexual assault of women are alcohol-related.
- New Zealand: 1 in 5 women aged 14 to 19 had been sexually harassed inthe previous 12 months, by someone who had been using alcohol.
Alcohol jeopardizes reproductive health and rights
Alcohol use has detrimental effects on the health of women and children. Alcohol consumption increases the risk of unintended pregnancies, through its contribution to unprotected sex. Alcohol use during pregnancy is also a risk factor for adverse pregnancy outcomes.
- Stillbirth, spontaneous abortion, and premature birth are some of the adverse pregnancy out- comes, due to alcohol.
- Alcohol use during pregnancy is associated with a dose-responsive increase in miscarriage risk.
- Evidence from Ghana shows that alcohol consumption is significantly associated with abortion-related maternal deaths.