Dr. Norman Giesbrecht
October 21 2018
In the coming days, the Pan American Health Organisation and World Health Organisation (PAHO/WHO), with input from the Public Health Ministry and stakeholders, will begin developing a policy for the prevention and control of use of alcohol in Guyana.
The project, which will be spearheaded by consultant Dr. Norman Giesbrecht, who has a record of conducting research focused on alcohol policy development, will culminate in February, 2019, with the submission of the final policy document.
The policy’s Terms of Reference (ToRs) state that in the quest to accelerate the implementation of the global agenda for alcohol prevention and control in Guyana, the Ministry requested support for the development of a policy that is aligned with the Global Strategy to Reduce the Harmful Use of Alcohol 2016 and the WHO “Best Buys” for alcohol prevention and control.
“Even though prevention of alcohol and substance use and related disorders are included in the agenda of the National Health Strategy for Guyana 2013-2020 (Health Vision 2020) and the Mental Health Action Plan 2015-2020, the country is still lagging with regard to the implementation of the WHO “Best Buys” (cost-effective interventions) to prevent and control alcohol use and abuse, especially among youth and indigenous populations in the country,” the ToRs, which were seen by the Sunday Stabroek state.
The Global Strategy to Reduce the Harmful Use of Alcohol, according to the WHO website, focuses on ten key areas of policy options and interventions at the national level and four priority areas for global action.
The ten areas for national action are: leadership, awareness and commitment; health services’ response; community action; drunk-driving policies and countermeasures; availability of alcohol; marketing of alcoholic beverages; pricing policies; reducing the negative consequences of drinking and alcohol intoxication; reducing the public health impact of illicit alcohol and informally produced alcohol; and monitoring and surveillance.
The four priority areas for global action are: public health advocacy and partnership; technical support and capacity building; production and dissemination of knowledge; and resource mobilization.
The “Best Buys” document, which lists harmful alcohol use as a risk factor/disease, proposes that there be tax increases, restricted access to retailed alcohol and bans on alcohol advertising. This document focuses on “Reducing the Economic Impact of Non-Communicable Diseases in Low and Middle-Income Countries.”
It is expected that Dr. Giesbrecht will submit a draft report sometime between January 28 and February 1, 2019 and submit the final report sometime during the period February 18-22, 2019.
Based on Dr. Giesbrecht’s schedule, work will begin on October 22. During the first week, attention will be paid to the development and submission of a draft outline for the possible structure and content of the policy document.
According to his CV (which spans 55 pages), Dr. Giesbrecht is currently the Emeritus Scientist at the Centre for Addiction and Mental Health (CAMH) and has several publications related to alcohol. He wrote the national alcohol strategy for Canada.He is also the recipient of the Lifetime Achievement Award from the American Public Health Association’s Alcohol, Tobacco and other Drugs Sector.
Months after taking office, President David Granger had registered his concern about excessive drinking and associated deaths, particularly on the roadways. Alcohol is also said to be a major contributing factor in the large number of suicides and sexual assaults which have been occurring in Baramita, in Region One, over the years.President Granger had described alcohol as “one of two evils” that the country has to contain and assured that, over time, measures would be put in place to deal with it.
Public Security Minister Khemraj Ramjattan, last year had also registered his concern and expressed his willingness to work along with the ministers of Social Cohesion, Public Health and Education to assist in bringing the alcohol abuse situation in the country under control. “It is a disease in this country,” he had stressed, before also noting that enforcement of existing regulations to curb excessive drinking is needed.
‘Serious problem’
Meanwhile, Dr. William Adu-Krow, PAHO’s country Director, during a recent interview, acknowledged that alcohol consumption in Guyana is a problem.
Quoting statistics, he told Sunday Stabroek that worldwide, consumption is about 6.2 litres per person compared with 9.4 litres in the Caribbean alone. He did not have figures for Guyana. These figures, which were recorded in 2010, pertain to pure alcohol and focuses on persons aged 15 years or older.
The ToRs for the upcoming consultancy state that a quarter of this consumption (24.8%) was unrecorded; that is, a quarter of the alcohol consumed was either homemade or illegally produced or sold outside normal government controls.
Of the total recorded alcohol consumed worldwide, it states that 50.1% was consumed in the form of spirits.
They add that in all WHO regions, females are more often lifetime abstainers than males. In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption, they said further, before noting that there are significant sex differences in the proportion of global deaths attributable to alcohol. For example, in 2012, 7.6% of deaths among males and 4.0% of deaths among females were attributable to alcohol.
Dr. Adu-Krow highlighted the fact that alcohol is a contributing factor in homicides, suicides and road accidents.
Noting that in Guyana it is spirits which account for about 77% of the alcohol consumed, he added that beer accounts for almost 23% and wine for under 1%. “That means that the persons who actually deal with alcohol, they deal with the rum…the very, very strong alcohol,” he pointed out.
He also noted the dire effects that excessive alcohol consumption has on the family, including school-aged children, the community, the workplace, health and the country’s health care system.
According to the country rep, there has always been varying opinions on what constitutes irresponsible drinking. He said that the general view is that consuming more than four drinks amounts to irresponsible drinking. The limit, he said, is four drinks per occasion for women or five for men.
Alcohol is one of the focal points for PAHO. According to its website, risky consumption is associated with various health and social harms, including over 200 conditions (non-communicable diseases, mental disorders, injuries, and HIV), as well as domestic violence, lost productivity, and many hidden costs.
“Harmful alcohol consumption is the leading risk factor for deaths in males aged 15-49 years, yet evidence shows that women are more vulnerable to alcohol-related harm,” the site states, while adding that people of low socioeconomic status are also more vulnerable to the negative consequences of harmful consumption.
“PAHO strives to aid in the formulation of public health policies and interventions to reduce the harmful use of alcohol based on clear public health goals, existing effective practices, and best-available knowledge”, the website informed, while pointing out that it works with countries to develop and implement strategies that will monitor alcohol-related problems, collaborate with countries in the development and implementation of effective policies, and promote research.
Asked about collaborative work and efforts to develop strategies, Dr. Adu-Krow said that it has been working with the Ministry of Health, through the Non-Communicable Diseases Unit, to look at the effects from the health angle. He admitted that “not too much” has been done in the area of alcohol as a standalone subject, even though it is the cause of many diseases.
Diabetes, cancer, hypertension and chronic respiratory tract infections, such as asthma, the non-communicable diseases which have a direct impact on 80% of the population, are all linked to excessive alcohol consumption.
Dr. Adu-Krow acknowledged that there is a need for some serious attention to alcohol on its own.
He informed too that during the discourses with the Health Minister, alcohol has been mentioned, but he stressed that PAHO can only be an enabling entity, not the implementer. “We provide technical ideas [but] how to do things better is up to the country…,” he stressed.
Next on the list
Dr. Adu-Krow pointed out that during consultations on the tobacco legislation, it was agreed that alcohol would be next on the list to be dealt with. Some parliamentarians were in favour of alcohol coming first, he said.
He expressed the view that it was wiser to deal with the tobacco issue first because the effects are widespread and longer lasting. He made reference to a person who got cancer because of second hand smoking; she was never a smoker. On the other hand, he admitted the effects of alcohol abuse is equally devastating and also affects persons who do not drink irresponsibly.
“For me, I think tobacco is more difficult…there are lessons learnt from other countries…so it is easier to use the lessons learnt”, he pointed out.
Observers have expressed the view that measures to curb alcohol abuse should have priority over legislation to ban smoking in public places, given the violent deaths associated with road accidents and the brutality of alcohol related murders.
“Yes, it makes a lot of sense and I think we are going to be working more and more with government in the area of alcohol use,” he said, adding that government has noticeably started some work in this area, which includes enforcing the 2 am curfew for alcohol sales. The sale of such beverages to minors is another area PAHO would like to see government working on, he noted.
Dr. Adu-Krow related that Ghana, his home country, had a similar problem with alcohol, but noted that while a national plan is in existence, it is not fully enforced.
Last month, President Granger had disclosed that a national plan to tackle excessive alcohol consumption was being developed by the Ministry but aside from a PSA video posted on the ministry’s Facebook page, there is nothing to suggest that any work was being done.
Prior to PAHO’s disclosure, the Ministry made no public pronouncements about collaborative efforts to formulate any strategy to tackle this scourge which has grave health, economic and social implications.